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+[
+  [
+    "Noonan syndrome: Noonan syndrome is a genetic disorder that prevents normal development in various parts of the body. A person can be affected by Noonan syndrome in a wide variety of ways. These include unusual facial characteristics, short stature, heart defects, other physical problems and possible developmental delays. Noonan syndrome is caused by a genetic mutation and is acquired when a child inherits a copy of an affected gene from a parent (dominant inheritance). It can also occur as a spontaneous mutation, meaning there's no family history involved. Management of Noonan syndrome focuses on controlling the disorder's symptoms and complications. Growth hormone may be used to treat short stature in some people with Noonan syndrome. Signs and symptoms of Noonan syndrome vary greatly among individuals and may be mild to severe. Characteristics may be related to the specific gene containing the mutation. Facial appearance is one of the key clinical features that leads to a diagnosis of Noonan syndrome. These features may be more pronounced in infants and young children, but change with age. In adulthood, these distinct features become more subtle. Features may include the following: - Eyes are wide-set and down-slanting with droopy lids. Irises are pale blue or green. - Ears are low-set and rotated backward. - Nose is depressed at the top, with a wide base and bulbous tip. - Mouth has a deep groove between the nose and the mouth and wide peaks in the upper lip. The crease that runs from the edge of the nose to the corner of the mouth becomes deeply grooved with age. Teeth may be crooked, the inside roof of the mouth (palate) may be highly arched and the lower jaw may be small. - Facial features may appear coarse, but appear sharper with age. The face may appear droopy and expressionless. - Head may appear large with a prominent forehead and a low hairline on the back of the head. - Skin may appear thin and transparent with age. Many people with Noonan syndrome are born with some form of heart defect (congenital heart disease), accounting for some of the key signs and symptoms of the disorder. Some heart problems can occur later in life. Some forms of congenital heart disease associated with this disorder include: - Valve disorders. Pulmonary valve stenosis is a narrowing of the pulmonary valve, the flap of tissue that separates the lower right chamber (ventricle) of the heart from the artery that supplies blood to the lungs (pulmonary artery). It's the most common heart problem seen with Noonan syndrome, and it may occur alone or with other heart defects. - Thickening of the heart muscle (hypertrophic cardiomyopathy). This is abnormal growth or thickening of the heart muscle that affects some people with Noonan syndrome. - Other structural defects of the heart. The defects can involve a hole in the wall that separates the two lower chambers of the heart (ventricular septal defect), narrowing of the artery that carries blood to the lungs for oxygen (pulmonary artery stenosis), or narrowing of the major blood vessel (aorta) that carries blood from the heart to the body (aortic coarctation). - Irregular heart rhythm. This can occur with or without structural heart abnormalities. Irregular heart rhythm occurs in the majority of people with Noonan syndrome. Noonan syndrome can affect normal growth. Many children with Noonan syndrome don't grow at a normal rate. Issues may include the following: - Birth weight will likely be normal, but growth slows over time. - Eating difficulties may result in inadequate nutrition and poor weight gain. - Growth hormone levels may be insufficient. - The growth spurt that's usually seen during the teenage years may be delayed. But because this disorder causes bone maturity to be delayed, growth sometimes continues into the late teens. - By adulthood, some people with Noonan syndrome may have normal height, but short stature is more common. Some common issues can include: - An unusually shaped chest often with a sunken sternum (pectus excavatum) or raised sternum (pectus carinatum) - Wide-set nipples - Short neck, often with extra folds of skin (webbed neck) or prominent neck muscles (trapezius) - Deformities of the spine Intelligence isn't affected for most people with Noonan syndrome. However, individuals may have: - An increased risk of learning disabilities and mild intellectual disability - A wide range of mental, emotional and behavioral issues that are usually mild - Hearing and vision deficits that may complicate learning A common sign of Noonan syndrome is abnormalities of the eyes and eyelids. These may include: - Problems with the eye muscles, such as cross-eye (strabismus) - Refractive problems, such as astigmatism, nearsightedness (myopia) or farsightedness (hyperopia) - Rapid movement of the eyeballs (nystagmus) - Cataracts Noonan syndrome can cause hearing deficits due to nerve issues or to structural abnormalities in the inner ear bones. Noonan syndrome can cause excessive bleeding and bruising due to clotting defects or having too few platelets. Noonan syndrome can cause problems with the lymphatic system, which drains excess fluid from the body and helps fight infection. These problems: - May show up before or after birth or develop in the teenage years or adulthood - Can be focused in a particular area of the body or widespread - Most commonly cause excess fluid (lymphedema) on the back of the hands or top of the feet Many people, especially males, with Noonan syndrome can have problems with the genitals and kidneys. - Testicles. Undescended testicles (cryptorchidism) are common in males. - Puberty. Puberty may be delayed in both boys and girls. - Fertility. Most females develop normal fertility. In males, however, fertility may not develop normally, often because of undescended testicles. - Kidneys. Kidney problems are generally mild and occur in a fairly small number of people with Noonan syndrome. People with Noonan syndrome may have skin conditions, which most commonly are: - Various problems that affect the color and texture of the skin - Curly, coarse hair or sparse hair The signs and symptoms of Noonan syndrome can be subtle. If you suspect you or your child may have the disorder, see your primary care doctor or your child's pediatrician. You or your child may be referred to a geneticist or a cardiologist. If your unborn child is at risk because of a family history of Noonan syndrome, prenatal tests may be available. Noonan syndrome is caused by a genetic mutation. These mutations can occur in multiple genes. Defects in these genes cause the production of proteins that are continually active. Because these genes play a role in the formation of many tissues throughout the body, this constant activation of proteins disrupts the normal process of cell growth and division. The mutations that cause Noonan syndrome can be: - Inherited. Children who have one parent with Noonan syndrome who carries the defective gene (autosomal dominant) have a 50 percent chance of developing the disorder. - Random. Noonan syndrome can develop because of a new mutation in children who don't have a genetic predisposition for the disorder (de novo). A parent with Noonan syndrome has a 50 percent chance (one chance in two) of passing the defective gene on to his or her child. The child who inherits the defective gene may have fewer or more symptoms than the affected parent. Complications can arise that may require special attention, including: - Developmental delays. If your child is affected developmentally, he or she may have difficulty with organization and spatial sense. Sometimes the developmental challenges are significant enough to require a special plan to address your child's learning and educational needs. - Bleeding and bruising. Sometimes the excessive bleeding common in Noonan syndrome isn't discovered until a person has dental work or surgery and experiences excessive bleeding. - Lymphatic complications. These usually involve excess fluid that gets stored in various places in the body. Sometimes fluid can collect in the space around the heart and lungs. - Urinary tract complications. Structural abnormalities in the kidneys may increase the risk of urinary tract infections. - Fertility issues. Males may have a low sperm count and other fertility problems because of undescended testicles or testicles that don't function properly. - Increased risk of cancer. There may be an increased risk of developing certain types of cancer, such as leukemia or certain types of tumors. A diagnosis of Noonan syndrome is usually made after a doctor observes some key signs, but this can be difficult because some features are subtle and hard to identify. Sometimes, Noonan syndrome isn't diagnosed until adulthood, only after a person has a child who is more obviously affected by the condition. Molecular genetic testing can help confirm a diagnosis. If there's evidence of heart problems, a doctor who specializes in heart conditions (cardiologist) can assess the type and severity. Although there's no way to repair the gene changes that cause Noonan syndrome, treatments can help minimize its effects. The earlier a diagnosis is made and treatment is started, the greater the benefits. Treatment of the symptoms and complications that occur with Noonan syndrome depends on type and severity. Many of the health and physical issues associated with this syndrome are treated as they would be for anyone with a similar health problem. Taken together, though, the many problems of this disorder require a coordinated team approach. Recommended approaches may include: - Heart treatment. Certain drugs may be effective in treating some kinds of heart problems. If there's a problem with the heart's valves, surgery may be necessary. The doctor also may recommend that heart function be evaluated periodically. - Treating low growth rate. Height should be measured three times a year until 3 years of age and then once every year until adulthood to make sure he or she is growing. To evaluate nutrition, the doctor will likely request blood tests. If your child's growth hormone levels are insufficient, growth hormone therapy may be a treatment option. - Addressing learning disabilities. For early childhood developmental delays, ask the doctor about infant stimulation programs. Physical and speech therapies may be helpful for addressing a variety of possible issues. In some cases special education or individualized teaching strategies may be appropriate. - Vision and hearing treatments. Eye exams are recommended at least every two years. Most eye issues can be treated with glasses alone. Surgery may be needed for some conditions, such as cataracts. Hearing screenings are recommended annually during childhood. - Treatment for bleeding and bruising. If there's a history of easy bruising or excessive bleeding, avoid aspirin and aspirin-containing products. In some cases, doctors may prescribe drugs that help the blood to clot. Notify your doctor before any procedures. - Treatment for lymphatic problems. Lymphatic problems can occur in many ways and may not require treatment. If they do require treatment, your doctor can suggest appropriate measures. - Treatment for genital problems. If one or both testicles haven't moved into proper position within the first few months of life (undescended testicle), surgery may be needed. Other evaluations and regular follow-up care may be recommended depending on specific issues, for example, regular dental care. Children, teens and adults should continue to have ongoing, periodic evaluations by their health care professional.",
+    "https://www.mayoclinic.org/diseases-conditions/noonan-syndrome/symptoms-causes/syc-20354422"
+  ],
+  [
+    "What are the treatments for Noonan syndrome?: How might Noonan syndrome be treated? Management generally focuses on the specific signs and symptoms present in each person. Treatments for the complications of Noonan syndrome (such as cardiovascular abnormalities) are generally standard and do not differ from treatment in the general population. Developmental disabilities are addressed by early intervention programs and individualized education strategies. Treatment for serious bleeding depends upon the specific factor deficiency or platelet abnormality. Growth hormone treatment increases growth velocity. More detailed information about treatment for Noonan syndrome can be viewed on the GeneReviews Web site.",
+    "https://rarediseases.info.nih.gov/gard/10955/noonan-syndrome"
+  ],
+  [
+    "Noonan syndrome: Noonan syndrome is a disease that can be passed down through families (inherited). It causes many parts of the body to develop abnormally. Noonan syndrome is linked to defects in several genes. In general, certain proteins involved in growth and development become overactive as a result of these gene changes. Noonan syndrome is an autosomal dominant condition. This means only one parent has to pass down the nonworking gene for the child to have the syndrome. However, some cases may not be inherited. Symptoms include: - Delayed puberty - Down-slanting or wide-set eyes - Hearing loss (varies) - Low-set or abnormally shaped ears - Mild intellectual disability (only in about 25% of cases) - Sagging eyelids (ptosis) - Short stature - Small penis - Undescended testicles - Unusual chest shape (most often a sunken chest called pectus excavatum) - Webbed and short-appearing neck The health care provider will perform a physical exam. This may show signs of heart problems the infant had from birth. These may include pulmonary stenosis and atrial septal defect. Tests depend on the symptoms, but may include: - Platelet count - Blood clotting factor test - EKG, chest x-ray, or echocardiogram - Hearing tests - Growth hormone levels Genetic testing can help diagnose this syndrome. There is no specific treatment. Your provider will suggest treatment to relieve or manage symptoms. Growth hormone has been used successfully to treat short height in some persons with Noonan syndrome. The Noonan Syndrome Foundation is a place where people dealing with this condition can find information and resources. Complications may include: - Abnormal bleeding or bruising - Buildup of fluid in tissues of body (lymphedema, cystic hygroma) - Failure to thrive in infants - Leukemia and other cancers - Low self-esteem - Infertility in males if both testes are undescended - Problems with the structure of the heart - Short height - Social problems due to physical symptoms This condition may be found during early infant exams. A geneticist is often needed to diagnose Noonan syndrome. Couples with a family history of Noonan syndrome may want to consider genetic counseling before having children. Updated by: Chad Haldeman-Englert, MD, FACMG, Fullerton Genetics Center, Asheville, NC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/001656.htm"
+  ],
+  [
+    "What are the treatments for Noonan syndrome?: These resources address the diagnosis or management of Noonan syndrome: - Gene Review: Gene Review: Noonan Syndrome - Genetic Testing Registry: Noonan syndrome - Genetic Testing Registry: Noonan syndrome 1 - Genetic Testing Registry: Noonan syndrome 2 - Genetic Testing Registry: Noonan syndrome 3 - Genetic Testing Registry: Noonan syndrome 4 - Genetic Testing Registry: Noonan syndrome 5 - Genetic Testing Registry: Noonan syndrome 6 - Genetic Testing Registry: Noonan syndrome 7 - MedlinePlus Encyclopedia: Noonan Syndrome These resources from MedlinePlus offer information about the diagnosis and management of various health conditions: - Diagnostic Tests - Drug Therapy - Surgery and Rehabilitation - Genetic Counseling - Palliative Care",
+    "https://ghr.nlm.nih.gov/condition/noonan-syndrome"
+  ],
+  [
+    "Noonan syndrome: Noonan syndrome is a genetic disorder that causes abnormal development of multiple parts of the body. Features of Noonan syndrome may include a distinctive facial appearance, short stature , a broad or webbed neck, congenital heart defects , bleeding problems, problems with bone structure (skeletal malformations), and developmental delay . [1] [2] Noonan syndrome may be caused by a mutation in any of several genes, and\u00a0can be classified into subtypes based on the responsible gene . It is typically inherited in an autosomal dominant manner, but many cases are due to a new mutation and are not inherited from either parent. Treatment depends on the symptoms present in each person. [3] Noonan syndrome belongs to a group of related conditions called the RASopathies. These conditions have some overlapping features and are all caused by genetic changes that disrupt the body's RAS pathway, affecting growth and development. Other conditions in this group include: [4] neurofibromatosis type 1 LEOPARD syndrome, also called Noonan syndrome with multiple lentigines\u00a0 Costello syndrome cardiofaciocutaneous syndrome Legius syndrome capillary malformation\u2013arteriovenous malformation syndrome The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Aplasia/Hypoplasia of the abdominal wall musculature Very frequent Cystic hygroma Very frequent Downslanted palpebral fissures Very frequent Dysarthria Very frequent Enlarged thorax Very frequent High forehead Very frequent High palate Very frequent Hypertelorism Very frequent Hypogonadotrophic hypogonadism Very frequent Joint hyperflexibility Very frequent Low-set, posteriorly rotated ears Very frequent Micrognathia Very frequent Midface retrusion Very frequent Pectus carinatum Very frequent Pectus excavatum Very frequent Proptosis Very frequent Ptosis Very frequent Pulmonary artery stenosis Very frequent Thick lower lip vermilion Very frequent Thickened helices Very frequent Thickened nuchal skin fold Very frequent Triangular face Very frequent Webbed neck Very frequent Wide intermamillary distance Very frequent Abnormal bleeding Frequent Abnormal dermatoglyphics Frequent Abnormal hair quantity Frequent Abnormal platelet function Frequent Abnormal pulmonary valve morphology Frequent Abnormality of coagulation Frequent Abnormality of the spleen Frequent Coarse hair Frequent Cryptorchidism Frequent Delayed skeletal maturation Frequent Feeding difficulties in infancy Frequent Hepatomegaly Frequent Low posterior hairline Frequent Muscular hypotonia Frequent Scoliosis Frequent Strabismus Frequent Aplasia of the semicircular canal Occasional Brachydactyly Occasional Clinodactyly of the 5th finger Occasional Hypogonadism Occasional Lymphedema Occasional Melanocytic nevus Occasional Nystagmus Occasional Radioulnar synostosis Occasional Sensorineural hearing impairment Occasional Intellectual disability Very rare Amegakaryocytic thrombocytopenia - Atrial septal defect - Autosomal dominant inheritance - Clinodactyly - Coarctation of aorta - Cubitus valgus - Dental malocclusion - Epicanthus - Failure to thrive in infancy - Heterogeneous - High, narrow palate - Hypertrophic cardiomyopathy - Kyphoscoliosis - Male infertility - Myopia - Neurofibrosarcoma - Patent ductus arteriosus - Pectus excavatum of inferior sternum - Postnatal growth retardation - Pulmonic stenosis - Radial deviation of finger - Reduced factor XII activity - Reduced factor XIII activity - Shield chest - Short neck - Superior pectus carinatum - Synovitis - Ventricular septal defect - View complete list of signs and symptoms... Noonan syndrome is inherited in an autosomal dominant manner. [5] This means that having one changed or mutated copy of the responsible gene in each cell is enough to cause the condition. Each child of a person with Noonan syndrome has a 50% (1 in 2) chance to inherit the condition. In other cases, the change in one of the genes that can cause Noonan syndrome is new and not found in either parent. This means that the genetic change was not passed down from either the mother or the father, but instead occurred for the first time (de novo) in the child who has the syndrome. [5]\u00a0 New changes or mutations in a gene can happen by mistake during the making of the egg or the sperm. Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. Orphanet lists international laboratories offering diagnostic testing for this condition. Management of Noonan syndrome generally focuses on the specific signs and symptoms present in each person. Treatments for the complications of Noonan syndrome (such as cardiovascular problems) are generally standard and do not differ from treatment in the general population. [5] Developmental disabilities are addressed by early intervention programs. Some children with Noonan syndrome may need special help in school, including for example, an individualized educational program (IEP). [5]\u00a0 Treatment for bleeding problems depends on the cause. [5] Growth hormone (GH) therapy can increase the rate at which a child with Noonan syndrome grows in most cases. GH therapy during childhood and teen years may also increase final adult height slightly, often enough to reach the low normal range of average height. [5] [6] Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. Project OrphanAnesthesia is a project whose aim is to create peer-reviewed, readily accessible guidelines for patients with rare diseases and for the anesthesiologists caring for them. The project is a collaborative effort of the German Society of Anesthesiology and Intensive Care, Orphanet, the European Society of Pediatric Anesthesia, anesthetists and rare disease experts with the aim to contribute to patient safety. There is a wide range in the nature and severity of signs and symptoms that may be present in people with Noonan syndrome , so the long-term outlook ( prognosis ) and life expectancy may differ among affected people. Studies generally suggest that long-term outcome depends largely on the presence and severity of congenital heart defects . Death in affected people has been frequently associated with the presence of complex left ventricular disease. [7] Studies have indicated that people with Noonan syndrome have a 3-fold higher mortality rate than those in the general population. [8] [9] Some affected people have ongoing health problems due to congenital heart defects, lymphatic vessel dysplasia, urinary tract malformations, blood disorders , or other associated health issues. [8] [9] However, with special care and counseling, the majority of children with Noonan syndrome grow up and function normally as adults. Signs and symptoms tend to lessen with age, and new medical problems associated with the condition are generally not expected to appear in adulthood. [8] The following diseases are related to Noonan syndrome. If you have a question about any of these diseases, you can contact GARD. Noonan syndrome 1 Noonan syndrome 2 Noonan syndrome 3 Noonan syndrome 4 Noonan syndrome 5 Noonan syndrome 6",
+    "https://rarediseases.info.nih.gov/diseases/10955/noonan-syndrome"
+  ],
+  [
+    "What are the treatments for Noonan syndrome?: There is no specific treatment. Your doctor will suggest treatment to relieve or manage symptoms. Growth hormone has been used successfully to treat short height in some persons with Noonan syndrome.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/001656.htm"
+  ],
+  [
+    "Neurofibromatosis-Noonan syndrome: This condition doesn't have a summary yet. Please see our page(s) on Neurofibromatosis. The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Abdominal wall muscle weakness Very frequent Abnormality of the helix Very frequent Downslanted palpebral fissures Very frequent Hypertelorism Very frequent Hypertrophic cardiomyopathy Very frequent Low-set, posteriorly rotated ears Very frequent Multiple cafe-au-lait spots Very frequent Ptosis Very frequent Pulmonic stenosis Very frequent Specific learning disability Very frequent Webbed neck Very frequent Abnormality of the lymphatic system Frequent Abnormality of the thorax Frequent Cryptorchidism Frequent Dysphagia Frequent Prolonged bleeding time Frequent Lisch nodules Occasional Autosomal dominant inheritance - Axillary freckling - Cafe-au-lait spot - Cubitus valgus - Delayed speech and language development - Epicanthus - Inguinal freckling - Low posterior hairline - Low-set ears - Macrocephaly - Malar flattening - Midface retrusion - Neurofibromas - Optic glioma - Pectus excavatum of inferior sternum - Posteriorly rotated ears - Prominent nasolabial fold - Scoliosis - Secundum atrial septal defect - Short neck - Superior pectus carinatum - View complete list of signs and symptoms... Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. The following diseases are related to Neurofibromatosis-Noonan syndrome. If you have a question about any of these diseases, you can contact GARD. Neurofibromatosis",
+    "https://rarediseases.info.nih.gov/diseases/372/neurofibromatosis-noonan-syndrome"
+  ],
+  [
+    "Noonan syndrome: Noonan syndrome is a condition that affects many areas of the body. It is characterized by mildly unusual facial features, short stature, heart defects, bleeding problems, skeletal malformations, and many other signs and symptoms. People with Noonan syndrome have distinctive facial features such as a deep groove in the area between the nose and mouth (philtrum), widely spaced eyes that are usually pale blue or blue-green in color, and low-set ears that are rotated backward. Affected individuals may have a high arch in the roof of the mouth (high-arched palate), poor teeth alignment, and a small lower jaw (micrognathia). Many children with Noonan syndrome have a short neck, and both children and adults may have excess neck skin (also called webbing) and a low hairline at the back of the neck. Between 50 and 70 percent of individuals with Noonan syndrome have short stature. At birth, they are usually a normal length and weight, but growth slows over time. Abnormal levels of growth hormone, a protein that is necessary for the normal growth of the body's bones and tissues, may contribute to the slow growth. Individuals with Noonan syndrome often have either a sunken chest (pectus excavatum) or a protruding chest (pectus carinatum). Some affected people may also have an abnormal side-to-side curvature of the spine (scoliosis). Most people with Noonan syndrome have some form of critical congenital heart disease. The most common heart defect in these individuals is a narrowing of the valve that controls blood flow from the heart to the lungs (pulmonary valve stenosis). Some have hypertrophic cardiomyopathy, which enlarges and weakens the heart muscle. A variety of bleeding disorders have been associated with Noonan syndrome. Some affected individuals have excessive bruising, nosebleeds, or prolonged bleeding following injury or surgery. Rarely, women with Noonan syndrome who have a bleeding disorder have excessive bleeding during menstruation (menorrhagia) or childbirth. Adolescent males with Noonan syndrome typically experience delayed puberty. They go through puberty starting at age 13 or 14 and have a reduced pubertal growth spurt that results in shortened stature. Most males with Noonan syndrome have undescended testes (cryptorchidism), which may contribute to infertility (inability to father a child) later in life. Females with Noonan syndrome can experience delayed puberty but most have normal puberty and fertility. Noonan syndrome can cause a variety of other signs and symptoms. Most children diagnosed with Noonan syndrome have normal intelligence, but a few have special educational needs, and some have intellectual disability. Some affected individuals have vision or hearing problems. Affected infants may have feeding problems, which typically get better by age 1 or 2 years. Infants with Noonan syndrome may be born with puffy hands and feet caused by a buildup of fluid (lymphedema), which can go away on its own. Older individuals can also develop lymphedema, usually in the ankles and lower legs. Some people with Noonan syndrome develop cancer, particularly those involving the blood-forming cells (leukemia). It has been estimated that children with Noonan syndrome have an eightfold increased risk of developing leukemia or other cancers over age-matched peers. Noonan syndrome is one of a group of related conditions, collectively known as RASopathies. These conditions all have similar signs and symptoms and are caused by changes in the same cell signaling pathway. In addition to Noonan syndrome, the RASopathies include cardiofaciocutaneous syndrome, Costello syndrome, neurofibromatosis type 1, Legius syndrome, and Noonan syndrome with multiple lentigines. Noonan syndrome occurs in approximately 1 in 1,000 to 2,500 people. Mutations in multiple genes can cause Noonan syndrome. Mutations in the PTPN11 gene cause about half of all cases. SOS1 gene mutations cause an additional 10 to 15 percent, and RAF1 and RIT1 genes each account for about 5 percent of cases. Mutations in other genes each account for a small number of cases. The cause of Noonan syndrome in 15 to 20 percent of people with this disorder is unknown. The PTPN11, SOS1, RAF1, and RIT1 genes all provide instructions for making proteins that are important in the RAS/MAPK cell signaling pathway, which is needed for cell division and growth (proliferation), the process by which cells mature to carry out specific functions (differentiation), and cell movement (migration). Many of the mutations in the genes associated with Noonan syndrome cause the resulting protein to be turned on (active) longer than normal, rather than promptly switching on and off in response to cell signals. This prolonged activation alters normal RAS/MAPK signaling, which disrupts the regulation of cell growth and division, leading to the characteristic features of Noonan syndrome. Rarely, Noonan syndrome is associated with genes that are not involved in the RAS/MAPK cell signaling pathway. Researchers are working to determine how mutations in these genes can lead to the signs and symptoms of Noonan syndrome. This condition is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder. Chen PC, Yin J, Yu HW, Yuan T, Fernandez M, Yung CK, Trinh QM, Peltekova VD, Reid JG, Tworog-Dube E, Morgan MB, Muzny DM, Stein L, McPherson JD, Roberts AE, Gibbs RA, Neel BG, Kucherlapati R. Next-generation sequencing identifies rare variants associated with Noonan syndrome. Proc Natl Acad Sci U S A. 2014 Aug 5;111(31):11473-8. doi: 10.1073/pnas.1324128111. Epub 2014 Jul 21.",
+    "https://ghr.nlm.nih.gov/condition/noonan-syndrome"
+  ],
+  [
+    "PTPN11 gene (Noonan syndrome): More than 90 mutations causing Noonan syndrome have been identified in the PTPN11 gene. This condition is characterized by mildly unusual facial characteristics, short stature, heart defects, bleeding problems, skeletal malformations, and many other signs and symptoms. Most of the PTPN11 gene mutations replace single amino acids used to make the SHP-2 protein. The resulting protein is either continuously turned on (active) or has prolonged activation, rather than promptly switching on and off in response to other cellular proteins. This increase in protein activity disrupts the regulation of the RAS/MAPK signaling pathway that controls cell functions such as proliferation. This misregulation can result in the heart defects, growth problems, skeletal abnormalities, and other features of Noonan syndrome. Rarely, a person with Noonan syndrome caused by PTPN11 gene mutations will also develop juvenile myelomonocytic leukemia, which is a type of blood cancer that typically affects children or adolescents.",
+    "https://ghr.nlm.nih.gov/gene/PTPN11"
+  ],
+  [
+    "Noonan syndrome (Symptoms): Signs and symptoms of Noonan syndrome vary greatly among individuals and may be mild to severe. Characteristics may be related to the specific gene containing the mutation. Facial appearance is one of the key clinical features that leads to a diagnosis of Noonan syndrome. These features may be more pronounced in infants and young children, but change with age. In adulthood, these distinct features become more subtle. Features may include the following: - Eyes are wide-set and down-slanting with droopy lids. Irises are pale blue or green. - Ears are low-set and rotated backward. - Nose is depressed at the top, with a wide base and bulbous tip. - Mouth has a deep groove between the nose and the mouth and wide peaks in the upper lip. The crease that runs from the edge of the nose to the corner of the mouth becomes deeply grooved with age. Teeth may be crooked, the inside roof of the mouth (palate) may be highly arched and the lower jaw may be small. - Facial features may appear coarse, but appear sharper with age. The face may appear droopy and expressionless. - Head may appear large with a prominent forehead and a low hairline on the back of the head. - Skin may appear thin and transparent with age. Many people with Noonan syndrome are born with some form of heart defect (congenital heart disease), accounting for some of the key signs and symptoms of the disorder. Some heart problems can occur later in life. Some forms of congenital heart disease associated with this disorder include: - Valve disorders. Pulmonary valve stenosis is a narrowing of the pulmonary valve, the flap of tissue that separates the lower right chamber (ventricle) of the heart from the artery that supplies blood to the lungs (pulmonary artery). It's the most common heart problem seen with Noonan syndrome, and it may occur alone or with other heart defects. - Thickening of the heart muscle (hypertrophic cardiomyopathy). This is abnormal growth or thickening of the heart muscle that affects some people with Noonan syndrome. - Other structural defects of the heart. The defects can involve a hole in the wall that separates the two lower chambers of the heart (ventricular septal defect), narrowing of the artery that carries blood to the lungs for oxygen (pulmonary artery stenosis), or narrowing of the major blood vessel (aorta) that carries blood from the heart to the body (aortic coarctation). - Irregular heart rhythm. This can occur with or without structural heart abnormalities. Irregular heart rhythm occurs in the majority of people with Noonan syndrome. Noonan syndrome can affect normal growth. Many children with Noonan syndrome don't grow at a normal rate. Issues may include the following: - Birth weight will likely be normal, but growth slows over time. - Eating difficulties may result in inadequate nutrition and poor weight gain. - Growth hormone levels may be insufficient. - The growth spurt that's usually seen during the teenage years may be delayed. But because this disorder causes bone maturity to be delayed, growth sometimes continues into the late teens. - By adulthood, some people with Noonan syndrome may have normal height, but short stature is more common. Some common issues can include: - An unusually shaped chest often with a sunken sternum (pectus excavatum) or raised sternum (pectus carinatum) - Wide-set nipples - Short neck, often with extra folds of skin (webbed neck) or prominent neck muscles (trapezius) - Deformities of the spine Intelligence isn't affected for most people with Noonan syndrome. However, individuals may have: - An increased risk of learning disabilities and mild intellectual disability - A wide range of mental, emotional and behavioral issues that are usually mild - Hearing and vision deficits that may complicate learning A common sign of Noonan syndrome is abnormalities of the eyes and eyelids. These may include: - Problems with the eye muscles, such as cross-eye (strabismus) - Refractive problems, such as astigmatism, nearsightedness (myopia) or farsightedness (hyperopia) - Rapid movement of the eyeballs (nystagmus) - Cataracts Noonan syndrome can cause hearing deficits due to nerve issues or to structural abnormalities in the inner ear bones. Noonan syndrome can cause excessive bleeding and bruising due to clotting defects or having too few platelets. Noonan syndrome can cause problems with the lymphatic system, which drains excess fluid from the body and helps fight infection. These problems: - May show up before or after birth or develop in the teenage years or adulthood - Can be focused in a particular area of the body or widespread - Most commonly cause excess fluid (lymphedema) on the back of the hands or top of the feet Many people, especially males, with Noonan syndrome can have problems with the genitals and kidneys. - Testicles. Undescended testicles (cryptorchidism) are common in males. - Puberty. Puberty may be delayed in both boys and girls. - Fertility. Most females develop normal fertility. In males, however, fertility may not develop normally, often because of undescended testicles. - Kidneys. Kidney problems are generally mild and occur in a fairly small number of people with Noonan syndrome. People with Noonan syndrome may have skin conditions, which most commonly are: - Various problems that affect the color and texture of the skin - Curly, coarse hair or sparse hair The signs and symptoms of Noonan syndrome can be subtle. If you suspect you or your child may have the disorder, see your primary care doctor or your child's pediatrician. You or your child may be referred to a geneticist or a cardiologist. If your unborn child is at risk because of a family history of Noonan syndrome, prenatal tests may be available.",
+    "https://www.mayoclinic.org/diseases-conditions/noonan-syndrome/symptoms-causes/syc-20354422"
+  ],
+  [
+    "Learn about gluten-free diets: On a gluten-free diet, you do not eat wheat, rye, and barley. These foods contain gluten, a type of protein. A gluten-free diet is the main treatment for celiac disease. Some people believe a gluten-free diet can also help improve other health problems, but there is little research to support this idea. People follow a gluten-free diet for a number of reasons: Celiac disease. People with this condition cannot eat gluten because it triggers an immune response that damages the lining of their GI tract. This response causes inflammation in the small intestine and makes it hard for the body to absorb nutrients in food. Symptoms include bloating, constipation, and diarrhea. Gluten sensitivity. People with gluten sensitivity do not have celiac disease. Eating gluten causes many of the same symptoms as in celiac disease, without the stomach damage. Gluten intolerance. This describes people who have symptoms and may or may not have celiac disease. Symptoms include cramping, bloating, nausea, and diarrhea. If you have one of these conditions, a gluten-free diet will help control your symptoms. It also helps prevent health problems in people with celiac disease. If you suspect you have one of these conditions, talk with your health care provider before making any diet changes. Other health claims. Some people go gluten-free because they believe it can help control health problems such as headaches, depression, chronic fatigue, and weight gain. However, these claims are unproven. Because you cut out a whole group of foods, a gluten-free diet can cause you to lose weight. However, there are easier diets to follow for weight loss. People with celiac disease often gain weight because their symptoms improve. On this diet, you need to learn which foods contain gluten and avoid them. This is not easy, because gluten is in many foods and food products. Many foods are naturally gluten-free, including: - Fruits and vegetables - Meat, fish, poultry, and eggs - Beans - Nuts and seeds - Dairy products Other grains and starches are fine to eat, as long as they do not come boxed with seasonings: - Quinoa - Amaranth - Buckwheat - Cornmeal - Millet - Rice You can also buy gluten-free versions of foods such as bread, flour, crackers, and cereals. These products are made with rice and other gluten-free flours. Keep in mind that they are often higher in sugar and calories and lower in fiber than the foods they replace. When following this diet, you must avoid foods that contain gluten: - Wheat - Barley (this includes malt, malt flavoring, and malt vinegar) - Rye - Triticale (a grain that is a cross between wheat and rye) You must also avoid these foods, which contain wheat: - Bulgur - Couscous - Durum flour - Farina - Graham flour - Kamut - Semolina - Spelt Note that \"wheat-free\" does not always mean gluten-free. Many foods contain gluten or traces of wheat. Read the label and only buy \"gluten-free\" options of: - Bread and other baked goods - Pastas - Cereals - Crackers - Beer - Soy sauce - Seitan - Breading - Battered or deep-fried foods - Oats - Packaged foods, including frozen foods, soups, and rice mixes - Salad dressings, sauces, marinades, and gravies - Some candies, licorice - Some medicines and vitamins (gluten is used to bind the pill ingredients together) A gluten-free diet is a way of eating, so exercise is not included as part of the plan. However, you should exercise for at least 30 minutes a day on most days for good health. People with celiac disease must follow a gluten-free diet to prevent damage to their intestines. Avoiding gluten will not improve your heart health if you do not eat healthy foods. Be sure to substitute plenty of whole grains, fruit, and vegetables in place of gluten. Many foods made with wheat flour are fortified with vitamins and minerals. Cutting out wheat and other grains can leave you short of nutrients like these: - Calcium - Fiber - Folate - Iron - Niacin - Riboflavin - Thiamin To get all the vitamins and minerals you need, eat a variety of healthy foods. Working with your provider or a dietitian can also help ensure you get proper nutrition. Because so many foods contain gluten, this can be a hard diet to follow. It can feel limiting when you shop or eat out. However, as the diet has become more popular, gluten-free foods have become available in more stores. Also, many restaurants are now offering gluten-free meals. The National Institutes of Health has a Celiac Awareness Campaign at celiac.nih.gov with information and resources. You can find information on celiac disease, gluten sensitivity, and gluten-free cooking from these organizations: - Beyond Celiac -- www.beyondceliac.org - The Celiac Disease Foundation -- celiac.org There are also a number of books on gluten-free eating. Your best bet is to find one written by a dietitian. If you think you may have celiac disease or gluten sensitivity, talk with your provider. You should be tested for celiac disease, which is a serious condition. If you have symptoms of gluten sensitivity or intolerance, DO NOT stop eating gluten without first getting tested for celiac disease. You may have a different health condition that a gluten-free diet cannot treat. Also, following a gluten-free diet for several months or years may make it more difficult to accurately diagnose celiac disease. If you stop eating gluten before being tested, it will affect the results. Updated by: Emily Wax, RD, The Brooklyn Hospital Center, Brooklyn, NY. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000813.htm"
+  ],
+  [
+    "What other information should I know about Zolmitriptan?: Keep all appointments with your doctor. Your blood pressure should be checked regularly. You should keep a headache diary by writing down when you have headaches and when you take zolmitriptan. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/meds/a601129.html"
+  ],
+  [
+    "Celiac disease: Celiac disease is an autoimmune disorder that damages the small intestine and inhibits absorption of nutrients. People with celiac disease cannot tolerate gluten, a protein in wheat, rye, barley, and in some products such as medicines, vitamins, and lip balms. When affected people eat food with gluten, or use a product with gluten, the immune system reacts by damaging tiny parts of the lining of the small intestine called villi. Because villi normally allow the blood to absorb nutrients from food, affected individuals become malnourished. [1] Classic signs and symptoms are caused by inflammation of the gastrointestinal tract and may include diarrhea, weight loss, abdominal pain, swelling, and food intolerance. However, many people have other symptoms involving many body systems, and some people have no symptoms. [2] [3] While celiac disease tends to run in families, it does not follow a specific inheritance pattern. The risk to develop celiac disease is raised by having certain forms of the HLA-DQA1 and HLA-DQB1 genes . [2] Treatment is a lifelong, gluten-free diet. [3] Celiac disease is a systemic autoimmune disease with gastrointestinal symptoms as well as multiple, but variable, non-gastrointestinal symptoms.\u00a0Signs and symptoms may begin from early childhood to adulthood. In adults, the age at diagnosis is usually between 30 and 50. On average, the time between the first symptoms and diagnosis is about 11 years due to the wide range of non-specific symptoms and lack of symptoms in some people. Gastrointestinal symptoms of celiac disease may include chronic or recurrent diarrhea; malabsorption; abdominal pain and distention; bloating; vomiting; and weight loss. People with mild to severe gastrointestinal symptoms are usually said to have 'classic celiac disease.' Non-gastrointestinal symptoms of celiac disease may include dermatitis herpetiformis; chronic fatigue; joint pain/inflammation; iron-deficiency anemia; migraines; depression; attention-deficit disorder; epilepsy ; osteoporosis / osteopenia; infertility and/or recurrent miscarriage; vitamin deficiencies; short stature ; failure to thrive; delayed puberty; dental enamel defects; and various secondary autoimmune disorders. People without prominent gastrointestinal symptoms are often said to have 'nonclassic celiac disease,' which is more common than classic celiac disease. Iron-deficiency anemia is the most common finding of nonclassic celiac disease, and may be the only finding. Some affected people have no symptoms (often identified because of an affected family member or screening ) and are said to have 'silent celiac disease.' [4] Susceptibility to developing celiac disease (CD) can be inherited , but the disease itself is not inherited.\u00a0Celiac disease is a multifactorial disorder , which means that multiple genes interact with environmental factors to cause CD. The condition is due to the interaction of the genes HLA-DQA1 and HLA-DQB1 (known to be associated with CD susceptibility); non- HLA genes that are less well-understood; gliadin (a component of gluten); and other environmental factors. [4] While multifactorial disorders can run in families, they generally do not follow a specific inheritance pattern. The risk for a relative of an affected person to develop CD is mostly based on empiric risk data. This means that the risk is assumed based on what has been reported, and the experiences of many families with affected people. However, genetic testing of the genes that cause susceptibility to CD can help people get a more personal risk assessment. For example, when the genetic status of an affected person's child is unknown, the child's overall risk for CD is 5-10% (1/10 to 1/20). However, if the child has testing of the susceptibility genes, the risk will increase or decrease depending on the results. [4] Individuals interested in learning about specific risks for themselves or family members should speak with their health care provider or a genetics professional. Genetic testing is available for celiac disease. However, genetic testing is often not required for a diagnosis of this condition. You can find information about labs that offer genetic testing for celiac disease through the Genetic Testing Registry (GTR). The intended audience for the GTR is health care providers and researchers. Therefore, people with specific questions about genetic testing for celiac disease should speak with their health care provider or a genetics professional. The resources below provide information about treatment options for this condition. If you have questions about which treatment is right for you, talk to your healthcare professional. Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. The long-term outlook ( prognosis ) for people with celiac disease can vary because some people have no symptoms, while others have severe malabsorption features. Overall, people with untreated or unresponsive celiac disease have increased early mortality compared to the general population. [4] Without diagnosis and treatment, celiac disease is ultimately fatal in 10 to 30% of people. Currently this outcome is rare, as most people do well if they avoid gluten. [5] Following a gluten-free diet heals the damage to the intestines and prevents further damage. This healing most often occurs within 3-6 months in children and may take 2-3 years in adults. In rare cases there can be long-term damage to the lining of the intestines before the diagnosis is made. [6] Strictly adhering to a gluten-free diet also significantly decreases the risk of cancer . [5]",
+    "https://rarediseases.info.nih.gov/diseases/11998/celiac-disease"
+  ],
+  [
+    "Celiac disease - sprue: Celiac disease is a condition caused by damage to the lining of the small intestine. This damage comes from a reaction to eating gluten. This is a substance that is found in wheat, rye, barley, and possibly oats. It is also found in food made from these ingredients. The damaged intestine does not absorb needed components of food. The exact cause of celiac disease is unknown. The lining of the intestines have small areas called villi which project outward into the opening of the intestine. These structures help absorb nutrients. - When people with celiac disease eat foods with gluten, their immune system reacts by damaging the villi. - Because of the damage, the villi are unable to properly absorb iron, vitamins, and other nutrients. - As a result, a number of symptoms and health problems may occur. The disease can develop at any point in life, from infancy to late adulthood. People who have a family member with celiac disease are at greater risk of developing the disease. The disorder is most common in Caucasians and persons of European ancestry. Women are affected more often than men. People with celiac disease are more likely to have: - Autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and Sjogren syndrome - Addison disease - Down syndrome - Intestinal cancer - Intestinal lymphoma - Lactose intolerance - Thyroid disease - Type 1 diabetes The symptoms of celiac disease can be different from person to person. This can make diagnosis difficult. For example, one person may have constipation, a second may have diarrhea, and a third may have no problem with stools. Gastrointestinal symptoms include: - Abdominal pain, bloating, gas, or indigestion - Constipation - Decreased appetite (may also be increased or unchanged) - Diarrhea, either constant or off and on - Lactose intolerance (common when the person is diagnosed, often goes away after treatment) - Nausea and vomiting - Stools that are foul smelling, oily, or stick to the toilet when flushed - Unexplained weight loss (although people can be overweight or of normal weight) Other problems that can develop over time because the intestines do not absorb key nutrients include: - Easy bruising - Depression or anxiety - Fatigue - Growth delay in children - Hair loss - Itchy skin with a rash (dermatitis herpetiformis) - Missed menstrual periods - Mouth ulcers - Muscle cramps and joint pain - Nosebleeds - Seizures - Tingling or numbness in the hands or feet - Unexplained short height Children with celiac disease may have: - Defects in the tooth enamel and changes in tooth color - Delayed puberty - Diarrhea, constipation, fatty or foul-smelling stools, nausea, or vomiting - Irritable and fussy behavior - Poor weight gain - Slowed growth and shorter than normal height for their age The following tests may be performed: - Bone density - Cholesterol (may be low) - Complete blood count (CBC - test for anemia) - Comprehensive metabolic panel - Folate level (serum) - Iron level (serum) - Prothrombin time - Vitamin B12 level (serum) - Vitamin D level Blood tests can detect antibodies, called antitissue transglutaminase antibodies (tTGA) or anti-endomysial antibodies (EMA) which may help detect the condition. The health care provider will order these antibody tests if celiac disease is suspected. If the tests are positive, upper endoscopy is often performed to sample a piece of tissue (biopsy) from the first part of the small intestine (duodenum). The biopsy may show a flattening of the villi in the parts of the intestine below the duodenum. Genetic testing of the blood can also be done to help determine who may be at risk for celiac disease. A follow-up biopsy or blood test may be ordered several months after the diagnosis and treatment. These tests assess how well treatment is working. Normal results mean that you have responded to treatment. This confirms the diagnosis. However, this does not mean that the disease has been cured. Celiac disease cannot be cured. Your symptoms will go away and the villi in the lining of the intestines will heal if you follow a lifelong gluten-free diet. Do not eat foods, drink beverages, or take medicines that contain wheat, barley, rye, and possibly oats. You must read food and drug labels carefully to look ingredients that may include these grains. It may be hard to stick to a gluten-free diet because wheat and barley grains are common in the American diet. Over time, most people are able to adapt and get better. You should NOT begin the gluten-free diet before you are diagnosed. Starting the diet will affect testing for the disease. In most cases, following a well-balanced, gluten-free diet is the only treatment you need to stay well. Your health care provider may need to prescribe vitamin and mineral supplements. Sometimes, short-term use of corticosteroids (such as prednisone) may be needed if sprue does not respond to treatment. When you are diagnosed, get help from a registered dietitian who specializes in celiac disease and the gluten-free diet. A support group may also help you cope with the disease and diet. Following a gluten-free diet heals the damage to the intestines and prevents further damage. This healing most often occurs within 3 to 6 months in children. Recovery may take 2 to 3 years in adults. Rarely, long-term damage will be done to the lining of the intestines before the diagnosis is made. Some problems caused by celiac disease may not improve, such as a shorter than expected height and damage to the teeth. You must carefully continue to follow the gluten-free diet. When untreated, the disease can cause life-threatening complications. Delaying diagnosis or not following the diet puts you at risk for related conditions such as: - Autoimmune disorders - Bone disease (osteoporosis, kyphoscoliosis, fractures) - Certain types of intestinal cancer - Low blood count (anemia) - Infertility or repeated miscarriage - Liver disease Call your provider if you have symptoms of celiac disease. Because the exact cause is unknown, there is no known way to prevent the development of celiac disease. However, being aware of the risk factors (such as having a family member with the disorder) may increase your chances of early diagnosis, treatment, and a long, healthy life. Updated by: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000233.htm"
+  ],
+  [
+    "Amphetamine: Amphetamine can be habit-forming. Do not take a larger dose, take it more often, or take it for a longer time than prescribed by your doctor. If you take too much amphetamine, you may find that the medication no longer controls your symptoms, you may feel a need to take large amounts of the medication, and you may experience symptoms such as rash, difficulty falling asleep or staying asleep, irritability, hyperactivity, and unusual changes in your personality or behavior. Overusing amphetamine may also cause serious heart problems or sudden death. Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, or has overused prescription medications. Your doctor will probably not prescribe amphetamine for you. Do not stop taking amphetamine without talking to your doctor, especially if you have overused the medication. Your doctor will probably decrease your dose gradually and monitor you carefully during this time. You may develop depression and extreme tiredness. if you suddenly stop taking amphetamine after overusing it. Do not sell, give away, or let anyone else take your medication. Selling or giving away amphetamine may harm others and is against the law. Store amphetamine in a safe place so that no one else can take it accidentally or on purpose. Keep track of how many tablets or how much suspension (liquid) are left so you will know if any are missing. Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with amphetamine and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) to obtain the Medication Guide. Amphetamine (Adzenys XR, Dyanavel XR, Evekeo) is used as part of a treatment program to control symptoms of attention deficit hyperactivity disorder (ADHD; more difficulty focusing, controlling actions, and remaining still or quiet than other people who are the same age) in adults and children. Amphetamine (Evekeo) is used to treat narcolepsy (a sleep disorder that causes excessive daytime sleepiness and sudden attacks of sleep). Amphetamine (Evekeo) is also used for a limited period of time (a few weeks) along with a reduced calorie diet and an exercise plan for weight loss in obese people unable to lose weight. Amphetamine is in a class of medications called central nervous system stimulants. It works by changing the amounts of certain natural substances in the brain. Amphetamine comes as an immediate-release tablet (Evekeo), an extended-release (long-acting) orally disintegrating tablet (tablet that dissolves quickly in the mouth) (Adzenys XR), and as an extended-release (long-acting) suspension (Dyanavel XR) to take by mouth. The suspension is usually taken once daily in the morning with or without food. The extended-release orally disintegrating tablet is usually taken once daily in the morning with or without food. For treatment of ADHD or narcolepsy, the immediate-release tablet is usually taken with or without food one to three times daily, 4 to 6 hours apart, with the first dose in the morning. For weight loss, the immediate-release tablet is usually taken 30 to 60 minutes before meals. Amphetamine should not be taken in the late afternoon or evening because it may cause difficulty falling asleep or staying asleep. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amphetamine exactly as directed. Do not try to push the extended-release orally disintegrating tablet through the blister pack foil. Instead, use dry hands to peel back the foil packaging. Immediately take out the tablet and place it in your mouth. The tablet will quickly dissolve and can be swallowed with saliva. No water is needed to swallow the tablet. Shake the suspension well before each use to mix the medication evenly. It is important to use an oral syringe (measuring device) to accurately measure and take your dose of the suspension. Ask your pharmacist for a device if it was not provided. Wash the oral syringe thoroughly after each use. If you or your child are taking amphetamine for ADHD, your doctor will probably start you on a low dose of amphetamine and increase your dose gradually, every 4 to 7 days, depending on the medication. Your doctor may tell you to stop taking amphetamine from time to time to see if the medication is still needed. Follow these directions carefully. If you are taking amphetamine for narcolepsy, your doctor will probably start you on a low dose of amphetamine and increase your dose gradually, not more often than once every week. Follow these directions carefully. The medication in each product is absorbed differently by the body, so one amphetamine product cannot be substituted for another product. If you are switching from one product to another, your doctor will prescribe a dose that is best for you. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before taking amphetamine, - tell your doctor and pharmacist if you are allergic to amphetamine, other stimulant medications such as benzphetamine, dextroamphetamine (Dexedrine, in Adderall), lisdexamfetamine (Vyvanse), and methamphetamine (Desoxyn); any other medications; or any of the ingredients in amphetamine products. Ask your pharmacist or check the Medication Guide for a list of the ingredients. - tell your doctor if you are taking the following medications or have stopped taking them in the past 14 days: monoamine oxidase (MAO) inhibitors including isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate). If you stop taking amphetamine, you should wait at least 14 days before you start to take an MAO inhibitor. - tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and herbal products you are taking. Be sure to mention any of the following: acetazolamide (Diamox); ammonium chloride; anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); ascorbic acid (Vitamin C); buspirone; medications for heartburn or ulcers such as omeprazole (Prilosec, in Zegerid); antihistamines (medications for colds and allergies); chlorpromazine; diuretics ('water pills'); fentanyl (Actiq, Duragesic, Subsys, others); guanethidine (Ismelin; no longer available in U.S.); haloperidol (Haldol); medications for high blood pressure; lithium (Lithobid); methenamine salts (Hiprex, Urex); medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, in Treximet), and zolmitriptan (Zomig); narcotic pain medications such as meperidine (Demerol); propoxyphene (Darvon; no longer available in U.S.); reserpine; medications for seizures such as ethosuximide (Zarontin), phenobarbital, and phenytoin (Dilantin, Phenytek); selective serotonin-reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Prozac, Pexeva), and sertraline (Zoloft); serotonin and norepinephrine reuptake inhibitors such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor); sodium acid phosphate; sodium bicarbonate (Arm and Hammer Baking Soda, Soda Mint); tramadol; or tricyclic antidepressants such as desipramine (Norpramin) and protriptyline (Vivactil). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor what herbal products you are taking, especially St. John's wort and tryptophan or nutritional supplements you are taking including glutamic acid (L-glutamine). - tell your doctor if you have hyperthyroidism (condition in which there is too much thyroid hormone in the body), or strong feelings of anxiety, tension, or agitation Your doctor will probably tell you not to take amphetamine. - tell your doctor if anyone in your family has or has ever had an irregular heartbeat or has died suddenly. Also tell your doctor if you have recently had a heart attack or if you have or have ever had a heart defect, arteriosclerosis (hardening of the arteries), coronary artery disease (narrowing of the blood vessels that supply blood to the heart), high blood pressure, an irregular heartbeat, cardiomyopathy (thickening of the heart muscles), heart or blood vessel disease, or other heart problems. Your doctor will examine you to see if your heart and blood vessels are healthy. Your doctor will probably tell you not to take amphetamine if you have a heart condition or if there is a high risk that you may develop a heart condition. - tell your doctor if you or anyone in your family has or has ever had depression, bipolar disorder (mood that changes from depressed to abnormally excited), mania (frenzied, abnormally excited mood), psychosis, motor tics (repeated uncontrollable movements), verbal tics (repetition of sounds or words that is hard to control), Tourette's syndrome (a condition characterized by the need to perform repeated motions or to repeat sounds or words), or has thought about or attempted suicide. Also tell your doctor if you have or have ever had seizures, an abnormal electroencephalogram (EEG; a test that measures electrical activity in the brain), or kidney disease. - tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking amphetamine, call your doctor. Do not breastfeed while taking amphetamine. - do not drive a car or operate machinery until you know how this medication affects you. - do not drink alcohol while you are taking amphetamine. Alcohol can make the side effects from amphetamine worse. - you should know that amphetamine should be used as part of a total treatment program for ADHD, which may include counseling and special education. Make sure to follow all of your doctor's and/or therapist's instructions. - you should know that amphetamine may cause sudden death in children and teenagers, especially children and teenagers who have heart defects or serious heart problems. This medication also may cause sudden death, heart attack, or stroke in adults, especially adults with heart defects or serious heart problems. Call your or your child's doctor right away if you or your child has any signs of heart problems while taking this medication including: chest pain, shortness of breath, or fainting. Talk to your doctor about drinking fruit juice while taking this medicine. Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Amphetamine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - dry mouth - nausea - diarrhea - constipation - unpleasant taste - weight loss - nose bleeding - headache - grinding or clenching teeth during sleep - changes in sex drive or ability - painful menstruation - pain or burning when urinating Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, stop taking amphetamine and call your doctor immediately: - dizziness or fainting - fast or pounding heartbeat - weakness or numbness of an arm or leg - motor or verbal tics - believing things that are not true - feeling unusually suspicious of others - hallucinating (seeing things or hearing voices that do not exist) - mania (frenzied or abnormally excited mood) - agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea - seizures - changes in vision or blurred vision - blistering or peeling skin - rash - hives - itching - swelling of the face, throat, tongue, lips, or eyes - difficulty breathing or swallowing - numbness, pain, or sensitivity to temperature in the fingers or toes - skin color change from pale to blue to red in the fingers or toes - unexplained wounds appearing on fingers or toes Amphetamine may slow children's growth or weight gain. Your child's doctor will watch his or her growth carefully. Talk to your child's doctor if you have concerns about your child's growth or weight gain while he or she is taking this medication. Talk to your child's doctor about the risks of giving amphetamine to your child. Amphetamine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the extended-release orally disintegrating tablet blister packages in the rigid, plastic travel case after removal from the carton. Store it at room temperature and away from light, excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of overdose may include the following: - restlessness - confusion - aggressive behavior - shaking of a part of the body - tiredness or weakness - depression - fast or irregular heartbeat - nausea - vomiting - diarrhea - stomach cramps - seizures - coma (loss of consciousness for a period of time) Keep all appointments with your doctor. Your doctor may order certain tests to check your body's response to amphetamine and your blood pressure. Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking amphetamine. This prescription is not refillable. Be sure to schedule appointments with your doctor on a regular basis so that you do not run out of medication. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Adzenys XR\u00ae - Dyanavel XR\u00ae - Evekeo\u00ae",
+    "https://medlineplus.gov/druginfo/meds/a616004.html"
+  ],
+  [
+    "How should Amphetamine be used and what is the dosage?: Amphetamine comes as an tablet (Evekeo) and as an extended-release (long-acting) suspension (Dyanavel XR) to take by mouth. The suspension is usually taken once daily in the morning with or without food. For treatment of ADHD or narcolepsy, the tablet is usually taken with or without food one to three times daily, 4 to 6 hours apart, with the first dose in the morning. For weight loss, the tablet is usually taken 30 to 60 minutes before meals. Amphetamine should not be taken in the late afternoon or evening because it may cause difficulty falling asleep or staying asleep. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amphetamine exactly as directed. Shake the suspension well before each use to mix the medication evenly. It is important to use an oral syringe (measuring device) to accurately measure and take your dose of the suspension. Ask your pharmacist for a device if it was not provided. Wash the oral syringe thoroughly after each use. If you or your child are taking amphetamine for ADHD, your doctor will probably start you on a low dose of amphetamine and increase your dose gradually, every 4 to 7 days, depending on the medication. Your doctor may tell you to stop taking amphetamine from time to time to see if the medication is still needed. Follow these directions carefully. If you are taking amphetamine for narcolepsy, your doctor will probably start you on a low dose of amphetamine and increase your dose gradually, not more often than once every week. Follow these directions carefully.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/meds/a616004.html"
+  ],
+  [
+    "Amphetamine (What special precautions should I follow?): Before taking amphetamine, - tell your doctor and pharmacist if you are allergic to amphetamine, other stimulant medications such as benzphetamine, dextroamphetamine (Dexedrine, in Adderall), lisdexamfetamine (Vyvanse), and methamphetamine (Desoxyn); any other medications; or any of the ingredients in amphetamine products. Ask your pharmacist or check the Medication Guide for a list of the ingredients. - tell your doctor if you are taking the following medications or have stopped taking them in the past 14 days: monoamine oxidase (MAO) inhibitors including isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate). If you stop taking amphetamine, you should wait at least 14 days before you start to take an MAO inhibitor. - tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and herbal products you are taking. Be sure to mention any of the following: acetazolamide (Diamox); ammonium chloride; anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); ascorbic acid (Vitamin C); buspirone; medications for heartburn or ulcers such as omeprazole (Prilosec, in Zegerid); antihistamines (medications for colds and allergies); chlorpromazine; diuretics ('water pills'); fentanyl (Actiq, Duragesic, Subsys, others); guanethidine (Ismelin; no longer available in U.S.); haloperidol (Haldol); medications for high blood pressure; lithium (Lithobid); methenamine salts (Hiprex, Urex); medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, in Treximet), and zolmitriptan (Zomig); narcotic pain medications such as meperidine (Demerol); propoxyphene (Darvon; no longer available in U.S.); reserpine; medications for seizures such as ethosuximide (Zarontin), phenobarbital, and phenytoin (Dilantin, Phenytek); selective serotonin-reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Prozac, Pexeva), and sertraline (Zoloft); serotonin and norepinephrine reuptake inhibitors such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor); sodium acid phosphate; sodium bicarbonate (Arm and Hammer Baking Soda, Soda Mint); tramadol; or tricyclic antidepressants such as desipramine (Norpramin) and protriptyline (Vivactil). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor what herbal products you are taking, especially St. John's wort and tryptophan or nutritional supplements you are taking including glutamic acid (L-glutamine). - tell your doctor if you have hyperthyroidism (condition in which there is too much thyroid hormone in the body), or strong feelings of anxiety, tension, or agitation Your doctor will probably tell you not to take amphetamine. - tell your doctor if anyone in your family has or has ever had an irregular heartbeat or has died suddenly. Also tell your doctor if you have recently had a heart attack or if you have or have ever had a heart defect, arteriosclerosis (hardening of the arteries), coronary artery disease (narrowing of the blood vessels that supply blood to the heart), high blood pressure, an irregular heartbeat, cardiomyopathy (thickening of the heart muscles), heart or blood vessel disease, or other heart problems. Your doctor will examine you to see if your heart and blood vessels are healthy. Your doctor will probably tell you not to take amphetamine if you have a heart condition or if there is a high risk that you may develop a heart condition. - tell your doctor if you or anyone in your family has or has ever had depression, bipolar disorder (mood that changes from depressed to abnormally excited), mania (frenzied, abnormally excited mood), psychosis, motor tics (repeated uncontrollable movements), verbal tics (repetition of sounds or words that is hard to control), Tourette's syndrome (a condition characterized by the need to perform repeated motions or to repeat sounds or words), or has thought about or attempted suicide. Also tell your doctor if you have or have ever had seizures, an abnormal electroencephalogram (EEG; a test that measures electrical activity in the brain), or kidney disease. - tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking amphetamine, call your doctor. Do not breastfeed while taking amphetamine. - do not drive a car or operate machinery until you know how this medication affects you. - do not drink alcohol while you are taking amphetamine. Alcohol can make the side effects from amphetamine worse. - you should know that amphetamine should be used as part of a total treatment program for ADHD, which may include counseling and special education. Make sure to follow all of your doctor's and/or therapist's instructions. - you should know that amphetamine may cause sudden death in children and teenagers, especially children and teenagers who have heart defects or serious heart problems. This medication also may cause sudden death, heart attack, or stroke in adults, especially adults with heart defects or serious heart problems. Call your or your child's doctor right away if you or your child has any signs of heart problems while taking this medication including: chest pain, shortness of breath, or fainting.",
+    "https://medlineplus.gov/druginfo/meds/a616004.html"
+  ],
+  [
+    "Amphetamine (Why is this medication prescribed?): Amphetamine (Adzenys XR, Dyanavel XR, Evekeo) is used as part of a treatment program to control symptoms of attention deficit hyperactivity disorder (ADHD; more difficulty focusing, controlling actions, and remaining still or quiet than other people who are the same age) in adults and children. Amphetamine (Evekeo) is used to treat narcolepsy (a sleep disorder that causes excessive daytime sleepiness and sudden attacks of sleep). Amphetamine (Evekeo) is also used for a limited period of time (a few weeks) along with a reduced calorie diet and an exercise plan for weight loss in obese people unable to lose weight. Amphetamine is in a class of medications called central nervous system stimulants. It works by changing the amounts of certain natural substances in the brain.",
+    "https://medlineplus.gov/druginfo/meds/a616004.html"
+  ],
+  [
+    "Dextroamphetamine and Amphetamine (Brand names of combination products): - Adderall\u00ae (containing Amphetamine, Dextroamphetamine) - Adderall\u00ae XR (containing Amphetamine, Dextroamphetamine) - Biphetamine\u00ae (containing Amphetamine, Dextroamphetamine)\u00b6",
+    "https://medlineplus.gov/druginfo/meds/a601234.html"
+  ],
+  [
+    "Amphetamine (What side effects can this medication cause?): Amphetamine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - dry mouth - nausea - diarrhea - constipation - unpleasant taste - weight loss - nose bleeding - headache - grinding or clenching teeth during sleep - changes in sex drive or ability - painful menstruation - pain or burning when urinating Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, stop taking amphetamine and call your doctor immediately: - dizziness or fainting - fast or pounding heartbeat - weakness or numbness of an arm or leg - motor or verbal tics - believing things that are not true - feeling unusually suspicious of others - hallucinating (seeing things or hearing voices that do not exist) - mania (frenzied or abnormally excited mood) - agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea - seizures - changes in vision or blurred vision - blistering or peeling skin - rash - hives - itching - swelling of the face, throat, tongue, lips, or eyes - difficulty breathing or swallowing - numbness, pain, or sensitivity to temperature in the fingers or toes - skin color change from pale to blue to red in the fingers or toes - unexplained wounds appearing on fingers or toes Amphetamine may slow children's growth or weight gain. Your child's doctor will watch his or her growth carefully. Talk to your child's doctor if you have concerns about your child's growth or weight gain while he or she is taking this medication. Talk to your child's doctor about the risks of giving amphetamine to your child. Amphetamine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).",
+    "https://medlineplus.gov/druginfo/meds/a616004.html"
+  ],
+  [
+    "Amphetamine (What other information should I know?): Keep all appointments with your doctor. Your doctor may order certain tests to check your body's response to amphetamine and your blood pressure. Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking amphetamine. This prescription is not refillable. Be sure to schedule appointments with your doctor on a regular basis so that you do not run out of medication. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.",
+    "https://medlineplus.gov/druginfo/meds/a616004.html"
+  ],
+  [
+    "VDRL test (What Abnormal Results Mean): A positive test result may mean you have syphilis. If the test is positive, the next step is to confirm the results with an FTA-ABS test, which is a more specific syphilis test. The VDRL test's ability to detect syphilis depends on the stage of the disease. The test's sensitivity to detect syphilis nears 100% during the middle stages; it is less sensitive during the earlier and later stages. Some conditions may cause a false-positive test, including: - HIV - Lyme disease - Certain types of pneumonia - Malaria - Systemic lupus erythematosus The body does not always produce antibodies specifically in response to the syphilis bacteria, so this test is not always accurate.",
+    "https://medlineplus.gov/ency/article/003515.htm"
+  ],
+  [
+    "What is Dual Diagnosis?: A person with dual diagnosis has both a mental disorder and an alcohol or drug problem. These conditions occur together frequently. In particular, alcohol and drug problems tend to occur with - Depression - Anxiety disorders - Schizophrenia - Personality disorders Sometimes the mental problem occurs first. This can lead people to use alcohol or drugs that make them feel better temporarily. Sometimes the substance abuse occurs first. Over time, that can lead to emotional and mental problems. Someone with a dual diagnosis must treat both conditions. For the treatment to be effective, the person needs to stop using alcohol or drugs. Treatments may include behavioral therapy, medicines, and support groups. NIH: National Institute on Drug Abuse",
+    "https://www.nlm.nih.gov/medlineplus/dualdiagnosis.html"
+  ],
+  [
+    "VDRL test: The VDRL test is a screening test for syphilis. It measures substances (proteins), called antibodies, that your body may produce if you have come in contact with the bacteria that cause syphilis. The test is most often done using a blood sample. It can also be done using a sample of spinal fluid. This article discusses the blood test. A blood sample is needed. When the needle is inserted to draw blood, some people may feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or a slight bruise. This soon goes away. This test is used to screen for syphilis. The bacteria that cause syphilis is called Treponema pallidum. Your health care provider may order this test if you have signs and symptoms of a sexually transmitted illness (STI). Syphilis screening is a routine part of prenatal care during pregnancy. Several states also require screening for syphilis prior to obtaining a marriage license. This test is similar to the newer rapid plasma reagin (RPR) test. A negative test is normal. It means that no antibodies to syphilis have been seen in your blood sample. The screening test is most likely to be positive in the secondary and latent stages of syphilis. This test may give a false-negative result during early- and late-stage syphilis. This test must be confirmed with another blood test to make the diagnosis of syphilis. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results. A positive test result may mean you have syphilis. If the test is positive, the next step is to confirm the results with an FTA-ABS test, which is a more specific syphilis test. The VDRL test's ability to detect syphilis depends on the stage of the disease. The test's sensitivity to detect syphilis nears 100% during the middle stages; it is less sensitive during the earlier and later stages. Some conditions may cause a false-positive test, including: - HIV - Lyme disease - Certain types of pneumonia - Malaria - Systemic lupus erythematosus The body does not always produce antibodies specifically in response to the syphilis bacteria, so this test is not always accurate. Veins and arteries vary in size from one person to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others. Other risks associated with having blood drawn are slight, but may include: - Excessive bleeding - Fainting or feeling lightheaded - Hematoma (blood accumulating under the skin) - Infection (a slight risk any time the skin is broken) Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003515.htm"
+  ],
+  [
+    "CSF-VDRL test: The CSF-VDRL test is used to help diagnose neurosyphilis. It looks for substances called antibodies, which are sometimes produced by the body in reaction to the syphilis-causing bacteria. A sample of spinal fluid is needed. Follow the health care provider's instructions on how to prepare for this test. The CSF-VDRL test is done to diagnose syphilis in the brain or spinal cord. Brain and spinal cord involvement is often a sign of late-stage syphilis. Blood screening tests (VDRL and RPR) are better at detecting middle-stage (secondary) syphilis. A negative result is normal. False-negatives can occur. This means you can have syphilis even if this test is normal. Therefore, a negative test does not always rule out the infection. Other signs and tests may be used to diagnose neurosyphilis. A positive result is abnormal and is a sign of neurosyphilis. Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003623.htm"
+  ],
+  [
+    "Oculocutaneous albinism type 2 (Diagnosis): Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional.",
+    "https://rarediseases.info.nih.gov/diseases/4038/oculocutaneous-albinism-type-2"
+  ],
+  [
+    "CSF-VDRL test (Why the Test is Performed): The CSF-VDRL test is done to diagnose syphilis in the brain or spinal cord. Brain and spinal cord involvement is often a sign of late-stage syphilis. Blood screening tests (VDRL and RPR) are better at detecting middle-stage (secondary) syphilis.",
+    "https://medlineplus.gov/ency/article/003623.htm"
+  ],
+  [
+    "Sneddon syndrome (Diagnosis): The main criteria for a diagnosis of Sneddon syndrome are general livedo racemosa with characteristic findings on skin biopsy , and focal neurological deficits. Supportive criteria include a history of transient ischemic attacks or stroke and evidence of small bright foci on T2-weighted MRI . [3] Anyone suspected to have Sneddon syndrome may undergo: [3] [2] blood tests (see below) a thorough cardiovascular (heart) evaluation; brain MRI which may reveal white matter changes, infarcts, microbleeds or atrophy; cerebral angiography\u00a0(abnormal in up to 75% of patients);\u00a0and skin biopsy, which may reveal occlusion of arterioles by proliferation of the inner lining (characteristic of Sneddon syndrome) Blood tests may screen for:[3][2] lupus anticoagulant immunoglobulin IgG and possibly IgM anti-cardiolipinantibodies\u00a0(types of antiphospholipid antibodies , which may be positive\u00a0in about 60% of cases) anti-nuclear (ANA) and anti-double-stranded DNA autoantibodies thrombocytopenia and leukopenia (low white cell count) VDRL cryoglobulins circulating immune complexes antithrombin-III protein C or protein S",
+    "https://rarediseases.info.nih.gov/diseases/7664/sneddon-syndrome"
+  ],
+  [
+    "Low Blood Glucose (Hypoglycemia): Someone will need to give you a glucagon injection if you have severe hypoglycemia. An injection of glucagon will quickly raise your blood glucose level. Talk with your health care provider about when and how to use a glucagon emergency kit. If you have an emergency kit, check the date on the package to make sure it hasn\u2019t expired.If you are likely to have severe hypoglycemia, teach your family, friends, and coworkers when and how to give you a glucagon injection. Also, tell your family, friends, and coworkers to call 911 right away after giving you a glucagon injection or if you don\u2019t have a glucagon emergency kit with you.If you have hypoglycemia often or have had severe hypoglycemia, you should wear a medical alert bracelet or pendant. A medical alert ID tells other people that you have diabetes and need care right away. Getting prompt care can help prevent the serious problems that hypoglycemia can cause.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia"
+  ],
+  [
+    "How should Glucagon be used and what is the dosage?: Glucagon is usually given by injection beneath the skin, in the muscle, or in the vein. It comes as a powder and liquid that will need to be mixed just before administering the dose. Instructions for mixing and giving the injection are in the package. Glucagon should be administered as soon as possible after discovering that the patient is unconscious from low blood sugar. After the injection, the patient should be turned onto the side to prevent choking if they vomit. Once the glucagon has been given, contact your doctor. It is very important that all patients have a household member who knows the symptoms of low blood sugar and how to administer glucagon. If you have low blood sugar often, keep a glucagon kit with you at all times. You should be able to recognize some of the signs and symptoms of low blood sugar (i.e., shakiness, dizziness or lightheadedness, sweating, confusion, nervousness or irritability, sudden changes in behavior or mood, headache, numbness or tingling around the mouth, weakness, pale skin, sudden hunger, clumsy or jerky movements). Try to eat or drink a food or beverage with sugar in it, such as hard candy or fruit juice, before it is necessary to administer glucagon. Follow the directions on your prescription label carefully, and ask your pharmacist or doctor to explain any part you or your household members do not understand. Use glucagon exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682480.html"
+  ],
+  [
+    "Low Blood Glucose (Hypoglycemia): Hypoglycemia, also called low blood glucose or low blood sugar, occurs when the level of glucose in your blood drops below normal. For many people with diabetes, that means a level of 70 milligrams per deciliter (mg/dL) or less. Your numbers might be different, so check with your health care provider to find out what level is too low for you. Symptoms of hypoglycemia tend to come on quickly and can vary from person to person. You may have one or more mild-to-moderate symptoms listed in the table below. Sometimes people don\u2019t feel any symptoms.Severe hypoglycemia is when your blood glucose level becomes so low that you\u2019re unable to treat yourself and need help from another person. Severe hypoglycemia is dangerous and needs to be treated right away. This condition is more common in people with type 1 diabetes.Hypoglycemia Symptoms Mild-to-Moderate Severe Shaky or jittery Sweaty Hungry Headachy Blurred vision Sleepy or tired Dizzy or lightheaded Confused or disoriented Pale Uncoordinated Irritable or nervous Argumentative or combative Changed behavior or personality Trouble concentrating Weak Fast or irregular heart beat Unable to eat or drink Seizures or convulsions (jerky movements) UnconsciousnessSome symptoms of hypoglycemia during sleep arecrying out or having nightmares sweating enough to make your pajamas or sheets damp feeling tired, irritable, or confused after waking up Hypoglycemia can be a side effect of insulin or other types of diabetes medicines that help your body make more insulin. Two types of diabetes pills can cause hypoglycemia: sulfonylureas and meglitinides. Ask your health care team if your diabetes medicine can cause hypoglycemia.Although other diabetes medicines don\u2019t cause hypoglycemia by themselves, they can increase the chances of hypoglycemia if you also take insulin, a sulfonylurea, or a meglitinide.If you take insulin or some other diabetes medicines, your blood glucose level can drop too low. If you take insulin or diabetes medicines that increase the amount of insulin your body makes\u2014but don\u2019t match your medications with your food or physical activity\u2014you could develop hypoglycemia. The following factors can make hypoglycemia more likely:Not eating enough carbohydrates (carbs)When you eat foods containing carbohydrates, your digestive system breaks down the sugars and starches into glucose. Glucose then enters your bloodstream and raises your blood glucose level. If you don\u2019t eat enough carbohydrates to match your medication, your blood glucose could drop too low.Skipping or delaying a mealIf you skip or delay a meal, your blood glucose could drop too low. Hypoglycemia also can occur when you are asleep and haven\u2019t eaten for several hours.Increasing physical activityIncreasing your physical activity level beyond your normal routine can lower your blood glucose level for up to 24 hours after the activity.Drinking too much alcohol without enough foodAlcohol makes it harder for your body to keep your blood glucose level steady, especially if you haven\u2019t eaten in a while. The effects of alcohol can also keep you from feeling the symptoms of hypoglycemia, which may lead to severe hypoglycemia.Being sickWhen you\u2019re sick, you may not be able to eat as much or keep food down, which can cause low blood glucose. Learn more about taking care of your diabetes when you\u2019re sick. If you are taking insulin, a sulfonylurea, or a meglitinide, using your diabetes management plan and working with your health care team to adjust your plan as needed can help you prevent hypoglycemia. The following actions can also help prevent hypoglycemia:Check blood glucose levelsKnowing your blood glucose level can help you decide how much medicine to take, what food to eat, and how physically active to be. To find out your blood glucose level, check yourself with a blood glucose meter as often as your doctor advises.Hypoglycemia unawareness. Sometimes people with diabetes don\u2019t feel or recognize the symptoms of hypoglycemia, a problem called hypoglycemia unawareness. If you have had hypoglycemia without feeling any symptoms, you may need to check your blood glucose more often so you know when you need to treat your hypoglycemia or take steps to prevent it. Be sure to check your blood glucose before you drive.If you have hypoglycemia unawareness or have hypoglycemia often, ask your health care provider about a continuous glucose monitor (CGM). A CGM checks your blood glucose level at regular times throughout the day and night. CGMs can tell you if your blood glucose is falling quickly and sound an alarm if your blood glucose falls too low. CGM alarms can wake you up if you have hypoglycemia during sleep.Eat regular meals and snacksYour meal plan is key to preventing hypoglycemia. Eat regular meals and snacks with the correct amount of carbohydrates to help keep your blood glucose level from going too low. Also, if you drink alcoholic beverages, it\u2019s best to eat some food at the same time.Be physically active safelyPhysical activity can lower your blood glucose during the activity and for hours afterward. To help prevent hypoglycemia, you may need to check your blood glucose before, during, and after physical activity and adjust your medicine or carbohydrate intake. For example, you might eat a snack before being physically active or decrease your insulin dose as directed by your health care provider to keep your blood glucose from dropping too low.Work with your health care teamTell your health care team if you have had hypoglycemia. Your health care team may adjust your diabetes medicines or other aspects of your management plan. Learn about balancing your medicines, eating plan, and physical activity to prevent hypoglycemia. Ask if you should have a glucagon emergency kit to carry with you at all times.You can help prevent hypoglycemia by working with your health care team. If you begin to feel one or more hypoglycemia symptoms, check your blood glucose. If your blood glucose level is below your target or less than 70, eat or drink 15 grams of carbohydrates right away. Examples includefour glucose tablets or one tube of glucose gel 1/2 cup (4 ounces) of fruit juice\u2014not low-calorie or reduced sugar* 1/2 can (4 to 6 ounces) of soda\u2014not low-calorie or reduced sugar 1 tablespoon of sugar, honey, or corn syrup 2 tablespoons of raisinsWait 15 minutes and check your blood glucose again. If your glucose level is still low, eat or drink another 15 grams of glucose or carbohydrates. Check your blood glucose again after another 15 minutes. Repeat these steps until your glucose level is back to normal.If your next meal is more than 1 hour away, have a snack to keep your blood glucose level in your target range. Try crackers or a piece of fruit. *People who have kidney disease shouldn\u2019t drink orange juice for their 15 grams of carbohydrates because it contains a lot of potassium. Apple, grape, or cranberry juice are good options.If your blood glucose is below your target, take 15 grams of glucose or carbohydrates right away.Treating hypoglycemia if you take acarbose or miglitolIf you take acarbose or miglitol along with diabetes medicines that can cause hypoglycemia, you will need to take glucose tablets or glucose gel if your blood glucose level is too low. Eating or drinking other sources of carbohydrates won\u2019t raise your blood glucose level quickly enough. Someone will need to give you a glucagon injection if you have severe hypoglycemia. An injection of glucagon will quickly raise your blood glucose level. Talk with your health care provider about when and how to use a glucagon emergency kit. If you have an emergency kit, check the date on the package to make sure it hasn\u2019t expired.If you are likely to have severe hypoglycemia, teach your family, friends, and coworkers when and how to give you a glucagon injection. Also, tell your family, friends, and coworkers to call 911 right away after giving you a glucagon injection or if you don\u2019t have a glucagon emergency kit with you.If you have hypoglycemia often or have had severe hypoglycemia, you should wear a medical alert bracelet or pendant. A medical alert ID tells other people that you have diabetes and need care right away. Getting prompt care can help prevent the serious problems that hypoglycemia can cause.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia"
+  ],
+  [
+    "Continuous Glucose Monitoring: A CGM is one part of the \u201cartificial pancreas\u201d systems that are beginning to reach people with diabetes.The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has played an important role in developing artificial pancreas technology. An artificial pancreas replaces manual blood glucose testing and the use of insulin shots. A single system monitors blood glucose levels around the clock and provides insulin or both insulin and a second hormone, glucagon, automatically. The system can also be monitored remotely, for example by parents or medical staff.In 2016, the U.S. Food and Drug Administration approved a type of artificial pancreas system called a hybrid closed-loop system. This system tests your glucose level every 5 minutes throughout the day and night through a CGM, and automatically gives you the right amount of basal insulin, a long-acting insulin, through a separate insulin pump. You will still need to test your blood with a glucose meter a few times a day. And you'll manually adjust the amount of insulin the pump delivers at mealtimes and when you need a correction dose.The hybrid closed-loop system may free you from some of the daily tasks needed to keep your blood glucose stable\u2014or help you sleep through the night without the need to wake and test your glucose or take medicine. Talk with your health care provider about whether this system might be right for you.The NIDDK has funded \u2013 and continues to fund \u2013 several important studies on different types of artificial pancreas devices to better help people with type 1 diabetes manage their disease. The devices may also help people with type 2 diabetes and gestational diabetes.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/continuous-glucose-monitoring"
+  ],
+  [
+    "CSF glucose test: A CSF glucose test measures the amount of sugar (glucose) in the cerebrospinal fluid (CSF). CSF is a clear fluid that flows in the space surrounding the spinal cord and brain. A sample of CSF is needed. A lumbar puncture, also called a spinal tap, is the most common way to collect this sample. For information on this procedure, see the article on lumbar puncture. Other methods for collecting CSF are rarely used, but may be recommended in some cases. They include: - Cisternal puncture - Ventricular puncture - Removal of CSF from a tube that is already in the CSF, such as a shunt or ventricular drain The sample is sent to a laboratory for testing. This test may be done to diagnose: - Tumors - Infections - Inflammation of the central nervous system - Delirium - Other neurological and medical conditions The glucose level in the CSF should be 50 to 80 mg/100 mL (or greater than 2/3 of the blood sugar level). Note: Normal value ranges may vary slightly among different laboratories. Talk to your health care provider about the meaning of your specific test results. The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens. Abnormal results include higher and lower glucose levels. Abnormal results may be due to: - Infection (bacterial or fungus) - Inflammation of the central nervous system - Tumor Updated by: Daniel Kantor, MD, Kantor Neurology, Coconut Creek, FL and immediate past president of the Florida Society of Neurology (FSN). Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003633.htm"
+  ],
+  [
+    "Continuous Glucose Monitoring: Continuous glucose monitoring automatically tracks blood glucose levels, also called blood sugar, throughout the day and night. You can see your glucose level anytime at a glance. You can also review how your glucose changes over a few hours or days to see trends. Seeing glucose levels in real time can help you make more informed decisions throughout the day about how to balance your food, physical activity, and medicines. A CGM works through a tiny sensor inserted under your skin, usually on your belly or arm. The sensor measures your interstitial glucose level, which is the glucose found in the fluid between the cells. The sensor tests glucose every few minutes. A transmitter wirelessly sends the information to a monitor.The monitor may be part of an insulin pump or a separate device, which you might carry in a pocket or purse. Some CGMs send information directly to a smartphone or tablet. Several models are available and are listed in the American Diabetes Association\u2019s product guide.Photo courtesy: U.S. Food and Drug Administration A tiny CGM sensor under the skin checks glucose. A transmitter sends data to a receiver. The CGM receiver may be part of an insulin pump, as shown here, or a separate device.Special Features of a CGMCGMs are always on and recording glucose levels\u2014whether you\u2019re showering, working, exercising, or sleeping. Many CGMs have special features that work with information from your glucose readings:An alarm can sound when your glucose level goes too low or too high. You can note your meals, physical activity, and medicines in a CGM device, too, alongside your glucose levels. You can download data to a computer or smart device to more easily see your glucose trends.Some models can send information right away to a second person\u2019s smartphone\u2014perhaps a parent, partner, or caregiver. For example, if a child\u2019s glucose drops dangerously low overnight, the CGM could be set to wake a parent in the next room.Currently, one CGM model is approved for treatment decisions, the Dexcom G5 Mobile. That means you can make changes to your diabetes care plan based on CGM results alone. With other models, you must first confirm a CGM reading with a finger-stick blood glucose test before you take insulin or treat hypoglycemia.Special Requirements Needed to Use a CGMTwice a day, you may need to check the CGM itself. You\u2019ll test a drop of blood on a standard glucose meter. The glucose reading should be similar on both devices.You\u2019ll also need to replace the CGM sensor every 3 to 7 days, depending on the model.For safety it\u2019s important to take action when a CGM alarm sounds about high or low blood glucose. You should follow your treatment plan to bring your glucose into the target range, or get help.CGM glucose readings need to be checked against a standard glucose meter twice a day. Most people who use CGMs have type 1 diabetes. Research is underway to learn how CGMs might help people with type 2 diabetes.CGMs are approved for use by adults and children with a doctor\u2019s prescription. Some models may be used for children as young as age 2. Your doctor may recommend a CGM if you or your child:are on intensive insulin therapy, also called tight blood sugar control have hypoglycemia unawareness often have high or low blood glucoseYour doctor may suggest using a CGM system all the time or only for a few days to help adjust your diabetes care plan. Compared with a standard blood glucose meter, using a CGM system can help youbetter manage your glucose levels every day have fewer low blood glucose emergencies need fewer finger sticksA graphic on the CGM screen shows whether your glucose is rising or dropping\u2014and how quickly\u2014so you can choose the best way to reach your target glucose level.Over time, good management of glucose greatly helps people with diabetes stay healthy and prevent complications of the disease. People who gain the largest benefit from a CGM are those who use it every day or nearly every day. Researchers are working to make CGMs more accurate and easier to use. But you still need a finger-stick glucose test twice a day to check the accuracy of your CGM against a standard blood glucose meter.With most CGM models, you can\u2019t yet rely on the CGM alone to make treatment decisions. For example, before changing your insulin dose, you must first confirm a CGM reading by doing a finger-stick glucose test.A CGM system is more expensive than using a standard glucose meter. Check with your health insurance plan or Medicare to see whether the costs will be covered. A CGM is one part of the \u201cartificial pancreas\u201d systems that are beginning to reach people with diabetes.The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has played an important role in developing artificial pancreas technology. An artificial pancreas replaces manual blood glucose testing and the use of insulin shots. A single system monitors blood glucose levels around the clock and provides insulin or both insulin and a second hormone, glucagon, automatically. The system can also be monitored remotely, for example by parents or medical staff.In 2016, the U.S. Food and Drug Administration approved a type of artificial pancreas system called a hybrid closed-loop system. This system tests your glucose level every 5 minutes throughout the day and night through a CGM, and automatically gives you the right amount of basal insulin, a long-acting insulin, through a separate insulin pump. You will still need to test your blood with a glucose meter a few times a day. And you'll manually adjust the amount of insulin the pump delivers at mealtimes and when you need a correction dose.The hybrid closed-loop system may free you from some of the daily tasks needed to keep your blood glucose stable\u2014or help you sleep through the night without the need to wake and test your glucose or take medicine. Talk with your health care provider about whether this system might be right for you.The NIDDK has funded \u2013 and continues to fund \u2013 several important studies on different types of artificial pancreas devices to better help people with type 1 diabetes manage their disease. The devices may also help people with type 2 diabetes and gestational diabetes.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/continuous-glucose-monitoring"
+  ],
+  [
+    "Glucose screening tests during pregnancy: A glucose screening test is a routine test during pregnancy that checks a pregnant woman's blood glucose (sugar) level. Gestational diabetes is high blood sugar (diabetes) that starts or is found during pregnancy. TWO-STEP TESTING During the first step, you will have a glucose screening test: - You DO NOT need to prepare or change your diet in any way. - You will be asked to drink a liquid that contains glucose. - Your blood will be drawn 1 hour after you drink the glucose solution to check your blood glucose level. If your blood glucose from the first step is too high, you will need to come back for a 3-hour glucose tolerance test. For this test: - DO NOT eat or drink anything (other than sips of water) for 8 to 14 hours before your test. (You also cannot eat during the test.) - You will be asked to drink a liquid that contains glucose, 100 grams (g) . - You will have blood drawn before you drink the liquid, and again 3 more times every 60 minutes after you drink it. Each time, your blood glucose level will be checked. - Allow at least 3 hours for this test. ONE-STEP TESTING You need to go to the lab one time for a 2-hour glucose tolerance test. For this test: - DO NOT eat or drink anything (other than sips of water) for 8 to 14 hours before your test. (You also cannot eat during the test.) - You will be asked to drink a liquid that contains glucose (75 g). - You will have blood drawn before you drink the liquid, and again 2 more times every 60 minutes after you drink it. Each time, your blood glucose level will be checked. - Allow at least 2 hours for this test. For either the two-step test or one-step test, eat your normal food in the days before your test. Ask your health care provider if any of the medicines you take can affect your test results. Most women DO NOT have side effects from the glucose tolerance test. Drinking the glucose solution is similar to drinking a very sweet soda. Some women may feel nauseated, sweaty, or lightheaded after they drink the glucose solution. Serious side effects from this test are very uncommon. This test checks for gestational diabetes. Most pregnant women have a glucose screening test between 24 and 28 weeks of pregnancy. The test may be done earlier if you have a high glucose level in your urine during your routine prenatal visits, or if you have a high risk for diabetes. Women who have a low risk for diabetes may not have the screening test. To be low-risk, all of these statements must be true: - You have never had a test that showed your blood glucose was higher than normal. - Your ethnic group has a low risk for diabetes. - You DO NOT have any first-degree relatives (parent, sibling, or child) with diabetes. - You are younger than 25 years old and have a normal weight. - You have not had any bad outcomes during an earlier pregnancy. TWO-STEP TESTING Most of the time, a normal result for the glucose screening test is a blood sugar that is equal to or less than 140 mg/dL (7.8 mmol/L) 1 hour after drinking the glucose solution. A normal result means you DO NOT have gestational diabetes. Note: mg/dL means milligrams per deciliter and mmol/L means millimoles per liter. These are two ways to indicate how much glucose is in the blood. If your blood glucose is higher than 140 mg/dL (7.8 mmol/L), the next step is the oral glucose tolerance test. This test will show if you have gestational diabetes. Most women (about 2 out of 3) who take this test DO NOT have gestational diabetes. ONE-STEP TESTING If your glucose level is lower than the abnormal results described below, you do not have gestational diabetes. TWO-STEP TESTING Abnormal blood values for a 3-hour 100-gram oral glucose tolerance test are: - Fasting: greater than 95 mg/dL (5.3 mmol/L) - 1 hour: greater than 180 mg/dL (10.0 mmol/L) - 2 hour: greater than 155 mg/dL (8.6 mmol/L) - 3 hour: greater than 140 mg/dL (7.8 mmol/L) ONE-STEP TESTING Abnormal blood values for a 2-hour 75-gram oral glucose tolerance test are: - Fasting: greater than 92 mg/dL (5.1 mmol/L) - 1 hour: greater than 180 mg/dL (10.0 mmol/L) - 2 hour: greater than 153 mg/dL (8.5 mmol/L) If only\u00a0one of your blood glucose results in the oral glucose tolerance test is higher than normal, your provider may simply suggest you change some of the foods you eat. Then, your provider may test you again after you have changed your diet. If more than\u00a0one of your blood glucose results is higher than normal, you have gestational diabetes. You may have some of the symptoms listed above under the heading titled \"How the Test will Feel.\" Veins and arteries vary in size from one person to another, and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others. Other risks associated with having blood drawn are slight, but may include: - Excessive bleeding - Fainting or feeling lightheaded - Hematoma (blood accumulating under the skin) - Infection (a slight risk any time the skin is broken) Updated by: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Editorial update 9/30/2016.",
+    "https://medlineplus.gov/ency/article/007562.htm"
+  ],
+  [
+    "Glucose tolerance test - non-pregnant: The glucose tolerance test is a lab test to check how your body breaks down sugar. Tests to screen for diabetes during pregnancy are done differently. The most common glucose tolerance test is the oral glucose tolerance test (OGTT). Before the test begins, a sample of blood will be taken. You will then be asked to drink a liquid containing a certain amount of glucose (usually 75 grams). Your blood will be taken again every 30 to 60 minutes after you drink the solution. The test may take up to 3 hours. A similar test is the intravenous (IV) glucose tolerance test (IGTT). It is rarely used, and is never used to diagnose diabetes. In one version of the IGTT, glucose is injected into your vein for 3 minutes. Blood insulin levels are measured before the injection, and again at 1 and 3 minutes after the injection. The timing may vary. This IGTT is almost always used for research purposes only. Make sure you eat normally for several days before the test. DO NOT eat or drink anything for at least 8 hours before the test. You cannot eat during the test. Ask your health care provider if any of the medicines you take can affect the test results. Drinking the glucose solution is similar to drinking very sweet soda. Serious side effects from this test are very uncommon. With the blood test, some people feel nauseated, sweaty, lightheaded, or may even feel short of breath or faint after drinking the glucose. Tell your doctor if you have a history of these symptoms related to blood tests or medical procedures. When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or a slight bruise. This soon goes away. Glucose is the sugar the body uses for energy. People with untreated diabetes have high blood glucose levels. Most often, the first tests used to diagnose diabetes in people who are not pregnant are: - Fasting blood glucose level: diabetes is diagnosed if it is higher than 126 mg/dL (7 mmol/L) on 2 different tests - Hemoglobin A1c test: diabetes is diagnosed if the test result is 6.5% or higher Glucose tolerance tests are also used to diagnose diabetes. The OGTT is used to screen for, or diagnose diabetes in people with a fasting blood glucose level that is high, but is not high enough (above 125 mg/dL or 7 mmol/L) to meet the diagnosis for diabetes. Normal blood values for a 75 gram OGTT used to check for type 2 diabetes in those who are not pregnant: - Fasting: 60 to 100 mg/dL (3.3 to 5.5 mmol/L) - 1 hour: less than 200 mg/dL (11.1 mmol/L) - 2 hours: less than 140 mg/dL (7.8 mmol/L) The examples above are common measurements for results of these tests. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results. A glucose level that is higher than normal may mean you have pre-diabetes or diabetes: - A 2 hour value between 140 and 200 mg/dL (7.8 and 11.1 mmol/L) is called impaired glucose tolerance. Your doctor may call this \"pre-diabetes.\" It means you are at increased risk of developing diabetes over time. - A glucose level of 200 mg/dL (11.1 mmol/L) or higher is used to diagnose diabetes. Serious stress to the body, such as from trauma, stroke, heart attack, or surgery, can raise your blood glucose level. Vigorous exercise can lower your blood glucose level. Some medicines can raise or lower your blood glucose level. Before having the test, tell your provider about any medicines you are taking. You may have some of the symptoms listed above under the heading titled \"How the Test will Feel.\" Veins and arteries vary in size from one person to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others. Other risks associated with having blood drawn are slight, but may include: - Excessive bleeding - Fainting or feeling lightheaded - Hematoma (blood accumulating under the skin) - Infection (a slight risk any time the skin is broken) Updated by: Robert Hurd, MD, Professor of Endocrinology and Health Care Ethics, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003466.htm"
+  ],
+  [
+    "Continuous Glucose Monitoring (How does a continuous glucose monitor (CGM) work?): A CGM works through a tiny sensor inserted under your skin, usually on your belly or arm. The sensor measures your interstitial glucose level, which is the glucose found in the fluid between the cells. The sensor tests glucose every few minutes. A transmitter wirelessly sends the information to a monitor.The monitor may be part of an insulin pump or a separate device, which you might carry in a pocket or purse. Some CGMs send information directly to a smartphone or tablet. Several models are available and are listed in the American Diabetes Association\u2019s product guide.Photo courtesy: U.S. Food and Drug Administration A tiny CGM sensor under the skin checks glucose. A transmitter sends data to a receiver. The CGM receiver may be part of an insulin pump, as shown here, or a separate device.Special Features of a CGMCGMs are always on and recording glucose levels\u2014whether you\u2019re showering, working, exercising, or sleeping. Many CGMs have special features that work with information from your glucose readings:An alarm can sound when your glucose level goes too low or too high. You can note your meals, physical activity, and medicines in a CGM device, too, alongside your glucose levels. You can download data to a computer or smart device to more easily see your glucose trends.Some models can send information right away to a second person\u2019s smartphone\u2014perhaps a parent, partner, or caregiver. For example, if a child\u2019s glucose drops dangerously low overnight, the CGM could be set to wake a parent in the next room.Currently, one CGM model is approved for treatment decisions, the Dexcom G5 Mobile. That means you can make changes to your diabetes care plan based on CGM results alone. With other models, you must first confirm a CGM reading with a finger-stick blood glucose test before you take insulin or treat hypoglycemia.Special Requirements Needed to Use a CGMTwice a day, you may need to check the CGM itself. You\u2019ll test a drop of blood on a standard glucose meter. The glucose reading should be similar on both devices.You\u2019ll also need to replace the CGM sensor every 3 to 7 days, depending on the model.For safety it\u2019s important to take action when a CGM alarm sounds about high or low blood glucose. You should follow your treatment plan to bring your glucose into the target range, or get help.CGM glucose readings need to be checked against a standard glucose meter twice a day.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/continuous-glucose-monitoring"
+  ],
+  [
+    "Glucose-galactose malabsorption: Glucose-galactose malabsorption\u00a0(GGM) is a genetic condition in which the sugars glucose and galactose cannot be properly absorbed by the body. Infants with GGM develop severe\u00a0 diarrhea\u00a0resulting in life-threatening\u00a0 dehydration,\u00a0 acidosis, and weight loss in the first few weeks of life. GGM is caused by mutations in the\u00a0 SLC5A1\u00a0 gene and is inherited in an\u00a0 autosomal recessive \u00a0manner. This gene normally makes a special\u00a0 protein \u00a0which helps the two sugars cross through the\u00a0 cell \u00a0membranes of the epithelial cells lining the\u00a0 small intestine\u00a0and special tubes in the kidneys. When the protein is missing, the cells cannot take in the glucose and galactose needed by the body. [1]\u00a0 Diagnosis of glucose-galactose malabsorption (GGM) is made by the early onset of severe diarrhea, ruling out infections, and the improvement of symptoms when glucose and galactose are avoided. The diagnosis can be confirmed by genetic testing . Treatment involves a fructose based formula and a continued diet low in foods with glucose and galactose. Many children are able to tolerate more glucose and galactose as they near adulthood, although why this happens is not understood. [1] People with GGM (even during infancy and childhood) are at an increased risk of developing kidney stones\u00a0or more widespread deposits of calcium within the kidneys. [2] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Abdominal distention - Abnormal oral glucose tolerance - Autosomal recessive inheritance - Chronic diarrhea - Failure to thrive - Glycosuria - Hyperactive bowel sounds - Hypertonic dehydration - Metabolic acidosis -",
+    "https://rarediseases.info.nih.gov/diseases/6521/glucose-galactose-malabsorption"
+  ],
+  [
+    "Spinal and epidural anesthesia: Spinal and epidural anesthesia are medicines that numb parts of your body to block pain. They are given through shots in or around the spine. The doctor who gives you epidural or spinal anesthesia is called an anesthesiologist. First, the area of your back where the needle is inserted is cleaned with a special solution. The area may also be numbed with a local anesthetic. You'll likely receive fluids through an intravenous line (IV) in a vein. You may receive medicine through the IV to help you relax or sleep lightly. For an epidural: - The doctor injects medicine just outside of the sac of fluid around your spinal cord. This is called the epidural space. - The medicine numbs, or blocks feeling in a certain part of your body so that you cannot feel pain. The medicine begins to take effect in about 10 to 20 minutes. It works well for longer procedures. Women often have an epidural during childbirth. - A small tube (catheter) is often left in place. You can receive more medicine through the catheter to help control your pain during or after your procedure. For a spinal: - The doctor injects medicine into the fluid in your spinal cord. This is usually done only once, so you will not need to have a catheter placed. - The medicine begins to take effect right away. It works well for shorter and simpler procedures. Your pulse, blood pressure and oxygen level in your blood are checked during the procedure. After the procedure, you will have a bandage where the needle was inserted. Spinal and epidural anesthesia have fewer side effects and risks than general anesthesia (asleep and pain-free). People usually recover their senses much faster. Sometimes, they have to wait for the anesthetic to wear off so they can walk. Spinal anesthesia is often used for genital, urinary tract, or lower body procedures. Epidural anesthesia is often used during labor and delivery, and surgery in the pelvis and legs. Epidural and spinal anesthesia are often used when: - The procedure or labor is too painful without any pain medicine. - The procedure is in the belly, legs, or feet. - Your body can remain in a comfortable position during your procedure. - You want fewer systemic side effects and a shorter recovery than you would have from general anesthesia. Spinal and epidural anesthesia are generally safe. Ask your doctor about these possible complications: - Allergic reaction to the anesthesia used - Bleeding around the spinal column (hematoma) - Difficulty urinating - Drop in blood pressure - Infection in your spine (meningitis or abscess) - Nerve damage - Seizures (this is rare) - Severe headache Tell your health care provider: - If you are or could be pregnant - What medicines you are taking, including medicines, supplements, or herbs you bought without a prescription During the days before the procedure: - Tell your doctor about any allergies or health conditions you have, what medicines you are taking, and what anesthesia or sedation you have had before. - If your procedure is planned, you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other blood thinners. - Ask your doctor which medicines you should still take on the day of your procedure. - Arrange for a responsible adult to drive you to and from the hospital or clinic. - If you smoke, try to stop. Ask your provider for help quitting. On the day of the procedure: - Follow instructions on when to stop eating and drinking. - Do not drink alcohol the night before and the day of your procedure. - Take the medicines your doctor told you to take with a small sip of water. - Follow instructions on when to arrive at the hospital. Be sure to arrive on time. After an epidural, the catheter in your back is removed. You lie in bed until you have feeling in your legs and can walk. You may feel sick to your stomach and be dizzy. You may be tired. After spinal anesthesia, you lie flat in bed for a few hours. This is to keep you from getting a headache. You may feel sick to your stomach and be dizzy. You may be tired. Most people feel no pain during spinal and epidural anesthesia and recover fully. Updated by: Jennifer Sobol, DO, urologist with the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007413.htm"
+  ],
+  [
+    "Do you have information about Hip Replacement: Summary : Hip replacement is surgery for people with severe hip damage. The most common cause of damage is osteoarthritis. Osteoarthritis causes pain, swelling, and reduced motion in your joints. It can interfere with your daily activities. If other treatments such as physical therapy, pain medicines, and exercise haven't helped, hip replacement surgery might be an option for you. During a hip replacement operation, the surgeon removes damaged cartilage and bone from your hip joint and replaces them with new, man-made parts. A hip replacement can - Relieve pain - Help your hip joint work better - Improve walking and other movements The most common problem after surgery is hip dislocation. Because a man-made hip is smaller than the original joint, the ball can come out of its socket. The surgery can also cause blood clots and infections. With a hip replacement, you might need to avoid certain activities, such as jogging and high-impact sports. NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases",
+    "https://www.nlm.nih.gov/medlineplus/hipreplacement.html"
+  ],
+  [
+    "General anesthesia: General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery. After you receive these medicines, you will not be aware of what is happening around you. Most times, a doctor called an anesthesiologist will give you the anesthesia. Sometimes, a certified and registered nurse anesthetist will take care of you. The medicine is given into your vein. You may be asked to breathe in (inhale) a special gas through a mask. Once you are asleep, the doctor may insert a tube into your windpipe (trachea) to help you breathe and protect your lungs. You will be watched very closely while you are asleep. Your blood pressure, pulse, and breathing will be monitored. The health care provider taking care of you can change how deeply asleep you are during the surgery. You will not move, feel any pain, or have any memory of the procedure because of this medicine. General anesthesia is a safe way to stay asleep and pain-free during procedures that would: - Be too painful - Take a long time - Affect your ability to breathe - Make you uncomfortable - Cause too much anxiety You may also be able to have conscious sedation for your procedure. Sometimes, though, it is not enough to make you comfortable. Children may need general anesthesia for a medical or dental procedure to handle any pain or anxiety they may feel. General anesthesia is usually safe for healthy people. You may have a higher risk of problems with general anesthesia if you: - Abuse alcohol or medicines - Have allergies or a family history of being allergic to medicines - Have heart, lung, or kidney problems - Smoke Ask your doctor about these complications: - Death (rare) - Harm to your vocal cords - Heart attack - Lung infection - Mental confusion (temporary) - Stroke - Trauma to the teeth or tongue - Waking during anesthesia (rare) - Allergy to the drugs - Malignant hyperthermia (fast rise in body temperature and severe muscle contractions) Tell your provider: - If you could be pregnant - What medicines you are taking, even drugs or herbs you bought without a prescription During the days before the surgery: - An anesthesiologist will take a complete medical history to determine the type and amount of the anesthesia you need. This includes asking you about any allergies, health conditions, medicines, and history of anesthesia. - Several days to a week before surgery, you may be asked to stop taking blood thinning drugs, such as aspirin, ibuprofen (Advil, Motrin), and warfarin (Coumadin, Jantoven). - Ask your provider which drugs you should still take on the day of your surgery. - Always try to stop smoking. Your doctor can help. On the day of your surgery: - You will likely be asked not to drink or eat anything after midnight the night before the surgery. This is to prevent you from vomiting while you are under the effect of the anesthesia. Vomiting can cause food in the stomach to be inhaled into the lungs. This can lead to breathing problems. - Take the drugs that your provider told you to take with a small sip of water. - Arrive at the hospital on time. You will wake up tired and groggy in the recovery or operating room. You may also feel sick to your stomach, and have a dry mouth, sore throat, or feel cold or restless until the effect of the anesthesia wears off. Your nurse will monitor these side effects, which will wear off, but it may take a few hours. Sometimes, nausea and vomiting can be treated with other medicines. Follow your surgeon's instructions while you recover and care for your surgical wound. General anesthesia is generally safe because of modern equipment, medicines, and safety standards. Most people recover completely and do not have any complications. Updated by: Mary C. Mancini, MD, PhD, Department of Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007410.htm"
+  ],
+  [
+    "Anesthesia - what to ask your doctor - child: Your child is scheduled to have a surgery or procedure. You will need to talk with your child's doctor about the type of anesthesia that will be best for your child. Below are some questions you may want to ask. BEFORE ANESTHESIA Which type of anesthesia is best for my child and the procedure that my child is having? - General anesthesia - Spinal or epidural anesthesia - Conscious sedation When does my child need to stop eating or drinking before the anesthesia? What if my child is breastfeeding? When do my child and I need to get to the hospital on the day of the surgery? Is the rest of our family allowed to be there too? If my child is taking the following medicines, what should I do? - Aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve), other arthritis drugs, vitamin E, warfarin (Coumadin), and any other drugs that make it hard for the child's blood to clot - Vitamins, minerals, herbs, or other supplements - Medicines for heart problems, lung problems, diabetes, allergies, or seizures - Other medicines the child is supposed to take everyday If my child has asthma, diabetes, seizures, heart disease, or any other medical problems, do I need to do anything special before my child has anesthesia? Can my child take a tour of the surgery and recovery areas of the hospital before the surgery? DURING ANESTHESIA - Will my child be awake or aware of what is happening? - Will my child feel any pain? - Will someone be watching to make sure my child is ok? - How long may I stay with my child? AFTER ANESTHESIA - How soon will my child wake up? - When can I see my child? - How soon before my child can get up and move around? - How long will my child need to stay? - Will my child have any pain? - Will my child have an upset stomach? - If my child had spinal or epidural anesthesia, will my child have a headache afterwards? - What if I have more questions after the surgery? Who can I contact? Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000184.htm"
+  ],
+  [
+    "Fragile X-Associated Tremor and Ataxia Syndrome (FXTAS): Fragile X-associated tremor and ataxia syndrome (FXTAS) is a late-onset condition (occurs in people older than age 50) that develops in some men and women with an altered form of the fragile X gene. Those with FXTAS do not have the intellectual or developmental disabilities common in fragile X syndrome. NICHD-supported researchers were the first to identify FXTAS and link it to changes in the FMR1 gene, which causes fragile X syndrome. The Institute is one of several federal agencies working to understand FXTAS and other conditions caused by changes in the FMR1 gene.\u00a0 What is Fragile X-Associated Tremor and Ataxia Syndrome (FXTAS)? FXTAS is a condition that develops in some men and women who have an altered form of a specific gene. People with FXTAS have a change or mutation in a gene called the Fragile X Mental Retardation 1 (FMR1) gene. This gene is found on the X chromosome. To learn more, visit the How is a change in a gene related to FXTAS? section. FXTAS occurs later in life (in people older than age 50) and is characterized by tremors when making purposeful movements, balance problems, Parkinson's-like symptoms such as muscle stiffness or rigidity, and memory loss. Most people have no symptoms until the onset of the condition later in life. How is a change in a gene related to FXTAS? \u00bb People with FXTAS have a change or mutation in the FMR1 gene found on the X chromosome. In the gene, the information for making a protein has two parts: the introduction, and the instructions for making the protein itself. Researchers call the introduction the promoter because of how it helps to start the process of building the protein. The promoter part of the FMR1 gene includes many repeats\u2014repeated instances of a specific DNA sequence called the CGG sequence. A normal FMR1 gene has between 6 and 40 repeats in the promoter; the average is 30 repeats. People with between 55 and 200 repeats have a premutation of the gene. The premutation causes the gene to not work properly, but it does not cause intellectual and developmental disability (IDD). FXTAS occurs in some people who have the premutation. The premutation is also related to fragile X-associated primary ovarian insufficiency (FXPOI). People with 200 or more repeats in the promoter part of the gene have a full mutation, meaning the gene might not work at all. People with a full mutation often have fragile X syndrome, the most common inherited form of IDD. Individuals with the full mutation are not at risk for FXTAS. Inheriting FXTAS Anyone with the FMR1 gene mutation can pass it to their children. However, a person who inherits the gene may not develop FXTAS. Males will pass it down to all of their daughters and not their sons. Females have a 50/50 chance to pass it along to both their sons and daughters. In addition, parents can have children with a condition associated with fragile X even if the parents do not have that condition themselves. Read more about how FMR1 changes as it is passed from parent to child. \u00ab Condition Information What causes it? \u00bb Because FXTAS occurs only in those who have the premutation on the FMR1 gene, the premutation is related to the condition. If the premutation was the only cause of FXTAS, then everyone with the premutation would develop FXTAS after age 50. However, it is still not clear why some people with the premutation develop FXTAS while others do not. This topic is an active area of study. \u00ab How is a change in a gene related to FXTAS? What are common symptoms? \u00bb Although FXTAS affects individuals differently, the symptoms of the disorder are similar to those of Parkinson's or Alzheimer's disease, including memory loss, slowed speech, tremors, and a shuffling gait. Some people will have many symptoms that appear quickly and get worse over time. Others have only a few mild symptoms. Men have slightly different symptoms of FXTAS than women do. Symptoms of FXTAS in men include: - Balance problems, called ataxia (pronounced uh-TAK-see-uh) - Intention tremor (shaking when trying to perform purposeful movements, such as touching one's nose or grabbing something) - Parkinson's-like symptoms, such as muscle stiffness or rigidity, a shuffling gait or walk, and slowed speech - Memory loss, including forgetting how to do things that were once done easily (such as balancing a checkbook), getting lost going to familiar places, or forgetting the names of everyday objects - Irritability and moodiness - Low blood pressure - Numbness or burning in the hands and feet - Incontinence - Impotence - Loss of reading skills and math skills - Difficulty learning new things Women with FXTAS may have the following symptoms: - High blood pressure - Balance problems, called ataxia - Premature ovarian failure, in about 20% of women - Intention tremors - Seizure disorders - Thyroid problems (usually an underactive thyroid gland, called hypothyroidism) in about 50% of women - Muscle pain such as fibromyalgia, in about 40% of women Symptoms of FXTAS usually develop after age 50. The average age of people newly diagnosed with FXTAS is about 61. \u00ab What causes it? How many people are affected/at risk? \u00bb \u200b\u200b The exact number of people with a premutation is unknown. Research shows that about 1 in 151 females and 1 in 468 males may have an FMR1 gene premutation, which puts them at risk for FXTAS. But not everyone with a premutation will show symptoms. FXTAS is less common among women, and their symptoms are generally milder. In people with a premutation, 30% to 40% of men older than 50 and 8% of women older than age 50 will develop FXTAS. \u00ab What are common symptoms? How is it diagnosed? \u00bb \u200b\u200b Health care providers can order a blood test to determine if a person who has symptoms of FXTAS is a carrier. A laboratory will conduct the tests to determine what form of the FMR1 gene is present. (Read a detailed explanation of the genetics of the FMR1 gene in the section How are genes altered in fragile X-associated disorders?) However, FXTAS is often misdiagnosed. The condition was identified only recently\u2015in 2001\u2014so it is not as familiar to health care providers as other common disorders in seniors, such as Alzheimer's disease and Parkinson's disease. The similarity of symptoms can lead some health care providers to pursue those conditions before considering FXTAS. Many of the FXTAS symptoms, such as memory problems and balance problems, may also be seen as natural parts of aging. A health care provider may use a combination of a blood test, symptoms, and information from brain imaging, such as magnetic resonance imaging (MRI), to confirm a FXTAS diagnosis. In about 60% of men and 13% of women with FXTAS, the MRI will show white matter lesions (areas of dead cells) in the middle cerebellar peduncle of the brain. This is called the MCP sign. \u00ab How many people are affected/at risk? What are the treatments? \u00bb \u200b\u200b Certain medications and therapies are helpful for treating symptoms of FXTAS and may help slow its progression. However, no treatment can stop FXTAS from progressing and none is considered a cure. Symptoms of FXTAS differ from person to person, and treatment should address a person's individual needs. Health care providers may work as a team to provide appropriate treatment, such as physical therapy for difficulty with movement and balance, medication for tremors, and psychological counseling and support services for the individual and family. Other therapies may include rehabilitative treatments such as speech and occupational therapy and gait training. A urologist may be consulted regarding sexual health. In addition, the children of FXTAS patients may want to confirm their FMR1 gene status and to discuss their situation with a genetic counselor. In many cases, medications have been used to treat symptoms associated with FXTAS, as shown in the table below. Please note that the NICHD does not endorse or support the use of any of these medications in treating symptoms of FXTAS, or for other conditions for which the medications are not approved by the U.S. Food and Drug Administration. Symptoms Medications Shaking (tremor) - Beta blockers - Primidone - Topiramate Problems with thinking and memory Most medications for FXTAS-associated cognitive problems and dementia are off-label uses of therapies used for Alzheimer's disease. Psychiatric symptoms such as anxiety, irritability, agitation, hostility, obsessive-compulsiveness, apathy, and depression - Selective serotonin reuptake inhibitors (SSRIs) Other medications for urinary urgency, bowel incontinence, difficulty swallowing, dizzy spells, high blood pressure, pain, and thyroid dysfunction may also be used. \u00ab How is it diagnosed? Other FAQs \u00bb \u200b\u200b Are there disorders or conditions associated with FXTAS? Some medical conditions are reported to be associated with the FMR1 premutation, but only in men. These include: - Abnormal heart rhythm (arrhythmia) - Balance disorders - Congestive heart failure - High blood sugar - Sleep apnea - Mood disorders, including major depressive disorder, anxiety disorder, and post-traumatic stress disorder High blood pressure is also associated with FXTAS in both men and women, but it seems to be more common among women with the FMR1 premutation. How can the FMR1 gene change when passed from parent to child? Premutation genes\u2014the kind associated with FXTAS and characterized by 55 to 199 extra CGG sequences in the FMR1 gene\u2014can grow spontaneously from generation to generation. That is, the gene's CGG sequences can increase in number on their own. They can even expand to the level of full mutation (200 or more CGG sequences), making fragile X syndrome more likely. The FMR1 premutation form is more likely to expand depending on the number of CGG repeats it has. The greater the number, the greater the risk of expansion. Risk also increases with each passing generation. Read more about how FMR1 changes as it is passed from parent to child. Why is FXTAS often misdiagnosed? Before NICHD-supported researchers discovered FXTAS in 2001, it was often misdiagnosed. The symptoms of FXTAS\u2014memory loss, tremors, muscle stiffness or rigidity, a shuffling gait or walk, and slowed speech\u2014are similar to Alzheimer's disease and Parkinson's disease symptoms. A characteristic of FXTAS is also ataxia, which means clumsiness of movement or loss of coordination that is not due to muscle weakness. Ataxia is most often caused by loss of function in the cerebellum, the part of the brain that controls the body's coordination. It can also be caused by problems with the motor sensory pathways leading in and out of the cerebellum. Although symptoms of FXTAS are similar to those of other conditions, its diagnosis is unique due to the white matter lesions (areas of dead cells) in the cerebellum. \u00ab What are the treatments?",
+    "https://www.nichd.nih.gov/health/topics/fxtas"
+  ],
+  [
+    "Corneal hypesthesia, familial: The following summary is from Orphanet, a European reference portal for information on rare diseases and orphan drugs. Orpha Number: 231013 Disease definition Congenital trigeminal anesthesia is a rare neuro-ophtalmological disorder characterized by a congenital sensory deficit involving all or some of the sensory components of the trigeminal nerve. Due to corneal anesthesia, it usually presents with recurrent, painless eye infections, painless corneal opacities and/or poorly healing, ulcerated wounds on the facial skin and mucosa (typically the buccal mucosa and/or nasal septum). Visit the Orphanet disease page for more resources. The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Abnormality of the skeletal system - Autosomal dominant inheritance - Decreased corneal sensation - Recurrent corneal erosions -",
+    "https://rarediseases.info.nih.gov/diseases/10034/corneal-hypesthesia-familial"
+  ],
+  [
+    "Fragile X-Associated Tremor and Ataxia Syndrome (FXTAS) (How is a change in a gene related to FXTAS?): People with FXTAS have a change or mutation in the FMR1 gene found on the X chromosome. In the gene, the information for making a protein has two parts: the introduction, and the instructions for making the protein itself. Researchers call the introduction the promoter because of how it helps to start the process of building the protein. The promoter part of the FMR1 gene includes many repeats\u2014repeated instances of a specific DNA sequence called the CGG sequence. A normal FMR1 gene has between 6 and 40 repeats in the promoter; the average is 30 repeats. People with between 55 and 200 repeats have a premutation of the gene. The premutation causes the gene to not work properly, but it does not cause intellectual and developmental disability (IDD). FXTAS occurs in some people who have the premutation. The premutation is also related to fragile X-associated primary ovarian insufficiency (FXPOI). People with 200 or more repeats in the promoter part of the gene have a full mutation, meaning the gene might not work at all. People with a full mutation often have fragile X syndrome, the most common inherited form of IDD. Individuals with the full mutation are not at risk for FXTAS. Inheriting FXTAS Anyone with the FMR1 gene mutation can pass it to their children. However, a person who inherits the gene may not develop FXTAS. Males will pass it down to all of their daughters and not their sons. Females have a 50/50 chance to pass it along to both their sons and daughters. In addition, parents can have children with a condition associated with fragile X even if the parents do not have that condition themselves. Read more about how FMR1 changes as it is passed from parent to child. \u00ab Condition Information What causes it? \u00bb",
+    "https://www.nichd.nih.gov/health/topics/fxtas"
+  ],
+  [
+    "Spinal and epidural anesthesia (Risks): Spinal and epidural anesthesia are generally safe. Ask your doctor about these possible complications: - Allergic reaction to the anesthesia used - Bleeding around the spinal column (hematoma) - Difficulty urinating - Drop in blood pressure - Infection in your spine (meningitis or abscess) - Nerve damage - Seizures (this is rare) - Severe headache",
+    "https://medlineplus.gov/ency/article/007413.htm"
+  ],
+  [
+    "Spinal and epidural anesthesia (Why the Procedure is Performed): Spinal and epidural anesthesia have fewer side effects and risks than general anesthesia (asleep and pain-free). People usually recover their senses much faster. Sometimes, they have to wait for the anesthetic to wear off so they can walk. Spinal anesthesia is often used for genital, urinary tract, or lower body procedures. Epidural anesthesia is often used during labor and delivery, and surgery in the pelvis and legs. Epidural and spinal anesthesia are often used when: - The procedure or labor is too painful without any pain medicine. - The procedure is in the belly, legs, or feet. - Your body can remain in a comfortable position during your procedure. - You want fewer systemic side effects and a shorter recovery than you would have from general anesthesia.",
+    "https://medlineplus.gov/ency/article/007413.htm"
+  ],
+  [
+    "General anesthesia (Before the Procedure): Tell your provider: - If you could be pregnant - What medicines you are taking, even drugs or herbs you bought without a prescription During the days before the surgery: - An anesthesiologist will take a complete medical history to determine the type and amount of the anesthesia you need. This includes asking you about any allergies, health conditions, medicines, and history of anesthesia. - Several days to a week before surgery, you may be asked to stop taking blood thinning drugs, such as aspirin, ibuprofen (Advil, Motrin), and warfarin (Coumadin, Jantoven). - Ask your provider which drugs you should still take on the day of your surgery. - Always try to stop smoking. Your doctor can help. On the day of your surgery: - You will likely be asked not to drink or eat anything after midnight the night before the surgery. This is to prevent you from vomiting while you are under the effect of the anesthesia. Vomiting can cause food in the stomach to be inhaled into the lungs. This can lead to breathing problems. - Take the drugs that your provider told you to take with a small sip of water. - Arrive at the hospital on time.",
+    "https://medlineplus.gov/ency/article/007410.htm"
+  ],
+  [
+    "Blood Clots (Summary): Summary Normally, if you get hurt, your body forms a blood clot to stop the bleeding. After the bleeding stops and healing takes place, your body usually breaks down and removes the clot. But some people get too many clots or their blood clots abnormally. Many conditions can cause the blood to clot too much or prevent blood clots from dissolving properly. Risk factors for excessive blood clotting include - Certain genetic disorders - Atherosclerosis - Diabetes - Atrial fibrillation - Overweight, obesity, and metabolic syndrome - Some medicines - Smoking - Staying in one position for a long time, such as being in the hospital or taking a long car or plane ride - Cancer and cancer treatments Blood clots can form in, or travel to, the blood vessels in the brain, heart, kidneys, lungs, and limbs. A clot in the veins deep in the limbs is called deep vein thrombosis (DVT). DVT usually affects the deep veins of the legs. If a blood clot in a deep vein breaks off and travels through the bloodstream to the lungs and blocks blood flow, it is called a pulmonary embolism. Other complications of blood clots include stroke, heart attack, kidney problems, kidney failure, and pregnancy-related problems. Treatments for blood clots include blood thinners and other medicines.",
+    "#"
+  ],
+  [
+    "Do I need to see a doctor for Controlling your high blood pressure?: Call your doctor if your blood pressure goes well above your normal range. Also call your doctor if you have any of the following symptoms: - Severe headache - Irregular heartbeat or pulse - Chest pain - Sweating - Nausea or vomiting - Shortness of breath - Dizziness or lightheadedness - Pain or tingling in the neck, jaw, shoulder, or arms - Numbness or weakness in your body - Fainting - Trouble seeing - Confusion - Difficulty speaking - Other side effects that you think might be from your medicine or your blood pressure",
+    "https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000101.htm"
+  ],
+  [
+    "Pulmonary Embolism (Summary): Summary A pulmonary embolism is a sudden blockage in a lung artery. The cause is usually a blood clot in the leg called a deep vein thrombosis that breaks loose and travels through the bloodstream to the lung. Pulmonary embolism is a serious condition that can cause - Permanent damage to the affected lung - Low oxygen levels in your blood - Damage to other organs in your body from not getting enough oxygen If a clot is large, or if there are many clots, pulmonary embolism can cause death. Half the people who have pulmonary embolism have no symptoms. If you do have symptoms, they can include shortness of breath, chest pain or coughing up blood. Symptoms of a blood clot include warmth, swelling, pain, tenderness and redness of the leg. The goal of treatment is to break up clots and help keep other clots from forming. NIH: National Heart, Lung, and Blood Institute",
+    "#"
+  ],
+  [
+    "Lupus anticoagulants and antiphospholipid antibodies (Treatment): LUPUS ANTICOAGULANT OR APL Often, you will not need treatment if you do not have symptoms or if you have never had a blood clot in the past. Take the following steps to help prevent blood clots from forming: - Avoid most birth control pills or hormone treatments for menopause (women). - DO NOT smoke or use other tobacco products. - Get up and move around during long plane flights or other times when you have to sit or lie down for extended periods. - Move your ankles up and down when you cannot move around. You will be prescribed blood-thinning medicines (such as heparin and warfarin) to help prevent blood clots: - After surgery - After a bone fracture - With active cancer - When you need to set or lie down for long periods of time, such as during a hospital stay or recovering at home You may also need to take blood thinners for 3 to 4 weeks after surgery to lower your risk of blood clots. ANTIPHOSPHOLIPID ANTIBODY SYNDROME (APS) In general, you will need long-term treatment with a blood thinner for a long time if you have the APS. Initial treatment may be heparin, either unfractionated or low-molecular heparin. These medicines are given by injection. In most cases, warfarin (Coumadin), which is given by mouth, is then started. It is necessary to monitor the level of anticoagulation frequently. This is most often done using the INR test. If you have APS and become pregnant, you will need to be followed closely by a provider expert in this condition. You will not take warfarin during pregnancy, but will be given low-molecular weight heparin instead. If you have SLE and APS your provider will also recommend that you take hydroxychloroquine.",
+    "https://medlineplus.gov/ency/article/000547.htm"
+  ],
+  [
+    "Lupus anticoagulants and antiphospholipid antibodies: Lupus anticoagulants are antibodies against substances in the lining of cells. These substances prevent blood clotting in a test tube. They are called phospholipids. People with antibodies to phospholipids (aPL) may have a very high risk of forming blood clots. In spite of the name anticoagulant, there is no increased risk of bleeding. Most often, lupus anticoagulants and aPL are found in people with diseases such as systemic lupus erythematosus (SLE). Lupus anticoagulants and aPL may also occur if: - You take medicines such as phenothiazines, phenytoin, hydralazine, quinine, or the antibiotic amoxicillin. - You have a condition such as inflammatory bowel disease (Crohn disease and ulcerative colitis), infections, or certain kinds of tumors. Some people have no risk factors for this condition. You may not have any symptoms even though you have the antibodies. Symptoms that may occur include: - Blood clots in the legs, arms or the lungs - Stroke or heart attack - Recurrent miscarriages Lupus anticoagulant tests may be done. These are blood clotting tests. The antiphospholipid antibodies (aPL) cause the tests to be abnormal in the laboratory. Types of clotting tests may include: - Activated partial thromboplastin time (aPTT) - Russell viper venom time - Thromboplastin inhibition test Tests for antiphospholipid antibodies (aPL) may include: - Anticardiolipin antibody tests - Antibodies to beta-2-glypoprotein I (Beta2-GPI) Your health care provider may check for antiphospholipid antibody syndrome (APS) if: - A blood clot is found. - Repeated miscarriages occur. - You have positive tests for aPL or the lupus anticoagulant. The positive tests need to be confirmed after 12 weeks. If you have a positive test without other indications of the disease, you will not have the diagnosis of APS. LUPUS ANTICOAGULANT OR APL Often, you will not need treatment if you do not have symptoms or if you have never had a blood clot in the past. Take the following steps to help prevent blood clots from forming: - Avoid most birth control pills or hormone treatments for menopause (women). - DO NOT smoke or use other tobacco products. - Get up and move around during long plane flights or other times when you have to sit or lie down for extended periods. - Move your ankles up and down when you cannot move around. You will be prescribed blood-thinning medicines (such as heparin and warfarin) to help prevent blood clots: - After surgery - After a bone fracture - With active cancer - When you need to set or lie down for long periods of time, such as during a hospital stay or recovering at home You may also need to take blood thinners for 3 to 4 weeks after surgery to lower your risk of blood clots. ANTIPHOSPHOLIPID ANTIBODY SYNDROME (APS) In general, you will need long-term treatment with a blood thinner for a long time if you have the APS. Initial treatment may be heparin, either unfractionated or low-molecular heparin. These medicines are given by injection. In most cases, warfarin (Coumadin), which is given by mouth, is then started. It is necessary to monitor the level of anticoagulation frequently. This is most often done using the INR test. If you have APS and become pregnant, you will need to be followed closely by a provider expert in this condition. You will not take warfarin during pregnancy, but will be given low-molecular weight heparin instead. If you have SLE and APS your provider will also recommend that you take hydroxychloroquine. Most of the time, outcome is good with proper treatment. Some people may have blood clots that are hard to control with treatments. Symptoms may recur. Call your provider if you notice symptoms of a blood clot, such as: - Swelling or redness in the leg - Shortness of breath - Pain, numbness, and pale skin color in an arm or leg Also talk to your provider if you have repeated loss of pregnancy (miscarriage). Updated by: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000547.htm"
+  ],
+  [
+    "Lupus anticoagulants and antiphospholipid antibodies (Outlook (Prognosis)): Most of the time, outcome is good with proper treatment. Some people may have blood clots that are hard to control with treatments. Symptoms may recur.",
+    "https://medlineplus.gov/ency/article/000547.htm"
+  ],
+  [
+    "Medicines and medication management (What Are Medicines? What Are Drugs?): Medicines, often referred to as drugs, can be:- Prescriptions. What you can get only with a doctor's order (for example, pills to lower your cholesterol or an asthma inhaler) - Over-the-counter pills, liquids, or creams. What you buy without a prescription (for example, pills for headaches or chew tablets for heartburn) - Vitamins, eye drops, or dietary supplements.Make sure your doctor knows about ALL the medicines you take. This includes those prescribed by other doctors, as well as vitamins, supplements, herbal remedies, and over-the-counter drugs you use every now and then.",
+    "https://www.nia.nih.gov/health/topics/medicines-and-medication-management"
+  ],
+  [
+    "Who should get Penicillin G Procaine Injection and why is it prescribed?: Penicillin G procaine injection is used to treat certain infections caused by bacteria. Penicillin G procaine injection should not be used to treat gonorrhea (a sexually transmitted disease) or early in the treatment of certain serious infections. Penicillin G procaine injection is in a class of medications called penicillins. It works by killing bacteria that cause infections. Antibiotics such as penicillin G procaine injection will not work for colds, flu, or other viral infections. Taking antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/meds/a615052.html"
+  ],
+  [
+    "Gastric bypass surgery - discharge (Drugs): You may need to take some medicines when you go home. - You may need to give yourself shots underneath the skin of a blood-thinning drug for 2 or more weeks. Your provider will show you how. - You may need to take medicine to prevent gallstones. - You will need to take certain vitamins that your body may not absorb well from your food. Two of these are vitamin B-12 and vitamin D. - You may need to take calcium and iron supplements as well. Aspirin, ibuprofen (Advil, Motrin), and some other drugs may harm the lining of your stomach or even cause ulcers. Talk with your provider before you take these drugs.",
+    "https://medlineplus.gov/ency/patientinstructions/000172.htm"
+  ],
+  [
+    "Bad breath: Bad breath, also called halitosis, can be embarrassing and in some cases may even cause anxiety. It's no wonder that store shelves are overflowing with gum, mints, mouthwashes and other products designed to fight bad breath. But many of these products are only temporary measures because they don't address the cause of the problem. Certain foods, health conditions and habits are among the causes of bad breath. In many cases, you can improve bad breath with consistent proper dental hygiene. If simple self-care techniques don't solve the problem, see your dentist or physician to be sure a more serious condition isn't causing your bad breath. Bad breath odors vary, depending on the source or the underlying cause. Some people worry too much about their breath even though they have little or no mouth odor, while others have bad breath and don't know it. Because it's difficult to assess how your own breath smells, ask a close friend or relative to confirm your bad-breath questions. When to see a doctor If you have bad breath, review your oral hygiene habits. Try making lifestyle changes, such as brushing your teeth and tongue after eating, using dental floss, and drinking plenty of water. If your bad breath persists after making such changes, see your dentist. If your dentist suspects a more serious condition is causing your bad breath, he or she may refer you to a physician to find the cause of the odor. Your dentist will likely smell both the breath from your mouth and the breath from your nose and rate the odor on a scale. Because the back of the tongue is most often the source of the smell, your dentist may also scrape it and rate its odor. There are sophisticated detectors that can identify the chemicals responsible for bad breath, though these aren't always available. To reduce bad breath, help avoid cavities and lower your risk of gum disease, consistently practice good oral hygiene. Further treatment for bad breath can vary, depending on the cause. If your bad breath is thought to be caused by an underlying health condition, your dentist will likely refer you to your primary care provider. For causes related to oral health, your dentist will work with you to help you better control that condition. Dental measures may include: - Mouth rinses and toothpastes. If your bad breath is due to a buildup of bacteria (plaque) on your teeth, your dentist may recommend a mouth rinse that kills the bacteria. Your dentist may also recommend a toothpaste that contains an antibacterial agent to kill the bacteria that cause plaque buildup. - Treatment of dental disease. If you have gum disease, you may be referred to a gum specialist (periodontist). Gum disease can cause gums to pull away from your teeth, leaving deep pockets that fill with odor-causing bacteria. Sometimes only professional cleaning removes these bacteria. Your dentist might also recommend replacing faulty tooth restorations, a breeding ground for bacteria. To reduce or prevent bad breath: - Brush your teeth after you eat. Keep a toothbrush at work to use after eating. Brush using a fluoride-containing toothpaste at least twice a day, especially after meals. Toothpaste with antibacterial properties has been shown to reduce bad breath odors. - Floss at least once a day. Proper flossing removes food particles and plaque from between your teeth, helping to control bad breath. - Brush your tongue. Your tongue harbors bacteria, so carefully brushing it may reduce odors. People who have a coated tongue from a significant overgrowth of bacteria (from smoking or dry mouth, for example) may benefit from using a tongue scraper. Or use a toothbrush that has a built-in tongue cleaner. - Clean dentures or dental appliances. If you wear a bridge or a denture, clean it thoroughly at least once a day or as directed by your dentist. If you have a dental retainer or mouth guard, clean it each time before you put it in your mouth. Your dentist can recommend the best cleaning product. - Avoid dry mouth. To keep your mouth moist, avoid tobacco and drink plenty of water - not coffee, soft drinks or alcohol, which can lead to a drier mouth. Chew gum or suck on candy (preferably sugarless) to stimulate saliva. For chronic dry mouth, your dentist or physician may prescribe an artificial saliva preparation or an oral medication that stimulates the flow of saliva. - Adjust your diet. Avoid foods such as onions and garlic that can cause bad breath. Eating a lot of sugary foods is also linked with bad breath. - Regularly get a new toothbrush. Change your toothbrush when it becomes frayed, about every three to four months, and choose a soft-bristled toothbrush. - Schedule regular dental checkups. See your dentist on a regular basis - generally twice a year - to have your teeth or dentures examined and cleaned.",
+    "https://www.mayoclinic.org/diseases-conditions/bad-breath/symptoms-causes/syc-20350922"
+  ],
+  [
+    "Bad breath (Lifestyle and home remedies): To reduce or prevent bad breath: - Brush your teeth after you eat. Keep a toothbrush at work to use after eating. Brush using a fluoride-containing toothpaste at least twice a day, especially after meals. Toothpaste with antibacterial properties has been shown to reduce bad breath odors. - Floss at least once a day. Proper flossing removes food particles and plaque from between your teeth, helping to control bad breath. - Brush your tongue. Your tongue harbors bacteria, so carefully brushing it may reduce odors. People who have a coated tongue from a significant overgrowth of bacteria (from smoking or dry mouth, for example) may benefit from using a tongue scraper. Or use a toothbrush that has a built-in tongue cleaner. - Clean dentures or dental appliances. If you wear a bridge or a denture, clean it thoroughly at least once a day or as directed by your dentist. If you have a dental retainer or mouth guard, clean it each time before you put it in your mouth. Your dentist can recommend the best cleaning product. - Avoid dry mouth. To keep your mouth moist, avoid tobacco and drink plenty of water - not coffee, soft drinks or alcohol, which can lead to a drier mouth. Chew gum or suck on candy (preferably sugarless) to stimulate saliva. For chronic dry mouth, your dentist or physician may prescribe an artificial saliva preparation or an oral medication that stimulates the flow of saliva. - Adjust your diet. Avoid foods such as onions and garlic that can cause bad breath. Eating a lot of sugary foods is also linked with bad breath. - Regularly get a new toothbrush. Change your toothbrush when it becomes frayed, about every three to four months, and choose a soft-bristled toothbrush. - Schedule regular dental checkups. See your dentist on a regular basis - generally twice a year - to have your teeth or dentures examined and cleaned.",
+    "https://www.mayoclinic.org/diseases-conditions/bad-breath/symptoms-causes/syc-20350922"
+  ],
+  [
+    "Pharmacology (How are drugs approved?): The U.S. Food and Drug Administration (FDA) is the federal agency responsible for labeling medications and supplements. However, the approval process is different for prescription and for over-the-counter medications. Prescription Drugs The FDA must regulate and approve new prescription drugs before they can be sold to the public. In 2011, the last year for which information is available, the FDA approved 35 new drugs for use by the general public. Although this number may seem small, the approval process for drugs is extensive. The manufacturer or sponsor follows a series of important steps, through animal studies and clinical trials in humans, to ensure that the medication is safe, does what it claims to do, and will provide a health benefit. Testing is performed first in laboratories and on animals to determine that the drug is safe and try to understand how the drug might work in humans. \"Clinical trial\" is the scientific term for a test or study of a drug or medical device in people. These tests are done to see if the product is safe and effective for people to use. Sometimes, multiple trials are completed to measure the effectiveness of a particular medication. Participants in the studies are often followed over a period of time. For comparison purposes, some are given a placebo, an inactive or \"dummy\" medication, while others are given the actual drug. The NICHD and other institutes of the NIH help conduct and support the research but are not involved in the approval or labeling process. The clinical trial phase can take years to complete. However, once research has shown that the drug is safe and useful, the FDA typically reviews and either approves or denies an application for a new drug within 6 months. View a PDF of the FDA drug approval process. (PDF - 2.79 MB) Over-the-Counter Drugs, Dietary and Herbal Supplements Over-the-counter drugs and dietary and herbal supplements are not formally approved through the FDA. The active ingredients and labeling of medications and supplements in certain classes (like antacids, for example) are reviewed by the FDA to ensure that acceptable ingredients are used and that they are safe. Drug companies must conform to the requirements in the medication or supplement class, but they do not need formal FDA approval to make and sell over-the-counter medications and supplements. The label will indicate whether a drug or supplement has been FDA approved. Talk to your health care provider about any medications you are currently taking or are considering taking to ensure that they are safe. Generic Drugs A generic drug is a medicine that is contains the same active pharmaceutical ingredient as a name-brand drug but is not sold under a brand name. FDA-approved generic drugs meet the same strict standards for safety, efficacy, and quality as name-brand drugs. Consumers usually can buy generic drugs at a much lower price than brand-name drugs. Generic versions are not available for every medicine, and in some cases may not be able to be substituted for a brand name product. When a pharmaceutical company develops a new drug, it is protected under a patent, usually for 20 years. During this time, no other company is allowed to make or sell it. Once the patent expires, that company or another company can make and test another version of the drug. After testing and FDA approval, the company can sell the drug as a generic. Consumers can learn whether a generic drug is FDA-approved by using the drug approval references on the FDA website. \u00ab Why is it important? Other FAQs \u00bb",
+    "https://www.nichd.nih.gov/health/topics/pharma"
+  ],
+  [
+    "Bad Breath (Summary): Summary There are many reasons why you might have bad breath. You can get it if you don't brush and floss regularly. Bacteria that build up in your mouth and between your teeth produce the bad odor. Other problems in your mouth, such as gum disease, dry mouth, or cavities, may also cause it. Sinusitis or problems with your nose may be to blame. You can also have bad breath if you eat some foods, like raw onions, garlic, or cabbage. And of course smoking causes its own bad smell. Some diseases and medicines can cause a specific breath odor. Having good dental habits, like brushing and flossing regularly, help fight bad breath. Mouthwashes, mints or chewing gum may make your breath fresher. If you have a disease that causes the bad breath, treating the disease may help give you fresher breath.",
+    "#"
+  ],
+  [
+    "Bad breath (Symptoms): Bad breath odors vary, depending on the source or the underlying cause. Some people worry too much about their breath even though they have little or no mouth odor, while others have bad breath and don't know it. Because it's difficult to assess how your own breath smells, ask a close friend or relative to confirm your bad-breath questions. When to see a doctor If you have bad breath, review your oral hygiene habits. Try making lifestyle changes, such as brushing your teeth and tongue after eating, using dental floss, and drinking plenty of water. If your bad breath persists after making such changes, see your dentist. If your dentist suspects a more serious condition is causing your bad breath, he or she may refer you to a physician to find the cause of the odor.",
+    "https://www.mayoclinic.org/diseases-conditions/bad-breath/symptoms-causes/syc-20350922"
+  ],
+  [
+    "Antiplatelet drugs - P2Y12 inhibitors (Who Should Take Antiplatelet Drugs): Antiplatelet drugs may be used to: - Prevent heart attack or stroke for those with PAD. - Clopidogrel (Plavix, generic) may be used in place of aspirin for patients who have narrowing of the coronary arteries or who have had a stent inserted. - Sometimes two anti-platelet drugs (one of which is almost always aspirin) are prescribed for patients with unstable angina, acute coronary syndrome (unstable angina or early signs of heart attack), or those who have received a stent during PCI. - For heart disease primary and secondary prevention, daily aspirin is generally the first choice for antiplatelet therapy. Clopidogrel is prescribed instead of aspirin for patients who are aspirin allergic or who cannot tolerate aspirin. - Clopidogrel and aspirin is recommended for patients who are undergoing angioplasty with or without stenting. - Prevent or treat heart attacks. - Prevent stroke or transient ischemic attacks (TIAs are early warning signs of stroke. The are also called \"mini-strokes.\") - Prevent clots from forming inside stents put inside your arteries to open them. - Acute coronary syndrome. - After bypass graft surgery that uses a man-made or prosthetic graft performed on arteries below the knee. Your health care provider will choose which one of these drugs are best for your problem. At times, you may be asked to take low dose aspirin along with one of these drugs.",
+    "https://medlineplus.gov/ency/patientinstructions/000100.htm"
+  ],
+  [
+    "Bad breath (Treatment): To reduce bad breath, help avoid cavities and lower your risk of gum disease, consistently practice good oral hygiene. Further treatment for bad breath can vary, depending on the cause. If your bad breath is thought to be caused by an underlying health condition, your dentist will likely refer you to your primary care provider. For causes related to oral health, your dentist will work with you to help you better control that condition. Dental measures may include: - Mouth rinses and toothpastes. If your bad breath is due to a buildup of bacteria (plaque) on your teeth, your dentist may recommend a mouth rinse that kills the bacteria. Your dentist may also recommend a toothpaste that contains an antibacterial agent to kill the bacteria that cause plaque buildup. - Treatment of dental disease. If you have gum disease, you may be referred to a gum specialist (periodontist). Gum disease can cause gums to pull away from your teeth, leaving deep pockets that fill with odor-causing bacteria. Sometimes only professional cleaning removes these bacteria. Your dentist might also recommend replacing faulty tooth restorations, a breeding ground for bacteria.",
+    "https://www.mayoclinic.org/diseases-conditions/bad-breath/symptoms-causes/syc-20350922"
+  ],
+  [
+    "Etiology: Etiology describes the cause or causes of a disease. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002356.htm"
+  ],
+  [
+    "What are the symptoms of Breast infection?: Symptoms of a breast infection are: - Breast enlargement on one side only - Breast lump - Breast pain - Fever and flu-like symptoms, including nausea and vomiting - Itching - Nipple discharge (may contain pus) - Nipple sensation changes - Swelling, tenderness, redness, and warmth in breast tissue - Tender or enlarged lymph nodes in armpit on the same side",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/001490.htm"
+  ],
+  [
+    "Ecthyma (Causes): Ecthyma is most often caused by the streptococcus bacteria. Sometimes, staphylococcus bacteria cause this skin infection on its own or in combination with streptococcus. The infection may start in skin that has been injured due to a scratch, rash, or insect bite. The infection often develops on the legs. People with diabetes or a weakened immune system are more prone to ecthyma.",
+    "https://medlineplus.gov/ency/article/000864.htm"
+  ],
+  [
+    "Rheumatic fever (Summary): Rheumatic fever is a disease that may develop after an infection with group A streptococcus bacteria (such as strep throat or scarlet fever). It can cause severe illness in the heart, joints, skin, and brain.",
+    "https://medlineplus.gov/ency/article/003940.htm"
+  ],
+  [
+    "PANDAS (Summary): PANDAS is an acronym for Pediatric Autoimmune Neuropsychiatric Disorder\u00a0 Associated with Streptococcus. It is used to describe a condition in children whose symptoms of\u00a0 obsessive-compulsive disorder\u00a0(OCD) or a tic disorder (i.e.\u00a0 Tourette syndrome) are worsened by\u00a0 group A streptococcal (GAS) infections.\u00a0The underlying cause of PANDAS is unclear, but studies suggest that a strep infection causes an abnormal\u00a0 immune response\u00a0resulting in neuropsychiatric symptoms. The association between PANDAS and GAS is controversial because the cause has not been proven. Management is centered on providing antibiotics for GAS infection, and medication or behavioral therapy for neuropsychiatric symptoms. [1] [2]",
+    "https://rarediseases.info.nih.gov/diseases/7312/pandas"
+  ],
+  [
+    "Rheumatic fever (Causes): Rheumatic fever is still common in countries that have a lot of poverty and poor health systems. It does not often occur in the United States and other developed countries. When rheumatic fever does occur in the United States, it is most often in small outbreaks. The latest outbreak in the United States was in the 1980s. Rheumatic fever occurs after infections with a germ or bacteria called Streptococcus pyogenes or group A streptococcus. This germ appears to trick the immune system into attacking healthy tissues in the body. These tissues become swollen or inflamed. This abnormal reaction seems to almost always occur with strep throat or scarlet fever. Strep infections that involve other parts of the body do not seem to trigger rheumatic fever.",
+    "https://medlineplus.gov/ency/article/003940.htm"
+  ],
+  [
+    "Pneumococcal Infections (Summary): Summary Pneumococci are a type of streptococcus bacteria. The bacteria spread through contact with people who are ill or by healthy people who carry the bacteria in the back of their nose. Pneumococcal infections can be mild or severe. The most common types of infections are - Ear infections - Sinus infections - Pneumonia - Sepsis - Meningitis How the diagnosis is made depends upon where the infection is. Your doctor will do a physical exam and health history. Possible tests may include blood, imaging, or lab tests. Treatment is with antibiotics. Vaccines can prevent pneumococcal infections. There are two vaccines. One is for infants and young children. The other is for people at high risk, including those who are over 65 years old, have chronic illnesses or weak immune systems, smoke, have asthma, or live in long-term care facilities. Centers for Disease Control and Prevention",
+    "#"
+  ],
+  [
+    "Diabetes (Treatment): Type 2 diabetes may be reversed with lifestyle changes, especially losing weight with exercise and by eating healthier foods. Some cases of type 2 diabetes can also be improved with weight loss surgery. There is no cure for type 1 diabetes. Treating either type 1 diabetes or type 2 diabetes involves medicines, diet, and exercise to control blood sugar level. Everyone with diabetes should receive proper education and support about the best ways to manage their diabetes. Ask your provider about seeing a diabetes nurse educator. Getting better control over your blood sugar, cholesterol, and blood pressure levels helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke. To prevent diabetes complications, visit your provider at least 2 to 4 times a year. Talk about any problems you are having. Follow your provider's instructions on managing your diabetes.",
+    "https://medlineplus.gov/ency/article/001214.htm"
+  ],
+  [
+    "Do you have information about Medication Errors: Summary : Medicines cure infectious diseases, prevent problems from chronic diseases, and ease pain. But medicines can also cause harmful reactions if not used correctly. Errors can happen in the hospital, at the doctor's office, at the pharmacy, or at home. You can help prevent errors by - Knowing your medicines. Keep a list of the names of your medicines, how much you take, and when you take them. Include over-the-counter medicines, vitamins, and supplements and herbs. Take this list to all your doctor visits. - Reading medicine labels and following the directions. Don't take medications prescribed for someone else. - Taking extra caution when giving medicines to children. - Asking questions. If you don't know the answers to these questions, ask your doctor or pharmacist. - Why am I taking this medicine? - What are the common problems to watch out for? - What should I do if they occur? - When should I stop this medicine? - Can I take this medicine with the other medicines on my list? Centers for Disease Control and Prevention",
+    "https://www.nlm.nih.gov/medlineplus/medicationerrors.html"
+  ],
+  [
+    "Diabetes Type 2 (Summary): Summary Diabetes means your blood glucose, or blood sugar, levels are too high. With type 2 diabetes, the more common type, your body does not make or use insulin well. Insulin is a hormone that helps glucose get into your cells to give them energy. Without insulin, too much glucose stays in your blood. Over time, high blood glucose can lead to serious problems with your heart, eyes, kidneys, nerves, and gums and teeth. You have a higher risk of type 2 diabetes if you are older, obese, have a family history of diabetes, or do not exercise. Having prediabetes also increases your risk. Prediabetes means that your blood sugar is higher than normal but not high enough to be called diabetes. If you are at risk for type 2 diabetes, you may be able to delay or prevent developing it by making some lifestyle changes. The symptoms of type 2 diabetes appear slowly. Some people do not notice symptoms at all. The symptoms can include - Being very thirsty - Urinating often - Feeling very hungry or tired - Losing weight without trying - Having sores that heal slowly - Having blurry eyesight Blood tests can show if you have diabetes. One type of test, the A1C, can also check on how you are managing your diabetes. Many people can manage their diabetes through healthy eating, physical activity, and blood glucose testing. Some people also need to take diabetes medicines. NIH: National Institute of Diabetes and Digestive and Kidney Diseases",
+    "#"
+  ],
+  [
+    "Diabetes type 2 - meal planning: When you have type 2 diabetes, taking time to plan your meals goes a long way toward controlling your blood sugar and weight. Your main focus is on keeping your blood sugar (glucose) level in your target range. To help manage your blood sugar, follow a meal plan that has: - Food from all the food groups - Fewer calories - About the same amount of carbohydrates at each meal and snack - Healthy fats Along with healthy eating, you can help\u00a0keep your blood sugar in target range by maintaining a healthy weight. Persons with type 2 diabetes are often overweight. Losing just 10 pounds (4.5 kilograms) can help you manage your diabetes better. Eating healthy foods and staying active (for example, 30 to 60 minutes of walking per day) can help you meet and maintain your weight loss goal. HOW CARBOHYDRATES AFFECT BLOOD SUGAR Carbohydrates in food give your body energy. You need to eat carbohydrates to maintain your energy. But carbohydrates also raise your blood sugar higher and faster than other kinds of food. The main kinds of carbohydrates are starches, sugars, and fiber. Learn which foods have carbohydrates. This will help with meal planning so that you can keep your blood sugar in your target range. MEAL PLANNING FOR CHILDREN WITH TYPE 2 DIABETES Meal plans should consider the amount of calories children need to grow. In general, three small meals and three snacks a day can help meet calorie needs. Many children with type 2 diabetes are overweight. The goal should be a healthy weight by eating healthy foods and getting more activity (60 minutes each day). Work with a registered dietitian to design a meal plan for your child. A registered dietitian is an expert in food and nutrition. The following tips can help your child stay on track: - No food is off-limits. Knowing how different foods affect your child's blood sugar helps you and your child keep it in target range. - Help your child learn how much food is a healthy amount. This is called portion control. - Have your family gradually switch from drinking soda and other sugary drinks, such as sports drinks and juices, to plain water or low-fat milk. PLANNING MEALS Everyone has individual needs. Work with your doctor, registered dietitian, or diabetes educator to develop a meal plan that works for you. When shopping, read food labels to make better food choices. A good way to make sure you get all the nutrients you need during meals is to use the plate method. This is a visual food guide that helps you choose the best types and right amounts of food to eat. It encourages larger portions of non-starchy vegetables (half the plate) and moderate portions of protein (one quarter of the plate) and starch (one quarter of the plate). You can find more information about the plate method at the American Diabetes Association website: www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate. EAT A VARIETY OF FOODS Eating a wide variety of foods helps you stay healthy. Try to include foods from all the food groups at each meal. VEGETABLES (2\u00bd to 3 cups or 450 to 550 grams a day) Choose fresh or frozen vegetables without added sauces, fats, or salt. Non-starchy vegetables include dark green and deep yellow vegetables, such as cucumber, spinach, broccoli, romaine lettuce, cabbage, chard, and bell peppers. Starchy vegetables include corn, green peas, lima beans, carrots, yams and taro.\u00a0Note that potato should be considered a pure starch, like white bread or white rice, instead of a vegetable. FRUITS (1\u00bd to 2 cups or 240 to 320 grams a day) Choose fresh, frozen, canned (without added sugar or syrup), or unsweetened dried fruits. Try apples, bananas, berries, cherries, fruit cocktail, grapes, melon, oranges, peaches, pears, papaya, pineapple, and raisins. Drink juices that are 100% fruit with no added sweeteners or syrups. GRAINS (3 to 4 ounces or 85 to 115 grams a day) There are 2 types of grains: - Whole grains are unprocessed and have the entire grain kernel. Examples are whole-wheat flour, oatmeal, whole cornmeal, amaranth, barley, brown and wild rice, buckwheat, and quinoa. - Refined grains have been processed (milled) to remove the bran and germ. Examples are white flour, de-germed cornmeal, white bread, and white rice. Grains have starch, a type of carbohydrate. Carbohydrates raise your blood sugar level. For healthy eating, make sure half of the grains you eat each day are whole grains. Whole grains have lots of fiber. Fiber in the diet keeps your blood sugar level from rising too fast. PROTEIN FOODS (5 to 6\u00bd ounces or 140 to 184 grams a day) Protein foods include meat, poultry, seafood, eggs, beans and peas, nuts, seeds, and processed soy foods. Eat fish and poultry more often. Remove the skin from chicken and turkey. Select lean cuts of beef, veal, pork, or wild game. Trim all visible fat from meat. Bake, roast, broil, grill, or boil instead of frying. When frying proteins, use healthy oils such as olive oil. DAIRY (3 cups or 245 grams a day) Choose low-fat dairy products. Be aware that milk, yogurt, and other dairy foods have natural sugar, even when they do not contain added sugar. Take this into account when planning meals to stay in your blood sugar target range. Some non-fat dairy products have a lot of added sugar. Be sure to read the label. OILS/FATS (no more than 7 teaspoons or 35 milliliters a day) Oils are not considered a food group. But they have nutrients that help your body stay healthy. Oils are different from fats in that oils remain liquid at room temperature. Fats remain solid at room temperature. Limit your intake of fatty foods, especially those high in saturated fat, such as hamburgers, deep-fried foods, bacon, and butter. Instead, choose foods that are high in polyunsaturated or monounsaturated fats. These include fish, nuts, and vegetable oils. Oils can raise your blood sugar, but not as fast as starch. Oils are also high in calories. Try to use no more than the recommended daily limit of 7 teaspoons (35 milliliters). WHAT ABOUT ALCOHOL AND SWEETS? If you choose to drink alcohol, limit the amount and have it with a meal. Check with your health care provider about how alcohol will affect your blood sugar and to determine a safe amount for you. Sweets are high in fat and sugar. Keep portion sizes small. Here are tips to help avoid eating too many sweets: - Ask for extra spoons and forks and split your dessert with others. - Eat sweets that are sugar-free. - Always ask for the smallest serving size or children's size. YOUR DIABETES CARE TEAM IS THERE TO HELP YOU In the beginning, meal planning may be overwhelming. But it will become easier as your knowledge grows about foods and their effects on your blood sugar. If you're having problems with meal planning, talk with your diabetes care team. They are there to help you. Updated by: Robert Hurd, MD, Professor of Endocrinology and Health Care Ethics, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007429.htm"
+  ],
+  [
+    "Type 2 diabetes - what to ask your doctor (Summary): Type 2 diabetes is a lifelong disease that causes a high level of sugar (glucose) in your blood. It can damage your organs. It can also lead to a heart attack or stroke and cause many other health problems. You can do many things to control your symptoms, prevent damage due to diabetes, and make your life better. Below are questions you may want to ask your health care provider to help you take care of your diabetes.",
+    "https://medlineplus.gov/ency/patientinstructions/000217.htm"
+  ],
+  [
+    "Type 2 diabetes - what to ask your doctor (Questions): Ask your provider to check the nerves, skin, and pulses in your feet. Also ask these questions: - How often should I check my feet? What should I do when I check them? What problems should I call my provider about? - Who should trim my toenails? Is it OK if I trim them? - How should I take care of my feet every day? What type of shoes and socks should I wear? - Should I see a foot doctor (podiatrist)? Ask your provider about getting exercise: - Before I start, do I need to have my heart checked? My eyes? My feet? - What type of exercise program should I do? What type of activities should I avoid? - When should I check my blood sugar when I exercise? What should I bring with me when I exercise? Should I eat before or during exercise? Do I need to adjust my medicines when I exercise? When should I next have an eye doctor check my eyes? What eye problems should I call my doctor about? Ask your provider about meeting with a dietitian. Questions for the dietitian may include: - What foods increase my blood sugar the most? - What foods can help me with my weight loss goals? Ask your provider about your diabetes medicines: - When should I take them? - What should I do if I miss a dose? - Are there any side effects? How often should I check my blood sugar level at home? Should I do it at different times of the day? What is too low? What is too high? What should I do if my blood sugar is too low or too high? Should I get a medical alert bracelet or necklace? Should I have glucagon at home? Ask your provider about symptoms that you are having if they have not been discussed. Tell your provider about blurred vision, skin changes, depression, reactions at injection sites, sexual dysfunction, tooth pain, muscle pain, or nausea. Ask your provider about other tests you may need, such as cholesterol, A1C, and a urine test to check for kidney problems. Ask your provider about vaccinations you should have like the flu shot, hepatitis B, or pneumonia vaccines. How should I take care of my diabetes when I travel? Ask your provider how you should take care of your diabetes when you are sick: - What should I eat or drink? - How should I take my diabetes medicines? - How often should I check my blood sugar? - When should I call the provider?",
+    "https://medlineplus.gov/ency/patientinstructions/000217.htm"
+  ],
+  [
+    "Diabetes: Diabetes is a chronic disease in which the body cannot regulate the amount of sugar in the blood. Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both. To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested: - A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body. - An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be stored or used as fuel. People with diabetes have high blood sugar because their body cannot move sugar from the blood into muscle and fat cells to be burned or stored for energy, and/or because their liver makes too much glucose and releases it into the blood. This is because either: - Their pancreas does not make enough insulin - Their cells do not respond to insulin normally - Both of the above There are two major types of diabetes. The causes and risk factors are different for each type: - Type 1 diabetes can occur at any age, but it is most often diagnosed in children, teens, or young adults. In this disease, the body makes little or no insulin. This is because the pancreas cells that make insulin stop working. Daily injections of insulin are needed. The exact cause is unknown. - Type 2 diabetes is much more common. It most often occurs in adulthood, but because of high obesity rates, children and teens are now being diagnosed with this disease. Some people with type 2 diabetes do not know they have it. With type 2 diabetes, the body is resistant to insulin and doesn't use insulin as well as it should. - There are other causes of diabetes, and some people cannot be classified as type 1 or type 2. Gestational diabetes is high blood sugar that develops at any time during pregnancy in a woman who does not have diabetes. If your parent, brother, or sister has diabetes, you may be more likely to develop the disease. A high blood sugar level can cause several symptoms, including: - Blurry vision - Excess thirst - Fatigue - Frequent urination - Hunger - Weight loss Because type 2 diabetes develops slowly, some people with high blood sugar have no symptoms. Symptoms of type 1 diabetes develop over a short period. People may be very sick by the time they are diagnosed. After many years, diabetes can lead to other serious problems. These problems are known as diabetes complications, and include: - Eye problems, including trouble seeing (especially at night), light sensitivity, and blindness - Sores and infections of the leg or foot, which if untreated, can lead to amputation of the leg or foot - Damage to nerves in the body, causing pain, tingling, a loss of feeling, problems digesting food, and erectile dysfunction - Kidney problems, which can lead to kidney failure - Weakened immune system, which can lead to more frequent infections - Increased chance of having a heart attack or stroke A urine analysis may show high blood sugar. But a urine test alone does not diagnose diabetes. Your health care provider may suspect that you have diabetes if your blood sugar level is higher than 200 mg/dL (11.1 mmol/L). To confirm the diagnosis, one or more of the following tests must be done. Blood tests: - Fasting blood glucose level. Diabetes is diagnosed if the fasting glucose level is higher than 126 mg/dL (7.0 mmol/L) on two different tests. Levels between 100 and 126 mg/dL (5.5 and 7.0 mmol/L) are called impaired fasting glucose or prediabetes. These levels are risk factors for type 2 diabetes. - Hemoglobin A1c (A1C) test. Normal is less than 5.7%; prediabetes is 5.7% to 6.4%; and diabetes is 6.5% or higher. - Oral glucose tolerance test. Diabetes is diagnosed if the glucose level is higher than 200 mg/dL (11.1 mmol/L) 2 hours after drinking a sugar drink (this test is used more often for type 2 diabetes). Screening for type 2 diabetes in people who have no symptoms is recommended for: - Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 3 years. - Overweight adults (BMI of 25 or higher) who have other risk factors such as having high blood pressure, or having a mother, father, sister or brother with diabetes. - Adults over age 45, repeated every 3 years. Type 2 diabetes may be reversed with lifestyle changes, especially losing weight with exercise and by eating healthier foods. Some cases of type 2 diabetes can also be improved with weight loss surgery. There is no cure for type 1 diabetes. Treating either type 1 diabetes or type 2 diabetes involves medicines, diet, and exercise to control blood sugar level. Everyone with diabetes should receive proper education and support about the best ways to manage their diabetes. Ask your provider about seeing a diabetes nurse educator. Getting better control over your blood sugar, cholesterol, and blood pressure levels helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke. To prevent diabetes complications, visit your provider at least 2 to 4 times a year. Talk about any problems you are having. Follow your provider's instructions on managing your diabetes. Many resources can help you understand more about diabetes. If you have diabetes, you can also learn ways to manage your condition and prevent diabetes complications. Diabetes is a lifelong disease and there is no cure. Tight control of blood glucose can prevent or delay diabetes complications. But these problems can occur, even in people with good diabetes control. After many years, diabetes can lead to serious health problems: - You could have eye problems, including trouble seeing (especially at night), and light sensitivity. You could become blind. - Your feet and skin can develop sores and infections. After a long time, your foot or leg may need to be amputated. Infection can also cause pain and itching in other parts of the body. - Diabetes may make it harder to control your blood pressure and cholesterol. This can lead to a heart attack, stroke, and other problems. It can become harder for blood to flow to your legs and feet. - Nerves in your body can get damaged, causing pain, tingling, and numbness. - Because of nerve damage, you could have problems digesting the food you eat. You could feel weakness or have trouble going to the bathroom. Nerve damage can make it harder for men to have an erection. - High blood sugar and other problems can lead to kidney damage. Your kidneys may not work as well as they used to. They may even stop working so that you need dialysis or a kidney transplant. Keeping an ideal body weight and an active lifestyle may prevent or delay the start of type 2 diabetes. If you're overweight, losing just 5% to 7% of your body weight even helps. Some medicines can also be used to delay or prevent the start of type 2 diabetes. At this time, type 1 diabetes cannot be prevented. But there is promising research that shows type 1 diabetes may be delayed in some high risk people. Updated by: Robert Hurd, MD, Professor of Endocrinology and Health Care Ethics, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/001214.htm"
+  ],
+  [
+    "Diabetes type 2 - meal planning (Review Date 4/15/2017): Updated by: Robert Hurd, MD, Professor of Endocrinology and Health Care Ethics, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007429.htm"
+  ],
+  [
+    "Macular Degeneration (Summary): Summary Macular degeneration, or age-related macular degeneration (AMD), is a leading cause of vision loss in Americans 60 and older. It is a disease that destroys your sharp, central vision. You need central vision to see objects clearly and to do tasks such as reading and driving. AMD affects the macula, the part of the eye that allows you to see fine detail. It does not hurt, but it causes cells in the macula to die. There are two types: wet and dry. Wet AMD happens when abnormal blood vessels grow under the macula. These new blood vessels often leak blood and fluid. Wet AMD damages the macula quickly. Blurred vision is a common early symptom. Dry AMD happens when the light-sensitive cells in the macula slowly break down. Your gradually lose your central vision. A common early symptom is that straight lines appear crooked. Regular comprehensive eye exams can detect macular degeneration before the disease causes vision loss. Treatment can slow vision loss. It does not restore vision. NIH: National Eye Institute",
+    "#"
+  ],
+  [
+    "What are the genetic changes related to Stargardt macular degeneration?: In most cases, Stargardt macular degeneration is caused by mutations in the ABCA4 gene. Less often, mutations in the ELOVL4 gene cause this condition. The ABCA4 and ELOVL4 genes provide instructions for making proteins that are found in light-sensing (photoreceptor) cells in the retina. The ABCA4 protein transports potentially toxic substances out of photoreceptor cells. These substances form after phototransduction, the process by which light entering the eye is converted into electrical signals that are transmitted to the brain. Mutations in the ABCA4 gene prevent the ABCA4 protein from removing toxic byproducts from photoreceptor cells. These toxic substances build up and form lipofuscin in the photoreceptor cells and the surrounding cells of the retina, eventually causing cell death. Loss of cells in the retina causes the progressive vision loss characteristic of Stargardt macular degeneration. The ELOVL4 protein plays a role in making a group of fats called very long-chain fatty acids. The ELOVL4 protein is primarily active (expressed) in the retina, but is also expressed in the brain and skin. The function of very long-chain fatty acids within the retina is unknown. Mutations in the ELOVL4 gene lead to the formation of ELOVL4 protein clumps (aggregates) that build up and may interfere with retinal cell functions, ultimately leading to cell death.",
+    "https://ghr.nlm.nih.gov/condition/stargardt-macular-degeneration"
+  ],
+  [
+    "Macular degeneration - age-related: Macular degeneration is an eye disorder that slowly destroys sharp, central vision. This makes it difficult to see fine details and read. The disease is most common in people over age 60, which is why it is often called age-related macular degeneration (ARMD or AMD). Watch this video about: Macular degeneration The retina is at the back of the eye. It changes light and images that enter the eye into nerve signals that are sent to the brain. A part of the retina called the macula makes vision sharper and more detailed. It is a yellow spot in the center of the retina. It is made up of 2 natural colors (pigments) called lutein and zeaxanthin. AMD is caused by damage to the blood vessels that supply the macula. This change also harms the macula. There are two types of AMD: - Dry AMD occurs when the blood vessels under the macula become thin and brittle. Small yellow deposits, called drusen, form. Almost all people with macular degeneration start with the dry form. - Wet AMD occurs in about 10% of people with macular degeneration. New abnormal and very fragile blood vessels grow under the macula. These vessels leak blood and fluid. This\u00a0type of AMD\u00a0causes most of the vision loss associated with the condition. Doctors are not sure what causes AMD. The condition is rare before age 55. It occurs most in persons 75 years or older. Risk factors for AMD are: - Family history of AMD - Being White - Cigarette smoking - High-fat diet - Being a woman You may not have any symptoms at first. As the disease gets worse, you may have problems with your central vision. SYMPTOMS OF DRY AMD The most common symptom of dry AMD is blurred vision. Objects in the center part of your vision often look distorted and dim, and colors look faded. You may have trouble reading print or seeing other details. But you can see well enough to walk and do most daily activities. As dry AMD gets worse, you may need more light to read or do everyday tasks. A blurred spot in the center of vision gradually gets larger and darker. In the later stages of dry AMD, you may not be able to recognize faces until they are close. SYMPTOMS OF WET AMD The most common early symptom of wet AMD is that straight lines look distorted and wavy. There may be a small dark spot in the center of your vision that gets larger over time. With both types of AMD, central vision loss can occur quickly. If this happens, you will need to be seen right away by an ophthalmologist. Make sure this eye doctor has experience in treating problems with the retina. You will have an eye exam. Drops will be placed into your eyes to widen (dilate) your pupils. The eye doctor will use special lenses to view your retina, blood vessels, and optic nerve. The eye doctor will look for specific changes in the macula and blood vessels and for drusen. You may be asked to cover one eye and look at a pattern of lines called an Amsler grid. If the straight lines look wavy, it may be a sign of AMD. Other tests that may be done include: - Using special dye and camera to look at blood flow in the retina (fluorescein angiogram) - Taking a photo of the inner lining of the eye (fundus photography) - Using light waves to view the retina (optical coherence tomography) - A test that measures the pigment in the macula If you have advanced or severe dry AMD, no treatment can restore your vision. If you have early AMD and do not smoke, a combination of certain vitamins, antioxidants, and zinc may prevent the disease from getting worse. But it cannot give you back vision that is already lost. The combination is often called the \"AREDS\" formula. The supplements contain: - 500 milligrams (mg) of vitamin C - 400 international units of beta-carotene - 80 mg of zinc - 2 mg of copper Only take this vitamin combination if your doctor recommends it. Make sure your doctor knows about any other vitamins or supplements you are taking. Smokers should\u00a0not use this supplement. AREDS may also benefit you if you have a family history and risk factors for AMD. Lutein and zeaxanthin, which are substances found in green leafy vegetables, may also decrease your risk of age-related macular degeneration. If you have wet AMD, your doctor may recommend: - Laser surgery (laser photocoagulation) -- a small beam of light destroys the leaking, abnormal blood vessels. - Photodynamic therapy -- a light activates a drug that is injected into your body to destroy leaking blood vessels. - Special medicines that prevent new blood vessels from forming in the eye are injected into the eye (this is a painless process). Low-vision aids (such as special lenses) and therapy can help you use the vision that you have more effectively, and improve your quality of life. Close follow-up with your eye doctor is important. - For dry AMD, visit your eye doctor once a year for a complete eye exam. - For wet AMD, you likely need frequent, perhaps monthly, follow-up visits. Early detection of vision changes is important because the sooner you are treated, the better your outcome. Early detection leads to earlier treatment and often, a better outcome. The best way to detect changes is by self-testing at home with the Amsler grid. Your eye doctor can give you a copy of the grid or you can print one from the Internet. Test each eye individually while wearing your reading glasses. If the lines look wavy, call your eye doctor right away for an appointment. AMD Alliance International - www.amdalliance.org Macular Degeneration Association - macularhope.org Macular Degeneration Partnership - www.amd.org AMD does not affect side (peripheral) vision. This means complete vision loss never occurs. AMD results in the loss of central vision only. Mild, dry AMD usually does not cause disabling central vision loss. Wet AMD often leads to significant vision loss. In general, with AMD you may lose the ability to read, drive a car, and recognize faces at a distance. But most people with AMD can carry out daily tasks without much difficulty. If you have AMD, your health care provider may recommend that you check your vision every day\u00a0with an Amsler grid. Call your provider immediately if the lines\u00a0look wavy. Also call if you notice other changes in your vision. Although there is no known way to prevent macular degeneration, leading a healthy lifestyle can reduce your risk of developing AMD: - Do not smoke - Maintain a healthy diet that is high in fruits and vegetables and low in animal fat - Exercise regularly - Maintain a healthy weight See your eye care professional regularly for dilated eye exams. Updated by: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/001000.htm"
+  ],
+  [
+    "Macular degeneration - age-related (Support Groups): AMD Alliance International - www.amdalliance.org Macular Degeneration Association - macularhope.org Macular Degeneration Partnership - www.amd.org",
+    "https://medlineplus.gov/ency/article/001000.htm"
+  ],
+  [
+    "Dry macular degeneration (Lifestyle and home remedies): Even after receiving a diagnosis of dry macular degeneration, you can take steps that may help slow vision loss. - Don't smoke. If you smoke, ask your doctor for help to quit. - Choose a healthy diet. The antioxidant vitamins in fruits and vegetables contribute to eye health. Kale, spinach, broccoli, peas and other vegetables have high levels of antioxidants, including lutein and zeaxanthin, which may benefit people with macular degeneration. Foods containing high levels of zinc may also be of particular value in patients with macular degeneration. These include high-protein foods, such as beef, pork and lamb. Nonmeat sources include milk, cheese, yogurt, whole-grain cereals and whole-wheat bread. Another good choice is healthy unsaturated fats, such as olive oil. And research studies have shown that a diet high in omega-3 fatty acids, such as found in salmon, tuna and walnuts, may lower the risk for advanced AMD. But the same benefit is not shown from taking omega-3 supplements, such as fish oil pills. - Manage your other medical conditions. If you have cardiovascular disease or high blood pressure, for example, take your medication and follow your doctor's instructions for controlling the condition. - Maintain a healthy weight and exercise regularly. If you need to lose weight, reduce the number of calories you eat and increase the amount of exercise you get each day. Maintain a healthy weight by exercising regularly and controlling your diet. - Have routine eye exams. Ask your eye doctor about the recommended schedule for follow-up exams. In between checkups, you can do a self-assessment of your vision using an Amsler grid. These steps will help identify if your condition develops into wet macular degeneration, which can be treated with drugs. For people with intermediate or advanced disease, taking a high-dose formulation of antioxidant vitamins and minerals may help reduce the risk of vision loss, the American Academy of Ophthalmology says. Research shows benefit in a formulation that includes: - 500 milligrams (mg) of vitamin C - 400 international units (IU) of vitamin E - 10 mg of lutein - 2 mg of zeaxanthin - 25 or 80 mg of zinc (as zinc oxide) - 2 mg of copper (as cupric oxide) The evidence doesn't show benefit in these supplements for people with early-stage dry macular degeneration. In addition, high doses of vitamin E may increase the risk of heart failure and other complications. Ask your doctor if taking supplements is right for you.",
+    "https://www.mayoclinic.org/diseases-conditions/dry-macular-degeneration/symptoms-causes/syc-20350375"
+  ],
+  [
+    "Dry macular degeneration: Dry macular degeneration is a common eye disorder among people over 65. It causes blurred or reduced central vision, due to thinning of the macula (MAK-u-luh). The macula is the part of the retina responsible for clear vision in your direct line of sight. Dry macular degeneration may first develop in one eye and then affect both. Over time your vision worsens, which may affect your ability to do things such as read, drive and recognize faces. But this doesn't mean you'll lose all of your sight. Early detection and self-care measures may delay vision loss due to dry macular degeneration. Dry macular degeneration symptoms usually develop gradually and without pain. They may include: - Visual distortions, such as straight lines seeming bent - Reduced central vision in one or both eyes - The need for brighter light when reading or doing close work - Increased difficulty adapting to low light levels, such as when entering a dimly lit restaurant - Increased blurriness of printed words - Decreased intensity or brightness of colors - Difficulty recognizing faces Dry macular degeneration usually affects both eyes. If only one eye is affected, you may not notice any changes in your vision because your good eye may compensate for the weak eye. And the condition doesn't affect side (peripheral) vision, so it rarely causes total blindness. Dry macular degeneration is one of two types of age-related macular degeneration. It can progress to wet (neovascular) macular degeneration, which is characterized by blood vessels that grow under the retina and leak. The dry type is more common, but it usually progresses slowly (over years). The wet type is more likely to cause a relatively sudden change in vision resulting in serious vision loss. See your eye doctor if: - You notice changes in your central vision - Your ability to see colors and fine detail becomes impaired These changes may be the first indication of macular degeneration, particularly if you're over age 50. No one knows exactly what causes dry macular degeneration. But research indicates it may be related to a combination of heredity and environmental factors, including smoking and diet. The condition develops as the eye ages. Dry macular degeneration affects the macula - an area of the retina that's responsible for clear vision in your direct line of sight. Over time tissue in your macula may thin and break down. Factors that may increase your risk of macular degeneration include: - Age. This disease is most common in people over 65. - Family history and genetics. This disease has a hereditary component. Researchers have identified several genes that are related to developing the condition. - Race. Macular degeneration is more common in whites than it is in other people. - Smoking. Smoking cigarettes or being regularly exposed to smoke significantly increases your risk of macular degeneration. - Obesity. Research indicates that being obese may increase your chance that early or intermediate macular degeneration will progress to the more severe form of the disease. - Cardiovascular disease. If you have had diseases that affected your heart and blood vessels, you may be at higher risk of macular degeneration. People whose dry macular degeneration has progressed to central vision loss may experience depression or visual hallucinations. And dry macular degeneration may progress to wet macular degeneration, which can cause rapid vision loss if left untreated. Your doctor may diagnose your condition by reviewing your medical and family history and conducting a complete eye exam. He or she may also do several other tests, including: - Examination of the back of your eye. Your eye doctor will put drops in your eyes to dilate them and use a special instrument to examine the back of your eye. He or she will look for a mottled appearance that's caused by drusen - yellow deposits that form under the retina. People with macular degeneration often have many drusen. - Test for defects in the center of your vision. During an eye examination, your eye doctor may use an Amsler grid to test for defects in the center of your vision. Macular degeneration may cause some of the straight lines in the grid to look faded, broken or distorted. - Fluorescein angiography. During this test, your doctor injects a colored dye into a vein in your arm. The dye travels to and highlights the blood vessels in your eye. A special camera takes several pictures as the dye travels through the blood vessels. The images will show if you have abnormal blood vessel or retinal changes. - Indocyanine green angiography. Like fluorescein angiography, this test uses an injected dye. It may be used to confirm the findings of a fluorescein angiography or to identify specific types of macular degeneration. - Optical coherence tomography. This noninvasive imaging test displays detailed cross-sectional images of the retina. It identifies areas of retina thinning, thickening or swelling. These can be caused by fluid accumulations from leaking blood vessels in and under your retina. Dry macular degeneration can't be cured. If your condition is diagnosed early, you can take steps to help slow its progression, such as taking vitamin supplements, eating healthfully and not smoking. Low vision rehabilitation Age-related macular degeneration doesn't affect your side (peripheral) vision and usually doesn't cause total blindness. But it can reduce or eliminate your central vision - which is necessary for driving an automobile, reading and recognizing people's faces. It may be beneficial for you to work with a low vision rehabilitation specialist, occupational therapist, your eye doctor and others trained in low vision rehabilitation. They can help you find ways to adapt to your changing vision Surgery to implant a telescopic lens For selected people with advanced dry macular degeneration in both eyes, one option to improve vision may be surgery to implant a telescopic lens in one eye. The telescopic lens, which looks like a tiny plastic tube, is equipped with lenses that magnify your field of vision. The telescopic lens implant may improve both distance and close-up vision, but it has a very narrow field of view. It can be particularly useful in an urban environment to aid in identifying street signs. Even after receiving a diagnosis of dry macular degeneration, you can take steps that may help slow vision loss. - Don't smoke. If you smoke, ask your doctor for help to quit. - Choose a healthy diet. The antioxidant vitamins in fruits and vegetables contribute to eye health. Kale, spinach, broccoli, peas and other vegetables have high levels of antioxidants, including lutein and zeaxanthin, which may benefit people with macular degeneration. Foods containing high levels of zinc may also be of particular value in patients with macular degeneration. These include high-protein foods, such as beef, pork and lamb. Nonmeat sources include milk, cheese, yogurt, whole-grain cereals and whole-wheat bread. Another good choice is healthy unsaturated fats, such as olive oil. And research studies have shown that a diet high in omega-3 fatty acids, such as found in salmon, tuna and walnuts, may lower the risk for advanced AMD. But the same benefit is not shown from taking omega-3 supplements, such as fish oil pills. - Manage your other medical conditions. If you have cardiovascular disease or high blood pressure, for example, take your medication and follow your doctor's instructions for controlling the condition. - Maintain a healthy weight and exercise regularly. If you need to lose weight, reduce the number of calories you eat and increase the amount of exercise you get each day. Maintain a healthy weight by exercising regularly and controlling your diet. - Have routine eye exams. Ask your eye doctor about the recommended schedule for follow-up exams. In between checkups, you can do a self-assessment of your vision using an Amsler grid. These steps will help identify if your condition develops into wet macular degeneration, which can be treated with drugs. For people with intermediate or advanced disease, taking a high-dose formulation of antioxidant vitamins and minerals may help reduce the risk of vision loss, the American Academy of Ophthalmology says. Research shows benefit in a formulation that includes: - 500 milligrams (mg) of vitamin C - 400 international units (IU) of vitamin E - 10 mg of lutein - 2 mg of zeaxanthin - 25 or 80 mg of zinc (as zinc oxide) - 2 mg of copper (as cupric oxide) The evidence doesn't show benefit in these supplements for people with early-stage dry macular degeneration. In addition, high doses of vitamin E may increase the risk of heart failure and other complications. Ask your doctor if taking supplements is right for you.",
+    "https://www.mayoclinic.org/diseases-conditions/dry-macular-degeneration/symptoms-causes/syc-20350375"
+  ],
+  [
+    "Dry macular degeneration (Risk factors): Factors that may increase your risk of macular degeneration include: - Age. This disease is most common in people over 65. - Family history and genetics. This disease has a hereditary component. Researchers have identified several genes that are related to developing the condition. - Race. Macular degeneration is more common in whites than it is in other people. - Smoking. Smoking cigarettes or being regularly exposed to smoke significantly increases your risk of macular degeneration. - Obesity. Research indicates that being obese may increase your chance that early or intermediate macular degeneration will progress to the more severe form of the disease. - Cardiovascular disease. If you have had diseases that affected your heart and blood vessels, you may be at higher risk of macular degeneration.",
+    "https://www.mayoclinic.org/diseases-conditions/dry-macular-degeneration/symptoms-causes/syc-20350375"
+  ],
+  [
+    "Macular degeneration - age-related (Causes): The retina is at the back of the eye. It changes light and images that enter the eye into nerve signals that are sent to the brain. A part of the retina called the macula makes vision sharper and more detailed. It is a yellow spot in the center of the retina. It is made up of 2 natural colors (pigments) called lutein and zeaxanthin. AMD is caused by damage to the blood vessels that supply the macula. This change also harms the macula. There are two types of AMD: - Dry AMD occurs when the blood vessels under the macula become thin and brittle. Small yellow deposits, called drusen, form. Almost all people with macular degeneration start with the dry form. - Wet AMD occurs in about 10% of people with macular degeneration. New abnormal and very fragile blood vessels grow under the macula. These vessels leak blood and fluid. This\u00a0type of AMD\u00a0causes most of the vision loss associated with the condition. Doctors are not sure what causes AMD. The condition is rare before age 55. It occurs most in persons 75 years or older. Risk factors for AMD are: - Family history of AMD - Being White - Cigarette smoking - High-fat diet - Being a woman",
+    "https://medlineplus.gov/ency/article/001000.htm"
+  ],
+  [
+    "Macular degeneration - age-related (Prevention): Although there is no known way to prevent macular degeneration, leading a healthy lifestyle can reduce your risk of developing AMD: - Do not smoke - Maintain a healthy diet that is high in fruits and vegetables and low in animal fat - Exercise regularly - Maintain a healthy weight See your eye care professional regularly for dilated eye exams.",
+    "https://medlineplus.gov/ency/article/001000.htm"
+  ],
+  [
+    "Molar pregnancy: A molar pregnancy - also known as hydatidiform mole - is a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta. There are two types of molar pregnancy, complete molar pregnancy and partial molar pregnancy. In a complete molar pregnancy, the placental tissue is abnormal and swollen and appears to form fluid-filled cysts. There's also no formation of fetal tissue. In a partial molar pregnancy, there may be normal placental tissue along with abnormally forming placental tissue. There may also be formation of a fetus, but the fetus is not able to survive, and is usually miscarried early in the pregnancy. A molar pregnancy can have serious complications - including a rare form of cancer - and requires early treatment. A molar pregnancy may seem like a normal pregnancy at first, but most molar pregnancies cause specific signs and symptoms, including: - Dark brown to bright red vaginal bleeding during the first trimester - Severe nausea and vomiting - Sometimes vaginal passage of grapelike cysts - Pelvic pressure or pain If you experience any signs or symptoms of a molar pregnancy, consult your doctor or pregnancy care provider. He or she may detect other signs of a molar pregnancy, such as: - Rapid uterine growth - the uterus is too large for the stage of pregnancy - High blood pressure - Preeclampsia - a condition that causes high blood pressure and protein in the urine after 20 weeks of pregnancy - Ovarian cysts - Anemia - Overactive thyroid (hyperthyroidism) A molar pregnancy is caused by an abnormally fertilized egg. Human cells normally contain 23 pairs of chromosomes. One chromosome in each pair comes from the father, the other from the mother. In a complete molar pregnancy, an empty egg is fertilized by one or two sperm, and all of the genetic material is from the father. In this situation, the chromosomes from the mother's egg are lost or inactivated and the father's chromosomes are duplicated. In a partial or incomplete molar pregnancy, the mother's chromosomes remain but the father provides two sets of chromosomes. As a result, the embryo has 69 chromosomes instead of 46. This most often occurs when two sperm fertilize an egg, resulting in an extra copy of the father's genetic material. Approximately 1 in every 1,000 pregnancies is diagnosed as a molar pregnancy. Various factors are associated with molar pregnancy, including: - Maternal age. A molar pregnancy is more likely in women older than age 35 or younger than age 20. - Previous molar pregnancy. If you've had one molar pregnancy, you're more likely to have another. A repeat molar pregnancy happens, on average, in 1 out of every 100 women. After a molar pregnancy has been removed, molar tissue may remain and continue to grow. This is called persistent gestational trophoblastic neoplasia (GTN). This occurs in approximately 15 to 20 percent of complete molar pregnancies, and up to 5 percent of partial molar pregnancies. One sign of persistent GTN is a high level of human chorionic gonadotropin (HCG) - a pregnancy hormone - after the molar pregnancy has been removed. In some cases, an invasive hydatidiform mole penetrates deep into the middle layer of the uterine wall, which causes vaginal bleeding. Persistent GTN can nearly always be successfully treated, most often with chemotherapy. Another treatment option is removal of the uterus (hysterectomy). Rarely, a cancerous form of GTN known as choriocarcinoma develops and spreads to other organs. Choriocarcinoma is usually successfully treated with multiple cancer drugs. A complete molar pregnancy is more likely to have this complication than a partial molar pregnancy. If your doctor suspects a molar pregnancy, he or she will order blood tests, including one to measure the level of human chorionic gonadotropin (HCG) - a pregnancy hormone - in your blood. He or she will also recommend an ultrasound. With a standard ultrasound, high-frequency sound waves are directed at the tissues in the abdominal and pelvic area. During early pregnancy, however, the uterus and fallopian tubes are closer to the vagina than to the abdominal surface, so the ultrasound may be done through a wandlike device placed in your vagina. An ultrasound of a complete molar pregnancy - which can be detected as early as eight or nine weeks of pregnancy - may show: - No embryo or fetus - No amniotic fluid - A thick cystic placenta nearly filling the uterus - Ovarian cysts An ultrasound of a partial molar pregnancy may show: - A growth-restricted fetus - Low amniotic fluid - A thick cystic placenta If your health care provider detects a molar pregnancy, he or she may check for other medical problems, including: - Preeclampsia - Hyperthyroidism - Anemia A molar pregnancy can't continue as a normal viable pregnancy. To prevent complications, the abnormal placental tissue must be removed. Treatment usually consists of one or more of the following steps: - Dilation and curettage (D and C). To treat a molar pregnancy, your doctor will remove the molar tissue from your uterus with a procedure called dilation and curettage (D and C). A D and C is usually done as an outpatient procedure in a hospital. During the procedure, you'll receive a local or general anesthetic and be positioned on the operating room table on your back with your legs in stirrups. Your doctor will insert a speculum into your vagina, as in a pelvic exam, to see your cervix. He or she will then dilate your cervix and remove uterine tissue with a vacuum device. - Hysterectomy. Rarely, if there is increased risk of gestational trophoblastic neoplasia (GTN) and there's no desire for future pregnancies, the uterus may be removed (hysterectomy). - HCG monitoring. After the molar tissue is removed, your doctor will repeat measurements of your HCG level until it returns to normal. If you continue to have HCG in your blood, you may need additional treatment. Once treatment for the molar pregnancy is complete, your doctor may continue to monitor your HCG levels for six months to one year to make sure there's no remaining molar tissue. Because pregnancy HCG levels also increase during a normal pregnancy, your doctor may recommend you wait six to 12 months before trying to become pregnant again. Your provider will recommend a reliable form of birth control during this time.",
+    "https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/syc-20375175"
+  ],
+  [
+    "Hydatidiform mole: Hydatidiform mole (HM) is a rare mass or growth that forms inside the womb (uterus) at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD). HM, or molar pregnancy, results from abnormal fertilization of the oocyte (egg). It results in an abnormal fetus. The placenta grows normally with little or no growth of the fetal tissue. The placental tissue forms a mass in the uterus. On ultrasound this mass often has a grape-like appearance, as it contains many small cysts. Chance of mole formation is higher in older women. A history of mole in earlier years is also a risk factor.\u00a0 Molar pregnancy can be of 2 types: - Partial molar pregnancy. There is an abnormal placenta and some fetal development. - Complete molar pregnancy. There is an abnormal placenta and no fetus. There is no way to prevent formation of these masses. Symptoms of a molar pregnancy may include: - Abnormal growth of the uterus, either bigger or smaller than usual - Severe nausea and vomiting - Vaginal bleeding during the first 3 months of pregnancy - Symptoms of hyperthyroidism, including heat intolerance,\u00a0loose stools, rapid heart rate, restlessness\u00a0or nervousness, warm and moist skin, trembling hands, or unexplained weight loss - Symptoms similar to preeclampsia that occur in the first trimester or early second trimester, including high blood pressure and swelling in the feet, ankles, and legs (this is almost always a sign of a hydatidiform mole, because preeclampsia is extremely rare this early in a normal pregnancy) Your health care provider will perform a pelvic exam, which may show signs similar to a normal pregnancy. However, the size of the womb may be abnormal and there may be no heart sounds from the baby. Also, there may be some vaginal bleeding. A pregnancy ultrasound will show a snowstorm appearance with an abnormal placenta, with or without some development of a baby. Tests done may include: - hCG (quantitative levels) blood test - Abdominal or vaginal ultrasound of the pelvis - Chest x-ray - CT or MRI of the abdomen (imaging tests) - Complete blood count (CBC) - Blood clotting tests - Kidney and liver function tests If your provider suspects a molar pregnancy, removal of the abnormal tissue with a dilation and curettage (D and C) will most likely be suggested. D and C may also be done using suction. This is called suction aspiration (The method uses a suction cup to remove contents from the uterus).\u00a0 Sometimes a partial molar pregnancy can continue. A woman may choose to continue her pregnancy in the hope of having a successful birth and delivery. However, these are very high-risk pregnancies. Risks may include bleeding, problems with blood pressure, and premature delivery (having the baby before it is fully developed). In rare cases, the fetus is genetically normal. Women need to completely discuss the risks with their provider before continuing the pregnancy. A hysterectomy (surgery to remove the uterus) may be an option for older women who DO NOT wish to become pregnant in the future. After treatment, your hCG level will be followed. It is important to avoid another pregnancy and to use a reliable contraceptive for 6 to 12 months after treatment for a molar pregnancy. This time allows for accurate testing to be sure that the abnormal tissue does not grow back. Women who get pregnant too soon after a molar pregnancy are at high risk of having another molar pregnancy. Most HMs are noncancerous (benign). Treatment is usually successful. Close follow-up by your provider is important to ensure that signs of the molar pregnancy are gone and pregnancy hormone levels return to normal. In some cases of complete HM, moles can become invasive. These moles can grow deep into the uterine wall and cause bleeding or other complications. In very few cases of complete HM, moles develop into a choriocarcinoma. This is a fast-growing cancer. It is usually successfully treated with chemotherapy, but can be life threatening.\u00a0 Complications of molar pregnancy may include: - Change\u00a0to invasive molar disease or choriocarcinoma - Preeclampsia - Thyroid problems - Molar pregnancy that continues or comes back Complications from surgery to remove a molar pregnancy may include: - Excessive bleeding, possibly requiring a blood transfusion - Side effects of anesthesia Updated by: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000909.htm"
+  ],
+  [
+    "Molar pregnancy (Risk factors): Approximately 1 in every 1,000 pregnancies is diagnosed as a molar pregnancy. Various factors are associated with molar pregnancy, including: - Maternal age. A molar pregnancy is more likely in women older than age 35 or younger than age 20. - Previous molar pregnancy. If you've had one molar pregnancy, you're more likely to have another. A repeat molar pregnancy happens, on average, in 1 out of every 100 women.",
+    "https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/syc-20375175"
+  ],
+  [
+    "Hydatidiform mole: Molar pregnancy is a condition in which the placenta does not develop properly. The symptoms of molar pregnancy, which may include vaginal bleeding, severe morning sickness, stomach cramps, and high blood pressure , typically begin around the 10th week of pregnancy. Because the embryo does not form or is malformed in molar pregnancies, and because there is a small risk of developing a cancer called choriocarcinoma, a D and C is usually performed. [1] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Anemia Very frequent Enlarged uterus Very frequent Menometrorrhagia Very frequent Nausea and vomiting Very frequent Preeclampsia Very frequent Spontaneous abortion Very frequent Hyperthyroidism Occasional Abnormality of the genitourinary system - Autosomal recessive inheritance - Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. The following diseases are related to Hydatidiform mole. If you have a question about any of these diseases, you can contact GARD. Gestational trophoblastic tumor Recurrent hydatidiform mole",
+    "https://rarediseases.info.nih.gov/diseases/10263/hydatidiform-mole"
+  ],
+  [
+    "Molar pregnancy (Symptoms): A molar pregnancy may seem like a normal pregnancy at first, but most molar pregnancies cause specific signs and symptoms, including: - Dark brown to bright red vaginal bleeding during the first trimester - Severe nausea and vomiting - Sometimes vaginal passage of grapelike cysts - Pelvic pressure or pain If you experience any signs or symptoms of a molar pregnancy, consult your doctor or pregnancy care provider. He or she may detect other signs of a molar pregnancy, such as: - Rapid uterine growth - the uterus is too large for the stage of pregnancy - High blood pressure - Preeclampsia - a condition that causes high blood pressure and protein in the urine after 20 weeks of pregnancy - Ovarian cysts - Anemia - Overactive thyroid (hyperthyroidism)",
+    "https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/syc-20375175"
+  ],
+  [
+    "Molar pregnancy (Treatment): A molar pregnancy can't continue as a normal viable pregnancy. To prevent complications, the abnormal placental tissue must be removed. Treatment usually consists of one or more of the following steps: - Dilation and curettage (D and C). To treat a molar pregnancy, your doctor will remove the molar tissue from your uterus with a procedure called dilation and curettage (D and C). A D and C is usually done as an outpatient procedure in a hospital. During the procedure, you'll receive a local or general anesthetic and be positioned on the operating room table on your back with your legs in stirrups. Your doctor will insert a speculum into your vagina, as in a pelvic exam, to see your cervix. He or she will then dilate your cervix and remove uterine tissue with a vacuum device. - Hysterectomy. Rarely, if there is increased risk of gestational trophoblastic neoplasia (GTN) and there's no desire for future pregnancies, the uterus may be removed (hysterectomy). - HCG monitoring. After the molar tissue is removed, your doctor will repeat measurements of your HCG level until it returns to normal. If you continue to have HCG in your blood, you may need additional treatment. Once treatment for the molar pregnancy is complete, your doctor may continue to monitor your HCG levels for six months to one year to make sure there's no remaining molar tissue. Because pregnancy HCG levels also increase during a normal pregnancy, your doctor may recommend you wait six to 12 months before trying to become pregnant again. Your provider will recommend a reliable form of birth control during this time.",
+    "https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/syc-20375175"
+  ],
+  [
+    "Molar pregnancy (Causes): A molar pregnancy is caused by an abnormally fertilized egg. Human cells normally contain 23 pairs of chromosomes. One chromosome in each pair comes from the father, the other from the mother. In a complete molar pregnancy, an empty egg is fertilized by one or two sperm, and all of the genetic material is from the father. In this situation, the chromosomes from the mother's egg are lost or inactivated and the father's chromosomes are duplicated. In a partial or incomplete molar pregnancy, the mother's chromosomes remain but the father provides two sets of chromosomes. As a result, the embryo has 69 chromosomes instead of 46. This most often occurs when two sperm fertilize an egg, resulting in an extra copy of the father's genetic material.",
+    "https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/syc-20375175"
+  ],
+  [
+    "Psoriatic arthritis (Diagnosis): During the exam, your doctor may: - Closely examine your joints for signs of swelling or tenderness - Check your fingernails for pitting, flaking and other abnormalities - Press on the soles of your feet and around your heels to find tender areas No single test can confirm a diagnosis of psoriatic arthritis. But some types of tests can rule out other causes of joint pain, such as rheumatoid arthritis or gout. Imaging tests - X-rays. Plain X-rays can help pinpoint changes in the joints that occur in psoriatic arthritis but not in other arthritic conditions. - Magnetic resonance imaging (MRI). MRI utilizes radio waves and a strong magnetic field to produce very detailed images of both hard and soft tissues in your body. This type of imaging test may be used to check for problems with the tendons and ligaments in your feet and lower back. Laboratory tests - Rheumatoid factor (RF). RF is an antibody that's often present in the blood of people with rheumatoid arthritis, but it's not usually in the blood of people with psoriatic arthritis. For that reason, this test can help your doctor distinguish between the two conditions. - Joint fluid test. Using a needle, your doctor can remove a small sample of fluid from one of your affected joints - often the knee. Uric acid crystals in your joint fluid may indicate that you have gout rather than psoriatic arthritis.",
+    "https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/symptoms-causes/syc-20354076"
+  ],
+  [
+    "What are the symptoms of Symphalangism with multiple anomalies of hands and feet?: What are the signs and symptoms of Symphalangism with multiple anomalies of hands and feet? The Human Phenotype Ontology provides the following list of signs and symptoms for Symphalangism with multiple anomalies of hands and feet. If the information is available, the table below includes how often the symptom is seen in people with this condition. You can use the MedlinePlus Medical Dictionary to look up the definitions for these medical terms. Signs and Symptoms Approximate number of patients (when available) Abnormal dermatoglyphics 90% Finger syndactyly 90% Symphalangism affecting the phalanges of the hand 90% Brachydactyly syndrome 50% Macrocephaly 50% Hearing impairment 7.5% Kyphosis 7.5% Tarsal synostosis 7.5% Absent dorsal skin creases over affected joints - Autosomal dominant inheritance - Clinodactyly of the 5th toe - Cutaneous finger syndactyly - Proximal symphalangism (hands) - Reduced proximal interphalangeal joint space - Small hypothenar eminence - Small thenar eminence - Toe syndactyly - The Human Phenotype Ontology (HPO) has collected information on how often a sign or symptom occurs in a condition. Much of this information comes from Orphanet, a European rare disease database. The frequency of a sign or symptom is usually listed as a rough estimate of the percentage of patients who have that feature. The frequency may also be listed as a fraction. The first number of the fraction is how many people had the symptom, and the second number is the total number of people who were examined in one study. For example, a frequency of 25/25 means that in a study of 25 people all patients were found to have that symptom. Because these frequencies are based on a specific study, the fractions may be different if another group of patients are examined. Sometimes, no information on frequency is available. In these cases, the sign or symptom may be rare or common.",
+    "https://rarediseases.info.nih.gov/gard/5077/symphalangism-with-multiple-anomalies-of-hands-and-feet"
+  ],
+  [
+    "Rheumatoid arthritis (Diagnosis): Rheumatoid arthritis can be difficult to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases. There is no one blood test or physical finding to confirm the diagnosis. During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she may also check your reflexes and muscle strength. Blood tests People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP), which may indicate the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies. Imaging tests Your doctor may recommend X-rays to help track the progression of rheumatoid arthritis in your joints over time. MRI and ultrasound tests can help your doctor judge the severity of the disease in your body.",
+    "https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648"
+  ],
+  [
+    "Reactive arthritis (Diagnosis): During the physical exam, your doctor is likely to check your joints for signs and symptoms of inflammation, such as swelling, warmth and tenderness, and test range of motion in your spine and affected joints. Your doctor might also check your eyes for inflammation and your skin for rashes. Blood tests Your doctor might recommend that a sample of your blood be tested for: - Evidence of past or current infection - Signs of inflammation - Antibodies associated with other types of arthritis - A genetic marker linked to reactive arthritis Joint fluid tests Your doctor might use a needle to withdraw a sample of fluid from within an affected joint. This fluid will be tested for: - White blood cell count. An increased number of white blood cells might indicate inflammation or an infection. - Infections. Bacteria in your joint fluid might indicate septic arthritis, which can result in severe joint damage. - Crystals. Uric acid crystals in your joint fluid might indicate gout. This very painful type of arthritis often affects the big toe. Imaging tests X-rays of your low back, pelvis and joints can indicate whether you have any of the characteristic signs of reactive arthritis. X-rays can also rule out other types of arthritis.",
+    "https://www.mayoclinic.org/diseases-conditions/reactive-arthritis/symptoms-causes/syc-20354838"
+  ],
+  [
+    "Juvenile idiopathic arthritis (Diagnosis): Diagnosis of juvenile idiopathic arthritis can be difficult because joint pain can be caused by many different types of problems. No single test can confirm a diagnosis, but tests can help rule out some other conditions that produce similar signs and symptoms. Blood tests Some of the most common blood tests for suspected cases include: - Erythrocyte sedimentation rate (ESR). The sedimentation rate is the speed at which your red blood cells settle to the bottom of a tube of blood. An elevated rate can indicate inflammation. Measuring the ESR is primarily used to determine the degree of inflammation. - C-reactive protein. This blood test also measures levels of general inflammation in the body but on a different scale than the ESR. - Anti-nuclear antibody. Anti-nuclear antibodies are proteins commonly produced by the immune systems of people with certain autoimmune diseases, including arthritis. They are a marker for an increased chance of eye inflammation. - Rheumatoid factor. This antibody is occasionally found in the blood of children who have juvenile idiopathic arthritis. - Cyclic citrullinated peptide (CCP). Like the rheumatoid factor, the CCP is another antibody that may be found in the blood of children with juvenile idiopathic arthritis. In many children with juvenile idiopathic arthritis, no significant abnormality will be found in these blood tests. Imaging scans X-rays or magnetic resonance imaging (MRI) may be taken to exclude other conditions, such as fractures, tumors, infection or congenital defects. Imaging may also be used from time to time after the diagnosis to monitor bone development and to detect joint damage.",
+    "https://www.mayoclinic.org/diseases-conditions/juvenile-idiopathic-arthritis/symptoms-causes/syc-20374082"
+  ],
+  [
+    "Arthritis (Diagnosis): During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she will also want to see how well you can move your joints. Depending on the type of arthritis suspected, your doctor may suggest some of the following tests. Laboratory tests The analysis of different types of body fluids can help pinpoint the type of arthritis you may have. Fluids commonly analyzed include blood, urine and joint fluid. To obtain a sample of your joint fluid, your doctor will cleanse and numb the area before inserting a needle in your joint space to withdraw some fluid (aspiration). Imaging These types of tests can detect problems within your joint that may be causing your symptoms. Examples include: - X-rays. Using low levels of radiation to visualize bone, X-rays can show cartilage loss, bone damage and bone spurs. X-rays may not reveal early arthritic damage, but they are often used to track progression of the disease. - Computerized tomography (CT). CT scanners take X-rays from many different angles and combine the information to create cross-sectional views of internal structures. CTs can visualize both bone and the surrounding soft tissues. - Magnetic resonance imaging (MRI). Combining radio waves with a strong magnetic field, MRI can produce more-detailed cross-sectional images of soft tissues such as cartilage, tendons and ligaments. - Ultrasound. This technology uses high-frequency sound waves to image soft tissues, cartilage and fluid-containing structures such as bursae. Ultrasound also is used to guide needle placement for joint aspirations and injections.",
+    "https://www.mayoclinic.org/diseases-conditions/arthritis/symptoms-causes/syc-20350772"
+  ],
+  [
+    "Thumb arthritis (Diagnosis): During a physical exam, your doctor will ask about your symptoms and look for noticeable swelling or lumps on your joints. Your doctor might hold your joint while moving your thumb, with pressure, against your wrist bone. If this movement produces a grinding sound, or causes pain or a gritty feeling, the cartilage has likely worn down, and the bones are rubbing against each other. Imaging techniques, usually X-rays, can reveal signs of thumb arthritis, including: - Bone spurs - Worn-down cartilage - Loss of joint space",
+    "https://www.mayoclinic.org/diseases-conditions/thumb-arthritis/symptoms-causes/syc-20378339"
+  ],
+  [
+    "rheumatoid arthritis (Description): Rheumatoid arthritis is a disease that causes chronic abnormal inflammation, primarily affecting the joints. The most common signs and symptoms are pain, swelling, and stiffness of the joints. Small joints in the hands and feet are involved most often, although larger joints (such as the shoulders, hips, and knees) may become involved later in the disease. Joints are typically affected in a symmetrical pattern; for example, if joints in the hand are affected, both hands tend to be involved. People with rheumatoid arthritis often report that their joint pain and stiffness is worse when getting out of bed in the morning or after a long rest. Rheumatoid arthritis can also cause inflammation of other tissues and organs, including the eyes, lungs, and blood vessels. Additional signs and symptoms of the condition can include a loss of energy, a low fever, weight loss, and a shortage of red blood cells (anemia). Some affected individuals develop rheumatoid nodules, which are firm lumps of noncancerous tissue that can grow under the skin and elsewhere in the body. The signs and symptoms of rheumatoid arthritis usually appear in mid- to late adulthood. Many affected people have episodes of symptoms (flares) followed by periods with no symptoms (remissions) for the rest of their lives. In severe cases, affected individuals have continuous health problems related to the disease for many years. The abnormal inflammation can lead to severe joint damage, which limits movement and can cause significant disability.",
+    "https://ghr.nlm.nih.gov/condition/rheumatoid-arthritis"
+  ],
+  [
+    "Septic arthritis (Diagnosis): The following tests typically help diagnose septic arthritis: - Joint fluid analysis. Infections can alter the color, consistency, volume and makeup of the fluid within your joints. A sample of this fluid can be withdrawn from your affected joint with a needle. Laboratory tests can determine what organism is causing your infection, so your doctor will know which medications to prescribe. - Blood tests. These can determine if there are signs of infection in your blood. A sample of your blood is removed from a vein with a needle. - Imaging tests. X-rays and other imaging tests of the affected joint can assess damage to the joint.",
+    "https://www.mayoclinic.org/diseases-conditions/bone-and-joint-infections/symptoms-causes/syc-20350755"
+  ],
+  [
+    "Psoriatic arthritis: Psoriatic arthritis is a joint problem (arthritis) that often occurs with a skin condition called psoriasis. Psoriasis is a common skin problem that causes red patches on the body. It is an ongoing (chronic) inflammatory condition. About 1 in 20 people with psoriasis may develop arthritis with the skin condition. Nail psoriasis is linked to psoriatic arthritis. In most cases, psoriasis comes before the arthritis. The cause of psoriatic arthritis is not known. Genes, immune system, and environmental factors may play a role. It is likely that the skin and joint diseases may have similar causes. However, they may not occur together. The arthritis may be mild and involve only a few joints. The joints at the end of the fingers or toes may be more affected. In some people the disease may be severe and affect many joints, including the spine. Symptoms in the spine include stiffness, burning, and pain. They most often occur in the lower spine and sacrum. Most of the time, people with psoriatic arthritis have the skin and nail changes of psoriasis. Often, the skin gets worse at the same time as the arthritis. During a physical exam, the health care provider will look for: - Joint swelling - Skin patches (psoriasis) and pitting in the nails - Tenderness Joint x-rays may be done. There are no specific blood tests for psoriatic arthritis or for psoriasis, but the doctor may test for a gene called HLA-B27. Your provider may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling of the joints. Worse arthritis will need to be treated with more powerful drugs called disease-modifying antirheumatic drugs (DMARDs). These include: - Leflunomide - Methotrexate - Sulfasalazine New medicines that block an inflammatory protein called tumor necrosis factor (TNF) are being widely used for progressive psoriatic arthritis. These drugs include: - Adalimumab (Humira) - Certolizumab (Cimzia) - Etanercept (Enbrel) - Golimumab (Simponi) - Infliximab (Remicade) Very painful joints may be injected with steroid medicines. In rare cases, surgery may be needed to repair or replace damaged joints. Your provider may suggest a mix of rest and exercise. Physical therapy may help increase joint movement. You may also use heat and cold therapy. The disease is often mild and affects only a few joints. In some people, very bad psoriatic arthritis may cause deformities in the hands, feet, and spine. Early treatment can ease pain and prevent joint damage even in very bad cases. Call your provider if arthritis symptoms develop along with psoriasis. Updated by: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Internal review and update on 07/24/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000413.htm"
+  ],
+  [
+    "Blood Clots (Summary): Summary Normally, if you get hurt, your body forms a blood clot to stop the bleeding. After the bleeding stops and healing takes place, your body usually breaks down and removes the clot. But some people get too many clots or their blood clots abnormally. Many conditions can cause the blood to clot too much or prevent blood clots from dissolving properly. Risk factors for excessive blood clotting include - Certain genetic disorders - Atherosclerosis - Diabetes - Atrial fibrillation - Overweight, obesity, and metabolic syndrome - Some medicines - Smoking - Staying in one position for a long time, such as being in the hospital or taking a long car or plane ride - Cancer and cancer treatments Blood clots can form in, or travel to, the blood vessels in the brain, heart, kidneys, lungs, and limbs. A clot in the veins deep in the limbs is called deep vein thrombosis (DVT). DVT usually affects the deep veins of the legs. If a blood clot in a deep vein breaks off and travels through the bloodstream to the lungs and blocks blood flow, it is called a pulmonary embolism. Other complications of blood clots include stroke, heart attack, kidney problems, kidney failure, and pregnancy-related problems. Treatments for blood clots include blood thinners and other medicines.",
+    "#"
+  ],
+  [
+    "Do I need to see a doctor for Low white blood cell count and cancer?: If you have any of the following symptoms, call your doctor: - Fevers, chills, or sweats. These may be signs of infection. - Diarrhea that does not go away or is bloody. - Severe nausea and vomiting. - Being unable to eat or drink. - Extreme weakness. - Redness, swelling, or drainage from any place where you have an IV line inserted into your body. - A new skin rash or blisters. - Pain in your stomach area. - A very bad headache or one that does not go away. - A cough that is getting worse. - Trouble breathing when you are at rest or when you are doing simple tasks. - Burning when you urinate.",
+    "https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000675.htm"
+  ],
+  [
+    "Vasculitis (Treatment): Treatment of vasculitis generally depends on the type of vasculitis, the organs affected and the severity in each individual. [1] The main goal of treatment is to reduce inflammation in the affected blood vessels. Individuals with mild vasculitis may only need over-the-counter pain medications, while those with severe vasculitis are often treated with prescription medications including corticosteroids and/or cytotoxic medicines that reduce or stop the immune response causing the inflammation. [1] Commonly used medications have included methotrexate, prednisone and/or cyclophosphamide. [2] In rare cases, surgery may be needed. Other treatments may be used for certain types of vasculitis (for example, high-dose aspirin and immune globulin for Kawasaki syndrome). [1] A study by U. Specks et al. published in August of 2013 in the New England Journal of Medicine found that a medication called rituximab is as effective as cyclophosphamide and glucocorticoids for ANCA-associated vasculitis; the authors reported that rituximab also requires a shorter treatment duration. For the patients in this study, administration of rituximab once a week for 4 weeks, followed by placebo, was as effective in the treatment of severe ANCA-associated vasculitis as conventional immunosuppressive therapy administered for 18 months. [3] See the NIH's news release \" Therapy for severe vasculitis shows long-term effectiveness\" for more information about this study.",
+    "https://rarediseases.info.nih.gov/diseases/9565/vasculitis"
+  ],
+  [
+    "Pulmonary Embolism (Summary): Summary A pulmonary embolism is a sudden blockage in a lung artery. The cause is usually a blood clot in the leg called a deep vein thrombosis that breaks loose and travels through the bloodstream to the lung. Pulmonary embolism is a serious condition that can cause - Permanent damage to the affected lung - Low oxygen levels in your blood - Damage to other organs in your body from not getting enough oxygen If a clot is large, or if there are many clots, pulmonary embolism can cause death. Half the people who have pulmonary embolism have no symptoms. If you do have symptoms, they can include shortness of breath, chest pain or coughing up blood. Symptoms of a blood clot include warmth, swelling, pain, tenderness and redness of the leg. The goal of treatment is to break up clots and help keep other clots from forming. NIH: National Heart, Lung, and Blood Institute",
+    "#"
+  ],
+  [
+    "Lupus anticoagulants and antiphospholipid antibodies (Treatment): LUPUS ANTICOAGULANT OR APL Often, you will not need treatment if you do not have symptoms or if you have never had a blood clot in the past. Take the following steps to help prevent blood clots from forming: - Avoid most birth control pills or hormone treatments for menopause (women). - DO NOT smoke or use other tobacco products. - Get up and move around during long plane flights or other times when you have to sit or lie down for extended periods. - Move your ankles up and down when you cannot move around. You will be prescribed blood-thinning medicines (such as heparin and warfarin) to help prevent blood clots: - After surgery - After a bone fracture - With active cancer - When you need to set or lie down for long periods of time, such as during a hospital stay or recovering at home You may also need to take blood thinners for 3 to 4 weeks after surgery to lower your risk of blood clots. ANTIPHOSPHOLIPID ANTIBODY SYNDROME (APS) In general, you will need long-term treatment with a blood thinner for a long time if you have the APS. Initial treatment may be heparin, either unfractionated or low-molecular heparin. These medicines are given by injection. In most cases, warfarin (Coumadin), which is given by mouth, is then started. It is necessary to monitor the level of anticoagulation frequently. This is most often done using the INR test. If you have APS and become pregnant, you will need to be followed closely by a provider expert in this condition. You will not take warfarin during pregnancy, but will be given low-molecular weight heparin instead. If you have SLE and APS your provider will also recommend that you take hydroxychloroquine.",
+    "https://medlineplus.gov/ency/article/000547.htm"
+  ],
+  [
+    "Vasculitis (Treatment): Treatment focuses on controlling the inflammation with medications and resolving any underlying disease that triggered your vasculitis. For your vasculitis, you may go through two treatment phases - first stopping the inflammation and then preventing relapse (maintenance therapy). Both phases involve prescription drugs. Which drugs and how long you need to take them depend on the type of vasculitis, the organs involved and how serious your condition is. Some people have initial success with treatment, then experience flare-ups later. Others may never see their vasculitis completely go away and need ongoing treatment. Medications Your doctor may prescribe a corticosteroid drug, such as prednisone or methylprednisolone (Medrol), to help control inflammation. Side effects of corticosteroids can be severe, especially if you take them for a long time. Possible side effects include weight gain, diabetes and bone thinning (osteoporosis). If a corticosteroid is needed for long-term (maintenance) therapy, you'll likely receive the lowest dose possible. Other medications may be prescribed with corticosteroids to control the inflammation so that the dosage of corticosteroids can be tapered more quickly. These medications are sometimes called steroid-sparing and may includemethotrexate (Trexall), azathioprine (Imuran, Azasan), mycophenolate (Cellcept) or cyclophosphamide. The specific medication that you'll need depends on the type and severity of vasculitis you have, which organs are involved, and any other medical problems that you have. Biologic therapies such as rituximab (Rituxan) or tocilizumab (Actemra) may be recommended, depending on the type of vasculitis you have. Surgery Sometimes, vasculitis causes a balloonlike bulge (aneurysm) to form in the wall of a blood vessel. This bulge may need surgery. Blocked arteries also may require surgical treatment.",
+    "https://www.mayoclinic.org/diseases-conditions/vasculitis/symptoms-causes/syc-20363435"
+  ],
+  [
+    "Blood clots: Blood clots are clumps that occur when blood hardens from a liquid to a solid. - A blood clot that forms inside\u00a0one of your veins or arteries is called a thrombus. A thrombus may also form in your heart. - A thrombus that breaks loose and travels from\u00a0one location in the body to another is called an embolus. A thrombus or embolus can partly or completely block the flow of blood in a blood vessel. - A blockage in an artery may prevent oxygen from reaching the tissues in that area. This is called ischemia. If ischemia is not treated promptly, it can lead to tissue damage or death. - A blockage in the vein will often cause fluid buildup and swelling. Situations in which a blood clot is more likely to form in veins include: - Being on long-term bed rest - Crossing your legs for long periods when sitting, or sitting for long periods, such as in a plane or car - During and after pregnancy - Taking birth control pills or estrogen hormones (especially in women who smoke) - Long-term use of an intravenous catheter - After surgery Blood clots are also more likely to form after an injury. People with cancer, obesity, and liver or kidney disease are also prone to blood clots. A buildup of cholesterol that narrows an artery may change or slow the flow of blood, making it easier for a blood clot or thrombus to form. Conditions that are passed down through families (inherited) may make you more likely to form abnormal blood clots. Inherited conditions that affect clotting are: - Factor V Leiden thrombophilia - Prothrombin G20210A mutation - Other rare conditions, such as protein C, protein S, and antithrombin III deficiencies A blood clot may block an artery or vein in the heart, affecting the: - Heart (angina or a heart attack) - Intestines (mesenteric ischemia\u00a0or mesenteric venous thrombosis) - Kidneys (renal vein thrombosis) - Leg or arm arteries - Legs (deep vein thrombosis) - Lungs (pulmonary embolism) - Neck or brain (stroke) Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists and Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/001124.htm"
+  ],
+  [
+    "Vasculitis: The following summary is from Orphanet, a European reference portal for information on rare diseases and orphan drugs. Orpha Number: 52759 Disease definition Vasculitis represents a clinically heterogenous group of diseases of multifactorial etiology characterized by inflammation of either large-sized vessels (large-vessel vasculitis, e.g. Giant- cell arteritis and Takayasu arteritis; see these terms), medium-sized vessels (medium-vessel vasculitis e.g. polyarteritis nodosa and Kawasaki disease; see these terms), or small-sized vessels (small-vessel vasculitis, e.g. granulomatosis with polyangiitis, microscopic polyangiitis, immunoglobulin A vasculitis, and cutaneous leukocytoclastic angiitis; see these terms). Vasculitis occurs at any age, may be acute or chronic, and manifests with general symptoms such as fever, weight loss and fatigue, as well as more specific clinical signs depending on the type of vessels and organs affected. The degree of severity is variable, ranging from life or sight threatening disease (e.g. Beh\u00e7et disease, see this term) to relatively minor skin disease. Visit the Orphanet disease page for more resources. Treatment of vasculitis generally depends on the type of vasculitis, the organs affected and the severity in each individual. [1] The main goal of treatment is to reduce inflammation in the affected blood vessels. Individuals with mild vasculitis may only need over-the-counter pain medications, while those with severe vasculitis are often treated with prescription medications including corticosteroids and/or cytotoxic medicines that reduce or stop the immune response causing the inflammation. [1] Commonly used medications have included methotrexate, prednisone and/or cyclophosphamide. [2] In rare cases, surgery may be needed. Other treatments may be used for certain types of vasculitis (for example, high-dose aspirin and immune globulin for Kawasaki syndrome). [1] A study by U. Specks et al. published in August of 2013 in the New England Journal of Medicine found that a medication called rituximab is as effective as cyclophosphamide and glucocorticoids for ANCA-associated vasculitis; the authors reported that rituximab also requires a shorter treatment duration. For the patients in this study, administration of rituximab once a week for 4 weeks, followed by placebo, was as effective in the treatment of severe ANCA-associated vasculitis as conventional immunosuppressive therapy administered for 18 months. [3] See the NIH's news release \" Therapy for severe vasculitis shows long-term effectiveness\" for more information about this study.",
+    "https://rarediseases.info.nih.gov/diseases/9565/vasculitis"
+  ],
+  [
+    "Hypersensitivity vasculitis: Hypersensitivity vasculitis is an extreme reaction to a drug, infection, or foreign substance. It leads to inflammation and damage to blood vessels, primarily in the skin. Hypersensitivity vasculitis is caused by an allergic reaction to a drug or other foreign substance. It can also be a reaction to an infection. Most often it affects people older than age 15. Often, the cause of the problem cannot be found even with a careful study of medical history. Hypersensitivity vasculitis may look like necrotizing vasculitis, which can affect blood vessels throughout the body. Symptoms may include: - New rash over large areas - Purple-colored spots and patches on the skin - Skin sores mostly located on the legs, buttocks, or trunk - Blisters on the skin - Hives (urticaria), may last longer than 24 hours - Open sores with dead tissue (necrotic ulcers) The health care provider will base the diagnosis on symptoms. The provider will evaluate how your skin looks after you have taken certain medicines or are exposed to a foreign substance (antigen). Results from an ESR test (erythrocyte sedimentation rate test) may be high. Skin biopsy shows inflammation of the small blood vessels. You may also have other tests to detect this condition. The goal of treatment is to reduce inflammation. Your provider may prescribe aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroids to reduce inflammation of the blood vessels. (DO NOT give aspirin to children except as advised by your provider). Your provider will tell you to stop taking medicines that could be causing this condition. Hypersensitivity vasculitis most often goes away over time. The condition may come back in some people. People with ongoing vasculitis should be checked for necrotizing vasculitis. Complications may include: - Lasting damage to the blood vessels or skin with scarring - Inflamed blood vessels affecting the internal organs Call your provider if you have symptoms of hypersensitivity vasculitis. DO NOT take medicines which have caused an allergic reaction in the past. Updated by: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000874.htm"
+  ],
+  [
+    "Fibromyalgia: - Fibromyalgia is a long-lasting or chronic disorder that causes muscle pain and fatigue (feeling tired). - The symptoms of fibromyalgia are pain and tenderness throughout your body. - You can treat your fibromyalgia with medicines, lifestyle changes, and complementary therapies. Fibromyalgia is a long-lasting or chronic disorder that causes muscle pain and fatigue (feeling tired). If you have fibromyalgia, you have pain and tenderness throughout your body. Sometime you may have two or more chronic pain conditions at the same time, such as: - Chronic fatigue syndrome. - Endometriosis. - Inflammatory bowel disease. - Interstitial cystitis. - Temporomandibular joint dysfunction (TMJ). - Vulvodynia. - Fibromyalgia is a long-lasting or chronic disorder that causes muscle pain and fatigue (feeling tired). - The symptoms of fibromyalgia are pain and tenderness throughout your body. - You can treat your fibromyalgia with medicines, lifestyle changes, and complementary therapies. - Fibromyalgia is a long-lasting or chronic disorder that causes muscle pain and fatigue (feeling tired). - The symptoms of fibromyalgia are pain and tenderness throughout your body. - You can treat your fibromyalgia with medicines, lifestyle changes, and complementary therapies. Fibromyalgia is a long-lasting or chronic disorder that causes muscle pain and fatigue (feeling tired). If you have fibromyalgia, you have pain and tenderness throughout your body. Sometime you may have two or more chronic pain conditions at the same time, such as: - Chronic fatigue syndrome. - Endometriosis. - Inflammatory bowel disease. - Interstitial cystitis. - Temporomandibular joint dysfunction (TMJ). - Vulvodynia. Anyone can get this disorder, though it occurs most often in women and often starts in middle age. If you have certain other diseases, you may be more likely to have fibromyalgia. These diseases include: - Rheumatoid arthritis. - Systemic lupus erythematosus (commonly called lupus). - Ankylosing spondylitis (spinal arthritis). If you have a family member with fibromyalgia, you may be more likely to get the disorder. Anyone can get this disorder, though it occurs most often in women and often starts in middle age. If you have certain other diseases, you may be more likely to have fibromyalgia. These diseases include: - Rheumatoid arthritis. - Systemic lupus erythematosus (commonly called lupus). - Ankylosing spondylitis (spinal arthritis). If you have a family member with fibromyalgia, you may be more likely to get the disorder. Doctors don\u2019t know the exact cause of fibromyalgia. Researchers continue to study fibromyalgia and think the following events may contribute to the cause of the disorder: - Stressful or traumatic events, such as car accidents. - Repetitive injuries. - Illness. - Certain diseases. Sometimes, fibromyalgia can develop on its own. Fibromyalgia tends to run in families and some scientists think that a gene or genes could make you more likely to develop fibromyalgia. The genes could make you react strongly to things that other people would not find painful. Doctors don\u2019t know the exact cause of fibromyalgia. Researchers continue to study fibromyalgia and think the following events may contribute to the cause of the disorder: - Stressful or traumatic events, such as car accidents. - Repetitive injuries. - Illness. - Certain diseases. Sometimes, fibromyalgia can develop on its own. Fibromyalgia tends to run in families and some scientists think that a gene or genes could make you more likely to develop fibromyalgia. The genes could make you react strongly to things that other people would not find painful. Doctors don\u2019t know the exact cause of fibromyalgia. Researchers continue to study fibromyalgia and think the following events may contribute to the cause of the disorder: - Stressful or traumatic events, such as car accidents. - Repetitive injuries. - Illness. - Certain diseases. Sometimes, fibromyalgia can develop on its own. Fibromyalgia tends to run in families and some scientists think that a gene or genes could make you more likely to develop fibromyalgia. The genes could make you react strongly to things that other people would not find painful. Currently there aren\u2019t any laboratory tests to diagnose fibromyalgia. You may see many doctors before receiving the diagnosis. This can happen because the main symptoms of fibromyalgia, pain and fatigue, are similar to many other conditions. Doctors often have to rule out other causes of these symptoms before making a diagnosis of fibromyalgia. Doctors use guidelines to help diagnose fibromyalgia, which can include: - A history of widespread pain lasting more than 3 months. - Physical symptoms including fatigue, waking unrefreshed, and cognitive (memory or thought) problems. - The number of areas throughout the body in which you had pain in the past week. Currently there aren\u2019t any laboratory tests to diagnose fibromyalgia. You may see many doctors before receiving the diagnosis. This can happen because the main symptoms of fibromyalgia, pain and fatigue, are similar to many other conditions. Doctors often have to rule out other causes of these symptoms before making a diagnosis of fibromyalgia. Doctors use guidelines to help diagnose fibromyalgia, which can include: - A history of widespread pain lasting more than 3 months. - Physical symptoms including fatigue, waking unrefreshed, and cognitive (memory or thought) problems. - The number of areas throughout the body in which you had pain in the past week. Currently there aren\u2019t any laboratory tests to diagnose fibromyalgia. You may see many doctors before receiving the diagnosis. This can happen because the main symptoms of fibromyalgia, pain and fatigue, are similar to many other conditions. Doctors often have to rule out other causes of these symptoms before making a diagnosis of fibromyalgia. Doctors use guidelines to help diagnose fibromyalgia, which can include: - A history of widespread pain lasting more than 3 months. - Physical symptoms including fatigue, waking unrefreshed, and cognitive (memory or thought) problems. - The number of areas throughout the body in which you had pain in the past week. You and your doctor can treat fibromyalgia with medicines, lifestyle changes, and complementary therapy. However, fibromyalgia can be hard to treat. It\u2019s important you find a doctor who is familiar with the disorder and its treatment. Doctors may prescribe one or more of the following medicines to help treat the symptoms of fibromyalgia: - Ibuprofen, aspirin, or naproxen you can buy over the counter.\u00a0 - Narcotic medicines to treat severe pain. - Duloxetine and minacipran to help the pain and fatigue. - Pregabalin to help treat nerve pain. Making lifestyle changes can also help you manage your fibromyalgia, including: - Getting enough sleep. - Exercising. - Adjusting your work demands. - Eating well. You can also try complementary therapies such as: - Massage therapy. - Movement therapy. - Chiropractic therapy. - Acupuncture. - Diet supplements. If you are using or would like to try a complementary therapy you should speak with your doctor, who may know more about if it is safe to try. You and your doctor can treat fibromyalgia with medicines, lifestyle changes, and complementary therapy. However, fibromyalgia can be hard to treat. It\u2019s important you find a doctor who is familiar with the disorder and its treatment. Doctors may prescribe one or more of the following medicines to help treat the symptoms of fibromyalgia: - Ibuprofen, aspirin, or naproxen you can buy over the counter.\u00a0 - Narcotic medicines to treat severe pain. - Duloxetine and minacipran to help the pain and fatigue. - Pregabalin to help treat nerve pain. Making lifestyle changes can also help you manage your fibromyalgia, including: - Getting enough sleep. - Exercising. - Adjusting your work demands. - Eating well. You can also try complementary therapies such as: - Massage therapy. - Movement therapy. - Chiropractic therapy. - Acupuncture. - Diet supplements. If you are using or would like to try a complementary therapy you should speak with your doctor, who may know more about if it is safe to try. You and your doctor can treat fibromyalgia with medicines, lifestyle changes, and complementary therapy. However, fibromyalgia can be hard to treat. It\u2019s important you find a doctor who is familiar with the disorder and its treatment. Doctors may prescribe one or more of the following medicines to help treat the symptoms of fibromyalgia: - Ibuprofen, aspirin, or naproxen you can buy over the counter.\u00a0 - Narcotic medicines to treat severe pain. - Duloxetine and minacipran to help the pain and fatigue. - Pregabalin to help treat nerve pain. Making lifestyle changes can also help you manage your fibromyalgia, including: - Getting enough sleep. - Exercising. - Adjusting your work demands. - Eating well. You can also try complementary therapies such as: - Massage therapy. - Movement therapy. - Chiropractic therapy. - Acupuncture. - Diet supplements. If you are using or would like to try a complementary therapy you should speak with your doctor, who may know more about if it is safe to try. Many family physicians, general internists, or rheumatologists can treat fibromyalgia. Rheumatologists are doctors who specialize in arthritis and other conditions that affect the joints or soft tissues. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is. Fibromyalgia treatment often requires a team approach. The team may include your doctor, a physical therapist, and possibly other health care providers. A pain or rheumatology clinic can be a good place to get treatment. Many family physicians, general internists, or rheumatologists can treat fibromyalgia. Rheumatologists are doctors who specialize in arthritis and other conditions that affect the joints or soft tissues. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is. Fibromyalgia treatment often requires a team approach. The team may include your doctor, a physical therapist, and possibly other health care providers. A pain or rheumatology clinic can be a good place to get treatment. Many family physicians, general internists, or rheumatologists can treat fibromyalgia. Rheumatologists are doctors who specialize in arthritis and other conditions that affect the joints or soft tissues. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is. Fibromyalgia treatment often requires a team approach. The team may include your doctor, a physical therapist, and possibly other health care providers. A pain or rheumatology clinic can be a good place to get treatment. There are many things you can do to while living with fibromyalgia, including: - Getting enough sleep. - Exercising. - Adjusting your work demands. - Eating well. Getting Enough Sleep Getting enough sleep and the right kind of sleep can help ease the pain and fatigue of fibromyalgia. You may have problems such as pain, restless legs syndrome, or brainwave changes that interfere with restful sleep. It is important to discuss any sleep problems with your doctor, who can prescribe or recommend treatment. Tips for Good Sleep - Keep regular sleep habits. Try to get to bed and wake up at the same time every day. - Avoid caffeine and alcohol in the late afternoon and evening. Even though alcohol can make you feel sleepy, drinking any close to bedtime can disturb your sleep. - Time your exercise. Regular daytime exercise can help improve your nighttime sleep. However, exercise within 3 hours of bedtime can keep you awake. - Avoid daytime naps. Sleeping in the afternoon can interfere with nighttime sleep. If you feel like you cannot get by without a nap, set an alarm for 1 hour. When it goes off, get up and start moving. - Reserve your bed for sleeping. Watching TV, reading, or using a laptop or phone in bed can keep you awake. - Keep your bedroom comfortable. Try to keep your bedroom dark, quiet, and cool. - Avoid drinking liquids and eating spicy meals before bed. Heartburn and late-night trips to the bathroom can interfere with your sleep. - Wind down before bed. Avoid working right up to bedtime. Try some relaxing activities that get you ready for sleep, such as listening to soft music or taking a warm bath. Exercising Although pain and fatigue may make exercise and daily activities difficult, it is important for you to be as physically active as possible. Research shows that regular exercise is one of the most useful treatments for fibromyalgia. If you have too much pain or fatigue to do exercise, you should begin with walking or other gentle exercise. Over time you can build your strength. Adjusting Your Work Life You can continue to work when you have fibromyalgia, but may have to make some changes to do so. For example, you may need to cut down the number of hours they work, switch to a less demanding job, or adapt your current job. An occupational therapist can help you make changes at work. For example, they can help design a more comfortable workstation or find more efficient and less painful ways to lift. Eating well Although some people with fibromyalgia report feeling better when they eat or avoid certain foods, no specific diet has been proven to influence fibromyalgia. Of course, it is important to have a healthy, balanced diet. Not only will proper nutrition give you more energy and make you generally feel better, it will also help you avoid other health problems. There are many things you can do to while living with fibromyalgia, including: - Getting enough sleep. - Exercising. - Adjusting your work demands. - Eating well. Getting Enough Sleep Getting enough sleep and the right kind of sleep can help ease the pain and fatigue of fibromyalgia. You may have problems such as pain, restless legs syndrome, or brainwave changes that interfere with restful sleep. It is important to discuss any sleep problems with your doctor, who can prescribe or recommend treatment. Tips for Good Sleep - Keep regular sleep habits. Try to get to bed and wake up at the same time every day. - Avoid caffeine and alcohol in the late afternoon and evening. Even though alcohol can make you feel sleepy, drinking any close to bedtime can disturb your sleep. - Time your exercise. Regular daytime exercise can help improve your nighttime sleep. However, exercise within 3 hours of bedtime can keep you awake. - Avoid daytime naps. Sleeping in the afternoon can interfere with nighttime sleep. If you feel like you cannot get by without a nap, set an alarm for 1 hour. When it goes off, get up and start moving. - Reserve your bed for sleeping. Watching TV, reading, or using a laptop or phone in bed can keep you awake. - Keep your bedroom comfortable. Try to keep your bedroom dark, quiet, and cool. - Avoid drinking liquids and eating spicy meals before bed. Heartburn and late-night trips to the bathroom can interfere with your sleep. - Wind down before bed. Avoid working right up to bedtime. Try some relaxing activities that get you ready for sleep, such as listening to soft music or taking a warm bath. Exercising Although pain and fatigue may make exercise and daily activities difficult, it is important for you to be as physically active as possible. Research shows that regular exercise is one of the most useful treatments for fibromyalgia. If you have too much pain or fatigue to do exercise, you should begin with walking or other gentle exercise. Over time you can build your strength. Adjusting Your Work Life You can continue to work when you have fibromyalgia, but may have to make some changes to do so. For example, you may need to cut down the number of hours they work, switch to a less demanding job, or adapt your current job. An occupational therapist can help you make changes at work. For example, they can help design a more comfortable workstation or find more efficient and less painful ways to lift. Eating well Although some people with fibromyalgia report feeling better when they eat or avoid certain foods, no specific diet has been proven to influence fibromyalgia. Of course, it is important to have a healthy, balanced diet. Not only will proper nutrition give you more energy and make you generally feel better, it will also help you avoid other health problems.",
+    "https://www.niams.nih.gov/health-topics/fibromyalgia"
+  ],
+  [
+    "Fibromyalgia (What causes it?): Doctors don\u2019t know the exact cause of fibromyalgia. Researchers continue to study fibromyalgia and think the following events may contribute to the cause of the disorder: - Stressful or traumatic events, such as car accidents. - Repetitive injuries. - Illness. - Certain diseases. Sometimes, fibromyalgia can develop on its own. Fibromyalgia tends to run in families and some scientists think that a gene or genes could make you more likely to develop fibromyalgia. The genes could make you react strongly to things that other people would not find painful. Doctors don\u2019t know the exact cause of fibromyalgia. Researchers continue to study fibromyalgia and think the following events may contribute to the cause of the disorder: - Stressful or traumatic events, such as car accidents. - Repetitive injuries. - Illness. - Certain diseases. Sometimes, fibromyalgia can develop on its own. Fibromyalgia tends to run in families and some scientists think that a gene or genes could make you more likely to develop fibromyalgia. The genes could make you react strongly to things that other people would not find painful. Doctors don\u2019t know the exact cause of fibromyalgia. Researchers continue to study fibromyalgia and think the following events may contribute to the cause of the disorder: - Stressful or traumatic events, such as car accidents. - Repetitive injuries. - Illness. - Certain diseases. Sometimes, fibromyalgia can develop on its own. Fibromyalgia tends to run in families and some scientists think that a gene or genes could make you more likely to develop fibromyalgia. The genes could make you react strongly to things that other people would not find painful.",
+    "https://www.niams.nih.gov/health-topics/fibromyalgia"
+  ],
+  [
+    "Fibromyalgia (How is it treated?): You and your doctor can treat fibromyalgia with medicines, lifestyle changes, and complementary therapy. However, fibromyalgia can be hard to treat. It\u2019s important you find a doctor who is familiar with the disorder and its treatment. Doctors may prescribe one or more of the following medicines to help treat the symptoms of fibromyalgia: - Ibuprofen, aspirin, or naproxen you can buy over the counter.\u00a0 - Narcotic medicines to treat severe pain. - Duloxetine and minacipran to help the pain and fatigue. - Pregabalin to help treat nerve pain. Making lifestyle changes can also help you manage your fibromyalgia, including: - Getting enough sleep. - Exercising. - Adjusting your work demands. - Eating well. You can also try complementary therapies such as: - Massage therapy. - Movement therapy. - Chiropractic therapy. - Acupuncture. - Diet supplements. If you are using or would like to try a complementary therapy you should speak with your doctor, who may know more about if it is safe to try. You and your doctor can treat fibromyalgia with medicines, lifestyle changes, and complementary therapy. However, fibromyalgia can be hard to treat. It\u2019s important you find a doctor who is familiar with the disorder and its treatment. Doctors may prescribe one or more of the following medicines to help treat the symptoms of fibromyalgia: - Ibuprofen, aspirin, or naproxen you can buy over the counter.\u00a0 - Narcotic medicines to treat severe pain. - Duloxetine and minacipran to help the pain and fatigue. - Pregabalin to help treat nerve pain. Making lifestyle changes can also help you manage your fibromyalgia, including: - Getting enough sleep. - Exercising. - Adjusting your work demands. - Eating well. You can also try complementary therapies such as: - Massage therapy. - Movement therapy. - Chiropractic therapy. - Acupuncture. - Diet supplements. If you are using or would like to try a complementary therapy you should speak with your doctor, who may know more about if it is safe to try. You and your doctor can treat fibromyalgia with medicines, lifestyle changes, and complementary therapy. However, fibromyalgia can be hard to treat. It\u2019s important you find a doctor who is familiar with the disorder and its treatment. Doctors may prescribe one or more of the following medicines to help treat the symptoms of fibromyalgia: - Ibuprofen, aspirin, or naproxen you can buy over the counter.\u00a0 - Narcotic medicines to treat severe pain. - Duloxetine and minacipran to help the pain and fatigue. - Pregabalin to help treat nerve pain. Making lifestyle changes can also help you manage your fibromyalgia, including: - Getting enough sleep. - Exercising. - Adjusting your work demands. - Eating well. You can also try complementary therapies such as: - Massage therapy. - Movement therapy. - Chiropractic therapy. - Acupuncture. - Diet supplements. If you are using or would like to try a complementary therapy you should speak with your doctor, who may know more about if it is safe to try.",
+    "https://www.niams.nih.gov/health-topics/fibromyalgia"
+  ],
+  [
+    "Genetic counseling: Genetics is the study of heredity, the process of a parent passing certain genes on to their children. - A person's appearance, such as height, hair color, skin color, and eye color, are determined by genes. - Birth defects and certain diseases are also often determined by genes. Genetic counseling is the process where parents can learn more about: - How likely it will be that their child would have a genetic disorder - What tests can check for genetic defects or disorders - Deciding whether or not you would like to haven these tests Couples who want to have a baby can have tests before they get pregnant. Health care providers can also test a fetus (unborn baby) to see if the baby will have a genetic disorder, such as cystic fibrosis or Down syndrome. It is up to you whether or not to have genetic counseling and testing. You will want to think about your personal desires, religious beliefs, and family circumstances. Some people have a greater risk than others for passing on genetic disorders to their children. They are: - People who have family members or children with genetic or birth defects - Jews of Eastern European descent. They may have a high risk of having babies with Tay-Sachs or Canavan's disease. - African-Americans, who may risk passing sickle-cell anemia (blood disease) on to their children - People of Southeast Asian or Mediterranean origin, who are at a higher risk of having children with thalassemia, a blood disease - Women who were exposed to toxins (poisons) that could cause birth defects - Women with a health problem, such as diabetes, that may affect their fetus - Couples who have had three of more miscarriages (fetus dies before 20 weeks of pregnancy) Testing is also suggested for: - Women who are over the age of 35, though genetic screening is now recommended for women of all ages. - Women who have had abnormal results on pregnancy screening, such as alpha-fetoprotein (AFP) Talk about genetic counseling with your provider and your family. Ask questions you may have about the test and what the results will mean for you. Keep in mind that genetic tests that are done before you get pregnant (conceive) can most often only tell you the odds of having a child with a certain birth defect. For instance, you may learn that you and your partner have a 1 in 4 chance of having a child with a certain disease or defect. If you decide to conceive, you will need more tests to see if your baby will have the defect or not. For those who may be at risk, test results can help answer such questions as: - Are the chances of having a baby with a genetic defect so high that we should look at other ways to start a family? - If you have a baby with a genetic disorder, are there treatments or surgeries that can help the baby? - How do we prepare ourselves for the chance we might have a child with a genetic problem? Are there classes or support groups for the disorder? Are there providers nearby who treat children with the disorder? - Should we continue the pregnancy? Are the baby's problems so severe that we might choose to end the pregnancy? You can prepare by finding out if any medical problems like these run in your family: - Child development problems - Miscarriages - Stillbirth - Severe childhood illnesses Steps in genetic counseling include: - You will fill out an in-depth family history form and talk to the counselor about health problems that run in your family. - You may also get blood tests to look at your chromosomes or other genes. - Your family history and test results will help the counselor look at genetic defects you may pass on to your children. If you choose to be tested after you become pregnant, tests that may be done during the pregnancy (either on the mother or fetus) include: - Amniocentesis, in which fluid is withdrawn from the amniotic sac (fluid that surrounds the baby) - Chorionic villus sampling (CVS), which takes a sample of the cells from the placenta - Percutaneous umbilical blood sampling (PUBS), which tests blood from the umbilical cord (the cord that connects the mother to the baby) - Noninvasive prenatal screening, which looks in the mother's blood for DNA from the baby that may have an extra or missing chromosome These tests have some risks. They may cause infection, harm the fetus, or cause a miscarriage. If you are worried about these risks, talk to your provider. The purpose of genetic counseling is simply to help parents make informed decisions. A genetic counselor will help you figure out how to use the information you get from your tests. If you are at risk, or if you find out that your baby has a disorder, your counselor and provider will talk to you about options and resources. But the decisions are yours to make. Updated by: Chad Haldeman-Englert, MD, FACMG, Fullerton Genetics Center, Asheville, NC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000510.htm"
+  ],
+  [
+    "Fibromyalgia: Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals. Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event. Women are more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression. While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help. Symptoms of fibromyalgia include: - Widespread pain. The pain associated with fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist. - Fatigue. People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea. - Cognitive difficulties. A symptom commonly referred to as \"fibro fog\" impairs the ability to focus, pay attention and concentrate on mental tasks. Fibromyalgia often co-exists with other painful conditions, such as: - Irritable bowel syndrome - Migraine and other types of headaches - Interstitial cystitis or painful bladder syndrome - Temporomandibular joint disorders Doctors don't know what causes fibromyalgia, but it most likely involves a variety of factors working together. These may include: - Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder. - Infections. Some illnesses appear to trigger or aggravate fibromyalgia. - Physical or emotional trauma. Fibromyalgia can sometimes be triggered by a physical trauma, such as a car accident. Psychological stress may also trigger the condition. Why does it hurt? Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals. Risk factors for fibromyalgia include: - Your sex. Fibromyalgia is diagnosed more often in women than in men. - Family history. You may be more likely to develop fibromyalgia if a relative also has the condition. - Other disorders. If you have osteoarthritis, rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia. In the past, doctors would check 18 specific points on a person's body to see how many of them were painful when pressed firmly. Newer guidelines don't require a tender point exam. Instead, a fibromyalgia diagnosis can be made if a person has had widespread pain for more than three months - with no underlying medical condition that could cause the pain. Blood tests While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include: - Complete blood count - Erythrocyte sedimentation rate - Cyclic citrullinated peptide test - Rheumatoid factor - Thyroid function tests In general, treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health. No one treatment works for all symptoms. Medications Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include: - Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Your doctor might suggest a prescription pain reliever such as tramadol (Ultram). Narcotics are not advised, because they can lead to dependence and may even worsen the pain over time. - Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or the muscle relaxant cyclobenzaprine to help promote sleep. - Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia. Therapy A variety of different therapies can help reduce the effect that fibromyalgia has on your body and your life. Examples include: - Physical therapy. A physical therapist can teach you exercises that will improve your strength, flexibility and stamina. Water-based exercises might be particularly helpful. - Occupational therapy. An occupational therapist can help you make adjustments to your work area or the way you perform certain tasks that will cause less stress on your body. - Counseling. Talking with a counselor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations. Self-care is critical in the management of fibromyalgia. - Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than do those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation. - Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping. - Exercise regularly. At first, exercise may increase your pain. But doing it gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful. - Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Moderation means not overdoing it on your good days, but likewise it means not self-limiting or doing too little on the days when symptoms flare. - Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day. Complementary and alternative therapies for pain and stress management aren't new. Some, such as meditation and yoga, have been practiced for thousands of years. But their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia. Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining acceptance in mainstream medicine. But many practices remain unproved because they haven't been adequately studied. - Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. Some studies indicate that acupuncture helps relieve fibromyalgia symptoms, while others show no benefit. - Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body's muscles and soft tissues. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body's natural painkillers. It often helps relieve stress and anxiety. - Yoga and tai chi. These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.",
+    "https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780"
+  ],
+  [
+    "Fibromyalgia (Who treats it?): Many family physicians, general internists, or rheumatologists can treat fibromyalgia. Rheumatologists are doctors who specialize in arthritis and other conditions that affect the joints or soft tissues. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is. Fibromyalgia treatment often requires a team approach. The team may include your doctor, a physical therapist, and possibly other health care providers. A pain or rheumatology clinic can be a good place to get treatment. Many family physicians, general internists, or rheumatologists can treat fibromyalgia. Rheumatologists are doctors who specialize in arthritis and other conditions that affect the joints or soft tissues. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is. Fibromyalgia treatment often requires a team approach. The team may include your doctor, a physical therapist, and possibly other health care providers. A pain or rheumatology clinic can be a good place to get treatment. Many family physicians, general internists, or rheumatologists can treat fibromyalgia. Rheumatologists are doctors who specialize in arthritis and other conditions that affect the joints or soft tissues. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is. Fibromyalgia treatment often requires a team approach. The team may include your doctor, a physical therapist, and possibly other health care providers. A pain or rheumatology clinic can be a good place to get treatment.",
+    "https://www.niams.nih.gov/health-topics/fibromyalgia"
+  ],
+  [
+    "Burning mouth syndrome: Burning mouth syndrome is the medical term for ongoing (chronic) or recurrent burning in the mouth without an obvious cause. This discomfort may affect the tongue, gums, lips, inside of your cheeks, roof of your mouth or widespread areas of your whole mouth. The burning sensation can be severe, as if you scalded your mouth. Burning mouth syndrome can appear suddenly or develop gradually over time. Unfortunately, the cause often can't be determined. Although that makes treatment more challenging, you can often get burning mouth syndrome under better control by working closely with your health care team. Burning mouth syndrome care at Mayo Clinic Symptoms of burning mouth syndrome may include: - A burning or scalded sensation that most commonly affects your tongue, but may also affect your lips, gums, palate, throat or whole mouth - A sensation of dry mouth with increased thirst - Taste changes, such as a bitter or metallic taste - Loss of taste The discomfort from burning mouth syndrome typically has several different patterns. It may: - Occur every day, with little discomfort when you wake, but become worse as the day progresses - Start as soon as you wake up and last all day - Come and go Whatever pattern of mouth discomfort you have, burning mouth syndrome may last for months to years. In rare cases, symptoms may suddenly go away on their own or become less frequent. Some sensations may be temporarily relieved during eating or drinking. Burning mouth syndrome usually doesn't cause any noticeable physical changes to your tongue or mouth. When to see a doctor If you have discomfort, burning or soreness of your tongue, lips, gums or other areas of your mouth, see your doctor or dentist. They may need to work together to help pinpoint a cause and develop an effective treatment plan. The cause of burning mouth syndrome can be classified as either primary or secondary. Primary burning mouth syndrome When no clinical or lab abnormalities can be identified, the condition is called primary or idiopathic burning mouth syndrome. Some research suggests that primary burning mouth syndrome is related to problems with taste and sensory nerves of the peripheral or central nervous system. Secondary burning mouth syndrome Sometimes burning mouth syndrome is caused by an underlying medical condition. In these cases, it's called secondary burning mouth syndrome. Underlying problems that may be linked to secondary burning mouth syndrome include: - Dry mouth (xerostomia), which can be caused by various medications, health problems, problems with salivary gland function or the side effects of cancer treatment - Other oral conditions, such as a fungal infection of the mouth (oral thrush), an inflammatory condition called oral lichen planus or a condition called geographic tongue that gives the tongue a map-like appearance - Nutritional deficiencies, such as a lack of iron, zinc, folate (vitamin B-9), thiamin (vitamin B-1), riboflavin (vitamin B-2), pyridoxine (vitamin B-6) and cobalamin (vitamin B-12) - Dentures, especially if they don't fit well, which can place stress on some muscles and tissues of your mouth, or if they contain materials that irritate mouth tissues - Allergies or reactions to foods, food flavorings, other food additives, fragrances, dyes or dental-work substances - Reflux of stomach acid (gastroesophageal reflux disease or GERD) that enters your mouth from your stomach - Certain medications, particularly high blood pressure medications - Oral habits, such as tongue thrusting, biting the tip of the tongue and teeth grinding (bruxism) - Endocrine disorders, such as diabetes or underactive thyroid (hypothyroidism) - Excessive mouth irritation, which may result from overbrushing your tongue, using abrasive toothpastes, overusing mouthwashes or having too many acidic drinks - Psychological factors, such as anxiety, depression or stress Burning mouth syndrome is uncommon. However, your risk may be greater if: - You're a woman - You're postmenopausal - You're over the age of 50 Burning mouth syndrome usually begins spontaneously, with no known triggering factor. However, certain factors may increase your risk of developing burning mouth syndrome, including: - Recent illness - Previous dental procedures - Wearing dentures - Allergic reactions to food - Medications - Traumatic life events - Stress - Anxiety - Depression Complications that burning mouth syndrome may cause or be associated with are mainly related to discomfort. They include, for example: - Difficulty falling asleep - Difficulty eating - Depression - Anxiety There's no one test that can determine if you have burning mouth syndrome. Instead, your doctor or dentist will try to rule out other problems before diagnosing burning mouth syndrome. Your doctor or dentist will review your medical history and medications, examine your mouth, and ask you to describe your symptoms, oral habits and oral care routine. In addition, your doctor will likely perform a general medical exam, looking for signs of other conditions. You may have some of the following tests: - Blood tests. Blood tests can check your complete blood count, glucose level, thyroid function, nutritional factors and immune functioning, all of which may provide clues about the source of your mouth discomfort. - Oral cultures or biopsies. Taking and analyzing samples from your mouth can determine whether you have a fungal, bacterial or viral infection. - Allergy tests. Your doctor may suggest allergy testing to see if you may be allergic to certain foods, additives or even substances in dentures. - Salivary measurements. With burning mouth syndrome, you may feel that you have a dry mouth. Salivary tests can confirm whether you have a reduced salivary flow. - Gastric reflux tests. These tests can determine if you have GERD. - Imaging. Your doctor may recommend an MRI, CT scan or other imaging tests to check for other health problems. - Temporarily stopping medication. If you take medications that may contribute to mouth discomfort, your doctor may suggest temporarily stopping them, if possible, to see if your discomfort goes away. Don't try this on your own, because it can be dangerous to stop some medications. - Psychological questionnaires. You may be asked to fill out questionnaires that can help determine if you have symptoms of depression, anxiety or other mental health conditions. For secondary burning mouth syndrome, treatment depends on any underlying conditions that may be causing your mouth discomfort. For example, replacing poorly fitting dentures or taking supplements for a vitamin deficiency may relieve your discomfort. That's why it's important to try to pinpoint the cause. Once any underlying causes are treated, your burning mouth syndrome symptoms should get better. There's no known cure for primary burning mouth syndrome and no one sure way to treat it. Solid research on the most effective methods is lacking. Treatment depends on your particular symptoms and is aimed at controlling them. You may need to try several treatment methods before finding one or a combination that helps reduce your mouth discomfort. Treatment options may include: - Saliva replacement products - Specific oral rinses or lidocaine - Capsaicin, a pain reliever that comes from chili peppers - An anticonvulsant medication called clonazepam (Klonopin) - Certain antidepressants - Medications that block nerve pain - Cognitive behavioral therapy In addition to medical treatment and prescription medications, these self-help measures may reduce your symptoms and your mouth discomfort: - Drink plenty of fluids to help ease the feeling of dry mouth, or suck on ice chips - Avoid acidic foods and liquids, such as tomatoes, orange juice, carbonated beverages and coffee - Avoid alcohol and products with alcohol, as they may irritate the lining of your mouth - Don't use tobacco products - Avoid spicy-hot foods - Avoid products with cinnamon or mint - Try different mild or flavor-free brands of toothpaste, such as one for sensitive teeth or one without mint or cinnamon - Take steps to reduce stress",
+    "https://www.mayoclinic.org/diseases-conditions/burning-mouth-syndrome/symptoms-causes/syc-20350911"
+  ],
+  [
+    "Do I need to see a doctor for Waardenburg syndrome?: Genetic counseling may be helpful if you have a family history of Waardenburg syndrome and plan to have children. Call for a hearing test if you or your child has deafness or decreased hearing.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/001428.htm"
+  ],
+  [
+    "Burning mouth syndrome (Risk factors): Burning mouth syndrome is uncommon. However, your risk may be greater if: - You're a woman - You're postmenopausal - You're over the age of 50 Burning mouth syndrome usually begins spontaneously, with no known triggering factor. However, certain factors may increase your risk of developing burning mouth syndrome, including: - Recent illness - Previous dental procedures - Wearing dentures - Allergic reactions to food - Medications - Traumatic life events - Stress - Anxiety - Depression",
+    "https://www.mayoclinic.org/diseases-conditions/burning-mouth-syndrome/symptoms-causes/syc-20350911"
+  ],
+  [
+    "Estradiol Transdermal Patch: Estradiol increases the risk that you will develop endometrial cancer (cancer of the lining of the uterus [womb]). The longer you use estradiol, the greater the risk that you will develop endometrial cancer. If you have not had a hysterectomy (surgery to remove the uterus), you should be given another medication called a progestin to take with transdermal estradiol. This may decrease your risk of developing endometrial cancer but may increase your risk of developing certain other health problems, including breast cancer. Before you begin using transdermal estradiol, tell your doctor if you have or have ever had cancer and if you have unusual vaginal bleeding. Call your doctor immediately if you have abnormal or unusual vaginal bleeding during your treatment with transdermal estradiol. Your doctor will watch you closely to help ensure you do not develop endometrial cancer during or after your treatment. In a large study, women who took estrogens (a group of medications that includes estradiol) by mouth with progestins had a higher risk of heart attacks, strokes, blood clots in the lungs or legs, breast cancer, and dementia (loss of ability to think, learn, and understand). Women who use transdermal estradiol alone or with progestins may also have a higher risk of developing these conditions. Tell your doctor if you smoke or use tobacco, if you have had a heart attack or a stroke in the past year, and if you or anyone in your family has or has ever had blood clots or breast cancer. Also tell your doctor if you have or have ever had high blood pressure, high blood levels of cholesterol or fats, diabetes, heart disease, lupus ( a condition in which the body attacks its own tissues causing damage and swelling), breast lumps, or an abnormal mammogram (x-ray of the breast used to find breast cancer). The following symptoms can be signs of the serious health conditions listed above. Call your doctor immediately if you experience any of the following symptoms while you are using transdermal estradiol: sudden, severe headache; sudden, severe vomiting; speech problems; dizziness or faintness; sudden complete or partial loss of vision; double vision; weakness or numbness of an arm or a leg; crushing chest pain or chest heaviness; coughing up blood; sudden shortness of breath; difficulty thinking clearly, remembering, or learning new things; breast lumps or other breast changes; discharge from nipples; or pain, tenderness, or redness in one leg. You can take steps to decrease the risk that you will develop a serious health problem while you are using transdermal estradiol. Do not use transdermal estradiol alone or with a progestin to prevent heart disease, heart attacks, strokes, or dementia. Use the lowest dose of transdermal estradiol that controls your symptoms and only use transdermal estradiol as long as needed. Talk to your doctor every 3 to 6 months to decide if you should use a lower dose of transdermal estradiol or should stop using the medication. You should examine your breasts every month and have a mammogram and a breast exam performed by a doctor every year to help detect breast cancer as early as possible. Your doctor will tell you how to properly examine your breasts and whether you should have these exams more often than once a year because of your personal or family medical history. Tell your doctor if you are having surgery or will be on bedrest. Your doctor may tell you to stop using transdermal estradiol 4 to 6 weeks before the surgery or bedrest to decrease the risk that you will develop blood clots. Talk to your doctor regularly about the risks and benefits of using transdermal estradiol. Most brands of estradiol transdermal patches are used to treat hot flushes (hot flashes; sudden strong feelings of heat and sweating) and/or vaginal dryness, itching, and burning in women who are experiencing menopause (change of life; the end of monthly menstrual periods). Transdermal estradiol is also used to prevent osteoporosis (a condition in which the bones become thin and weak and break easily) in women who are experiencing or have experienced menopause. Women who need to use transdermal estradiol for more than one of these reasons can benefit most from the medication. Women whose only bothersome symptoms are vaginal dryness, itching, or burning may benefit more from an estrogen product that is applied topically to the vagina. Women who only need a medication to prevent osteoporosis may benefit more from a different medication that does not contain estrogen. Most brands of estradiol transdermal patches are also sometimes used as a source of estrogen in young women who do not produce enough estrogen naturally. Estradiol is in a class of medications called estrogen hormones. It works by replacing estrogen that is normally produced by the body. Menostar\u00ae brand patches contain less estrogen than other brands of estradiol transdermal patches. Menostar\u00ae patches are used only to prevent osteoporosis in women who are experiencing or have experienced menopause. Transdermal estradiol comes as a patch to apply to the skin. Transdermal estradiol is usually applied once or twice a week, depending on the brand of patch that is used. Some women wear a patch all the time, and other women wear a patch according to a rotating schedule that alternates 3 weeks when the patch is worn followed by 1 week when the patch is not worn. Always apply your transdermal patch on the same day(s) of the week every week. There may be a calendar on the inner flap of your medication carton where you can keep track of your patch change schedule. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use transdermal estradiol exactly as directed. Do not apply more or fewer patches or apply the patches more often than prescribed by your doctor. Your doctor will start you on a low dose of transdermal estradiol and may increase your dose if your symptoms are still bothersome. If you are already taking or using an estrogen medication, your doctor will tell you how to switch from the estrogen medication you are taking or using to transdermal estradiol. Be sure you understand these instructions. Talk to your doctor about how well transdermal estradiol works for you. You should apply estradiol patches to clean, dry, cool skin in the lower stomach area, below your waistline. Some brands of patches may also be applied to the upper buttocks or the hips. Ask your doctor or pharmacist or read the manufacturer's information that comes with your patches to find the best place(s) to apply the brand of patches you have received. Do not apply any brand of estradiol patches to the breasts or to skin that is oily, damaged, cut, or irritated. Do not apply estradiol patches to the waistline where they may be rubbed off by tight clothing or to the lower buttocks where they may be rubbed off by sitting. Be sure that the skin in the area where you plan to apply an estradiol patch is free of lotion, powders, or creams. After you apply a patch to a particular area, wait at least 1 week before applying another patch to that spot. Some brands of patches should not be applied to an area of the skin that is exposed to sunlight. Talk to your doctor or pharmacist to find out whether your patch should be applied to an area that will not be exposed to sunlight. Talk to your doctor or pharmacist or read the manufacturer's information that came with your medication to find out if you need to be careful when you swim, bathe, shower, or use a sauna while wearing an estradiol transdermal patch. Some brands of patches are not likely to be affected by these activities, but some brands of patches may loosen. Some types of patches may also be pulled and loosened by your clothes or towel when you change clothes or dry your body. You may need to check that your patch is still firmly attached after these activities. If the patch loosens or falls off before it is time to replace it, try to press it back in place with your fingers. Be careful not to touch the sticky side of the patch with your fingers while you are doing this. If the patch cannot be pressed back on, fold it in half so it sticks to itself, dispose of it safely, so that it is out of the reach of children and pets, and apply a fresh patch to a different area. Replace the fresh patch on your next scheduled patch change day. Each brand of estradiol transdermal patches should be applied following the specific directions given in the manufacturer's information for the patient. Read this information carefully before you start using estradiol transdermal and each time you refill your prescription. Ask your doctor or pharmacist if you have any questions. The following general directions can help you remember some important things to do when you apply any type of estradiol transdermal patch. - Tear open the pouch with your fingers. Do not use scissors because they may damage the patch. Do not open the pouch until you are ready to apply the patch. - Remove the patch from the pouch. There may be a silver foil sticker used to protect the patch from moisture inside the pouch. Do not remove this sticker from the pouch. - Remove the protective liner from the patch and press the sticky side of the patch against your skin in the area you have chosen to wear your patch. Some patches have a liner that is made to peel off in two pieces. If your patch has that type of liner, you should peel off one part of the liner and press that side of the patch against your skin. Then fold back the patch, peel off the other part of the liner and press the second side of the patch against your skin. Always be careful not to touch the sticky side of the patch with your fingers. - Press down on the patch with your fingers or palm for 10 seconds. Be sure that the patch is firmly attached to your skin, especially around its edges. - Wear the patch all the time until it is time to remove it. When it is time to remove the patch, slowly peel it off of your skin. Fold the patch in half so that the sticky sides are pressed together and dispose of it safely, so that is out of reach of children and pets. - Some brands of patches may leave a sticky substance on your skin. In some cases, this can be rubbed off easily. In other cases, you should wait 15 minutes and then remove the substance using an oil or lotion. Read the information that came with your patches to find out what to do if a substance is left on your skin after you remove your patch. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before using transdermal estradiol, - tell your doctor and pharmacist if you are allergic to any brand of transdermal estradiol, any other estrogen products, any other medications, or any adhesives. Ask your doctor or pharmacist if you are not sure if a medication you are allergic to contains estrogen. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); antifungals such as itraconazole (Sporanox) and ketoconazole (Nizoral); aprepitant (Emend); carbamazepine (Carbatrol, Epitol, Tegretol); cimetidine (Tagamet); clarithromycin (Biaxin); cyclosporine (Neoral, Sandimmune); dexamethasone (Decadron, Dexpak); diltiazem (Cardizem, Dilacor, Tiazac, others); erythromycin (E.E.S, Erythrocin); fluoxetine (Prozac, Sarafem); fluvoxamine (Luvox); griseofulvin (Fulvicin, Grifulvin, Gris-PEG); lovastatin (Altocor, Mevacor); medications for human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) such as atazanavir (Reyataz), delaviridine (Rescriptor); efavirenz (Sustiva);indinavir (Crixivan), lopinavir (in Kaletra),nelfinavir (Viracept), nevirapine (Viramune); ritonavir (Norvir, in Kaletra), and saquinavir (Fortovase, Invirase); medications for thyroid disease; nefazodone; other medications that contain estrogen; phenobarbital; phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane, in Rifamate); sertraline (Zoloft);troleandomycin (TAO); verapamil (Calan, Covera, Isoptin, Verelan); and zafirlukast (Accolate). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor what herbal products you are taking, especially St. John's wort. - tell your doctor if you have or have ever had asthma; seizures; migraine headaches; endometriosis (a condition in which the type of tissue that lines the uterus [womb] grows in other areas of the body); uterine fibroids (growths in the uterus that are not cancer); yellowing of the skin or eyes, especially during pregnancy or while you were using an estrogen product; very high or very low levels of calcium in your blood; porphyria (condition in which abnormal substances build up in the blood and cause problems with the skin or nervous system)or gallbladder, thyroid, pancreas, liver or kidney disease. - tell your doctor if you are pregnant or plan to become pregnant, or are breast-feeding. If you become pregnant while using transdermal estradiol, call your doctor. - if you are using transdermal estradiol to prevent osteoporosis, talk to your doctor about additional ways to prevent the disease such as exercising and taking vitamin D and/or calcium supplements. Talk to your doctor about eating grapefruit and drinking grapefruit juice while using this medication. Talk to your doctor about ways to increase the amount of calcium and vitamin D in your diet. Apply the missed patch as soon as you remember. Then apply the next patch according to your regular schedule. Do not apply extra patches to make up for a missed patch. Transdermal estradiol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - headache - breast pain or tenderness - nausea - vomiting - constipation - gas - heartburn - weight gain or loss - hair loss - redness or irritation of the skin that was covered by the estradiol patch - swelling, redness, burning, irritation or itching of the vagina - vaginal discharge - painful menstrual periods - anxiety - depression - changes in mood - change in sexual desire - back, neck, or muscle pain - runny nose or congestion - cough - darkening of skin on face (may not go away even after you stop using transdermal estradiol) - unwanted hair growth - difficulty wearing contact lenses Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately: - bulging eyes - yellowing of the skin or eyes - loss of appetite - fever - joint pain - stomach tenderness, pain, or swelling - movements that are difficult to control - itching - hives - rash, blisters on skin, or other skin changes - swelling, of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs - hoarseness - difficulty breathing or swallowing Transdermal estradiol may increase your risk of developing cancer of the ovaries and gallbladder disease that may need to be treated with surgery. Talk to your doctor about the risks of using transdermal estradiol. Transdermal estradiol may cause growth to slow or stop early in children who use large doses for a long time. Your child's doctor will monitor her carefully during her treatment with transdermal estradiol. Talk to your child's doctor about the risks of giving this medication to your child. Transdermal estradiol may cause other side effects. Call your doctor if you have any unusual problems while using this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep estradiol patches sealed in their original pouches and out of reach of children. Store the patches at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of overdose may include: - nausea - vomiting - vaginal bleeding Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to transdermal estradiol. Before having any laboratory test, tell your doctor and the laboratory personnel that you are using transdermal estradiol. Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Alora\u00ae - Climara\u00ae - Esclim\u00ae\u00b6 - Estraderm\u00ae - FemPatch\u00ae\u00b6 - Menostar\u00ae - Vivelle\u00ae - Vivelle-Dot\u00ae",
+    "https://medlineplus.gov/druginfo/meds/a605042.html"
+  ],
+  [
+    "Who should get Estradiol Transdermal Patch and why is it prescribed?: Most brands of estradiol transdermal patches are used to treat hot flushes (hot flashes; sudden strong feelings of heat and sweating) and/or vaginal dryness, itching, and burning in women who are experiencing menopause (change of life; the end of monthly menstrual periods). Transdermal estradiol is also used to prevent osteoporosis (a condition in which the bones become thin and weak and break easily) in women who are experiencing or have experienced menopause. Women who need to use transdermal estradiol for more than one of these reasons can benefit most from the medication. Women whose only bothersome symptoms are vaginal dryness, itching, or burning may benefit more from an estrogen product that is applied topically to the vagina. Women who only need a medication to prevent osteoporosis may benefit more from a different medication that does not contain estrogen. Most brands of estradiol transdermal patches are also sometimes used as a source of estrogen in young women who do not produce enough estrogen naturally. Estradiol is in a class of medications called estrogen hormones. It works by replacing estrogen that is normally produced by the body. Menostar brand patches contain less estrogen than other brands of estradiol transdermal patches. Menostar patches are used only to prevent osteoporosis in women who are experiencing or have experienced menopause.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/meds/a605042.html"
+  ],
+  [
+    "Ethinyl Estradiol and Norelgestromin Transdermal Patch: Cigarette smoking increases the risk of serious side effects from the contraceptive patch, including heart attacks, blood clots, and strokes. This risk is higher for women over 35 years old and heavy smokers (15 or more cigarettes per day). If you use the contraceptive patch, you should not smoke. Ethinyl estradiol and norelgestromin transdermal system (patch) is used to prevent pregnancy. Norelgestromin is a progestin and ethinyl estradiol is an estrogen. Estrogen and progestin are two female sex hormones. Ethinyl estradiol and norelgestromin contraceptive patch works by preventing ovulation (the release of eggs from the ovaries) and by changing the cervical mucus and the lining of the uterus. The contraceptive patch is a very effective method of birth control, but it does not prevent the spread of human immunodeficiency virus (HIV; the virus that causes acquired immunodeficiency syndrome [AIDS]) and other sexually transmitted diseases. Ethinyl estradiol and norelgestromin transdermal system comes as a patch to apply to the skin. One patch is applied once a week for 3 weeks, followed by a patch-free week. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use the contraceptive patch exactly as directed. If you are just starting to use the contraceptive patch, you may apply your first patch on the first day of your menstrual period or the first Sunday after your period begins. If you apply your first patch after the first day of your menstrual period, you must use a backup method of birth control (such as a condom and/or a spermicide) for the first 7 days of the first cycle. Always apply your new patch on the same day of the week (the Patch Change Day). Apply a new patch once a week for 3 weeks. During Week 4, remove the old patch but do not apply a new patch, and expect to begin your menstrual period. On the day after Week 4 ends, apply a new patch to start a new 4-week cycle even if your menstrual period has not started or has not ended. You should not go more than 7 days without a patch. Apply the contraceptive patch to a clean, dry, intact, healthy area of skin on the buttock, abdomen, upper outer arm, or upper torso, in a place where it will not be rubbed by tight clothing. Do not place the contraceptive patch on the breasts or on skin that is red, irritated, or cut. Do not apply makeup, creams, lotions, powders, or other topical products to the skin area where the contraceptive patch is placed. Each new patch should be applied to a new spot on the skin to help avoid irritation. Do not cut, decorate, or change the patch in any way. Do not use extra tape, glue, or wraps to hold the patch in place. To use the contraceptive patch, follow these steps: - Open the foil pouch by tearing it along the edge. - Peel apart the foil pouch and open it flat. - Use your fingernail to lift one corner of the patch and peel the patch and its clear plastic liner off the foil liner. Sometimes patches can stick to the inside of the pouch; be careful not to remove the clear liner as you remove the patch. - Peel away half of the plastic liner. Avoid touching the sticky surface of the patch. - Apply the sticky surface of the patch to the skin and remove the other half of the plastic liner. Press down firmly on the patch with the palm of your hand for 10 seconds, making sure that the edges stick well. - After one week, remove the patch from your skin. Fold the used patch in half so that it sticks to itself and dispose of it so that it is out of the reach of children and pets. Do not flush the used patch down the toilet. Check your patch every day to make sure it is sticking. If the patch has been partially or completely detached for less than one day, try to reapply it in the same place immediately. Do not try to reapply a patch that is no longer sticky, that has stuck to itself or another surface, that has any material stuck to its surface or that has loosened or fallen off before. Apply a new patch instead. Your Patch Change Day will stay the same. If the patch has been partially or completely detached for more than one day, or if you do not know how long the patch has been detached, you may not be protected from pregnancy. You must start a new cycle by applying a new patch immediately; the day that you apply the new patch becomes your new Patch Change Day. Use backup birth control for the first week of the new cycle. If the skin under your patch becomes irritated, you may remove the patch and apply a new patch to a different spot on the skin. Leave the new patch in place until your regular Patch Change Day. Be sure to remove the old patch because you should never wear more than one patch at a time. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before using ethinyl estradiol and norelgestromin contraceptive patch, - tell your doctor and pharmacist if you are allergic to estrogens, progestins, or any other medications. - tell your doctor if you are using any other type of hormonal birth control, such as pills, rings, injections, or implants. Your doctor will tell you how and when you should stop using the other type of birth control and start using the contraceptive patch. Do not use any other type of hormonal birth control while you are using the contraceptive patch. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking. Be sure to mention any of the following: acetaminophen (APAP, Tylenol); antibiotics such as ampicillin; anticoagulants ('blood thinners') such as warfarin (Coumadin); antifungals such as itraconazole (Sporanox) and ketoconazole (Nizoral); ascorbic acid (vitamin C); atorvastatin (Lipitor); clofibrate ; cyclosporine (Neoral, Sandimmune); griseofulvin (Fulvicin, Grifulvin, Grisactin); HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir); medications for seizures such as carbamazepine (Tegretol), felbamate (Felbatol), phenobarbital (Luminal, Solfoton), oxcarbazepine (Trileptal), phenytoin (Dilantin), and topiramate (Topamax); morphine (Kadian, MS Contin, MSIR, others); oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), prednisone (Deltasone), and prednisolone (Prelone); rifampin (Rifadin, Rimactane); temazepam (Restoril); theophylline (Theobid, Theo-Dur); and thyroid medication such as levothyroxine (Levothroid, Levoxyl, Synthroid). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor what herbal products you are taking, especially products containing St. John's wort. - tell your doctor if you have recently had surgery or if you are on bedrest. Also tell your doctor if you have or have ever had a heart attack; a stroke; blood clots in your legs, lungs, or eyes; chest pain due to heart disease; cancer of the breasts, lining of the uterus, cervix, or vagina; vaginal bleeding between menstrual periods; hepatitis (swelling of the liver); yellowing of the skin or eyes, especially while you were pregnant or using hormonal contraceptives; a liver tumor; headaches that happen with other symptoms such as weakness or difficulty seeing or moving; high blood pressure; diabetes that has caused problems with your kidneys, eyes, nerves, or blood vessels; or heart valve disease. Your doctor will probably tell you that you should not use the contraceptive patch. - tell your doctor if you have recently given birth or had a miscarriage or abortion and if you weigh 198 lbs or more. Also tell your doctor if anyone in your family has ever had breast cancer and if you have or have ever had breast lumps, fibrocystic disease of the breast (condition in which lumps or masses that are not cancer form in the breasts) or an abnormal mammogram (x-ray of the breasts). Also tell your doctor if you have or have ever had high blood cholesterol and fats; diabetes; asthma; migraines or other types of headaches; depression; seizures; scanty or irregular menstrual periods; or liver, heart, gallbladder, or kidney disease. - tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using ethinyl estradiol and norelgestromin contraceptive patch, call your doctor immediately. You should suspect that you are pregnant and call your doctor if you have used the contraceptive patch correctly and you have missed two periods in a row, or if you have not used the contraceptive patch correctly and you have missed one period. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are using ethinyl estradiol and norelgestromin contraceptive patch. Talk to your doctor about this as soon as your surgery is scheduled because your doctor may want you to stop using the contraceptive patch several weeks before your surgery. - tell your doctor if you wear contact lenses. If you notice changes in your vision or ability to wear your lenses while using ethinyl estradiol and norelgestromin contraceptive patch, see an eye doctor. - you should know that when you use the contraceptive patch, the average amount of estrogen in your blood will be higher than it would be if you used an oral contraceptive (birth control pill), and this may increase the risk of serious side effects such as blood clots in the legs or lungs. Three studies were done to learn more about this risk. Two studies found that women who used contraceptive patches were more likely to develop blood clots than women who used oral contraceptives. The other study found that women who used contraceptive patches were no more likely to develop blood clots than women who used oral contraceptives. Talk to your doctor about the risks of using the contraceptive patch. Unless your doctor tells you otherwise, continue your normal diet. If you forget to apply your patch at the start of any patch cycle (Week 1, Day 1), you may not be protected from pregnancy. Apply the first patch of the new cycle as soon as you remember. There is now a new Patch Change Day and a new Day 1. Use a backup method of birth control for one week. If you forget to change your patch in the middle of the patch cycle (Week 2 or Week 3) for 1 or 2 days, apply a new patch immediately and apply the next patch on your usual Patch Change Day. If you forget to change your patch in the middle of the cycle for more than 2 days, you may not be protected from pregnancy. Stop the current cycle and start a new cycle immediately by applying a new patch. There is now a new Patch Change Day and a new Day 1. Use a backup method of birth control for 1 week. If you forget to remove your patch at the end of the patch cycle (Week 4), take it off as soon as you remember. Start the next cycle on the usual Patch Change Day, the day after Day 28. Ethinyl estradiol and norelgestromin contraceptive patch may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - irritation, redness, or rash in the place where you applied the patch - breast tenderness, enlargement, or discharge - nausea - vomiting - stomach cramps or bloating - weight gain or weight loss - change in appetite - brown or black skin patches - acne - swelling of the hands, feet, ankles, or lower legs - hair loss - bleeding or spotting between menstrual periods - changes in menstrual flow - painful or missed periods - vaginal itching or irritation - white vaginal discharge - difficulty wearing contact lenses Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately: - sudden severe headache or vomiting - speech problems - dizziness or faintness - weakness or numbness of an arm or leg - sudden partial or complete loss of vision - double vision - bulging eyes - sharp or crushing chest pain - chest tightness - coughing up blood - shortness of breath - calf pain - severe stomach pain - sleep problems, mood changes, and other signs of depression - yellowing of the skin or eyes - unusual bleeding - loss of appetite - extreme tiredness, weakness, or lack of energy - fever - dark-colored urine - light-colored stool - rash Ethinyl estradiol and norelgestromin contraceptive patch may increase the risk of developing endometrial and breast cancer, gallbladder disease, liver tumors, heart attack, stroke, and blood clots. Talk to your doctor about the risks of using this medication. Ethinyl estradiol and norelgestromin contraceptive patch may cause other side effects. Call your doctor if you have any unusual problems while using this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, remove all the patches that were applied and call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Keep all appointments with your doctor and the laboratory. You should have a complete physical examination every year, including blood pressure measurements, breast and pelvic exams, and a Pap test. Follow your doctor's directions for examining your breasts; report any lumps immediately. Before you have any laboratory tests, tell the laboratory personnel that you use ethinyl estradiol and norelgestromin contraceptive patch, as this medication may interfere with some laboratory tests. Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Ortho Evra\u00ae (containing Ethinyl Estradiol, Norelgestromin)",
+    "https://medlineplus.gov/druginfo/meds/a602006.html"
+  ],
+  [
+    "Estradiol Transdermal Patch (How should this medicine be used?): Transdermal estradiol comes as a patch to apply to the skin. Transdermal estradiol is usually applied once or twice a week, depending on the brand of patch that is used. Some women wear a patch all the time, and other women wear a patch according to a rotating schedule that alternates 3 weeks when the patch is worn followed by 1 week when the patch is not worn. Always apply your transdermal patch on the same day(s) of the week every week. There may be a calendar on the inner flap of your medication carton where you can keep track of your patch change schedule. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use transdermal estradiol exactly as directed. Do not apply more or fewer patches or apply the patches more often than prescribed by your doctor. Your doctor will start you on a low dose of transdermal estradiol and may increase your dose if your symptoms are still bothersome. If you are already taking or using an estrogen medication, your doctor will tell you how to switch from the estrogen medication you are taking or using to transdermal estradiol. Be sure you understand these instructions. Talk to your doctor about how well transdermal estradiol works for you. You should apply estradiol patches to clean, dry, cool skin in the lower stomach area, below your waistline. Some brands of patches may also be applied to the upper buttocks or the hips. Ask your doctor or pharmacist or read the manufacturer's information that comes with your patches to find the best place(s) to apply the brand of patches you have received. Do not apply any brand of estradiol patches to the breasts or to skin that is oily, damaged, cut, or irritated. Do not apply estradiol patches to the waistline where they may be rubbed off by tight clothing or to the lower buttocks where they may be rubbed off by sitting. Be sure that the skin in the area where you plan to apply an estradiol patch is free of lotion, powders, or creams. After you apply a patch to a particular area, wait at least 1 week before applying another patch to that spot. Some brands of patches should not be applied to an area of the skin that is exposed to sunlight. Talk to your doctor or pharmacist to find out whether your patch should be applied to an area that will not be exposed to sunlight. Talk to your doctor or pharmacist or read the manufacturer's information that came with your medication to find out if you need to be careful when you swim, bathe, shower, or use a sauna while wearing an estradiol transdermal patch. Some brands of patches are not likely to be affected by these activities, but some brands of patches may loosen. Some types of patches may also be pulled and loosened by your clothes or towel when you change clothes or dry your body. You may need to check that your patch is still firmly attached after these activities. If the patch loosens or falls off before it is time to replace it, try to press it back in place with your fingers. Be careful not to touch the sticky side of the patch with your fingers while you are doing this. If the patch cannot be pressed back on, fold it in half so it sticks to itself, dispose of it safely, so that it is out of the reach of children and pets, and apply a fresh patch to a different area. Replace the fresh patch on your next scheduled patch change day. Each brand of estradiol transdermal patches should be applied following the specific directions given in the manufacturer's information for the patient. Read this information carefully before you start using estradiol transdermal and each time you refill your prescription. Ask your doctor or pharmacist if you have any questions. The following general directions can help you remember some important things to do when you apply any type of estradiol transdermal patch. - Tear open the pouch with your fingers. Do not use scissors because they may damage the patch. Do not open the pouch until you are ready to apply the patch. - Remove the patch from the pouch. There may be a silver foil sticker used to protect the patch from moisture inside the pouch. Do not remove this sticker from the pouch. - Remove the protective liner from the patch and press the sticky side of the patch against your skin in the area you have chosen to wear your patch. Some patches have a liner that is made to peel off in two pieces. If your patch has that type of liner, you should peel off one part of the liner and press that side of the patch against your skin. Then fold back the patch, peel off the other part of the liner and press the second side of the patch against your skin. Always be careful not to touch the sticky side of the patch with your fingers. - Press down on the patch with your fingers or palm for 10 seconds. Be sure that the patch is firmly attached to your skin, especially around its edges. - Wear the patch all the time until it is time to remove it. When it is time to remove the patch, slowly peel it off of your skin. Fold the patch in half so that the sticky sides are pressed together and dispose of it safely, so that is out of reach of children and pets. - Some brands of patches may leave a sticky substance on your skin. In some cases, this can be rubbed off easily. In other cases, you should wait 15 minutes and then remove the substance using an oil or lotion. Read the information that came with your patches to find out what to do if a substance is left on your skin after you remove your patch. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.",
+    "https://medlineplus.gov/druginfo/meds/a605042.html"
+  ],
+  [
+    "Ethinyl Estradiol and Norelgestromin Transdermal Patch (Why is this medication prescribed?): Ethinyl estradiol and norelgestromin transdermal system (patch) is used to prevent pregnancy. Norelgestromin is a progestin and ethinyl estradiol is an estrogen. Estrogen and progestin are two female sex hormones. Ethinyl estradiol and norelgestromin contraceptive patch works by preventing ovulation (the release of eggs from the ovaries) and by changing the cervical mucus and the lining of the uterus. The contraceptive patch is a very effective method of birth control, but it does not prevent the spread of human immunodeficiency virus (HIV; the virus that causes acquired immunodeficiency syndrome [AIDS]) and other sexually transmitted diseases.",
+    "https://medlineplus.gov/druginfo/meds/a602006.html"
+  ],
+  [
+    "Estradiol Transdermal Patch (What side effects can this medication cause?): Transdermal estradiol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - headache - breast pain or tenderness - nausea - vomiting - constipation - gas - heartburn - weight gain or loss - hair loss - redness or irritation of the skin that was covered by the estradiol patch - swelling, redness, burning, irritation or itching of the vagina - vaginal discharge - painful menstrual periods - anxiety - depression - changes in mood - change in sexual desire - back, neck, or muscle pain - runny nose or congestion - cough - darkening of skin on face (may not go away even after you stop using transdermal estradiol) - unwanted hair growth - difficulty wearing contact lenses Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately: - bulging eyes - yellowing of the skin or eyes - loss of appetite - fever - joint pain - stomach tenderness, pain, or swelling - movements that are difficult to control - itching - hives - rash, blisters on skin, or other skin changes - swelling, of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs - hoarseness - difficulty breathing or swallowing Transdermal estradiol may increase your risk of developing cancer of the ovaries and gallbladder disease that may need to be treated with surgery. Talk to your doctor about the risks of using transdermal estradiol. Transdermal estradiol may cause growth to slow or stop early in children who use large doses for a long time. Your child's doctor will monitor her carefully during her treatment with transdermal estradiol. Talk to your child's doctor about the risks of giving this medication to your child. Transdermal estradiol may cause other side effects. Call your doctor if you have any unusual problems while using this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).",
+    "https://medlineplus.gov/druginfo/meds/a605042.html"
+  ],
+  [
+    "Ethinyl Estradiol and Norelgestromin Transdermal Patch (What special precautions should I follow?): Before using ethinyl estradiol and norelgestromin contraceptive patch, - tell your doctor and pharmacist if you are allergic to estrogens, progestins, or any other medications. - tell your doctor if you are using any other type of hormonal birth control, such as pills, rings, injections, or implants. Your doctor will tell you how and when you should stop using the other type of birth control and start using the contraceptive patch. Do not use any other type of hormonal birth control while you are using the contraceptive patch. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking. Be sure to mention any of the following: acetaminophen (APAP, Tylenol); antibiotics such as ampicillin; anticoagulants ('blood thinners') such as warfarin (Coumadin); antifungals such as itraconazole (Sporanox) and ketoconazole (Nizoral); ascorbic acid (vitamin C); atorvastatin (Lipitor); clofibrate ; cyclosporine (Neoral, Sandimmune); griseofulvin (Fulvicin, Grifulvin, Grisactin); HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir); medications for seizures such as carbamazepine (Tegretol), felbamate (Felbatol), phenobarbital (Luminal, Solfoton), oxcarbazepine (Trileptal), phenytoin (Dilantin), and topiramate (Topamax); morphine (Kadian, MS Contin, MSIR, others); oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), prednisone (Deltasone), and prednisolone (Prelone); rifampin (Rifadin, Rimactane); temazepam (Restoril); theophylline (Theobid, Theo-Dur); and thyroid medication such as levothyroxine (Levothroid, Levoxyl, Synthroid). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor what herbal products you are taking, especially products containing St. John's wort. - tell your doctor if you have recently had surgery or if you are on bedrest. Also tell your doctor if you have or have ever had a heart attack; a stroke; blood clots in your legs, lungs, or eyes; chest pain due to heart disease; cancer of the breasts, lining of the uterus, cervix, or vagina; vaginal bleeding between menstrual periods; hepatitis (swelling of the liver); yellowing of the skin or eyes, especially while you were pregnant or using hormonal contraceptives; a liver tumor; headaches that happen with other symptoms such as weakness or difficulty seeing or moving; high blood pressure; diabetes that has caused problems with your kidneys, eyes, nerves, or blood vessels; or heart valve disease. Your doctor will probably tell you that you should not use the contraceptive patch. - tell your doctor if you have recently given birth or had a miscarriage or abortion and if you weigh 198 lbs or more. Also tell your doctor if anyone in your family has ever had breast cancer and if you have or have ever had breast lumps, fibrocystic disease of the breast (condition in which lumps or masses that are not cancer form in the breasts) or an abnormal mammogram (x-ray of the breasts). Also tell your doctor if you have or have ever had high blood cholesterol and fats; diabetes; asthma; migraines or other types of headaches; depression; seizures; scanty or irregular menstrual periods; or liver, heart, gallbladder, or kidney disease. - tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using ethinyl estradiol and norelgestromin contraceptive patch, call your doctor immediately. You should suspect that you are pregnant and call your doctor if you have used the contraceptive patch correctly and you have missed two periods in a row, or if you have not used the contraceptive patch correctly and you have missed one period. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are using ethinyl estradiol and norelgestromin contraceptive patch. Talk to your doctor about this as soon as your surgery is scheduled because your doctor may want you to stop using the contraceptive patch several weeks before your surgery. - tell your doctor if you wear contact lenses. If you notice changes in your vision or ability to wear your lenses while using ethinyl estradiol and norelgestromin contraceptive patch, see an eye doctor. - you should know that when you use the contraceptive patch, the average amount of estrogen in your blood will be higher than it would be if you used an oral contraceptive (birth control pill), and this may increase the risk of serious side effects such as blood clots in the legs or lungs. Three studies were done to learn more about this risk. Two studies found that women who used contraceptive patches were more likely to develop blood clots than women who used oral contraceptives. The other study found that women who used contraceptive patches were no more likely to develop blood clots than women who used oral contraceptives. Talk to your doctor about the risks of using the contraceptive patch.",
+    "https://medlineplus.gov/druginfo/meds/a602006.html"
+  ],
+  [
+    "Estradiol Topical (How should this medicine be used?): Topical estradiol comes as a gel, a spray, and an emulsion to apply to the skin. It is usually applied once a day. Estradiol emulsion should be applied in the morning. Estradiol gel may be applied at any time of day, but should be applied at around the same time of day every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use topical estradiol exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor. If you are using estradiol gel, you should apply it in a thin layer to one arm, from the wrist to the shoulder. If you are using estradiol emulsion, you should apply it to both thighs and calves (lower legs). Do not apply estradiol gel or emulsion to your breasts. Be sure that the skin where you will apply topical estradiol is clean and completely dry, and is not red, irritated, or broken. If you take a bath or a shower or use a sauna, apply topical estradiol after you have finished bathing, showering or using the sauna and have dried your skin completely. If you plan to swim, allow as much time as possible between applying estradiol gel and swimming. Do not apply sunscreen shortly before, at the same time, or soon after you apply topical estradiol. Estradiol gel may catch fire. When you apply estradiol gel, do not smoke or go near a fire or open flame until the gel dries. Be careful not to get estradiol gel in your eyes. If you do get estradiol gel in your eyes, wash them with plenty of warm water right away. Call a doctor if your eyes become irritated. You should apply estradiol gel yourself. Do not let anyone else rub the gel onto your skin. To use estradiol gel, follow these steps: - Before you use your first dose of estradiol gel, remove the large cover of the pump and fully press down the pump twice. Wash the gel that comes out down the sink or dispose of it safely so that it is out of the reach of children and pets. This primes the pump so that it will dispense the same amount of medication each time it is pressed. Do not repeat this step after the first time you use the pump. - Hold the pump with one hand and cup your other hand below the nozzle of the pump. Press the pump firmly and fully to dispense one dose of gel onto your palm. - Use your hand to spread the gel as thinly as possible over your entire arm. Try to cover the inside and outside of your arm from your wrist to your shoulder with the gel. - Do not rub or massage the gel into your skin. Wait 5 minutes to allow the skin to dry before covering your arm with clothing. - Cover the pump with the small and large protective caps. - Wash your hands with soap and water. To use estradiol emulsion, follow these steps: - Get two pouches of estradiol emulsion and sit in a comfortable position. - Open one pouch of estradiol emulsion by cutting or tearing across the notches near the top of the pouch. - Place the pouch flat on top of your left thigh with the open end facing your knee. - Hold the closed end of the pouch with one hand and use the forefinger of your other hand to push all of the emulsion in the pouch onto your thigh. - Use one or both hands to rub the emulsion into your entire thigh and calf for 3 minutes until completely absorbed. - Rub any emulsion that is left on your hands onto your buttocks. - Repeat steps 1-6 using a fresh pouch of estradiol emulsion and your right thigh so that you apply the contents of the second pouch to your right thigh and calf. - Wait until the skin where you applied estradiol emulsion is completely dry and cover it with clothing. - Wash your hands with soap and water. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.",
+    "https://medlineplus.gov/druginfo/meds/a605041.html"
+  ],
+  [
+    "Ear wax: The ear canal is lined with hair follicles. The ear canal also has glands that produce a waxy oil called cerumen. The wax will most often make its way to the opening of the ear. There it will fall out or be removed by washing. Wax can build up and block the ear canal. Wax blockage is one of the most common causes of hearing loss. Ear wax protects the ear by: - Trapping and preventing dust, bacteria, and other germs and small objects from entering and damaging the ear - Protecting the delicate skin of the ear canal from getting irritated when water is in the canal In some people, the glands produce more wax than can be easily removed from the ear. This extra wax may harden in the ear canal and block the ear. When you try to clean the ear, you may instead push wax deeper and block the ear canal. Some of the common symptoms are: - Earache - Fullness in the ear or a sensation that the ear is plugged - Noises in the ear (tinnitus) - Partial hearing loss, may get worse Most cases of ear wax blockage can be treated at home. The following remedies can be used to soften wax in the ear: - Baby oil - Commercial drops - Glycerin - Mineral oil - Water Another method is to wash out the wax. - Use body-temperature water (cooler or warmer water may cause brief but severe dizziness or vertigo). - Hold your head upright and straighten the ear canal by holding the outside ear and gently pulling upward. - Use a syringe (you can buy one at the store) to gently direct a small stream of water against the ear canal wall next to the wax plug. - Tip your head to allow the water to drain. You may need to repeat irrigation several times. To avoid damaging your ear or causing an infection: - Never irrigate the ear if the eardrum may have a hole in it. - Do not irrigate the ear with a jet irrigator designed for cleaning teeth (such as a WaterPik). After the wax is removed, dry the ear thoroughly. You may use a few drops of alcohol in the ear or a hair dryer set on low to help dry the ear. You may clean the outer ear canal by using a cloth or paper tissue wrapped around your finger. Mineral oil can be used to moisturize the ear and prevent the wax from drying. Do not clean your ears too often or too hard. Ear wax also helps protect your ears. Never try to clean the ear by putting any object, such as a cotton swab, into the ear canal. If you cannot remove the wax plug or you have discomfort, consult a health care provider, who may remove the wax by: - Repeating the irrigation attempts - Suctioning the ear canal - Using a small device called a curette - Using a microscope to help The ear may become blocked with wax again in the future. Hearing loss is often temporary. In most cases, hearing returns completely after the blockage is removed. Rarely, trying to remove ear wax may cause an infection in the ear canal. This can also damage the eardrum. See your provider if your ears are blocked with wax and you are unable to remove the wax. Also call if you have an ear wax blockage and you develop new symptoms, such as: - Drainage from the ear - Ear pain - Fever - Hearing loss that continues after you clean the wax Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000979.htm"
+  ],
+  [
+    "What is Coconut Water?: Coconut water is the clear liquid found inside immature coconuts. As the coconut matures, the water is replaced by coconut meat. Coconut water is sometimes referred to as green coconut water because the immature coconuts are green in color. Coconut water is different than coconut milk. Coconut milk is produced from an emulsion of the grated meat of a mature coconut. Coconut water is commonly used as a beverage and as a solution for treating dehydration related to diarrhea or exercise. It is also tried for high blood pressure.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/natural/1261.html"
+  ],
+  [
+    "Ear wax (Treatment): Most cases of ear wax blockage can be treated at home. The following remedies can be used to soften wax in the ear: - Baby oil - Commercial drops - Glycerin - Mineral oil - Water Another method is to wash out the wax. - Use body-temperature water (cooler or warmer water may cause brief but severe dizziness or vertigo). - Hold your head upright and straighten the ear canal by holding the outside ear and gently pulling upward. - Use a syringe (you can buy one at the store) to gently direct a small stream of water against the ear canal wall next to the wax plug. - Tip your head to allow the water to drain. You may need to repeat irrigation several times. To avoid damaging your ear or causing an infection: - Never irrigate the ear if the eardrum may have a hole in it. - Do not irrigate the ear with a jet irrigator designed for cleaning teeth (such as a WaterPik). After the wax is removed, dry the ear thoroughly. You may use a few drops of alcohol in the ear or a hair dryer set on low to help dry the ear. You may clean the outer ear canal by using a cloth or paper tissue wrapped around your finger. Mineral oil can be used to moisturize the ear and prevent the wax from drying. Do not clean your ears too often or too hard. Ear wax also helps protect your ears. Never try to clean the ear by putting any object, such as a cotton swab, into the ear canal. If you cannot remove the wax plug or you have discomfort, consult a health care provider, who may remove the wax by: - Repeating the irrigation attempts - Suctioning the ear canal - Using a small device called a curette - Using a microscope to help",
+    "https://medlineplus.gov/ency/article/000979.htm"
+  ],
+  [
+    "Ear wax (Review Date 5/21/2016): Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000979.htm"
+  ],
+  [
+    "Swimmer's ear: Swimmer's ear is inflammation, irritation, or infection of the outer ear and ear canal. The medical term for swimmer's ear is otitis externa. Swimmer's ear may be sudden and short-term (acute) or long-term (chronic). Swimmer's ear is more common among children in their teens and young adults. It may occur with a middle ear infection or a respiratory infection such as a cold. Swimming in unclean water can lead to swimmer's ear. Bacteria commonly often found in water can cause ear infections. Rarely, the infection may be caused by a fungus. Other causes of swimmer's ear include: - Scratching the ear or inside the ear - Getting something stuck in the ear Trying to clean (wax from the ear canal) with cotton swabs or small objects can damage the skin. Long-term (chronic) swimmer's ear may be due to: - Allergic reaction to something placed in the ear - Chronic skin conditions, such as eczema or psoriasis Symptoms of swimmer's ear include: - Drainage from the ear -- yellow, yellow-green, pus-like, or foul smelling - Ear pain, which may get worse when you pull on the outer ear - Hearing loss - Itching of the ear or ear canal The health care provider will look inside your ears. The ear canal area will look red and swollen. The skin inside the ear canal may be scaly or shedding. Touching or moving the outer ear will increase the pain. The eardrum may be hard to see because of a swelling in the outer ear. The eardrum may have a hole in it. This is called a perforation. A sample of fluid may be removed from the ear and sent to a lab to look for bacteria or fungus. In most cases, you will need to use ear antibiotic drops for 10 to 14 days. If the ear canal is very swollen, a wick may be put into the ear. The wick will allow the drops to travel to the end of the canal. Your provider can show you how to do this. Other treatments may include: - Antibiotics taken by mouth if you have a middle ear infection or infection that spreads beyond the ear - Corticosteroids to reduce itching and inflammation - Pain medicine, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) - Vinegar (acetic acid) ear drops People with chronic swimmer's ear may need long-term or repeated treatment. This will to avoid complications. Placing something warm against the ear may reduce pain. Swimmer's ear most often gets better with the proper treatment. The infection may spread to other areas around the ear, including the skull bone. In older people or those who have diabetes, the infection may become severe. This condition is called malignant otitis externa. This condition is treated with high-dose antibiotics given through a vein. Call your provider if: - You develop any symptoms of swimmer's ear - You notice any drainage coming from your ears - Your symptoms get worse or continue despite treatment - You have new symptoms, such as fever or pain and redness of the skull behind the ear These steps can help protect your ears from further damage: - DO NOT scratch the ears or insert cotton swabs or other objects in the ears. - Keep ears clean and dry, and DO NOT let water enter the ears when showering, shampooing, or bathing. - Dry your ear very well after it has gotten wet. - Avoid swimming in polluted water. - Use earplugs when swimming. - Try mixing 1 drop of alcohol with 1 drop of white vinegar and placing the mixture into the ears after they get wet. The alcohol and acid in the vinegar help prevent bacterial growth. Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000622.htm"
+  ],
+  [
+    "Understanding your hospital bill (Charges Listed on Your Hospital Bill): A hospital bill will list the major charges from your visit. It lists the services you received (such as procedures and tests), as well as medicines and supplies. Most of time, you will get a separate bill for health care provider fees. It is a good idea to ask for a more detailed hospital bill with all of the charges described separately. That can help you make sure the bill is correct. If you have insurance, you may also get a form from your insurance company, called an Explanation of Benefits (EOB). This is not a bill. It explains: - What is covered by your insurance - Amount of payment made and to whom - Deductibles or co-insurance A deductible is the amount of money you must pay each year to cover your medical care expenses before your insurance policy starts to pay. Co-insurance is the amount you pay for medical care after you have met your health insurance deductible. It is often given as a percentage. The information on the EOB should match your hospital bill. If it does not, or there is something you do not understand, call your insurance company.",
+    "https://medlineplus.gov/ency/patientinstructions/000881.htm"
+  ],
+  [
+    "How effective is Lycopene?: Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate. The effectiveness ratings for LYCOPENE are as follows: Possibly ineffective for... - Bladder cancer. Research suggests that there is no link between lycopene consumption in the diet or lycopene blood levels and the risk for bladder cancer. - Diabetes. Research suggests that increased lycopene consumption in the diet does not decrease the risk of developing diabetes. Insufficient evidence to rate effectiveness for... - Age-related eye disease (age-related maculopathy). Research on the effect of lycopene in age-related eye disease is inconsistent. Some evidence suggests that people with low lycopene levels are almost twice as likely to develop age-related eye disease compared to people with high levels. However, other research suggests that there is no link between lycopene levels or lycopene intake and the risk of age-related eye disease. - Asthma. Research on the effects of lycopene in people with asthma is inconsistent. Taking lycopene does not seem to reduce asthma symptoms in adults with stable asthma. However, in people with a history of exercise-induced asthma, taking a specific lycopene product (LycoMato, LycoRed Corp., Orange, NJ) seems to improve lung function after exercise. - Hardening of the arteries (atherosclerosis). There is some evidence showing that higher lycopene blood levels is associated with a reduced risk of hardening of the arteries. There is also early evidence that higher lycopene blood levels can reduce the risk of heart disease associated with hardening of the arteries. However, there does not appear to be a link between lycopene levels and stroke risk. - Enlarged prostate (benign prostatic hypertrophy). Early research shows that taking lycopene can slow the progression of prostate enlargement and can improve symptoms in people with this condition. However, other research found no link between lycopene intake in the diet and the development of an enlarged prostate. - Breast cancer. Research about how lycopene affects breast cancer risk is inconsistent. Some evidence suggests that having higher lycopene blood levels is associated with a lower risk of breast cancer. However, other research shows that neither lycopene intake nor lycopene blood levels are linked to breast cancer risk. - Heart disease. Some research shows that women with higher levels of lycopene in their blood have a lower risk of developing heart disease. However, other research shows no link between lycopene intake and the risk of heart attack or stroke in women. Also, increasing dietary lycopene does not seem to prevent heart attacks in men at low risk for heart disease. - Cataracts. One study suggests that higher lycopene blood levels are associated with a lower risk of developing cataracts. However, other studies have found no link between lycopene intake or lycopene blood levels and the risk of developing cataracts. - Cervical cancer. Research about how lycopene affects the risk of cervical cancer is inconsistent. Some evidence suggests that higher lycopene blood levels or higher lycopene intake in the diet is linked to a lower risk of cervical cancer. Other studies have not found this link. - Colorectal cancer. Research about how lycopene affects the risk of colorectal cancer is inconsistent. Some research suggests that people with high lycopene intake in the diet are less likely to develop colorectal cancer than those with low intake. However, other research shows no link between lycopene intake and the risk of colorectal cancer. - Gingivitis. Early research shows that taking a specific lycopene supplement by mouth (LycoRed, Jagsonpal Pharmaceuticals) for 2 weeks or receiving a single injection of lycopene gel into the gums reduces gingivitis. - Brain tumor (giloma). Early research shows that taking lycopene by mouth for 3 months does not improve the response to radiotherapy and chemotherapy in people with brain tumors. - Ulcers caused by H. pylori infection. Early research shows that taking lycopene by along with antibiotics does not help treat H. pylori infection compared to taking antibiotics alone. - Human papilloma virus (HPV) infection. Women with higher levels of lycopene in their blood seem to recover from cancer-associated HPV infection faster than women with lower lycopene blood levels. - High cholesterol. Early research shows that taking a specific lycopene supplement (LycoRed, Jagsonpal Pharmaceuticals) by mouth daily for 6 months lowers total cholesterol and low-density lipoprotein (LDL or bad) cholesterol, and increases high-density lipoprotein (HDL or good) cholesterol. However, other evidence suggests that lycopene does not affect cholesterol levels in healthy adults or in those with heart disease. - High blood pressure. Early research shows that taking a specific lycopene product (LycoMato, LycoRed Corp., Organge, NJ) daily for 8 weeks lowers blood pressure in people with high blood pressure. However, other research suggests that there is no link between lycopene blood levels and the risk of developing high blood pressure. - Lung cancer. Research about how lycopene affects the risk of lung cancer is inconsistent. Some research shows that lower lycopene intake in the diet is linked to an increased risk of lung cancer. However, other research suggests that there is no link between lycopene consumption in the diet or lycopene blood levels and lung cancer risk. - Male fertility problems. Early research shows that taking lycopene by mouth daily for 3 months improves sperm quality in some men with fertility problems due to unknown causes. - Menopausal symptoms. Early research shows that taking a specific product containing lycopene, calcium, vitamin D3, astaxanthin, and citrus bioflavonoids (Cor. Con. International, Parma, Italy) daily for 8 weeks reduces menopausal symptoms including hot flashes, joint pain, anxiety, and depression. - White pre-cancerous patches in the mouth (oral leukoplakia). Early research shows that taking a specific lycopene supplement (LycoRed, Jagsonpal Pharmaceutical) by mouth twice daily improves white pre-cancerous patches in the mouth. - Ulcers and swelling in the mouth (oral mucositis). Early research shows that taking lycopene by mouth daily for 2 months improves ulcerations in the mouth in people with oral mucositis. - Ovarian cancer. There is inconsistent evidence about the effect of lycopene on ovarian cancer risk. Some research shows that a diet rich in carotenoids, including lycopene, seems to help prevent ovarian cancer in young (premenopausal) women. However, other research shows that the risk of developing ovarian cancer is not linked to lycopene blood levels. - Pancreatic cancer. Some early research shows that a diet high in lycopene, primarily from tomatoes, seems to lower the risk of developing pancreatic cancer. - High blood pressure during pregnancy. Research on the effect of lycopene for preventing high blood pressure during pregnancy is unclear. Some research shows that taking a specific lycopene supplement (LycoRed, Jagonpal Pharmaceuticals) twice daily starting between weeks 16 and 20 of pregnancy and continuing until delivery lowers blood pressure and reduces associated complications. However, other research suggests that lycopene does not affect blood pressure during pregnancy. - Prostate cancer. Research on the effects of lycopene for preventing or treating prostate cancer is inconsistent. Some research suggests that increasing lycopene consumption in the diet, or higher lycopene blood levels, is linked with a lower risk of developing prostate cancer. However, other research shows no link between lycopene intake or blood levels and prostate cancer risk. In addition, early research in men with precancerous changes in their prostate shows that taking lycopene supplements might delay or prevent the progression to prostate cancer. However, in other research, taking lycopene daily for up to one year did not seem to help treat prostate cancer. - Prostate swelling and pelvic pain. Early research shows that taking a specific combination of lycopene, selenium, and saw palmetto (Profluss, KonPharma) by mouth for 8 weeks reduces pain in men with prostate swelling and pelvic pain compared to saw palmetto alone. - Kidney cancer (renal cell carcinoma). Early research shows no link between lycopene consumption in the diet and the risk of developing kidney cancer - Sunburn. Early research shows that taking lycopene by mouth, alone or together with other ingredients, might protect against sunburn - Other conditions. More evidence is needed to rate lycopene for these uses.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/natural/554.html"
+  ],
+  [
+    "Healthy Eating (Product Dates): You might see one of three types of product dates on some foods you buy:- \"Sell by\" tells how long the store can sell foods like meat, poultry, eggs, or milk products-buy it before this date - \"Use by\" tells how long the food will be at peak quality-if you buy or use it after that date, some foods might not be safe any longer - \"Best if used by\" (or \"best if used before\") tells how long the food has the best flavor or quality-it is not a purchase or safety date",
+    "https://www.nia.nih.gov/health/healthy-eating"
+  ],
+  [
+    "Breast milk - pumping and storing (Giving Your Baby a Bottle): Wait until your baby is 3 to 4 weeks old to try a bottle. This gives you and your baby time to get good at breastfeeding first. Your baby has to learn to suck from a bottle. Here are ways to help your baby learn to take a bottle. - Give your baby a bottle while your baby is still calm, before hunger starts. - Have someone else give your baby the bottle. This way, your baby is not confused why you are not breastfeeding. - Leave the room when someone is giving your baby a bottle. Your baby can smell you and will wonder why you are not breastfeeding. Start bottle feeding about 2 weeks before you go back to work so your baby has time to get used to it.",
+    "https://medlineplus.gov/ency/patientinstructions/000633.htm"
+  ],
+  [
+    "Glucosamine Hydrochloride (How effective is it?): Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate. The effectiveness ratings for GLUCOSAMINE HYDROCHLORIDE are as follows: Insufficient evidence to rate effectiveness for... High cholesterol. Early research suggests that glucosamine hydrochloride does not affect cholesterol or triglyceride levels in people with high cholesterol. Bone and joint disease called Kashin-Beck disease. Early evidence shows that taking glucosamine hydrochloride along with chondroitin sulfate reduces pain and improves physical function in adults with a bone and joint disorder called Kashin-Beck disease. The effects of glucosamine sulfate on symptoms of Kashin-Beck disease are mixed when the supplement is taken as a single agent. Knee pain. There is some early evidence that glucosamine hydrochloride might provide some pain relief for people who have frequent knee pain as a result of joint injury. Osteoarthritis. There is conflicting evidence about the effectiveness of glucosamine hydrochloride for osteoarthritis. Most of the evidence supporting the use of glucosamine hydrochloride comes from studies of a particular product (CosaminDS, Nutramax Laboratories). This product contains a combination of glucosamine hydrochloride, chondroitin sulfate, and manganese ascorbate. Some evidence suggests that this combination can improve pain in people with knee osteoarthritis. This combination might work better in people with mild-to-moderate osteoarthritis than in people with severe osteoarthritis. Another product (Gurukosamin and Kondoroichin, Suntory Wellness Ltd., Tokyo, Japan) containing glucosamine hydrochloride, chondroitin sulfate, and quercetin glycosides also seems to improve knee osteoarthritis symptoms. The effects of taking glucosamine hydrochloride along with only chondroitin sulfate are mixed. Some evidence shows that taking a specific product (Droglican, Bioiberica S.A., Barcelona, Spain) containing glucosamine hydrochloride and chondroitin sulfate reduces pain in adults with knee osteoarthritis. However, other research shows that formulas containing glucosamine hydrochloride and chondroitin sulfate are not effective at reducing pain in patients with knee osteoarthritis. Most research suggests that taking glucosamine hydrochloride alone does not reduce pain in people with osteoarthritis of the knee. More research has been done on glucosamine sulfate (see separate listing) than on glucosamine hydrochloride. There is some thought that glucosamine sulfate may be more effective than glucosamine hydrochloride for osteoarthritis. Most research comparing the two forms of glucosamine showed no difference. However, some researchers have criticized the quality of some of these studies. Rheumatoid arthritis. Early research shows that taking a specific glucosamine hydrochloride product (Rohto Pharmaceuticals Co.) in combination with prescription medical treatments reduces pain compared to a sugar pill. However, this product does not seem to decrease inflammation or reduce the number of painful or swollen joints. Jaw pain (temporomandibular disorder). Early research shows that taking a combination of glucosamine hydrochloride, chondroitin sulfate, and calcium ascorbate twice daily reduces joint swelling and pain, as well as noise made at the jaw joint, in people with temporomandibular disorder. Back pain. Glaucoma. Weight loss. Other conditions. More evidence is needed to rate glucosamine hydrochloride for these uses.",
+    "https://medlineplus.gov/druginfo/natural/747.html"
+  ],
+  [
+    "Devil\u2019s Claw (How effective is it?): Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate. The effectiveness ratings for DEVIL'S CLAW are as follows: Possibly effective for... Back pain. Taking devil\u2019s claw by mouth seems to reduce low-back pain. Devil\u2019s claw seems to work about as well as some non-steroidal anti-inflammatory drugs (NSAIDs). Osteoarthritis. Taking devil\u2019s claw alone or along with nonsteroidal anti-inflammatory drugs (NSAIDs) seems to help decrease osteoarthritis-related pain. Some evidence suggests that devil\u2019s claw works about as well as diacerhein (a slow-acting drug for osteoarthritis that is not available in the U.S.) for improving osteoarthritis pain in the hip and knee after 16 weeks of treatment. Some people taking devil\u2019s claw seem to be able to lower the dose of NSAIDs they need for pain relief. This evidence comes from a study that used a specific powdered devil\u2019s claw root product (Harpadol, Arkopharma) containing 2% of the devil\u2019s claw ingredient harpagoside (9.5 mg/capsule) and 3% total iridoid glycosides (14.5 mg per capsule). Another specific devil\u2019s claw extract (Doloteffin, Ardeypharm) 2400 mg/day providing 60 mg/day of the harpagoside ingredient has also been used. Insufficient evidence to rate effectiveness for... Rheumatoid arthritis (RA). Early research suggests that taking devil\u2019s claw extract by mouth might not improve RA. Upset stomach. Loss of appetite. High cholesterol. Gout. Muscle pain. Migraine headache. Skin injuries and conditions. Other conditions. More evidence is needed to rate devil\u2019s claw for these uses.",
+    "https://medlineplus.gov/druginfo/natural/984.html"
+  ],
+  [
+    "Breast milk - pumping and storing (Nursing and Bottle Feeding): If you are nursing as well as bottle feeding: - Nurse your baby before leaving for work in the morning and right when you get home. - Expect your baby to nurse more often in the evenings and weekends when you are home. Feed on-demand when you are with your baby. - Have your child care provider give your baby bottles of breast milk when you are at work. - The American Academy of Pediatrics recommends that you exclusively give breast milk to your baby for the first 6 months. This means not giving any other food, drinks, or formula. - If you use formula, still breastfeed and give as much breast milk as you can. The more breast milk your baby gets, the better. Supplementing with too much formula will decrease your milk supply.",
+    "https://medlineplus.gov/ency/patientinstructions/000633.htm"
+  ],
+  [
+    "Resources (Summary): Local and national support groups can be found on the web, through local libraries, your health care provider, and the yellow pages under \"social service organizations.\" - AIDS - resources - Alcoholism - resources - Allergy - resources - ALS - resources - Alzheimer's - resources - Anorexia nervosa - resources - Arthritis - resources - Asthma and allergy - resources - Autism - resources - Blindness - resources - BPH - resources - Breastfeeding - resources - Bulimia - resources - Burns - resources - Cancer - resources - Cerebral palsy - resources - Celiac disease - resources - Child abuse - resources - Chronic fatigue syndrome - resources - Chronic pain - resources - Cleft palate - resources - Colon cancer - resources - Cystic fibrosis - resources - Depression - resources - Diabetes - resources - Digestive disease - resources - Drug abuse - resources - Eating disorders - resources - Elder care - resources - Epilepsy - resources - Family troubles - resources - Gastrointestinal disorders - resources - Hearing impairment - resources - Hearing or speech impairment - resources - Heart disease - resources - Hemophilia - resources - Herpes - resources - Incest - resources - Incontinence - resources - Infertility - resources - Interstitial cystitis - resources - Kidney disease - resources - Leukemia - resources - Liver disease - resources - Loss of a child - resources - Loss of a spouse - resources - Lung disease - resources - Lupus - resources - Migraine - resources - Multiple sclerosis - resources - Muscular dystrophy - resources - Myasthenia gravis - resources - Ostomy - resources - Overeating - resources - Pain - resources - Parkinson's disease - resources - Prostate cancer - resources - Psoriasis - resources - Rape - resources - Reye's syndrome - resources - Scleroderma - resources - Scoliosis - resources - Selective mutism - resources - Sickle cell anemia - resources - SIDS - resources - SLE - resources - Speech impairment - resources - Spina bifida - resources - Spinal injury - resources - Tay-Sachs - resources - Troubled families - resources - Victim assistance - resources",
+    "https://medlineplus.gov/ency/article/002150.htm"
+  ],
+  [
+    "What is Learning about depression?: Depression is feeling sad, blue, unhappy, or down in the dumps. Most people feel this way once in a while. Clinical depression is a mood disorder. It occurs when feelings of sadness, loss, anger, or frustration get in the way of your life over a long period of time. It also changes how your body works. Depression is caused by changes in the chemicals in your brain. The condition may start during or after a painful event in your life. It may happen when you take certain medicines. It can also start during or after pregnancy. Sometimes there is no clear trigger or reason.",
+    "https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000325.htm"
+  ],
+  [
+    "Resources (Review Date 12/10/2016): Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002150.htm"
+  ],
+  [
+    "Klinefelter Syndrome (KS) (What are common symptoms?): Because XXY males do not really appear different from other males and because they may not have any or have mild symptoms, XXY males often don't know they have KS. In other cases, males with KS may have mild or severe symptoms. Whether or not a male with KS has visible symptoms depends on many factors, including how much testosterone his body makes, if he is mosaic (with both XY and XXY cells), and his age when the condition is diagnosed and treated. KS symptoms fall into these main categories: - Physical Symptoms - Language and Learning Symptoms - Social and Behavioral Symptoms - Symptoms of Poly-X KS Physical Symptoms Many physical symptoms of KS result from low testosterone levels in the body. The degree of symptoms differs based on the amount of testosterone needed for a specific age or developmental stage and the amount of testosterone the body makes or has available. During the first few years of life, when the need for testosterone is low, most XXY males do not show any obvious differences from typical male infants and young boys. Some may have slightly weaker muscles, meaning they might sit up, crawl, and walk slightly later than average. For example, on average, baby boys with KS do not start walking until age 18 months. After age 5 years, when compared to typically developing boys, boys with KS may be slightly: - Taller - Fatter around the belly - Clumsier - Slower in developing motor skills, coordination, speed, and muscle strength Puberty for boys with KS usually starts normally. But because their bodies make less testosterone than non-KS boys, their pubertal development may be disrupted or slow. In addition to being tall, KS boys may have: - Smaller testes and penis - Breast growth (about one-third of teens with KS have breast growth) - Less facial and body hair - Reduced muscle tone - Narrower shoulders and wider hips - Weaker bones, greater risk for bone fractures - Decreased sexual interest - Lower energy - Reduced sperm production An adult male with KS may have these features: - Infertility: Nearly all men with KS are unable to father a biologically-related child without help from a fertility specialist. - Small testes, with the possibility of testes shrinking slightly after the teen years - Lower testosterone levels, which lead to less muscle, hair, and sexual interest and function - Breasts or breast growth (called gynecomastia, pronounced GUY-nuh-kow-mast-ee-uh). In some cases, breast growth can be permanent, and about 10% of XXY males need breast-reduction surgery. [top] Language and Learning Symptoms Most males with KS have normal intelligence quotients (IQs) and successfully complete education at all levels. (IQ is a frequently used intelligence measure, but does not include emotional, creative, or other types of intelligence.) Between 25% and 85% of all males with KS have some kind of learning or language-related problem, which makes it more likely that they will need some extra help in school. Without this help or intervention, KS males might fall behind their classmates as schoolwork becomes harder. KS males may experience some of the following learning and language-related challenges: - A delay in learning to talk. Infants with KS tend to make only a few different vocal sounds. As they grow older, they may have difficulty saying words clearly. It might be hard for them to distinguish differences between similar sounds. - Trouble using language to express their thoughts and needs. Boys with KS might have problems putting their thoughts, ideas, and emotions into words. Some may find it hard to learn and remember some words, such as the names of common objects. - Trouble processing what they hear. Although most boys with KS can understand what is being said to them, they might take longer to process multiple or complex sentences. In some cases, they might fidget or \"tune out\" because they take longer to process the information. It might also be difficult for KS males to concentrate in noisy settings. They might also be less able to understand a speaker's feelings from just speech alone. - Reading difficulties. Many boys with KS have difficulty understanding what they read (called poor reading comprehension). They might also read more slowly than other boys. By adulthood, most males with KS learn to speak and converse normally, although they may have a harder time doing work that involves extensive reading and writing. [top] Social and Behavioral Symptoms Many of the social and behavioral symptoms in KS may result from the language and learning difficulties. For instance, boys with KS who have language difficulties might hold back socially and could use help building social relationships. Boys with KS, compared to typically developing boys, tend to be: - Quieter - Less assertive or self-confident - More anxious or restless - Less physically active - More helpful and eager to please - More obedient or more ready to follow directions In the teenage years, boys with KS may feel their differences more strongly. As a result, these teen boys are at higher risk of depression, substance abuse, and behavioral disorders. Some teens might withdraw, feel sad, or act out their frustration and anger. As adults, most men with KS have lives similar to those of men without KS. They successfully complete high school, college, and other levels of education. They have successful and meaningful careers and professions. They have friends and families. Contrary to research findings published several decades ago, males with KS are no more likely to have serious psychiatric disorders or to get into trouble with the law. [top] Symptoms of Poly-X KS Males with poly-X Klinefelter syndrome have more than one extra X chromosome, so their symptoms might be more pronounced than in males with KS. In childhood, they may also have seizures, crossed eyes, constipation, and recurrent ear infections. Poly-KS males might also show slight differences in other physical features. Some common additional symptoms for several poly-X Klinefelter syndromes are listed below. 48,XXYY - Long legs - Little body hair - Lower IQ, average of 60 to 80 (normal IQ is 90 to 110) - Leg ulcers and other vascular disease symptoms - Extreme shyness, but also sometimes aggression and impulsiveness 48,XXXY (or tetrasomy) - Eyes set further apart - Flat nose bridge - Arm bones connected to each other in an unusual way - Short - Fifth (smallest) fingers curve inward (clinodactyly, pronounced KLAHY-noh-dak-tl-ee) - Lower IQ, average 40 to 60 - Immature behavior 49,XXXXY (or pentasomy) - Low IQ, usually between 20 and 60 - Small head - Short - Upward-slanted eyes - Heart defects, such as when the chambers do not form properly - High feet arches - Shy, but friendly - Difficulty with changing routines [top] \u00ab How many people are affected/at risk? What are the treatments? \u00bb",
+    "https://www.nichd.nih.gov/health/topics/klinefelter"
+  ],
+  [
+    "Klinefelter Syndrome (KS) (Is there a cure?): Currently, there is no way to remove chromosomes from cells to \"cure\" the XXY condition. But many symptoms can be successfully treated, minimizing the impact the condition has on length and quality of life. Most adult XXY men have full independence and have friends, families, and normal social relationships. They live about as long as other men, on average. \u00ab How is it diagnosed? Other FAQs \u00bb",
+    "https://www.nichd.nih.gov/health/topics/klinefelter"
+  ],
+  [
+    "Klinefelter Syndrome (KS) (What are the treatments?): It's important to remember that because symptoms can be mild, many males with KS are never diagnosed ore treated. The earlier in life that KS symptoms are recognized and treated, the more likely it is that the symptoms can be reduced or eliminated. It is especially helpful to begin treatment by early puberty. Puberty is a time of rapid physical and psychological change, and treatment can successfully limit symptoms. However, treatment can bring benefits at any age. The type of treatment needed depends on the type of symptoms being treated. Treating Physical Symptoms Treating Language and Learning Symptoms Treating Social and Behavioral Symptoms Treating Physical Symptoms Treatment for Low Testosterone About one-half of XXY males' chromosomes have low testosterone levels. These levels can be raised by taking supplemental testosterone. Testosterone treatment can: - Improve muscle mass - Deepen the voice - Promote growth of facial and body hair - Help the reproductive organs to mature - Build and maintain bone strength and help prevent osteoporosis in later years - Produce a more masculine appearance, which can also help relieve anxiety and depression - Increase focus and attention There are various ways to take testosterone: - Injections or shots, every 2 to 3 weeks - Pills - Through the skin, also called transdermal (pronounced tranz-DERM-ul); current methods include wearing a testosterone patch or rubbing testosterone gel on the skin Males taking testosterone treatment should work closely with an endocrinologist (pronounced en-doe-kren-AWL-oh-jist), a doctor who specializes in hormones and their functions, to ensure the best outcome from testosterone therapy. For information on how to find an endocrinologist, see the Resources and Publications section. Is testosterone therapy right for every XXY male? Not all males with XXY condition benefit from testosterone therapy. For males whose testosterone level is low to normal, the benefits of taking testosterone are less clear than for when testosterone is very low. Side effects, although generally mild, can include acne, skin rashes from patches or gels, breathing problems (especially during sleep), and higher risk of an enlarged prostate gland or prostate cancer in older age. In addition, testosterone supplementation will not increase testicular size, decrease breast growth, or correct infertility. Although the majority of boys with KS grow up to live as males, some develop atypical gender identities. For these males, supplemental testosterone may not be suitable. Gender identity should be discussed with health care specialists before starting treatment. Treatment for Enlarged Breasts No approved drug treatment exists for this condition of over-developed breast tissue, termed gynecomastia. Some health care providers recommend surgery\u2014called mastectomy (pronounced ma-STEK-tuh-mee)\u2014to remove or reduce the breasts of XXY males. When adult men have breasts, they are at higher risk for breast cancer than other men and need to be checked for this condition regularly. The mastectomy lowers the risk of cancer and can reduce the social stress associated with XXY males having enlarged breasts. Because it is a surgical procedure, mastectomy carries a variety of risks. XXY males who are thinking about mastectomy should discuss all the risks and benefits with their health care provider. Treatment for Infertility Between 95% and 99% of XXY men are infertile because they do not produce enough sperm to fertilize an egg naturally. But, sperm are found in more than 50% of men with KS. Advances in assistive reproductive technology (ART) have made it possible for some men with KS to conceive. One type of ART, called testicular sperm extraction with intracytoplasmic (pronounced in-trah-sigh-toe-PLAZ-mick) sperm injection (TESE-ICSI), has shown success for XXY males. For this procedure, a surgeon removes sperm from the testes and places one sperm into an egg. Like all ART, TESE-ICSI carries both risks and benefits. For instance, it is possible that the resulting child might have the XXY condition. In addition, the procedure is expensive and is often is not covered by health insurance plans. Importantly, there is no guarantee the procedure will work. Recent studies suggest that collecting sperm from adolescent XXY males and freezing the sperm until later might result in more pregnancies during subsequent fertility treatments. This is because although XXY males may make some healthy sperm during puberty, this becomes more difficult as they leave adolescence and enter adulthood. [top] Treating Language and Learning Symptoms Some, but not all, children with KS have language development and learning delays. They might be slow to learn to talk, read, and write, and they might have difficulty processing what they hear. But various interventions, such as speech therapy and educational assistance, can help to reduce and even eliminate these difficulties. The earlier treatment begins, the better the outcomes. Parents might need to bring these types of problems to the teacher's attention. Because these boys can be quiet and cooperative in the classroom, teachers may not notice the need for help. Boys and men with KS can benefit by visiting therapists who are experts in areas such as coordination, social skills, and coping. XXY males might benefit from any or all of the following: - Physical therapists design activities and exercises to build motor skills and strength and to improve muscle control, posture, and balance. - Occupational therapists help build skills needed for daily functioning, such as social and play skills, interaction and conversation skills, and job or career skills that match interests and abilities. - Behavioral therapists help with specific social skills, such as asking other kids to play and starting conversations. They can also teach productive ways of handling frustration, shyness, anger, and other emotions that can arise from feeling \"different.\" - Mental health therapists or counselors help males with KS find ways to cope with feelings of sadness, depression, self-doubt, and low self-esteem. They can also help with substance abuse problems. These professionals can also help families deal with the emotions of having a son with KS. - Family therapists provide counseling to a man with KS, his spouse, partner, or family. They can help identify relationship problems and help patients develop communication skills and understand other people's needs. Parents of XXY males have also mentioned that taking part in physical activities at low-key levels, such as karate, swimming, tennis, and golf, were helpful in improving motor skills, coordination, and confidence. With regard to education, some boys with KS will qualify to receive state-sponsored special needs services to address their developmental and learning symptoms. But, because these symptoms may be mild, many XXY males will not be eligible for these services. Families can contact a local school district official or special education coordinator to learn more about whether XXY males can receive the following free services: - The Early Intervention Program for Infants and Toddlers with Disabilities is required by two national laws, the Individuals with Disabilities and Education Improvement Act (IDEIA) and the Individuals with Disabilities Education Act (IDEA). Every state operates special programs for children from birth to age 3, helping them develop in areas such as behavior, development, communication, and social play. - An Individualized Education Plan (IEP) for school is created and administered by a team of people, starting with parents and including teachers and school psychologists. The team works together to design an IEP with specific academic, communication, motor, learning, functional, and socialization goals, based on the child's educational needs and specific symptoms. [top] Treating Social and Behavioral Symptoms Many of the professionals and methods for treating learning and language symptoms of the XXY condition are similar to or the same as the ones used to address social and behavioral symptoms. For instance, boys with KS may need help with social skills and interacting in groups. Occupational or behavioral therapists might be able to assist with these skills. Some school districts and health centers might also offer these types of skill-building programs or classes. In adolescence, symptoms such as lack of body hair could make XXY males uncomfortable in school or other social settings, and this discomfort can lead to depression, substance abuse, and behavioral problems or \"acting out.\" They might also have questions about their masculinity or gender identity. In these instances, consulting a psychologist, counselor, or psychiatrist may be helpful. Contrary to research results released decades ago, current research shows that XXY males are no more likely than other males to have serious psychiatric disorders or to get into trouble with the law. [top] \u00ab What are common symptoms? How is it diagnosed? \u00bb \u200b\u200b",
+    "https://www.nichd.nih.gov/health/topics/klinefelter"
+  ],
+  [
+    "Klinefelter Syndrome (KS) (Condition Information): What is KS? The term \"Klinefelter (pronounced KLAHYN-fel-ter) syndrome,\" or KS, describes a set of features that can occur in a male who is born with an extra X chromosome (pronounced KROH-muh-sohm) in his cells. It is named after Dr. Henry Klinefelter, who identified the condition in the 1940s. Usually, every cell in a male's body, except sperm and red blood cells, contains 46 chromosomes. The 45th and 46th chromosomes\u2014the X and Y chromosomes\u2014are sometimes called \"sex chromosomes\" because they determine a person's sex. Normally, males have one X and one Y chromosome, making them XY. Males with KS have an extra X chromosome, making them XXY. KS is sometimes called \"47,XXY\" (47 refers to total chromosomes) or the \"XXY condition.\" Those with KS are sometimes called \"XXY males.\" Some males with KS may have both XY cells and XXY cells in their bodies. This is called \"mosaic\" (mo-ZAY-ik). Mosaic males may have fewer symptoms of KS depending on the number of XY cells they have in their bodies and where these cells are located. For example, males who have normal XY cells in their testes may be fertile. In very rare cases, males might have two or more extra X chromosomes in their cells, for instance XXXY or XXXXY, or an extra Y, such as XXYY. This is called poly-X Klinefelter syndrome, and it causes more severe symptoms. What causes it? \u00bb",
+    "https://www.nichd.nih.gov/health/topics/klinefelter"
+  ],
+  [
+    "Klinefelter Syndrome (KS): \u200b\u200b\u200bKS describes a set of physical, language, and social development symptoms in males who have an extra X chromosome. Its main feature is infertility. Outward signs of KS can be subtle, so symptoms often are not recognized, and may not be treated in a timely manner. The NICHD is one of many federal agencies and NIH Institutes working to understand KS, discover why it occurs, and identify and treat its symptoms. \u200b\u200b\u200b \u200b \u200b What is KS? The term \"Klinefelter (pronounced KLAHYN-fel-ter) syndrome,\" or KS, describes a set of features that can occur in a male who is born with an extra X chromosome (pronounced KROH-muh-sohm) in his cells. It is named after Dr. Henry Klinefelter, who identified the condition in the 1940s. Usually, every cell in a male's body, except sperm and red blood cells, contains 46 chromosomes. The 45th and 46th chromosomes\u2014the X and Y chromosomes\u2014are sometimes called \"sex chromosomes\" because they determine a person's sex. Normally, males have one X and one Y chromosome, making them XY. Males with KS have an extra X chromosome, making them XXY. KS is sometimes called \"47,XXY\" (47 refers to total chromosomes) or the \"XXY condition.\" Those with KS are sometimes called \"XXY males.\" Some males with KS may have both XY cells and XXY cells in their bodies. This is called \"mosaic\" (mo-ZAY-ik). Mosaic males may have fewer symptoms of KS depending on the number of XY cells they have in their bodies and where these cells are located. For example, males who have normal XY cells in their testes may be fertile. In very rare cases, males might have two or more extra X chromosomes in their cells, for instance XXXY or XXXXY, or an extra Y, such as XXYY. This is called poly-X Klinefelter syndrome, and it causes more severe symptoms. What causes it? \u00bb The extra chromosome results from a random error that occurs when a sperm or egg is formed; this error causes an extra X cell to be included each time the cell divides to form new cells. In very rare cases, more than one extra X or an extra Y is included. \u00ab Condition Information How many people are affected/at risk? \u00bb Researchers estimate that 1 male in about 500 newborn males has an extra X chromosome, making KS among the most common chromosomal disorders seen in all newborns.The likelihood of a third or fourth X is much rarer: Prevalence of Klinefelter syndrome variants Number of extra X chromosomes One (XXY) Two (XXXY) Three (XXXXY) Number of newborn males with the condition 1 in 500 1 in 50,000 1 in 85,000 to 100,000 Scientists are not sure what factors increase the risk of KS. The error that produces the extra chromosome occurs at random, meaning the error is not hereditary (pronounced huh-RED-i-ter-ee) or passed down from parent to child. Research suggests that older mothers might be slightly more likely to have a son with KS. However, the extra X chromosome in KS comes from the father about one-half of the time. - Nielsen, J., and Wohlert, M. (1991). Chromosome abnormalities found among 34,910 newborn children: Results from a 13-year incidence study in Arhus, Denmark. Human Genetics, 87(1), 81\u201383. [top] - Klinefelter, H.F., Reifenstein, E.C., and Albright, F. (1942). Syndrome characterized by gynecomastia aspermatogenesis without A-Leydigism and increased excretion of follicle stimulating hormone. Journal of Clinical Endocrinology and Metabolism, 2, 615\u2013627. [top] - National Human Genome Research Institute. Learning about Klinefelter Syndrome. Retrieved on June 5, 2012 from http://www.genome.gov/19519068 [top] \u00ab What causes it? What are common symptoms? \u00bb Because XXY males do not really appear different from other males and because they may not have any or have mild symptoms, XXY males often don't know they have KS. In other cases, males with KS may have mild or severe symptoms. Whether or not a male with KS has visible symptoms depends on many factors, including how much testosterone his body makes, if he is mosaic (with both XY and XXY cells), and his age when the condition is diagnosed and treated. KS symptoms fall into these main categories: - Physical Symptoms - Language and Learning Symptoms - Social and Behavioral Symptoms - Symptoms of Poly-X KS Physical Symptoms Many physical symptoms of KS result from low testosterone levels in the body. The degree of symptoms differs based on the amount of testosterone needed for a specific age or developmental stage and the amount of testosterone the body makes or has available. During the first few years of life, when the need for testosterone is low, most XXY males do not show any obvious differences from typical male infants and young boys. Some may have slightly weaker muscles, meaning they might sit up, crawl, and walk slightly later than average. For example, on average, baby boys with KS do not start walking until age 18 months. After age 5 years, when compared to typically developing boys, boys with KS may be slightly: - Taller - Fatter around the belly - Clumsier - Slower in developing motor skills, coordination, speed, and muscle strength Puberty for boys with KS usually starts normally. But because their bodies make less testosterone than non-KS boys, their pubertal development may be disrupted or slow. In addition to being tall, KS boys may have: - Smaller testes and penis - Breast growth (about one-third of teens with KS have breast growth) - Less facial and body hair - Reduced muscle tone - Narrower shoulders and wider hips - Weaker bones, greater risk for bone fractures - Decreased sexual interest - Lower energy - Reduced sperm production An adult male with KS may have these features: - Infertility: Nearly all men with KS are unable to father a biologically-related child without help from a fertility specialist. - Small testes, with the possibility of testes shrinking slightly after the teen years - Lower testosterone levels, which lead to less muscle, hair, and sexual interest and function - Breasts or breast growth (called gynecomastia, pronounced GUY-nuh-kow-mast-ee-uh). In some cases, breast growth can be permanent, and about 10% of XXY males need breast-reduction surgery. [top] Language and Learning Symptoms Most males with KS have normal intelligence quotients (IQs) and successfully complete education at all levels. (IQ is a frequently used intelligence measure, but does not include emotional, creative, or other types of intelligence.) Between 25% and 85% of all males with KS have some kind of learning or language-related problem, which makes it more likely that they will need some extra help in school. Without this help or intervention, KS males might fall behind their classmates as schoolwork becomes harder. KS males may experience some of the following learning and language-related challenges: - A delay in learning to talk. Infants with KS tend to make only a few different vocal sounds. As they grow older, they may have difficulty saying words clearly. It might be hard for them to distinguish differences between similar sounds. - Trouble using language to express their thoughts and needs. Boys with KS might have problems putting their thoughts, ideas, and emotions into words. Some may find it hard to learn and remember some words, such as the names of common objects. - Trouble processing what they hear. Although most boys with KS can understand what is being said to them, they might take longer to process multiple or complex sentences. In some cases, they might fidget or \"tune out\" because they take longer to process the information. It might also be difficult for KS males to concentrate in noisy settings. They might also be less able to understand a speaker's feelings from just speech alone. - Reading difficulties. Many boys with KS have difficulty understanding what they read (called poor reading comprehension). They might also read more slowly than other boys. By adulthood, most males with KS learn to speak and converse normally, although they may have a harder time doing work that involves extensive reading and writing. [top] Social and Behavioral Symptoms Many of the social and behavioral symptoms in KS may result from the language and learning difficulties. For instance, boys with KS who have language difficulties might hold back socially and could use help building social relationships. Boys with KS, compared to typically developing boys, tend to be: - Quieter - Less assertive or self-confident - More anxious or restless - Less physically active - More helpful and eager to please - More obedient or more ready to follow directions In the teenage years, boys with KS may feel their differences more strongly. As a result, these teen boys are at higher risk of depression, substance abuse, and behavioral disorders. Some teens might withdraw, feel sad, or act out their frustration and anger. As adults, most men with KS have lives similar to those of men without KS. They successfully complete high school, college, and other levels of education. They have successful and meaningful careers and professions. They have friends and families. Contrary to research findings published several decades ago, males with KS are no more likely to have serious psychiatric disorders or to get into trouble with the law. [top] Symptoms of Poly-X KS Males with poly-X Klinefelter syndrome have more than one extra X chromosome, so their symptoms might be more pronounced than in males with KS. In childhood, they may also have seizures, crossed eyes, constipation, and recurrent ear infections. Poly-KS males might also show slight differences in other physical features. Some common additional symptoms for several poly-X Klinefelter syndromes are listed below. 48,XXYY - Long legs - Little body hair - Lower IQ, average of 60 to 80 (normal IQ is 90 to 110) - Leg ulcers and other vascular disease symptoms - Extreme shyness, but also sometimes aggression and impulsiveness 48,XXXY (or tetrasomy) - Eyes set further apart - Flat nose bridge - Arm bones connected to each other in an unusual way - Short - Fifth (smallest) fingers curve inward (clinodactyly, pronounced KLAHY-noh-dak-tl-ee) - Lower IQ, average 40 to 60 - Immature behavior 49,XXXXY (or pentasomy) - Low IQ, usually between 20 and 60 - Small head - Short - Upward-slanted eyes - Heart defects, such as when the chambers do not form properly - High feet arches - Shy, but friendly - Difficulty with changing routines [top] \u00ab How many people are affected/at risk? What are the treatments? \u00bb It's important to remember that because symptoms can be mild, many males with KS are never diagnosed ore treated. The earlier in life that KS symptoms are recognized and treated, the more likely it is that the symptoms can be reduced or eliminated. It is especially helpful to begin treatment by early puberty. Puberty is a time of rapid physical and psychological change, and treatment can successfully limit symptoms. However, treatment can bring benefits at any age. The type of treatment needed depends on the type of symptoms being treated. Treating Physical Symptoms Treating Language and Learning Symptoms Treating Social and Behavioral Symptoms Treating Physical Symptoms Treatment for Low Testosterone About one-half of XXY males' chromosomes have low testosterone levels. These levels can be raised by taking supplemental testosterone. Testosterone treatment can: - Improve muscle mass - Deepen the voice - Promote growth of facial and body hair - Help the reproductive organs to mature - Build and maintain bone strength and help prevent osteoporosis in later years - Produce a more masculine appearance, which can also help relieve anxiety and depression - Increase focus and attention There are various ways to take testosterone: - Injections or shots, every 2 to 3 weeks - Pills - Through the skin, also called transdermal (pronounced tranz-DERM-ul); current methods include wearing a testosterone patch or rubbing testosterone gel on the skin Males taking testosterone treatment should work closely with an endocrinologist (pronounced en-doe-kren-AWL-oh-jist), a doctor who specializes in hormones and their functions, to ensure the best outcome from testosterone therapy. For information on how to find an endocrinologist, see the Resources and Publications section. Is testosterone therapy right for every XXY male? Not all males with XXY condition benefit from testosterone therapy. For males whose testosterone level is low to normal, the benefits of taking testosterone are less clear than for when testosterone is very low. Side effects, although generally mild, can include acne, skin rashes from patches or gels, breathing problems (especially during sleep), and higher risk of an enlarged prostate gland or prostate cancer in older age. In addition, testosterone supplementation will not increase testicular size, decrease breast growth, or correct infertility. Although the majority of boys with KS grow up to live as males, some develop atypical gender identities. For these males, supplemental testosterone may not be suitable. Gender identity should be discussed with health care specialists before starting treatment. Treatment for Enlarged Breasts No approved drug treatment exists for this condition of over-developed breast tissue, termed gynecomastia. Some health care providers recommend surgery\u2014called mastectomy (pronounced ma-STEK-tuh-mee)\u2014to remove or reduce the breasts of XXY males. When adult men have breasts, they are at higher risk for breast cancer than other men and need to be checked for this condition regularly. The mastectomy lowers the risk of cancer and can reduce the social stress associated with XXY males having enlarged breasts. Because it is a surgical procedure, mastectomy carries a variety of risks. XXY males who are thinking about mastectomy should discuss all the risks and benefits with their health care provider. Treatment for Infertility Between 95% and 99% of XXY men are infertile because they do not produce enough sperm to fertilize an egg naturally. But, sperm are found in more than 50% of men with KS. Advances in assistive reproductive technology (ART) have made it possible for some men with KS to conceive. One type of ART, called testicular sperm extraction with intracytoplasmic (pronounced in-trah-sigh-toe-PLAZ-mick) sperm injection (TESE-ICSI), has shown success for XXY males. For this procedure, a surgeon removes sperm from the testes and places one sperm into an egg. Like all ART, TESE-ICSI carries both risks and benefits. For instance, it is possible that the resulting child might have the XXY condition. In addition, the procedure is expensive and is often is not covered by health insurance plans. Importantly, there is no guarantee the procedure will work. Recent studies suggest that collecting sperm from adolescent XXY males and freezing the sperm until later might result in more pregnancies during subsequent fertility treatments. This is because although XXY males may make some healthy sperm during puberty, this becomes more difficult as they leave adolescence and enter adulthood. [top] Treating Language and Learning Symptoms Some, but not all, children with KS have language development and learning delays. They might be slow to learn to talk, read, and write, and they might have difficulty processing what they hear. But various interventions, such as speech therapy and educational assistance, can help to reduce and even eliminate these difficulties. The earlier treatment begins, the better the outcomes. Parents might need to bring these types of problems to the teacher's attention. Because these boys can be quiet and cooperative in the classroom, teachers may not notice the need for help. Boys and men with KS can benefit by visiting therapists who are experts in areas such as coordination, social skills, and coping. XXY males might benefit from any or all of the following: - Physical therapists design activities and exercises to build motor skills and strength and to improve muscle control, posture, and balance. - Occupational therapists help build skills needed for daily functioning, such as social and play skills, interaction and conversation skills, and job or career skills that match interests and abilities. - Behavioral therapists help with specific social skills, such as asking other kids to play and starting conversations. They can also teach productive ways of handling frustration, shyness, anger, and other emotions that can arise from feeling \"different.\" - Mental health therapists or counselors help males with KS find ways to cope with feelings of sadness, depression, self-doubt, and low self-esteem. They can also help with substance abuse problems. These professionals can also help families deal with the emotions of having a son with KS. - Family therapists provide counseling to a man with KS, his spouse, partner, or family. They can help identify relationship problems and help patients develop communication skills and understand other people's needs. Parents of XXY males have also mentioned that taking part in physical activities at low-key levels, such as karate, swimming, tennis, and golf, were helpful in improving motor skills, coordination, and confidence. With regard to education, some boys with KS will qualify to receive state-sponsored special needs services to address their developmental and learning symptoms. But, because these symptoms may be mild, many XXY males will not be eligible for these services. Families can contact a local school district official or special education coordinator to learn more about whether XXY males can receive the following free services: - The Early Intervention Program for Infants and Toddlers with Disabilities is required by two national laws, the Individuals with Disabilities and Education Improvement Act (IDEIA) and the Individuals with Disabilities Education Act (IDEA). Every state operates special programs for children from birth to age 3, helping them develop in areas such as behavior, development, communication, and social play. - An Individualized Education Plan (IEP) for school is created and administered by a team of people, starting with parents and including teachers and school psychologists. The team works together to design an IEP with specific academic, communication, motor, learning, functional, and socialization goals, based on the child's educational needs and specific symptoms. [top] Treating Social and Behavioral Symptoms Many of the professionals and methods for treating learning and language symptoms of the XXY condition are similar to or the same as the ones used to address social and behavioral symptoms. For instance, boys with KS may need help with social skills and interacting in groups. Occupational or behavioral therapists might be able to assist with these skills. Some school districts and health centers might also offer these types of skill-building programs or classes. In adolescence, symptoms such as lack of body hair could make XXY males uncomfortable in school or other social settings, and this discomfort can lead to depression, substance abuse, and behavioral problems or \"acting out.\" They might also have questions about their masculinity or gender identity. In these instances, consulting a psychologist, counselor, or psychiatrist may be helpful. Contrary to research results released decades ago, current research shows that XXY males are no more likely than other males to have serious psychiatric disorders or to get into trouble with the law. [top] \u00ab What are common symptoms? How is it diagnosed? \u00bb \u200b\u200b The only way to confirm the presence of an extra chromosome is by a karyotype (pronounced care-EE-oh-type) test. A health care provider will take a small blood or skin sample and send it to a laboratory, where a technician inspects the cells under a microscope to find the extra chromosome. A karyotype test shows the same results at any time in a person's life. Tests for chromosome disorders, including KS, may be done before birth. To obtain tissue or liquid for this test, a pregnant woman undergoes chorionic villus (pronounced KAWR-ee-on-ik vil-uhs) sampling or amniocentesis (am-nee-oh-sen-TEE-sis). These types of prenatal testing carry a small risk for miscarriage and are not routinely conducted unless the woman has a family history of chromosomal disorders, has other medical problems, or is above 35 years of age. Factors that Influence when KS is Diagnosed Because symptoms can be mild, some males with KS are never diagnosed. Several factors affect whether and when a diagnosis occurs: - Few newborns and boys are tested for or diagnosed with KS. - Although newborns in the United States are screened for some conditions, they are not screened for XXY or other sex-chromosome differences. - In childhood, symptoms can be subtle and overlooked easily. Only about 1 in 10 males with KS is diagnosed before puberty. - Sometimes, visiting a health care provider will not produce a diagnosis. Some symptoms, such as delayed early speech, might be treated successfully without further testing for KS. - Most XXY diagnoses occur at puberty or in adulthood. - Puberty brings a surge in diagnoses as some males (or their parents) become concerned about slow testes growth or breast development and consult a health care provider. - Many men are diagnosed for the first time in fertility clinics. Among men seeking help for infertility, about 15% have KS; \u00ab What are the treatments? Is there a cure? \u00bb Currently, there is no way to remove chromosomes from cells to \"cure\" the XXY condition. But many symptoms can be successfully treated, minimizing the impact the condition has on length and quality of life. Most adult XXY men have full independence and have friends, families, and normal social relationships. They live about as long as other men, on average. \u00ab How is it diagnosed? Other FAQs \u00bb Are there disorders or conditions associated with KS? Can KS lead to cancer? If I have KS, will I be able to get a woman pregnant? If my son, family member, partner, or spouse is diagnosed with XXY condition, how can I help him and the family? What is the best way to teach or communicate with males who have KS? Are there disorders or conditions associated with KS? Males with KS are at higher risk for some other health conditions, for reasons that are not fully understood. But these risks can be minimized by paying attention to symptoms and treating them appropriately. Associated conditions include: - Autoimmune disorders, such as type 1 diabetes, rheumatoid arthritis, hypothyroidism, and lupus. In these disorders, the immune cells attack parts of the body instead of protecting them. - Breast cancer. Males with KS have a higher risk of developing this cancer, although still a lower risk than females'. XXY males should pay attention to any changes in their breasts, such as lumps or any leakage from the nipple, and should see their health care provider right away if they have any concerns. - Venous (pronounced VEE-nuss) disease, or diseases of the arteries and veins. Some of these include: - Varicose veins - Deep vein thrombosis (pronounced thrahm-BOW-siss), a blood clot in a deep vein - Pulmonary embolism (pronounced PUHL-muh-ner-ee EM-buh-liz-uhm), a blockage of an artery in the lungs - To reduce their risk, males can keep a normal body weight; get regular, moderate physical activity; quit smoking; and avoid sitting or standing in the same position for long periods of time. If venous diseases develop, they can be treated in different ways, depending on their severity. For instance, some treatments include wearing compression socks and others require taking blood thinner medications. - Tooth decay. Almost one-half of men with KS have taurodontism (pronounced tawr-oh-DAWNT-iz-uhm), a dental problem in which the teeth have larger-than-normal chambers for holding pulp (the soft tissue that contains nerve endings and blood vessels) and shorter-than-normal tooth roots, both of which make it easier for tooth decay to develop. Regular dental check-ups and good oral hygiene habits will help prevent, catch, and treat problems. - Osteoporosis (pronounced os-tee-oh-puh-ROH-sis), in which bones lose calcium, become brittle, and break more easily, may develop over time in KS males who have low testosterone levels for long periods of time. Testosterone treatment; regular, moderate physical activity; and eating a healthy diet can decrease the risk of osteoporosis. If the disease develops, medications can help limit its severity. [top] Can KS lead to cancer? Compared with the general male population, men with KS may have a higher chance over time of getting breast cancer, non-Hodgkin lymphoma, and lung cancer. There are ways to reduce this risk, such as removing the breasts and avoiding use of tobacco products. In general, XXY males are also at lower risk for prostate cancer. [top] If I have KS, will I be able to get a woman pregnant? It is possible that an XXY male could get a woman pregnant naturally. Although sperm are found in more than 50% of men with KS, low sperm production could make conception very difficult. A few men with KS have recently been able to father a biologically related child by undergoing assisted fertility services, specifically, a procedure called \u00a0testicular sperm extraction with intracytoplasmic sperm injection (TESE-ICSI). TESE-ICSI, this carries a slightly higher risk of chromosomal disorders in the child, including having an extra X. [top] If my son, family member, partner, or spouse is diagnosed with XXY condition, how can I help him and the family? If someone you know is diagnosed with KS: - Recognize your feelings. It is natural for parents or family members to feel that they have done something to cause KS. But, remember it is a genetic disorder that occurs at random\u2014there is nothing you could have done or not done to prevent it from happening. Allow yourself and your family time to deal with your feelings. Talk with your health care provider about your concerns. - Educate yourself about the disorder. It is common to fear the unknown. Educate yourself about the XXY condition and its symptoms so you know how you can help your son, family member, or partner/spouse. - Support your son, family member, or partner/spouse. Provide appropriate education about KS and give him the emotional support and encouragement he needs. Remember, most XXY males go through life with few problems, and many never find out they have the condition. - Be actively involved in your son's, family member's, or partner's/spouse's care. Talk with your health care provider and his health care provider about his treatment. If counseling for behavioral problems is needed, or if special learning environments or methods are needed, get help from qualified professionals who have experience working with XXY males. - Encourage your son, family member, partner/spouse to do activities to improve his physical motor skills, such as karate or swimming. - Work with your teachers/educators and supervisors/co-workers. - Contact these people regularly to compare how he is doing at home and at school/work. - When appropriate, encourage him to talk with his teachers, educators, supervisor, and co-workers. Suggest using brief notes, telephone calls, and meetings to identify problems and propose solutions. - Encourage your son's, family member's, partner's/spouse's independence. Although it is important to be supportive, realize that watching over too much can send the message that you think he is not able to do things on his own. - Share the following information with health care providers about XXY problems: XXY males may have Consider recommending Delayed early expressive language and speech milestones Early speech therapy and language evaluation Difficulty during transition from elementary school to middle school or high school Re-testing to identify learning areas that require extra attention at or before entrance to middle/high school Difficulty with math at all ages Testing to identify problem areas and remediation for math disabilities Difficulty with complex language processing, specifically with understanding and creating spoken language Language evaluation, increased opportunities to communicate through written language, possibly getting written notes from lectures/discussions Decreased running speed, agility, and overall strength in childhood Physical therapy, occupational therapy, activities that build strength [top] What is the best way to teach or communicate with males who have KS? Research has identified some ways in which educators and parents can improve learning and communication among XXY males, including: - Using images and visual clues - Teaching them new words - Encouraging conversation - Using examples in language - Minimizing distractions - Breaking tasks into small steps - Creating opportunities for social interaction and understanding - Reminding them to stay focused [top] - Michael, J. (2008). Endodontic treatment in three taurodontic teeth associated with 48,XXXY Klinefelter syndrome: A review and case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 105(5), 670-677. [top] - Swerdlow, A.J., Schoemaker, M.J., Higgins, C.D., Wright, A.F., and Jacobs, P.A.; UK Clinical Cytogenetics Group. (2005). Cancer incidence and mortality in men with Klinefelter syndrome: A cohort study. Journal of the National Cancer Institute, 97(16),1204-1210. [top] - Paduch, D.A., Fine, R.G., Bolyakov, A., and Kiper, J. (2008). New concepts in Klinefelter syndrome. Current Opinion in Urology, 18(6), 621-627. [top] - Staessen, C., Tournaye, H., Van Assche, E., Michiels, A., Van Landryt, L., Devroey, P., et al. (2003). PGD in 47,XXY Klinefelter's syndrome patients. Human Reproduction Update, 9(4), 319-330. [top] - Simpson, J.L., de la Cruz, F., Swerdloff, R.F., Samanga-Sprouse, C., Skakkebaek, N.E., Graham, J.M. Jr., et al. (2003). Klinefelter syndrome: Expanding the phenotype and identifying new research directions. Genetics in Medicine, 5(6), 460-468. [top] \u00ab Is there a cure?",
+    "https://www.nichd.nih.gov/health/topics/klinefelter"
+  ],
+  [
+    "Schizotypal personality disorder (Symptoms): SPD should not be confused with schizophrenia. People with SPD can have odd beliefs and behaviors, but unlike people with schizophrenia, they are not disconnected from reality and usually DO NOT hallucinate. They also DO NOT have delusions. People with SPD may be very disturbed. They may also have unusual preoccupations and fears, such as fear of being monitored by government agencies. More commonly, people with this disorder behave oddly and have unusual beliefs (such as aliens). They cling to these beliefs so strongly that they have difficulty forming and keeping close relationships. People with SPD may also have depression. A second personality disorder, such as paranoid personality disorder, is also common. Common signs of SPD include: - Discomfort in social situations - Inappropriate displays of feelings - No close friends - Odd behavior or appearance - Odd beliefs, fantasies, or preoccupations - Odd speech",
+    "https://medlineplus.gov/ency/article/001525.htm"
+  ],
+  [
+    "Klinefelter Syndrome (KS) (How many people are affected/at risk?): Researchers estimate that 1 male in about 500 newborn males has an extra X chromosome, making KS among the most common chromosomal disorders seen in all newborns.The likelihood of a third or fourth X is much rarer: Prevalence of Klinefelter syndrome variants Number of extra X chromosomes One (XXY) Two (XXXY) Three (XXXXY) Number of newborn males with the condition 1 in 500 1 in 50,000 1 in 85,000 to 100,000 Scientists are not sure what factors increase the risk of KS. The error that produces the extra chromosome occurs at random, meaning the error is not hereditary (pronounced huh-RED-i-ter-ee) or passed down from parent to child. Research suggests that older mothers might be slightly more likely to have a son with KS. However, the extra X chromosome in KS comes from the father about one-half of the time. - Nielsen, J., and Wohlert, M. (1991). Chromosome abnormalities found among 34,910 newborn children: Results from a 13-year incidence study in Arhus, Denmark. Human Genetics, 87(1), 81\u201383. [top] - Klinefelter, H.F., Reifenstein, E.C., and Albright, F. (1942). Syndrome characterized by gynecomastia aspermatogenesis without A-Leydigism and increased excretion of follicle stimulating hormone. Journal of Clinical Endocrinology and Metabolism, 2, 615\u2013627. [top] - National Human Genome Research Institute. Learning about Klinefelter Syndrome. Retrieved on June 5, 2012 from http://www.genome.gov/19519068 [top] \u00ab What causes it? What are common symptoms? \u00bb",
+    "https://www.nichd.nih.gov/health/topics/klinefelter"
+  ],
+  [
+    "Beckwith-Wiedemann syndrome: Beckwith-Wiedemann syndrome is a growth disorder that causes large body size, large organs, and other symptoms. It is a congenital condition, which means it is present at birth. The signs and symptoms of the disorder vary somewhat from child to child. Infancy can be a critical period in babies with this condition because of the possibility of: - Low blood sugar - A type of hernia called an omphalocele (when present) - An enlarged tongue (macroglossia) - An increased rate of tumor growth. Wilms tumors and hepatoblastomas are the most common tumors in children with this syndrome. Beckwith-Wiedemann syndrome is caused by a defect in the genes on chromosome 11. About 10% of cases can be passed down through families. Signs and symptoms of Beckwith-Wiedemann syndrome include: - Large size for a newborn - Red birth mark on forehead or eyelids (Nevus flammeus) - Creases in ear lobes - Large tongue (macroglossia) - Low blood sugar - Abdominal wall defect (umbilical hernia or omphalocele) - Enlargement of some organs - Overgrowth of one side of the body (hemihyperplasia/hemihypertrophy) - Tumor growth, such as Wilms tumors and hepatoblastomas The health care provider will do a physical exam to look for signs and symptoms of Beckwith-Wiedemann syndrome. Often this is enough to make a diagnosis. Tests for the disorder include: - Blood tests for low blood sugar - Chromosomal studies for abnormalities in chromosome 11 - Ultrasound of the abdomen Infants with low blood sugar may be treated with fluids given through a vein (intravenous, IV). Some infants may need medicine or other management if low blood sugar continues. Defects in the abdominal wall may need to be repaired. If the enlarged tongue makes it hard to breath or eat, surgery may be needed, Children with overgrowth on one side of the body should be watched for a curved spine (scoliosis). The child also must be watched closely for the development of tumors. Tumor screening includes blood tests and abdominal ultrasounds. Children with Beckwith-Wiedemann syndrome typically lead normal lives. Further study is needed to develop long-term follow-up information. These complications can occur: - Development of tumors - Feeding problems due to enlarged tongue - Breathing problems due to enlarged tongue - Scoliosis due to hemihypertrophy If you have a child with Beckwith-Wiedemann syndrome and worrisome symptoms develop, call your pediatrician right away. There is no known prevention for Beckwith-Wiedemann syndrome. Genetic counseling may be of value for families who would like to have more children. Updated by: Jennifer M. Kalish, MD, PhD, Attending Physician, Division of Human Genetics, The Children\u2019s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/001186.htm"
+  ],
+  [
+    "What is Beckwith-Wiedemann syndrome?: Beckwith-Wiedemann syndrome is a condition that affects many parts of the body. It is classified as an overgrowth syndrome, which means that affected infants are considerably larger than normal (macrosomia) and tend to be taller than their peers during childhood. Growth begins to slow by about age 8, and adults with this condition are not unusually tall. In some children with Beckwith-Wiedemann syndrome, specific parts of the body on one side or the other may grow abnormally large, leading to an asymmetric or uneven appearance. This unusual growth pattern, which is known as hemihyperplasia, usually becomes less apparent over time. The signs and symptoms of Beckwith-Wiedemann syndrome vary among affected individuals. Some children with this condition are born with an opening in the wall of the abdomen (an omphalocele) that allows the abdominal organs to protrude through the belly-button. Other abdominal wall defects, such as a soft out-pouching around the belly-button (an umbilical hernia), are also common. Some infants with Beckwith-Wiedemann syndrome have an abnormally large tongue (macroglossia), which may interfere with breathing, swallowing, and speaking. Other major features of this condition include abnormally large abdominal organs (visceromegaly), creases or pits in the skin near the ears, low blood sugar (hypoglycemia) in infancy, and kidney abnormalities. Children with Beckwith-Wiedemann syndrome are at an increased risk of developing several types of cancerous and noncancerous tumors, particularly a form of kidney cancer called Wilms tumor and a form of liver cancer called hepatoblastoma. Tumors develop in about 10 percent of people with this condition and almost always appear in childhood. Most children and adults with Beckwith-Wiedemann syndrome do not have serious medical problems associated with the condition. Their life expectancy is usually normal.",
+    "https://ghr.nlm.nih.gov/condition/beckwith-wiedemann-syndrome"
+  ],
+  [
+    "Beckwith-Wiedemann syndrome: Beckwith-Wiedemann syndrome (BWS) is a growth disorder that can affect several parts of the body. Affected infants are larger than normal and are taller than their peers during childhood. Growth slows down in several years, and affected adults are not unusually tall. Some children have asymmetric growth which usually becomes less apparent over time. Other signs and symptoms may include an omphalocele or other abdominal wall defect at birth; low blood sugar (hypoglycemia) in infancy; an abnormally large tongue (macroglossia); abnormally large abdominal organs ; creases or pits in the skin near the ears; and kidney abnormalities. Affected children have an increased risk to develop tumors , particularly Wilms tumor and hepatoblastoma. BWS may be caused by several types of genetic changes, but in about 85% of cases only one person in a family is diagnosed with the disorder. [1] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Large for gestational age Very frequent Tall stature Very frequent Abnormality of the shape of the midface Frequent Accelerated skeletal maturation Frequent Anterior creases of earlobe Frequent Branchial cyst Frequent Choroideremia Frequent Coarse facial features Frequent Congenital diaphragmatic hernia Frequent Enlarged kidney Frequent Exocrine pancreatic insufficiency Frequent Hemihypertrophy Frequent Hypercalciuria Frequent Infra-orbital crease Frequent Large placenta Frequent Melanocytic nevus Frequent Midface retrusion Frequent Neonatal hypoglycemia Frequent Nephropathy Frequent Nevus flammeus Frequent Obesity Frequent Omphalocele Frequent Polyhydramnios Frequent Posterior helix pit Frequent Premature birth Frequent Prominent occiput Frequent Proptosis Frequent Redundant skin Frequent Subchorionic septal cyst Frequent Umbilical hernia Frequent Wide mouth Frequent Abnormality of pancreas morphology Occasional Adrenocortical carcinoma Occasional Adrenocortical cytomegaly Occasional Cardiomegaly Occasional Congenital megaureter Occasional Cryptorchidism Occasional Diastasis recti Occasional Elevated alpha-fetoprotein Occasional Facial hemangioma Occasional Feeding difficulties in infancy Occasional Gonadoblastoma Occasional Hepatoblastoma Occasional Hepatomegaly Occasional Hypertrophic cardiomyopathy Occasional Hypothyroidism Occasional Inguinal hernia Occasional Large intestinal polyposis Occasional Leiomyosarcoma Occasional Multiple renal cysts Occasional Nephroblastoma Occasional Nephrolithiasis Occasional Neuroblastoma Occasional Neurodevelopmental delay Occasional Neurological speech impairment Occasional Otosclerosis Occasional Polycythemia Occasional Prominent metopic ridge Occasional Rhabdomyosarcoma Occasional Sleep apnea Occasional Splenomegaly Occasional Ureteral duplication Occasional Urogenital fistula Occasional Vesicoureteral reflux Occasional Wide anterior fontanel Occasional Arnold-Chiari malformation Very rare Pseudohypoparathyroidism Very rare Autosomal dominant inheritance - Cardiomyopathy - Dandy-Walker malformation - Large fontanelles - Nephrocalcinosis - Overgrowth - Overgrowth of external genitalia - Pancreatic hyperplasia - Renal cortical cysts - View complete list of signs and symptoms... Beckwith-Wiedemann syndrome (BWS) is a genetic disorder and the various causes are very complex. BWS usually results from abnormal gene regulation in a particular region of chromosome 11. [1] Gene regulation is the process of turning genes \"on\" or \"off\" and ensures that the appropriate genes are expressed at the proper times. [2] Normally, people inherit one copy of each chromosome from each parent. This also means that people normally inherit one copy of each gene (on the chromosomes) from each parent. For most genes on chromosome 11, both copies of each gene are \"turned on\" (expressed). However, for some genes, only the paternal copy ( inherited from a person's father) is expressed, or only the maternal copy is expressed. These parent-specific differences in gene expression are due to a phenomenon called genomic imprinting. Most cases of BWS are due to abnormalities involving genes on chromosome 11 that undergo genomic imprinting (imprinted genes). [1] At least 50% of cases of BWS result from changes in a process called methylation, a chemical reaction that attaches molecules called methyl groups to pieces of DNA . Methylation is one way that a gene's original parent is \"marked\" for imprinting when egg and sperm cells are formed. BWS is often associated with changes in regions of DNA on chromosome 11 called imprinting centers (ICs), which control the methylation of several genes involved in normal growth. Abnormal methylation disrupts the regulation of these genes, leading to overgrowth and the other features of BWS. The genes affected include the CDKN1C , H19, IGF2, and KCNQ1OT1 genes. [1] About 20% of cases of BWS are caused by a genetic abnormality called paternal uniparental disomy (UPD), in which both copies of chromosome 11 are inherited from the father and no copy is inherited from the mother. Paternal UPD results in 2 active copies of paternally inherited genes (rather than 1 active copy from the father and 1 inactive copy from the mother). It also results in missing genes that are normally active only on the copy inherited from the mother. Paternal UPD in BWS usually occurs early in embryonic development, affecting only some of the body's cells (called mosaicism). Mosaic paternal UPD leads to an imbalance of the active genes on chromosome 11, causing the characteristic features of the disorder. [1] Even less commonly, BWS may be caused by mutations in the CDKN1C gene, which gives instructions for making a protein that helps control growth before birth. Mutations in this gene prevent the protein from restricting growth, leading to the features of BWS. [1] Lastly, about 1% of people with BWS have a different type of chromosome abnormality , such as a translocation , duplication , or deletion of genetic material on chromosome 11. These changes also disrupt the normal regulation of certain genes on the chromosome. [1] Because the genetic changes responsible for BWS are very complex, people with questions about the causes and inheritance of BWS should consult with a genetics professional. In about 85% percent of cases of Beckwith-Wiedemann syndrome (BWS), only one person in a family has been diagnosed. However, the parents of an affected child may be at risk of having other affected children; the risk depends on the underlying genetic cause in each case. About 10% to 15% of affected people are part of families with more than one affected person. In most of these families, the condition appears to be inherited in an autosomal dominant \u00a0manner. This means that having only one changed ( mutated ) copy of the responsible gene in each cell is enough to cause symptoms of the disorder.\u00a0In most of these cases, the affected person inherits the genetic change from their mother. In some cases, a person inherits the mutated gene but does not have symptoms of the disorder. Rarely, BWS results from abnormalities of the structure of chromosome 11. Some of these chromosome abnormalities are inherited from a parent, while others occur randomly during the formation of eggs and sperm, or very early in fetal development. [1] In order to assess the recurrence risk for BWS in a family, the underlying cause needs to be identified. Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. Orphanet lists international laboratories offering diagnostic testing for this condition. The resources below provide information about treatment options for this condition. If you have questions about which treatment is right for you, talk to your healthcare professional. Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. Project OrphanAnesthesia is a project whose aim is to create peer-reviewed, readily accessible guidelines for patients with rare diseases and for the anesthesiologists caring for them. The project is a collaborative effort of the German Society of Anesthesiology and Intensive Care, Orphanet, the European Society of Pediatric Anesthesia, anesthetists and rare disease experts with the aim to contribute to patient safety.",
+    "https://rarediseases.info.nih.gov/diseases/3343/beckwith-wiedemann-syndrome"
+  ],
+  [
+    "CDKN1C gene (Beckwith-Wiedemann syndrome): Beckwith-Wiedemann syndrome is a condition that causes overgrowth and has other signs and symptoms that affect many parts of the body. At least half of all cases of Beckwith-Wiedemann syndrome result from changes in methylation of the IC2 region. Specifically, the maternally inherited copy of the IC2 region has too few methyl groups attached (hypomethylation). This abnormality disrupts the regulation of several genes that are normally controlled by IC2, including CDKN1C. Because this gene normally restrains cell growth and division, a reduction in its activity leads to overgrowth and the other features of Beckwith-Wiedemann syndrome. In a few cases, Beckwith-Wiedemann syndrome has been caused by deletions of a small amount of DNA from the maternally inherited copy of the IC2 region. Like abnormal methylation, these deletions disrupt the activity of several genes, including CDKN1C. Beckwith-Wiedemann syndrome can also result from mutations within the maternally inherited copy of the CDKN1C gene. More than two dozen such mutations have been identified. Some of these genetic changes lead to an abnormally short, nonfunctional version of the CDKN1C protein, while others alter single protein building blocks (amino acids) or delete a small number of amino acids from the protein. All of these mutations are described as \"loss-of-function\" because they alter the structure of the CDKN1C protein such that it can no longer control growth effectively. The resulting problems with growth regulation lead to overgrowth and the other features of Beckwith-Wiedemann syndrome.",
+    "https://ghr.nlm.nih.gov/gene/CDKN1C"
+  ],
+  [
+    "Beckwith-Wiedemann syndrome (Inheritance Pattern): In about 85 percent of cases of Beckwith-Wiedemann syndrome, only one person in a family has been diagnosed with the condition. However, parents of one child with Beckwith-Wiedemann syndrome may be at risk of having other children with the disorder. This risk depends on the genetic cause of the condition. Another 10 to 15 percent of people with Beckwith-Wiedemann syndrome are part of families with more than one affected family member. In most of these families, the condition appears to have an autosomal dominant pattern of inheritance. Autosomal dominant inheritance means that one copy of an altered gene in each cell is typically sufficient to cause the disorder. In most of these cases, individuals with Beckwith-Wiedemann syndrome inherit the genetic change from their mothers. Occasionally, a person who inherits the altered gene will not have any of the characteristic signs and symptoms of the condition. Rarely, Beckwith-Wiedemann syndrome results from changes in the structure of chromosome 11. Some of these chromosomal abnormalities are inherited from a parent, while others occur as random events during the formation of reproductive cells (eggs and sperm) or in the earliest stages of development before birth.",
+    "https://ghr.nlm.nih.gov/condition/beckwith-wiedemann-syndrome"
+  ],
+  [
+    "Beckwith-Wiedemann syndrome (Genetic Changes): The genetic causes of Beckwith-Wiedemann syndrome are complex. The condition usually results from the abnormal regulation of genes in a particular region of chromosome 11. People normally inherit one copy of this chromosome from each parent. For most genes on chromosome 11, both copies of the gene are expressed, or \"turned on,\" in cells. For some genes, however, only the copy inherited from a person's father (the paternally inherited copy) is expressed. For other genes, only the copy inherited from a person's mother (the maternally inherited copy) is expressed. These parent-specific differences in gene expression are caused by a phenomenon called genomic imprinting. Abnormalities involving genes on chromosome 11 that undergo genomic imprinting are responsible for most cases of Beckwith-Wiedemann syndrome. At least half of all cases result from changes in a process called methylation. Methylation is a chemical reaction that attaches small molecules called methyl groups to certain segments of DNA. In genes that undergo genomic imprinting, methylation is one way that a gene's parent of origin is marked during the formation of egg and sperm cells. Beckwith-Wiedemann syndrome is often associated with changes in regions of DNA on chromosome 11 called imprinting centers (ICs). ICs control the methylation of several genes that are involved in normal growth, including the CDKN1C, H19, IGF2, and KCNQ1OT1 genes. Abnormal methylation disrupts the regulation of these genes, which leads to overgrowth and the other characteristic features of Beckwith-Wiedemann syndrome. About twenty percent of cases of Beckwith-Wiedemann syndrome are caused by a genetic change known as paternal uniparental disomy (UPD). Paternal UPD causes people to have two active copies of paternally inherited genes rather than one active copy from the father and one inactive copy from the mother. People with paternal UPD are also missing genes that are active only on the maternally inherited copy of the chromosome. In Beckwith-Wiedemann syndrome, paternal UPD usually occurs early in embryonic development and affects only some of the body's cells. This phenomenon is called mosaicism. Mosaic paternal UPD leads to an imbalance in active paternal and maternal genes on chromosome 11, which underlies the signs and symptoms of the disorder. Less commonly, mutations in the CDKN1C gene cause Beckwith-Wiedemann syndrome. This gene provides instructions for making a protein that helps control growth before birth. Mutations in the CDKN1C gene prevent this protein from restraining growth, which leads to the abnormalities characteristic of Beckwith-Wiedemann syndrome. About 1 percent of all people with Beckwith-Wiedemann syndrome have a chromosomal abnormality such as a rearrangement (translocation), abnormal copying (duplication), or loss (deletion) of genetic material from chromosome 11. Like the other genetic changes responsible for Beckwith-Wiedemann syndrome, these abnormalities disrupt the normal regulation of certain genes on this chromosome.",
+    "https://ghr.nlm.nih.gov/condition/beckwith-wiedemann-syndrome"
+  ],
+  [
+    "St\u00fcve-Wiedemann syndrome: St\u00fcve-Wiedemann syndrome is a severe condition characterized by bone abnormalities and dysfunction of the autonomic nervous system, which controls involuntary body processes such as the regulation of breathing rate and body temperature. The condition is apparent from birth, and its key features include abnormal curvature (bowing) of the long bones in the legs, difficulty feeding and swallowing, and episodes of dangerously high body temperature (hyperthermia). In addition to bowed legs, affected infants can have bowed arms, permanently bent fingers and toes (camptodactyly), and joint deformities (contractures) in the elbows and knees that restrict their movement. Other features include abnormalities of the pelvic bones (the ilia) and reduced bone mineral density (osteopenia). In infants with St\u00fcve-Wiedemann syndrome, dysfunction of the autonomic nervous system typically leads to difficulty feeding and swallowing, breathing problems, and episodes of hyperthermia. Affected infants may also sweat excessively, even when the body temperature is not elevated, or have a reduced ability to feel pain. Many babies with this condition do not survive past infancy because of the problems regulating breathing and body temperature; however, some people with St\u00fcve-Wiedemann syndrome live into adolescence or later. Problems with breathing and swallowing usually improve in affected children who survive infancy; however, they still have difficulty regulating body temperature. In addition, the leg bowing worsens, and children with St\u00fcve-Wiedemann syndrome may develop prominent joints, an abnormal curvature of the spine (scoliosis), and spontaneous bone fractures. Some affected individuals have a smooth tongue that lacks the bumps that house taste buds (fungiform papillae). Affected children may also lose certain reflexes, particularly the reflex to blink when something touches the eye (corneal reflex) and the knee-jerk reflex (patellar reflex). Another condition once known as Schwartz-Jampel syndrome type 2 is now considered to be part of St\u00fcve-Wiedemann syndrome. Researchers have recommended that the designation Schwartz-Jampel syndrome type 2 no longer be used. St\u00fcve-Wiedemann syndrome is a rare condition that has been found worldwide. Its prevalence is unknown. St\u00fcve-Wiedemann syndrome is usually caused by mutations in the LIFR gene. This gene provides instructions for making a protein called leukemia inhibitory factor receptor (LIFR). Receptor proteins have specific sites into which certain other proteins, called ligands, fit like keys into locks. Together, ligands and their receptors trigger signals that affect cell development and function. The LIFR protein acts as a receptor for a ligand known as leukemia inhibitory factor (LIF). LIFR signaling can control several cellular processes, including growth and division (proliferation), maturation (differentiation), and survival. First found to be important in blocking (inhibiting) growth of blood cancer (leukemia) cells, this signaling is also involved in the formation of bone and the development of nerve cells. It appears to play an important role in normal development and functioning of the autonomic nervous system. Most LIFR gene mutations that cause St\u00fcve-Wiedemann syndrome prevent production of any LIFR protein. Other mutations lead to production of an altered protein that likely cannot function. Without functional LIFR, signaling is impaired. The lack of LIFR signaling disrupts normal bone formation, leading to osteopenia, bowed legs, and other skeletal problems common in St\u00fcve-Wiedemann syndrome. In addition, development of nerve cells, particularly those involved in the autonomic nervous system, is abnormal, leading to the problems with breathing, feeding, and regulating body temperature characteristic of this condition. A small number of people with St\u00fcve-Wiedemann syndrome do not have an identified mutation in the LIFR gene. Researchers suggest that other genes that have not been identified may be involved in this condition. This condition is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition. Dagoneau N, Scheffer D, Huber C, Al-Gazali LI, Di Rocco M, Godard A, Martinovic J, Raas-Rothschild A, Sigaudy S, Unger S, Nicole S, Fontaine B, Taupin JL, Moreau JF, Superti-Furga A, Le Merrer M, Bonaventure J, Munnich A, Legeai-Mallet L, Cormier-Daire V. Null leukemia inhibitory factor receptor (LIFR) mutations in Stuve-Wiedemann/Schwartz-Jampel type 2 syndrome. Am J Hum Genet. 2004 Feb;74(2):298-305. Epub 2004 Jan 21.",
+    "https://ghr.nlm.nih.gov/condition/stuve-wiedemann-syndrome"
+  ],
+  [
+    "Mastocytosis (Treatment): The treatment for mastocytosis depends on the particular symptoms of each person. Treatment for symptoms that affect the skin include\u00a0 antihistamines\u00a0and\u00a0 oral psoralen plus UVA (PUVA) therapy.\u00a0If the symptoms are not responsive to other treatment, a doctor may prescribe\u00a0 steroid\u00a0creams, ointments, or solutions to be applied to the skin ( topical\u00a0 corticosteroids \u00a0treatment). [1]\u00a0 Proton pump inhibitors\u00a0can be used to treat gastrointestinal symptoms and bone pain. Different treatments work better for some people than others. [1] Many specialists recommended that people with mastocytosis have\u00a0 injectable epinephrine\u00a0that they can use in case of\u00a0 anaphylactic shock. Other recommendations include trying to avoid known triggers of symptoms of mastocytosis. [7] FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal National Library of Medicine Drug Information Portal",
+    "https://rarediseases.info.nih.gov/diseases/6987/mastocytosis"
+  ],
+  [
+    "Retroperitoneal fibrosis (Treatment): Corticosteroids are tried first. Some\u00a0health care providers\u00a0also prescribe a drug called tamoxifen. If corticosteroid treatment does not work, a biopsy should be done to confirm the diagnosis. Other medicines to suppress the immune system can be prescribed. When medicine does not work, surgery and stents (draining tubes) are needed.",
+    "https://medlineplus.gov/ency/article/000463.htm"
+  ],
+  [
+    "Pericarditis - after heart attack (Treatment): The goal of treatment is to make the heart work better and reduce pain and other symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin may be used to treat inflammation of the pericardium. A drug called colchicine is often used with these medicines. Steroids are commonly used for Dressler syndrome. They are not often used for early pericarditis unless the condition does not respond to other treatment. In some cases, excess fluid surrounding the heart (pericardial effusion) may need to be removed. This is done with a procedure called pericardiocentesis. If complications develop, part of the pericardium may need to be removed with surgery (pericardiectomy).",
+    "https://medlineplus.gov/ency/article/000166.htm"
+  ],
+  [
+    "Prescription drug abuse (Treatment): Treatment options for prescription drug abuse vary, depending on the type of drug used and your needs. But counseling, or sometimes psychotherapy, is typically a key part of treatment. Treatment may also require withdrawal (detoxification), addiction medication and recovery support. Counseling A licensed alcohol and drug counselor or other addiction specialist can provide individual, group or family counseling. This can help you: - Determine what factors may have led to the prescription drug abuse, such as an underlying mental health problem or relationship problems - Learn the skills needed to resist cravings, avoid abuse of drugs and help prevent recurrence of prescription drug problems - Learn strategies for developing positive relationships - Identify ways to become involved in healthy activities that aren't related to drugs - Learn the steps to take if a relapse happens Withdrawal Depending on the prescription drug and usage, detoxification may be needed as part of treatment. Withdrawal can be dangerous and should be done under a doctor's care. - Opioid withdrawal. Opioid tapering involves gradually decreasing the dose of medication until it's no longer used. Other medications - such as clonidine (Catapres), a drug mainly used for high blood pressure - can be used to help manage opioid withdrawal symptoms during this process. Buprenorphine, buprenorphine with naloxone (Suboxone) or methadone may be used by doctors under specific, legally regulated and monitored conditions to ease symptoms of withdrawal from opioid painkillers. Vivitrol, a version of the drug naltrexone, given by injection once a month by a health care provider may help people stay off opioids early in their recovery. - Withdrawal from sedatives or anti-anxiety medications. If you've used prescription sedatives or anti-anxiety drugs for a long time, it may take weeks to slowly taper off them. Because of withdrawal symptoms, it can take that long for your body to adjust to low doses of the medication and then get used to taking none at all. You may need other types of medication to stabilize your mood, manage the final phases of tapering or help with anxiety, and you'll need to work closely with your doctor. - Stimulant withdrawal. There are no approved drugs used for treating stimulant withdrawal. Treatment typically focuses on tapering off the medication and relieving withdrawal symptoms - such as sleep, appetite and mood disturbances.",
+    "https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/symptoms-causes/syc-20376813"
+  ],
+  [
+    "Erectile Dysfunction (ED) (Treatment): You can work with a health care professional to treat an underlying cause of your erectile dysfunction (ED). Choosing an ED treatment is a personal decision. However, you also may benefit from talking with your partner about which treatment is best for you as a couple.Your health care professional may suggest that you make lifestyle changes to help reduce or improve ED. You canquit smoking limit or stop drinking alcohol increase physical activity and maintain a healthy body weight stop illegal drug useYou can seek help from a health professional if you have trouble making these changes on your own.Talk with your doctor about going to a counselor if psychological or emotional issues are affecting your ED. A counselor can teach you how to lower your anxiety or stress related to sex. Your counselor may suggest that you bring your partner to counseling sessions to learn how to support you. As you work on relieving your anxiety or stress, a doctor can focus on treating the physical causes of ED.",
+    "https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction"
+  ],
+  [
+    "Crigler-Najjar syndrome (Treatment): Light treatment (phototherapy) is needed throughout a person's life. In infants, this is done using bilirubin lights (bili or 'blue' lights). Phototherapy does not work as well after age 4, because thickened skin blocks the light. A liver transplant can be done in some people with type I disease. Blood transfusions may help control the amount of bilirubin in blood. Calcium compounds are sometimes used to remove bilirubin in the gut. The drug phenobarbitol is sometimes used to treat type II Crigler-Najjar syndrome.",
+    "https://medlineplus.gov/ency/article/001127.htm"
+  ],
+  [
+    "Soft tissue sarcoma (Treatment): Your treatment options for soft tissue sarcoma will depend on the size, type and location of your tumor. Surgery Surgery is a common treatment for soft tissue sarcoma. Surgery generally involves removing the cancer and some healthy tissue surrounding it. When soft tissue sarcoma affects the arms and legs, radiation and chemotherapy may be considered to shrink the tumor to avoid amputation. Radiation therapy Radiation therapy involves treating cancer with high-powered beams of energy. Options include: - Before surgery. Radiation before surgery can help shrink the tumor so that it's easier to remove. - During surgery. Intraoperative radiation allows a higher dose of radiation to be delivered directly to the target area, while sparing surrounding tissues. - After surgery. Postoperative radiation can help kill any remaining cancer cells. Chemotherapy Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy can be administered by pill or through a vein (intravenously). Some forms of soft tissue sarcoma respond better to chemotherapy than do others. For instance, chemotherapy is often used to treat rhabdomyosarcoma. Targeted drug treatment Some types of soft tissue sarcoma have specific characteristics in their cells that can be attacked via targeted drug treatments. These medicines work better than chemotherapy and aren't nearly as toxic. Targeted treatments have been particularly helpful in gastrointestinal stromal tumors (GISTs).",
+    "https://www.mayoclinic.org/diseases-conditions/epithelioid-sarcoma/cdc-20392420"
+  ],
+  [
+    "Nerve Damage (Diabetic Neuropathies) (What is proximal neuropathy?): 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.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies"
+  ],
+  [
+    "Do you have information about Toddler development: Summary : Toddlers are children ages 1 - 3. CHILD DEVELOPMENT THEORIES Cognitive (thought) development skills typical for toddlers include: - Early use of instruments or tools - Following visual (then later, invisible) displacement (moving from one place to another) of objects - Understanding that objects and people are there, even if you can't see them (object and people permanence) Personal-social development in the toddler stage focuses on the child learning to adjust to society's demands, while trying to maintain independence and a sense of self. These milestones are typical of children in the toddler stages. Some variation is normal. Talk to your health care provider if you have questions about your child's development. PHYSICAL DEVELOPMENT The following are signs of expected physical development in a toddler: GROSS MOTOR SKILLS (use of large muscles in the legs and arms) - Stands alone well by 12 months - Walks well by 12 - 15 months (Ifa child is not walking by 18 months, he or she should be evaluated by a health care provider.) - Learns to walk backwards and up steps with help at about 16 - 18 months - Jumps in place by about 24 months - Rides a tricycle and stands briefly on one foot by about 36 months FINE MOTOR SKILLS (use of small muscles in hands and fingers) - Makes tower of three cubes by around 15 months - Scribbles by 15 - 18 months - Can use spoon by 24 months - Can copy a circle by 36 months LANGUAGE DEVELOPMENT - Uses 2 - 3 words (other than Mama or Dada) at 12 - 15 months - Understands and follows simple commands (such as \"bring to Mommy\") at 14 - 16 months - Names pictures of items and animals at 18 - 24 months - Points to named body parts at 18 - 24 months - Begins to say his or her own name at 22 - 24 months - Combines 2 words at 16 to 24 months (There is a range of ages at which children are first able to combine words into sentences. Talk to your child's health care provider if the toddler cannot make sentences by 24 months.) - Knows gender and age by 36 months SOCIAL DEVELOPMENT - Indicates some needs by pointing at 12 - 15 months - Looks for help when in trouble by 18 months - Helps to undress and put things away by 18 - 24 months - Listens to stories when shown pictures and can tell aboutrecent experiences by 24 months - Cantake partin pretend play and simple games by 24 - 36 months BEHAVIOR Toddlers are always trying to be more independent. This creates safety concerns as well as discipline challenges. The child must be consistently taught the limits of appropriate vs. inappropriate behavior. When toddlers try out activities they haven't yet mastered, they can get frustrated and angry. Breath-holding, crying, screaming, and temper tantrums may often occur. It is important for a child at this stage to: - Learn from experiences - Rely on boundaries between acceptable and unacceptable behaviors SAFETY Toddler safety is very important. - Parents need to be aware that the child can now walk, run, climb, jump, and explore. This new stage of movement makes child-proofing the home very important. Window guards, gates on stairways, cabinet locks, toilet seat locks, electric outlet covers, and other safety features are needed to keep the child safe. - Put the toddler in a safety restraint (toddler car seat) when riding in a car. - Do not leave a toddler unattended for even short periods of time. Remember, more accidents occur during the toddler years than at any other stage of childhood. - Make clear rules about not playing in streets or crossing without an adult. - Falls are a major cause of injury. Keep gates or doors to stairways closed, and use guards for all windows above the ground floor. Do not leave chairs or ladders in areas that are likely to tempt the toddler into climbing up to explore new heights. Use corner guards on furniture in areas where the toddler is likely to walk, play, or run. - Poisoning is a common cause of toddler illness and death. Keep all medicines in a locked cabinet. Keep all toxic household products (polishes, acids, cleaning solutions, chlorine bleach, lighter fluid, insecticides, or poisons) in a locked cabinet or closet. Many household and garden plants, such as toad stools, may cause serious illness or death if eaten. Ask your child's health care provider for a list of common poisonous plants. - If someone in the household owns a firearm, make sure it is unloaded and locked in a secure place. - Keep toddlers away from the kitchen with a safety gate, or place them in a playpen or high chair. This will eliminate the danger of burns from pulling hot foods off the stove or bumping into the hot oven door. - Do not let toddlers play in water alone. A toddler may drown, even in shallow water in a bathtub. Parent-child swimming lessons can be another safe and enjoyable way for toddlers to play in water. Never leave a child unattended near a pool, open toilet, or bathtub. Toddlers cannot learn how to swim and cannot be independent near any body of water. PARENTING TIPS - The toddler years are for children to learn accepted rules of behavior. It is important for parents to be consistent both in modeling behavior (behaving the way you want your child to behave), and in pointing out inappropriate behavior in the child. Recognize and reward positive behavior. You can introduce time-outs for negative behavior, or for going beyond the limits you set for your child. - The toddler's favorite word may seem to be \"NO!!!\" It is important for parents not to fall into a pattern of negative behaviorusing yelling, spanking, and threats. - Teach children the proper names of body parts. - Stress the unique, individual qualities of the child. - Teach the concepts of please, thank you, and sharing with others. - Read to the child regularly. This will help develop verbal skills. - Toddlers thrive on regularity. Major changes in their routine are hard for them. Toddlers should have regular nap, bed, snack, and meal times. - Toddlers should not be allowed to eat many snacks throughout the day. Too many snacks can take away the desire to eat regular meals, which tend to offer more balanced nutrition. - Traveling with a toddler or having guests at the house can disrupt the childs routine. This may make the child more irritable. In these situations, reassure the child and try to get back to a routine in a calm way.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/002010.htm"
+  ],
+  [
+    "Nerve Damage (Diabetic Neuropathies): The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.What are clinical trials, and are they right for you? Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.What are clinical trials, and are they right for you?Find out if clinical trials are right for youWhat clinical trials are open? Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.What clinical trials are open?www.ClinicalTrials.govWhat are diabetic neuropathies? 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 numbness\u2014loss of feeling\u2014in 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. What causes diabetic neuropathies? 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 What are the symptoms of diabetic neuropathies? 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 autonomic\u2014or involuntary\u2014nervous 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. What are the types of diabetic neuropathy? 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 What is peripheral neuropathy? 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 affects the nerves in your toes, feet, legs, hands, and arms. 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. What is autonomic neuropathy? 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. Autonomic neuropathy affects the nerves in your heart, stomach, intestines, bladder, sex organs, sweat glands, eyes, and lungs. 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. What is proximal neuropathy? 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. What is focal neuropathy? 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. Can diabetic neuropathies be prevented? 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. How are diabetic neuropathies diagnosed? 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 monofilament\u2014similar to a bristle on a hairbrush\u2014attached 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. How are diabetic neuropathies treated? 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 skin\u2014typically to the feet\u2014include 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 gastroparesis\u2014indigestion, belching, nausea, or vomiting\u2014doctors 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 intervals\u2014every 3 hours, for example\u2014because 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 warm\u2014not hot\u2014water 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 mirror\u2014handheld or placed on the floor\u2014may 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. Points to Remember 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. Clinical Trials The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. What are clinical trials, and are they right for you? Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you. What clinical trials are open? Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies"
+  ],
+  [
+    "Nerve Damage (Diabetic Neuropathies) (What are the symptoms of diabetic neuropathies?): 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 autonomic\u2014or involuntary\u2014nervous systems. In some people, mainly those with focal neuropathy, the onset of pain may be sudden and severe.Symptoms of nerve damage may includenumbness, 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 weaknessnumbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingerswasting of the muscles of the feet or handsindigestion, nausea, or vomitingdiarrhea or constipationdizziness or faintness due to a drop in blood pressure after standing or sitting upproblems with urinationerectile dysfunction in men or vaginal dryness in womenweaknessSymptoms that are not due to neuropathy, but often accompany it, include weight loss and depression.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies"
+  ],
+  [
+    "Nerve Damage (Diabetic Neuropathies) (What causes diabetic neuropathies?): 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 usemetabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulinneurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to nervesautoimmune factors that cause inflammation in nervesmechanical injury to nerves, such as carpal tunnel syndromeinherited traits that increase susceptibility to nerve diseaselifestyle factors, such as smoking or alcohol use",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies"
+  ],
+  [
+    "Nerve Damage (Diabetic Neuropathies): 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 numbness\u2014loss of feeling\u2014in 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. 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 usemetabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulinneurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to nervesautoimmune factors that cause inflammation in nervesmechanical injury to nerves, such as carpal tunnel syndromeinherited traits that increase susceptibility to nerve diseaselifestyle factors, such as smoking or alcohol use 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 autonomic\u2014or involuntary\u2014nervous systems. In some people, mainly those with focal neuropathy, the onset of pain may be sudden and severe.Symptoms of nerve damage may includenumbness, 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 weaknessnumbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingerswasting of the muscles of the feet or handsindigestion, nausea, or vomitingdiarrhea or constipationdizziness or faintness due to a drop in blood pressure after standing or sitting upproblems with urinationerectile dysfunction in men or vaginal dryness in womenweaknessSymptoms that are not due to neuropathy, but often accompany it, include weight loss and depression. 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.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 Peripheral neuropathy affectstoes feet legs hands armstoesfeetlegshandsarmsAutonomic neuropathy affectsheart and blood vessels digestive system urinary tract sex organs sweat glands eyes lungsheart and blood vesselsdigestive systemurinary tractsex organssweat glandseyeslungsProximal neuropathy affectsthighs hips buttocks legsthighshipsbuttockslegsFocal neuropathy affectseyes facial muscles ears pelvis and lower back chest abdomen thighs legs feeteyesfacial musclesearspelvis and lower backchestabdomenthighslegsfeet 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 includenumbness 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 coordinationnumbness or insensitivity to pain or temperaturea tingling, burning, or prickling sensationsharp pains or crampsextreme sensitivity to touch, even light touchloss of balance and coordinationThese symptoms are often worse at night.Peripheral neuropathy affects the nerves in your toes, feet, legs, hands, and arms.Peripheral neuropathy affects the nerves in your toes, feet, legs, hands, and arms.Peripheral neuropathy affects the nerves in your toes, feet, legs, hands, and arms.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. 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.Autonomic neuropathy affects the nerves in your heart, stomach, intestines, bladder, sex organs, sweat glands, eyes, and lungs.Autonomic neuropathy affects the nerves in your heart, stomach, intestines, bladder, sex organs, sweat glands, eyes, and lungs.Autonomic neuropathy affects the nerves in your heart, stomach, intestines, bladder, sex organs, sweat glands, eyes, and lungs.Hypoglycemia UnawarenessNormally, 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 VesselsThe 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 SystemNerve 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 OrgansAutonomic 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 GlandsAutonomic 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.EyesFinally, 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. 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. Focal neuropathy appears suddenly and affects specific nerves, most often in the head, torso, or leg. Focal neuropathy may causeinability 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 appendicitisinability to focus the eyedouble visionaching behind one eyeparalysis on one side of the face, called Bell's palsysevere pain in the lower back or pelvispain in the front of a thighpain in the chest, stomach, or sidepain on the outside of the shin or inside of the footchest or abdominal pain that is sometimes mistaken for heart disease, a heart attack, or appendicitisFocal 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. 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. 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 ExamsExperts 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 monofilament\u2014similar to a bristle on a hairbrush\u2014attached 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 TestsThe 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.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.Nerve conduction studies or electromyographyA check of heart rate variability shows how the heart responds to deep breathing and to changes in blood pressure and posture.A check of heart rate variabilityUltrasound 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.Ultrasound 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 ReliefDoctors 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 includetricyclic 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 antidepressanttricyclic 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 antidepressantDuloxetine 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 skin\u2014typically to the feet\u2014include 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 ProblemsTo relieve mild symptoms of gastroparesis\u2014indigestion, belching, nausea, or vomiting\u2014doctors 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 WeaknessSitting 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 ProblemsTo 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 intervals\u2014every 3 hours, for example\u2014because 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 CarePeople 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 involvescleaning the feet daily using warm\u2014not hot\u2014water 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 mirror\u2014handheld or placed on the floor\u2014may 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.cleaning the feet daily using warm\u2014not hot\u2014water 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 mirror\u2014handheld or placed on the floor\u2014may 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. 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.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. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.What are clinical trials, and are they right for you? Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.What are clinical trials, and are they right for you?Find out if clinical trials are right for youWhat clinical trials are open? Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.What clinical trials are open?www.ClinicalTrials.govWhat are diabetic neuropathies? 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 numbness\u2014loss of feeling\u2014in 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. What causes diabetic neuropathies? 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 What are the symptoms of diabetic neuropathies? 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 autonomic\u2014or involuntary\u2014nervous 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. What are the types of diabetic neuropathy? 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 What is peripheral neuropathy? 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 affects the nerves in your toes, feet, legs, hands, and arms. 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. What is autonomic neuropathy? 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. Autonomic neuropathy affects the nerves in your heart, stomach, intestines, bladder, sex organs, sweat glands, eyes, and lungs. 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. What is proximal neuropathy? 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. What is focal neuropathy? 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. Can diabetic neuropathies be prevented? 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. How are diabetic neuropathies diagnosed? 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 monofilament\u2014similar to a bristle on a hairbrush\u2014attached 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. How are diabetic neuropathies treated? 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 skin\u2014typically to the feet\u2014include 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 gastroparesis\u2014indigestion, belching, nausea, or vomiting\u2014doctors 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 intervals\u2014every 3 hours, for example\u2014because 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 warm\u2014not hot\u2014water 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 mirror\u2014handheld or placed on the floor\u2014may 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. Points to Remember 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. Clinical Trials The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. What are clinical trials, and are they right for you? Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you. What clinical trials are open? Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies"
+  ],
+  [
+    "Nerve Damage (Diabetic Neuropathies) (What is focal neuropathy?): Focal neuropathy appears suddenly and affects specific nerves, most often in the head, torso, or leg. Focal neuropathy may causeinability 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 appendicitisinability to focus the eyedouble visionaching behind one eyeparalysis on one side of the face, called Bell's palsysevere pain in the lower back or pelvispain in the front of a thighpain in the chest, stomach, or sidepain on the outside of the shin or inside of the footchest or abdominal pain that is sometimes mistaken for heart disease, a heart attack, or appendicitisFocal 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.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies"
+  ],
+  [
+    "Etiology: Etiology describes the cause or causes of a disease. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002356.htm"
+  ],
+  [
+    "Nerve Damage (Diabetic Neuropathies) (What is autonomic neuropathy?): 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.Autonomic neuropathy affects the nerves in your heart, stomach, intestines, bladder, sex organs, sweat glands, eyes, and lungs.Autonomic neuropathy affects the nerves in your heart, stomach, intestines, bladder, sex organs, sweat glands, eyes, and lungs.Autonomic neuropathy affects the nerves in your heart, stomach, intestines, bladder, sex organs, sweat glands, eyes, and lungs.Hypoglycemia UnawarenessNormally, 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 VesselsThe 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 SystemNerve 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 OrgansAutonomic 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 GlandsAutonomic 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.EyesFinally, 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.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies"
+  ],
+  [
+    "Pain Medicine and Kidney Damage: Some patient case reports have attributed incidents of sudden-onset acute kidney failure to the use of over-the-counter painkillers, including aspirin, ibuprofen, and naproxen sodium. Some of these patients experienced acute illnesses involving fluid loss or decreased fluid intake. Other patients in these reports had risk factors such as systemic lupus erythematosus, advanced age, chronic kidney disease, or recent heavy alcohol consumption. These cases involved a single dose in some instances and generally short-term analgesic use of not more than 10 days.Acute kidney failure requires emergency dialysis to clean the blood. Kidney damage is frequently reversible, with normal kidney function returning after the emergency is over and the analgesic use is stopped. A second form of kidney damage, called analgesic nephropathy, can result from taking painkillers every day for several years. Analgesic nephropathy is a chronic kidney disease that over years gradually leads to irreversible kidney failure and the permanent need for dialysis or a kidney transplant to restore kidney function. Researchers estimate that four out of 100,000 people will develop analgesic nephropathy. It is most common in women over 30.The painkiller phenacetin has been taken off the market because of its association with analgesic nephropathy. Recent studies have suggested that longstanding daily use of analgesics such as acetaminophen or ibuprofen may also increase the risk of chronic kidney damage, but this evidence is not as clear.In view of these findings, people with conditions that put them at risk for acute kidney failure should check with their health care provider before taking any analgesic medicine. People who take over-the-counter painkillers regularly should check with their primary care physician to make sure the drugs are not hurting their kidneys. The physician may be able to recommend a safer alternative and can order regular tests to monitor their kidney function. 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. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.What are clinical trials, and are they right for you?Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.Find out if clinical trials are right for youWhat clinical trials are open?Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.www.ClinicalTrials.govThis information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your health care provider for more information.This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your health care provider for more information.www.fda.govThe U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.An analgesic is any medicine intended to relieve pain. Over-the-counter analgesics-that is, painkillers available without a prescription-include aspirin, acetaminophen, ibuprofen, naproxen sodium, and others. These drugs present no danger for most people when taken in the recommended dosage. But some conditions make taking even these common painkillers dangerous for the kidneys. Also, taking one of these drugs regularly over a long period of time may increase the risk for kidney problems. Most drugs that can cause kidney damage are excreted only through the kidneys. That is, they are not broken down by the liver, as alcohol is, or passed out of the body through the digestive tract. Analgesic use has been associated with two different forms of kidney damage: acute renal failure and a type of chronic kidney disease called analgesic nephropathy. Acute Kidney Failure Some patient case reports have attributed incidents of sudden-onset acute kidney failure to the use of over-the-counter painkillers, including aspirin, ibuprofen, and naproxen sodium. Some of these patients experienced acute illnesses involving fluid loss or decreased fluid intake. Other patients in these reports had risk factors such as systemic lupus erythematosus, advanced age, chronic kidney disease, or recent heavy alcohol consumption. These cases involved a single dose in some instances and generally short-term analgesic use of not more than 10 days. Acute kidney failure requires emergency dialysis to clean the blood. Kidney damage is frequently reversible, with normal kidney function returning after the emergency is over and the analgesic use is stopped. Analgesic Nephropathy A second form of kidney damage, called analgesic nephropathy, can result from taking painkillers every day for several years. Analgesic nephropathy is a chronic kidney disease that over years gradually leads to irreversible kidney failure and the permanent need for dialysis or a kidney transplant to restore kidney function. Researchers estimate that four out of 100,000 people will develop analgesic nephropathy. It is most common in women over 30. The painkiller phenacetin has been taken off the market because of its association with analgesic nephropathy. Recent studies have suggested that longstanding daily use of analgesics such as acetaminophen or ibuprofen may also increase the risk of chronic kidney damage, but this evidence is not as clear. In view of these findings, people with conditions that put them at risk for acute kidney failure should check with their health care provider before taking any analgesic medicine. People who take over-the-counter painkillers regularly should check with their primary care physician to make sure the drugs are not hurting their kidneys. The physician may be able to recommend a safer alternative and can order regular tests to monitor their kidney function. Treatment 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. Clinical Trials The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions. What are clinical trials, and are they right for you? Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you. What clinical trials are open? Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov. This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your health care provider for more information. The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.",
+    "https://www.niddk.nih.gov/health-information/kidney-disease/pain-medicine-kidney-damage"
+  ],
+  [
+    "Otitis media with effusion (Summary): Otitis media with effusion (OME)\u00a0is thick or sticky fluid behind the eardrum in the middle ear. It occurs without an ear infection.",
+    "https://medlineplus.gov/ency/article/007010.htm"
+  ],
+  [
+    "What are the treatments for Otitis media with effusion?: Most health care providers will not treat OME at first, unless there are also signs of an infection. Instead, they will recheck the problem in 2 to 3 months. Some children who have had repeat ear infections may receive a small, daily dose of antibiotics to prevent new infections. You can make the following changes to help clear up the fluid behind the eardrum: - Avoid cigarette smoke - Encourage infants to breastfeed - Treat allergies by staying away from triggers (such as dust). Adults and older children may be given allergy medications. Most often the fluid will clear on its own. You doctor may suggest watching the condition for a while to see if it is getting worse before recommending treatment. If the fluid is still present after 6 weeks, the doctor may recommend: - Continuing to watch the problem - A hearing test - A single trial of antibiotics (if they were not given earlier) If the fluid is still present at 8 to 12 weeks, antibiotics may be tried. These medicines are not always helpful. At some point, the child's hearing should be tested. If there is significant hearing loss (more than 20 decibels), antibiotics or ear tubes might be needed. If the fluid is still present after 4 to 6 months, tubes are probably needed, even if there is no major hearing loss. Sometimes the adenoids must be taken out for the Eustachian tube to work properly.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/007010.htm"
+  ],
+  [
+    "Ear Infections (Summary): Summary Ear infections are the most common reason parents bring their child to a doctor. Three out of four children will have at least one ear infection by their third birthday. Adults can also get ear infections, but they are less common. The infection usually affects the middle ear and is called otitis media. The tubes inside the ears become clogged with fluid and mucus. This can affect hearing, because sound cannot get through all that fluid. If your child isn't old enough to say \"My ear hurts,\" here are a few things to look for - Tugging at ears - Crying more than usual - Fluid draining from the ear - Trouble sleeping - Balance difficulties - Hearing problems Your health care provider will diagnose an ear infection by looking inside the ear with an instrument called an otoscope. Often, ear infections go away on their own. Your health care provider may recommend pain relievers. Severe infections and infections in young babies may require antibiotics. Children who get infections often may need surgery to place small tubes inside their ears. The tubes relieve pressure in the ears so that the child can hear again. NIH: National Institute on Deafness and Other Communication Disorders",
+    "#"
+  ],
+  [
+    "Otitis media with effusion (Exams and Tests): The health care provider may find OME while checking your child's ears after an ear infection has been treated. The provider will examine the eardrum and look for certain changes, such as: - Air bubbles on the surface of the eardrum - Dullness of the eardrum when a light is used - Eardrum that does not seem to move when little puffs of air are blown at it - Fluid behind the eardrum A test called tympanometry\u00a0is an accurate tool for diagnosing OME. The results of this test can help tell the amount and thickness of the fluid. The fluid in the middle ear can be accurately detected with: - Acoustic otoscope - Reflectometer: A portable device An audiometer or other type of formal hearing test may be done. This can help the provider decide on treatment.",
+    "https://medlineplus.gov/ency/article/007010.htm"
+  ],
+  [
+    "Otitis media with effusion (Causes): The Eustachian tube connects the inside of the ear to the back of the throat. This tube helps drain fluid to prevent it from building up in the ear. The fluid drains from the tube and is swallowed. OME and ear infections are connected in two ways: - After most ear infections have been treated, fluid (an effusion) remains in the middle ear for a few days or weeks. - When the Eustachian tube is partially blocked, fluid builds up in the middle ear. Bacteria inside the ear become trapped and begin to grow. This may lead to an ear infection. The following can cause swelling of the Eustachian tube lining that leads to increased fluid: - Allergies - Irritants (particularly cigarette smoke) - Respiratory infections The following can cause the Eustachian tube to close or become blocked: - Drinking while lying on your back - Sudden increases in air pressure (such as descending in an airplane or on a mountain road) Getting water in a baby's ears will not lead to a blocked tube. OME is most common in winter or early spring, but it can occur at any time of year. It can affect people of any age. It occurs most often in children under age 2, but is rare in newborns. Younger children get OME more often than older children or adults for several reasons: - The tube is shorter, more horizontal, and straighter, making it easier for bacteria to enter. - The tube is floppier, with a tinier opening that's easy to block. - Young children get more colds because it takes time for the immune system to be able to recognize and ward off cold viruses. The fluid in OME is often thin and watery. In the past, it was thought that the fluid got thicker the longer it was present in the ear. (\"Glue ear\" is a common name given to OME with thick fluid.) However, fluid thickness is now thought to be\u00a0related to the ear itself, rather than to how long the fluid is present.",
+    "https://medlineplus.gov/ency/article/007010.htm"
+  ],
+  [
+    "Otitis media with effusion (Outlook (Prognosis)): OME most often goes away on its own over a few weeks or months. Treatment may speed up this process. Glue ear may not clear up as quickly as OME with a thinner fluid. OME is most often not life threatening. Most children do not have long-term damage to their hearing or speaking ability, even when the fluid remains for many months.",
+    "https://medlineplus.gov/ency/article/007010.htm"
+  ],
+  [
+    "Otitis media with effusion (Symptoms): Unlike children with an ear infection, children with OME do not act sick. OME often does not have obvious symptoms. Older children and adults often complain of muffled hearing or a sense of fullness in the ear. Younger children may turn up the television volume because of hearing loss.",
+    "https://medlineplus.gov/ency/article/007010.htm"
+  ],
+  [
+    "Otitis media with effusion (Prevention): Helping your child reduce the risk of ear infections\u00a0can help prevent OME.",
+    "https://medlineplus.gov/ency/article/007010.htm"
+  ],
+  [
+    "Otitis media with effusion (When to Contact a Medical Professional): Call your provider if: - You think you or your child might have OME. (You should continue to watch the condition until the fluid has disappeared.) - New symptoms develop during or after treatment for this disorder.",
+    "https://medlineplus.gov/ency/article/007010.htm"
+  ],
+  [
+    "Drug allergies (Treatment): The goal of treatment is to relieve symptoms and prevent a severe reaction. Treatment may include: - Antihistamines to relieve mild symptoms such as rash, hives, and itching - Bronchodilators such as albuterol to reduce asthma-like symptoms (moderate wheezing or cough) - Corticosteroids applied to the skin, given by mouth, or given through a vein (intravenously) - Epinephrine by injection to treat anaphylaxis The offending medicine and similar drugs should be avoided. Make sure all your providers -- including dentists and hospital staff -- know about any drug allergies that you or your children have. In some cases, a penicillin (or other drug) allergy responds to desensitization. This treatment involves being given very small doses at first, followed by larger and larger doses of a medicine to improve your tolerance of the drug. This process should be done only by an allergist, when there is no alternative drug for you to take.",
+    "https://medlineplus.gov/ency/article/000819.htm"
+  ],
+  [
+    "What are Drug Reactions?: Most of the time, medicines make our lives better. They reduce aches and pains, fight infections, and control problems such as high blood pressure or diabetes. But medicines can also cause unwanted reactions. One problem is interactions, which may occur between - Two drugs, such as aspirin and blood thinners - Drugs and food, such as statins and grapefruit - Drugs and supplements, such as gingko and blood thinners - Drugs and diseases, such as aspirin and peptic ulcers Interactions can change the actions of one or both drugs. The drugs might not work, or you could get side effects. Side effects are unwanted effects caused by the drugs. Most are mild, such as a stomach aches or drowsiness, and go away after you stop taking the drug. Others can be more serious. Drug allergies are another type of reaction. They can be mild or life-threatening. Skin reactions, such as hives and rashes, are the most common type. Anaphylaxis, a serious allergic reaction, is more rare. When you start a new prescription or over-the-counter medication, make sure you understand how to take it correctly. Know which other medications and foods you need to avoid. Ask your health care provider or pharmacist if you have questions.",
+    "https://www.nlm.nih.gov/medlineplus/drugreactions.html"
+  ],
+  [
+    "Drug allergies: Drug allergies are a group of symptoms caused by an allergic reaction to a drug (medicine). A drug allergy involves an immune response in the body that produces an allergic reaction to a medicine. The first time you take the medicine, you may have no problems. But, your body's immune system may produce a substance (antibody) against that drug. The next time you take the drug, the antibody may tell your white blood cells to make a chemical called histamine. Histamines and other chemicals cause your allergy symptoms. Common allergy-causing drugs include: - Drugs used to treat seizures - Insulin (especially animal sources of insulin) - Substances containing iodine, such as x-ray contrast dyes (these can cause allergy-like reactions) - Penicillin and related antibiotics - Sulfa drugs Most side effects of drugs are not due to an allergic reaction. For example, aspirin can cause hives or trigger asthma without involving the immune system. Many people confuse an unpleasant, but not serious, side effect of a medicine (such as nausea) with a drug allergy. Most drug allergies cause minor skin rashes and hives. These symptoms may occur right away or hours after receiving the drug. Serum sickness is a delayed type of drug allergy that occurs a week or more after you are exposed to a medicine or vaccine. Common symptoms of a drug allergy include: - Hives - Itching of the skin or eyes (common) - Skin rash (common) - Swelling of the lips, tongue, or face - Wheezing Symptoms of anaphylaxis include: - Abdominal pain or cramping - Confusion - Diarrhea - Difficulty breathing with wheezing or hoarse voice - Dizziness - Fainting, lightheadedness - Hives over different parts of the body - Nausea, vomiting - Rapid pulse - Sensation of feeling the heart beat (palpitations) An examination may show: - Decreased blood pressure - Hives - Rash - Swelling of the lips, face, or tongue (angioedema) - Wheezing Skin testing may help diagnose an allergy to penicillin-type medicines. There are no good skin or blood tests to help diagnose other drug allergies. If you have had allergy-like symptoms after taking a medicine or receiving contrast (dye) before getting an x-ray, your health care provider will often tell you that this is proof of a drug allergy. You do not need more testing. The goal of treatment is to relieve symptoms and prevent a severe reaction. Treatment may include: - Antihistamines to relieve mild symptoms such as rash, hives, and itching - Bronchodilators such as albuterol to reduce asthma-like symptoms (moderate wheezing or cough) - Corticosteroids applied to the skin, given by mouth, or given through a vein (intravenously) - Epinephrine by injection to treat anaphylaxis The offending medicine and similar drugs should be avoided. Make sure all your providers -- including dentists and hospital staff -- know about any drug allergies that you or your children have. In some cases, a penicillin (or other drug) allergy responds to desensitization. This treatment involves being given very small doses at first, followed by larger and larger doses of a medicine to improve your tolerance of the drug. This process should be done only by an allergist, when there is no alternative drug for you to take. Most drug allergies respond to treatment. But sometimes, they can lead to severe asthma, anaphylaxis, or death. Call your provider if you are taking a medicine and seem to be having a reaction to it. Go to the emergency room or call the local emergency number (such as 911) if you have difficulty breathing or develop other symptoms of severe asthma or anaphylaxis. These are emergency conditions. There is generally no way to prevent a drug allergy. If you have a known drug allergy, avoiding the drug is the best way to prevent an allergic reaction. You may also be told to avoid similar medicines. In some cases, a provider may approve the use of a drug that causes an allergy if you are first treated with medicines that slow or block the immune response. These include corticosteroids (such as prednisone) and antihistamines. Do not try this without a provider's supervision. Pretreatment with corticosteroids and antihistamines has been shown to prevent allergic reactions in people who need to get x-ray contrast dye. Your provider may also recommend densensitization. Updated by: Stuart I. Henochowicz, MD, FACP, Associate Clinical Professor of Medicine, Division of Allergy, Immunology, and Rheumatology, Georgetown University Medical School, Washington, DC. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000819.htm"
+  ],
+  [
+    "Transfusion reaction - hemolytic (Treatment): If symptoms occur during the transfusion, the transfusion must be stopped right away. Blood samples from the recipient (person getting the transfusion) and from the donor may be tested to tell whether symptoms are being caused by a transfusion reaction. Mild symptoms may be treated with: - Acetaminophen, a pain reliever to reduce fever and discomfort - Fluids given through a vein (intravenous) and other medicines to treat or prevent kidney failure and shock",
+    "https://medlineplus.gov/ency/article/001303.htm"
+  ],
+  [
+    "Drug allergies (When to Contact a Medical Professional): Call your provider if you are taking a medicine and seem to be having a reaction to it. Go to the emergency room or call the local emergency number (such as 911) if you have difficulty breathing or develop other symptoms of severe asthma or anaphylaxis. These are emergency conditions.",
+    "https://medlineplus.gov/ency/article/000819.htm"
+  ],
+  [
+    "Drug allergies (Outlook (Prognosis)): Most drug allergies respond to treatment. But sometimes, they can lead to severe asthma, anaphylaxis, or death.",
+    "https://medlineplus.gov/ency/article/000819.htm"
+  ],
+  [
+    "Drug allergies (Symptoms): Most drug allergies cause minor skin rashes and hives. These symptoms may occur right away or hours after receiving the drug. Serum sickness is a delayed type of drug allergy that occurs a week or more after you are exposed to a medicine or vaccine. Common symptoms of a drug allergy include: - Hives - Itching of the skin or eyes (common) - Skin rash (common) - Swelling of the lips, tongue, or face - Wheezing Symptoms of anaphylaxis include: - Abdominal pain or cramping - Confusion - Diarrhea - Difficulty breathing with wheezing or hoarse voice - Dizziness - Fainting, lightheadedness - Hives over different parts of the body - Nausea, vomiting - Rapid pulse - Sensation of feeling the heart beat (palpitations)",
+    "https://medlineplus.gov/ency/article/000819.htm"
+  ],
+  [
+    "Phentermine: Phentermine is used for a limited period of time to speed weight loss in overweight people who are exercising and eating a low-calorie diet. Phentermine is in a class of medications called anorectics. It works by decreasing appetite. Phentermine comes as tablets and extended-release capsules. It usually is taken as a single daily dose in the morning or three times a day 30 minutes before meals. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take phentermine exactly as directed. Most people takephentermine for 3 to 6 weeks; the length of treatment depends on how you respond to the medication. Phentermine can be habit-forming. Do not take a larger dose, take it more often, or take it for a longer period than your doctor tells you to. If you are taking the extended-release (long-acting) tablets, do not split, chew, or crush them tablet. There are some tablets that can be crushed and mixed with food. This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information. Before taking phentermine, - tell your doctor and pharmacist if you are allergic to phentermine, any other medications, or any of the ingredients in phentermine tablets. Ask your pharmacist for a list of the ingredients. - tell your doctor and pharmacist what prescription and nonprescription medications, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: fluoxetine (Prozac), fluvoxamine (Luvox), guanethidine, insulin medications for weight loss and depression, paroxetine (Paxil), and sertraline (Zoloft). Also tell your doctor if you are taking monoamine oxidase (MAO) inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar) and tranylcypromine (Parnate), or if you have stopped taking one of these medications in the past 2 weeks. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor if you have or have ever had heart disease, high blood pressure, arteriosclerosis (narrowing of the arteries), hyperthyroidism (overactive thyroid gland), diabetes, glaucoma, or a history of drug abuse. - tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking phentermine, call your doctor. - talk to your doctor about the risks and benefits of taking phentermine if you are 65 years of age or older. Older adults should not usually take phentermine because it is not as safe as other medications that can be used to treat the same condition. - you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. - ask your doctor about the safe use of alcohol while you are taking phentermine. Alcohol can make the side effects of phentermine worse. - if you have diabetes, you may need to decrease your dose of insulin while taking phentermine. Call your doctor if you have questions or problems. Follow the diet and exercise program your doctor has given you. Phentermine works best in combination with a diet program. Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Phentermine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - dry mouth - unpleasant taste - diarrhea - constipation - vomiting Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately: - increased blood pressure - heart palpitations - restlessness - dizziness - tremor - insomnia - shortness of breath - chest pain - swelling of the legs and ankles - difficulty doing exercise that you have been able to do Phentermine may cause other side effects. Call your doctor if you have any unusual problems during your treatment with phentermine. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to phentermine. Do not let anyone else take your medication. Phenteramine is a controlled substance. Prescriptions may be refilled only a limited number of times; ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Adipex-P\u00ae - Ionamin\u00ae",
+    "https://medlineplus.gov/druginfo/meds/a682187.html"
+  ],
+  [
+    "What other information should I know about Dicyclomine?: Keep all appointments with your doctor. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/meds/a684007.html"
+  ],
+  [
+    "Phentermine and Topiramate: Phentermine and topiramate extended-release (long-acting) capsules are used to help adults who are obese or who are overweight and have weight-related medical problems to lose weight and to keep from gaining back that weight. Phentermine and topiramate extended-release capsules must be used along with a reduced calorie diet and exercise plan. Phentermine is in a class of medications called anorectics. It works by decreasing appetite. Topiramate is in a class of medications called anticonvulsants. It works by decreasing appetite and by causing feelings of fullness to last longer after eating. Phentermine and topiramate come as extended-release capsules to take by mouth. The medication is usually taken with or without food once a day in the morning. This medication may cause difficulty falling asleep or staying asleep if it is taken in the evening. Take phentermine and topiramate at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take phentermine and topiramate exactly as directed. Your doctor will probably start you on a low dose of phentermine and topiramate and increase your dose after 14 days. After you take this dose for 12 weeks, your doctor will check to see how much weight you have lost. If you have not lost a certain amount of weight, your doctor may tell you to stop taking phentermine and topiramate or may increase your dose and then increase it again after 14 days. After you take the new dose for 12 weeks, your doctor will check to see how much weight you have lost. If you have not lost a certain amount of weight, it is not likely that you will benefit from taking phentermine and topiramate, so your doctor will probably tell you to stop taking the medication. Phentermine and topiramate may be habit forming. Do not take a larger dose, take it more often, or take it for a longer period of time than prescribed by your doctor. Phentermine and topiramate will help control your weight only as long as you continue to take the medication. Do not stop taking phentermine and topiramate without talking to your doctor. If you suddenly stop taking phentermine and topiramate, you may experience seizures. Your doctor will tell you how to decrease your dose gradually. Phentermine and topiramate is not available at retail pharmacies. This medication is available only through specific mail order pharmacies. Ask your doctor if you have any questions about how you will receive your medication. Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with phentermine and topiramate and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before taking phentermine and topiramate, - tell your doctor and pharmacist if you are allergic to phentermine (Adipex-P, Suprenza); topiramate (Topamax); sympathomimetic amine medications such as midodrine (Orvaten, ProAmatine) or phenylephrine (in cough and cold medications); any other medications, or any of the ingredients in phentermine and topiramate capsules. Ask your pharmacist or check the Medication Guide for a list of the ingredients. - tell your doctor if you are taking a monoamine oxidase inhibitor (MAOI) including isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate), or if you have taken one of these medications during the past two weeks. Your doctor will probably tell you not to take phentermine and topiramate if you are taking one or more of these medications or have taken one of these medications during the past 2 weeks. - tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention other prescription or nonprescription medications or herbal products for weight loss and any of the following: amitriptyline (Elavil); carbonic anhydrase inhibitors such as acetazolamide (Diamox), methazolamide, or zonisamide (Zonegran); diuretics ('water pills') including furosemide (Lasix) or hydrochlorothiazide (HCTZ); insulin or other medications for diabetes; ipratropium (Atrovent); lithium (Lithobid); medications for anxiety, high blood pressure, irritable bowel disease, mental illness, motion sickness, Parkinson's disease, ulcers, or urinary problems; medications for seizures such as carbamazepine (Carbatrol, Equetro, Tegretol), phenytoin (Dilantin), or valproic acid (Stavzor, Depakene); pioglitazone (Actos, in Actoplus, in Duetact); sedatives; sleeping pills; and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor if you have glaucoma (condition in which increased pressure in the eye can cause vision loss) or an overactive thyroid gland. Your doctor will probably tell you not to take phentermine and topiramate. - tell your doctor if you have had a heart attack or a stroke in the past 6 months, if you have ever thought about killing yourself or tried to do so, and if you are following a ketogenic diet (high fat, low carbohydrate diet used to control seizures). Also tell your doctor if you have or have ever had depression; an irregular heartbeat; heart failure; seizures; metabolic acidosis (too much acid in the blood); osteopenia, osteomalacia, or osteoporosis (conditions in which the bones are brittle or weak and may break easily); ongoing diarrhea; any condition that affects your breathing; diabetes; kidney stones; or kidney or liver disease. - tell your doctor if you are pregnant or plan to become pregnant. If you take phentermine and topiramate during pregnancy, your baby may develop a birth defect called cleft lip or cleft palate. Your baby may develop this birth defect very early in the pregnancy, before you know that you are pregnant. You must use birth control to prevent pregnancy during your treatment. You must take a pregnancy test before you begin your treatment and once every month during your treatment. If you become pregnant while taking phentermine and topiramate, stop taking the medication and call your doctor immediately. - you can use oral contraceptives (birth control pills) to prevent pregnancy during your treatment with phentermine and topiramate. You may experience unusual spotting (unexpected vaginal bleeding) if you use this type of birth control. You will still be protected from pregnancy if you are spotting, but you can talk to your doctor about other forms of birth control if the spotting is bothersome. - tell your doctor if you are breast-feeding. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking phentermine and topiramate. - you should know that phentermine and topiramate may slow your thinking and movements and affect your vision. Do not drive a car or operate machinery until you know how this medication affects you. - do not drink alcoholic beverages while you are taking phentermine and topiramate. Alcohol can make the side effects of phentermine and topiramate worse. - you should know that phentermine and topiramate can prevent you from sweating and make it harder for your body to cool down when it gets very hot. Avoid exposure to heat, drink plenty of fluids and tell your doctor if you have a fever, headache, muscle cramps, or an upset stomach, or if you are not sweating as usual. - you should know that your mental health may change in unexpected ways and you may become suicidal (thinking about harming or killing yourself or planning or trying to do so) while you are taking phentermine and topiramate. A small number of adults and children 5 years of age and older (about 1 in 500 people) who took antiepileptics such as topiramate to treat various conditions during clinical studies became suicidal during their treatment. Some of these people developed suicidal thoughts and behavior as early as 1 week after they started taking the medication. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: panic attacks; agitation or restlessness; new or worsening irritability, anxiety, or depression; acting on dangerous impulses; difficulty falling or staying asleep; aggressive, angry, or violent behavior; mania (frenzied, abnormally excited mood); talking or thinking about wanting to hurt yourself or end your life; withdrawing from friends and family; preoccupation with death and dying; giving away prized possessions; or any other unusual changes in behavior or mood. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own. Drink extra fluids during your treatment with phentermine and topiramate. Unless your doctor tells you otherwise, continue your normal diet. Skip the missed dose and take your usual dose the next morning. Do not take a double dose to make up for a missed one. Phentermine and topiramate may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - headache - dizziness - numbness, burning, or tingling in the hands, feet, face, or mouth - decreased sense of touch or ability to feel sensation - difficulty concentrating, thinking, paying attention, speaking, or remembering - excessive tiredness - dry mouth - unusual thirst - changes or decreased ability to taste food - diarrhea - constipation - heartburn - painful menstrual periods - pain in the back, neck, muscles, arms or legs - tightening of the muscles - painful, difficult, or frequent urination - hair loss Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment: - racing or pounding heartbeat that lasts several minutes - sudden decrease in vision - eye pain or redness - fast, shallow breathing - severe pain in the pack or side - blood in urine - rash or blisters, especially if you also have fever - hives Phentermine and topiramate may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Store phentermine and topiramate in a safe place so that no one else can take it accidentally or on purpose. Keep track of how many capsules are left so you will know if any are missing. Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of overdose may include the following: - restlessness - uncontrollable shaking of a part of the body - fast breathing - confusion - aggressiveness - hallucinations (seeing things or hearing voices that do not exist) - panic - excessive tiredness - depression - irregular heartbeat - nausea - vomiting - diarrhea - stomach pain or cramps - seizures - coma (loss of consciousness for a period of time) - dizziness - speech disturbances - blurred or double vision - problems with coordination Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to phentermine and topiramate. Do not let anyone else take your medication. Giving or selling phentermine and topiramate to others may harm them and is against the law. Phentermine and topiramate is a controlled substance. Prescriptions may be refilled only a limited number of times; ask your pharmacist if you have any questions. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Qsymia\u00ae (containing Phentermine, Topiramate)",
+    "https://medlineplus.gov/druginfo/meds/a612037.html"
+  ],
+  [
+    "Phentermine (What special precautions should I follow?): Before taking phentermine, - tell your doctor and pharmacist if you are allergic to phentermine, any other medications, or any of the ingredients in phentermine tablets. Ask your pharmacist for a list of the ingredients. - tell your doctor and pharmacist what prescription and nonprescription medications, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: fluoxetine (Prozac), fluvoxamine (Luvox), guanethidine, insulin medications for weight loss and depression, paroxetine (Paxil), and sertraline (Zoloft). Also tell your doctor if you are taking monoamine oxidase (MAO) inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar) and tranylcypromine (Parnate), or if you have stopped taking one of these medications in the past 2 weeks. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor if you have or have ever had heart disease, high blood pressure, arteriosclerosis (narrowing of the arteries), hyperthyroidism (overactive thyroid gland), diabetes, glaucoma, or a history of drug abuse. - tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking phentermine, call your doctor. - talk to your doctor about the risks and benefits of taking phentermine if you are 65 years of age or older. Older adults should not usually take phentermine because it is not as safe as other medications that can be used to treat the same condition. - you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. - ask your doctor about the safe use of alcohol while you are taking phentermine. Alcohol can make the side effects of phentermine worse. - if you have diabetes, you may need to decrease your dose of insulin while taking phentermine. Call your doctor if you have questions or problems.",
+    "https://medlineplus.gov/druginfo/meds/a682187.html"
+  ],
+  [
+    "Phentermine (What side effects can this medication cause?): Phentermine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - dry mouth - unpleasant taste - diarrhea - constipation - vomiting Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately: - increased blood pressure - heart palpitations - restlessness - dizziness - tremor - insomnia - shortness of breath - chest pain - swelling of the legs and ankles - difficulty doing exercise that you have been able to do Phentermine may cause other side effects. Call your doctor if you have any unusual problems during your treatment with phentermine. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).",
+    "https://medlineplus.gov/druginfo/meds/a682187.html"
+  ],
+  [
+    "Phentermine (How should this medicine be used?): Phentermine comes as tablets and extended-release capsules. It usually is taken as a single daily dose in the morning or three times a day 30 minutes before meals. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take phentermine exactly as directed. Most people takephentermine for 3 to 6 weeks; the length of treatment depends on how you respond to the medication. Phentermine can be habit-forming. Do not take a larger dose, take it more often, or take it for a longer period than your doctor tells you to. If you are taking the extended-release (long-acting) tablets, do not split, chew, or crush them tablet. There are some tablets that can be crushed and mixed with food.",
+    "https://medlineplus.gov/druginfo/meds/a682187.html"
+  ],
+  [
+    "Phentermine and Topiramate (How should this medicine be used?): Phentermine and topiramate come as extended-release capsules to take by mouth. The medication is usually taken with or without food once a day in the morning. This medication may cause difficulty falling asleep or staying asleep if it is taken in the evening. Take phentermine and topiramate at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take phentermine and topiramate exactly as directed. Your doctor will probably start you on a low dose of phentermine and topiramate and increase your dose after 14 days. After you take this dose for 12 weeks, your doctor will check to see how much weight you have lost. If you have not lost a certain amount of weight, your doctor may tell you to stop taking phentermine and topiramate or may increase your dose and then increase it again after 14 days. After you take the new dose for 12 weeks, your doctor will check to see how much weight you have lost. If you have not lost a certain amount of weight, it is not likely that you will benefit from taking phentermine and topiramate, so your doctor will probably tell you to stop taking the medication. Phentermine and topiramate may be habit forming. Do not take a larger dose, take it more often, or take it for a longer period of time than prescribed by your doctor. Phentermine and topiramate will help control your weight only as long as you continue to take the medication. Do not stop taking phentermine and topiramate without talking to your doctor. If you suddenly stop taking phentermine and topiramate, you may experience seizures. Your doctor will tell you how to decrease your dose gradually. Phentermine and topiramate is not available at retail pharmacies. This medication is available only through specific mail order pharmacies. Ask your doctor if you have any questions about how you will receive your medication. Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with phentermine and topiramate and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide.",
+    "https://medlineplus.gov/druginfo/meds/a612037.html"
+  ],
+  [
+    "Phentermine and Topiramate (What other information should I know?): Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to phentermine and topiramate. Do not let anyone else take your medication. Giving or selling phentermine and topiramate to others may harm them and is against the law. Phentermine and topiramate is a controlled substance. Prescriptions may be refilled only a limited number of times; ask your pharmacist if you have any questions. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.",
+    "https://medlineplus.gov/druginfo/meds/a612037.html"
+  ],
+  [
+    "Dementia - home care (Information): A loved one with dementia will need support in the home as the disease gets worse. You can help by trying to understand how the person with dementia perceives his or her world. Give the person a chance to talk about any challenges and take part in his or her own daily care. Start by talking with your loved one's health care provider. Ask how you can: - Help the person stay calm and oriented - Make dressing and grooming easier - Talk to the person - Help with memory loss - Manage behavior and sleep problems Tips for reducing confusion in people with dementia include: - Have familiar objects and people around. - Keep lights on at night. - Use reminders, notes, lists of routine tasks, or directions for daily activities. - Stick to a simple activity schedule. Taking regular walks with a caregiver can help improve communication skills and prevent wandering. Calming music may reduce wandering and restlessness, ease anxiety, and improve sleep and behavior. People with dementia should have their eyes and ears checked. If problems are found, hearing aids, glasses, or cataract surgery may be needed. People with dementia should also have regular driving tests. At some point, it won't be safe for them to continue to drive. This may not be an easy conversation, so seek help from their provider and other family members. State laws vary on the ability of a person with dementia to continue to drive. Supervised meals can help with feeding. People with dementia often forget to eat and drink, and can become dehydrated as a result. Talk to the provider about the need for extra calories due to increased physical activity from restlessness and wandering. Also talk to the provider about: - Watching for risk of choking and what to do if choking occurs - How to increase safety in the home - How to prevent falls - Ways to improve bathroom safety The Alzheimer's Association's Safe Return Program requires people with dementia to wear an identification bracelet. If they wander, their caregiver can contact the police and the national Safe Return office, where information about them is stored and shared nationwide. Eventually, people with dementia may need 24-hour monitoring and assistance to provide a safe environment, control aggressive or agitated behavior, and meet their needs. LONG-TERM CARE A person with dementia may need monitoring and help at home or in an institution. Possible options include: - Adult day care - Boarding homes - Nursing homes - In-home care Many organizations are available to help you care for a person with dementia. They include: - Adult protective services - Community resources - Local or state government departments of aging - Visiting nurses or aides - Volunteer services In some communities, dementia-related support groups may be available. Family counseling can help family members cope with home care. Advance directives, power of attorney, and other legal actions may make it easier to decide on care for the person with dementia. Seek legal advice early, before the person is unable to make these decisions. There are support groups that can provide information and resources for people with Alzheimer disease and their caregivers.",
+    "https://medlineplus.gov/ency/article/007428.htm"
+  ],
+  [
+    "What are the genetic changes related to inclusion body myopathy with early-onset Paget disease and frontotemporal dementia?: Mutations in the VCP gene cause IBMPFD. The VCP gene provides instructions for making an enzyme called valosin-containing protein, which has a wide variety of functions within cells. One of its most critical jobs is to help break down (degrade) proteins that are abnormal or no longer needed. Mutations in the VCP gene alter the structure of valosin-containing protein, disrupting its ability to break down other proteins. As a result, excess and abnormal proteins may build up in muscle, bone, and brain cells. The proteins form clumps that interfere with the normal functions of these cells. It remains unclear how damage to muscle, bone, and brain cells leads to the specific features of IBMPFD.",
+    "https://ghr.nlm.nih.gov/condition/inclusion-body-myopathy-with-early-onset-paget-disease-and-frontotemporal-dementia"
+  ],
+  [
+    "Etiology: Etiology describes the cause or causes of a disease. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002356.htm"
+  ],
+  [
+    "Dementia - home care: Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, and behavior. A loved one with dementia will need support in the home as the disease gets worse. You can help by trying to understand how the person with dementia perceives his or her world. Give the person a chance to talk about any challenges and take part in his or her own daily care. Start by talking with your loved one's health care provider. Ask how you can: - Help the person stay calm and oriented - Make dressing and grooming easier - Talk to the person - Help with memory loss - Manage behavior and sleep problems Tips for reducing confusion in people with dementia include: - Have familiar objects and people around. - Keep lights on at night. - Use reminders, notes, lists of routine tasks, or directions for daily activities. - Stick to a simple activity schedule. Taking regular walks with a caregiver can help improve communication skills and prevent wandering. Calming music may reduce wandering and restlessness, ease anxiety, and improve sleep and behavior. People with dementia should have their eyes and ears checked. If problems are found, hearing aids, glasses, or cataract surgery may be needed. People with dementia should also have regular driving tests. At some point, it won't be safe for them to continue to drive. This may not be an easy conversation, so seek help from their provider and other family members. State laws vary on the ability of a person with dementia to continue to drive. Supervised meals can help with feeding. People with dementia often forget to eat and drink, and can become dehydrated as a result. Talk to the provider about the need for extra calories due to increased physical activity from restlessness and wandering. Also talk to the provider about: - Watching for risk of choking and what to do if choking occurs - How to increase safety in the home - How to prevent falls - Ways to improve bathroom safety The Alzheimer's Association's Safe Return Program requires people with dementia to wear an identification bracelet. If they wander, their caregiver can contact the police and the national Safe Return office, where information about them is stored and shared nationwide. Eventually, people with dementia may need 24-hour monitoring and assistance to provide a safe environment, control aggressive or agitated behavior, and meet their needs. LONG-TERM CARE A person with dementia may need monitoring and help at home or in an institution. Possible options include: - Adult day care - Boarding homes - Nursing homes - In-home care Many organizations are available to help you care for a person with dementia. They include: - Adult protective services - Community resources - Local or state government departments of aging - Visiting nurses or aides - Volunteer services In some communities, dementia-related support groups may be available. Family counseling can help family members cope with home care. Advance directives, power of attorney, and other legal actions may make it easier to decide on care for the person with dementia. Seek legal advice early, before the person is unable to make these decisions. There are support groups that can provide information and resources for people with Alzheimer disease and their caregivers. Updated by: Daniel Kantor, MD, Kantor Neurology, Coconut Creek, FL and Immediate Past President of the Florida Society of Neurology (FSN). Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007428.htm"
+  ],
+  [
+    "Dementia (Overview): Dementia isn't a specific disease. Instead, dementia describes a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with daily functioning. Though dementia generally involves memory loss, memory loss has different causes. So memory loss alone doesn't mean you have dementia. Alzheimer's disease is the most common cause of a progressive dementia in older adults, but there are a number of causes of dementia. Depending on the cause, some dementia symptoms can be reversed. Dementia care at Mayo Clinic",
+    "https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013"
+  ],
+  [
+    "Dementia (WHAT IS DEMENTIA?): Dementia is the loss of cognitive functioning-thinking, remembering, and reasoning-and behavioral abilities to such an extent that it interferes with a person's daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person's functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.Signs and symptoms of dementia result when once-healthy neurons (nerve cells) in the brain stop working, lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience far greater loss.While dementia is more common as people grow older (up to half of all people age 85 or older may have some form of dementia), it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia. One type of dementia, frontotemporal disorders, is more common in middle-aged than older adults.Memory loss, though common, is not the only sign of dementia. For a person to have dementia, he or she must have:- Two or more core mental functions that are impaired. These functions include memory, language skills, visual perception, and the ability to focus and pay attention. These also include cognitive skills such as the ability to reason and solve problems. - A loss of brain function severe enough that a person cannot do normal, everyday tasksIn addition, some people with dementia cannot control their emotions. Their personalities may change. They can have delusions, which are strong beliefs without proof, such as the idea that someone is stealing from them. They also may hallucinate, seeing or otherwise experiencing things that are not real.The causes of dementia can vary, depending on the types of brain changes that may be taking place. Other dementias include Lewy body dementia, frontotemporal disorders, and vascular dementia. It is common for people to have mixed dementia-a combination of two or more disorders, at least one of which is dementia. For example, some people have both Alzheimer's disease and vascular dementia.Learn more about dementia from MedlinePlus.",
+    "https://www.nia.nih.gov/health/topics/dementia"
+  ],
+  [
+    "Dementia (Definition): Dementia is not a specific disease. It is a descriptive term for a collection of symptoms that can be caused by a number of disorders that affect the brain. People with dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships. They also lose their ability to solve problems and maintain emotional control, and they may experience personality changes and behavioral problems, such as agitation, delusions, and hallucinations. While memory loss is a common symptom of dementia, memory loss by itself does not mean that a person has dementia. Doctors diagnose dementia only if two or more brain functions - such as memory and language skills -- are significantly impaired without loss of consciousness.\u00a0 Some of the diseases that can cause symptoms of dementia are Alzheimer\u2019s disease, vascular dementia, Lewy body dementia, frontotemporal dementia, Huntington\u2019s disease, and Creutzfeldt-Jakob disease.\u00a0 Doctors have identified other conditions that can cause dementia or dementia-like symptoms including reactions to medications, metabolic problems and endocrine abnormalities, nutritional deficiencies, infections, poisoning, brain tumors, anoxia or hypoxia (conditions in which the brain\u2019s oxygen supply is either reduced or cut off entirely), and heart and lung problems.\u00a0 Although it is common in very elderly individuals, dementia is not a normal part of the aging process.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Dementia-Information-Page"
+  ],
+  [
+    "Dementia (VASCULAR DEMENTIA AND VASCULAR COGNITIVE IMPAIRMENT: A RESOURCE LIST): Vascular dementia, the second most common form of dementia in older adults after Alzheimer's disease, and vascular cognitive impairment (VCI) result from injuries to vessels that supply blood to the brain, often after a stroke or series of strokes. The symptoms of vascular dementia can be similar to those of Alzheimer's, and both conditions can occur at the same time (a condition called \"mixed dementia\"). Symptoms of vascular dementia and VCI can begin suddenly and worsen or improve over time.Caregivers of people with vascular dementia or VCI face a variety of challenges. Learning more about these disorders can help. This resource list is a place to start. All resources on this list are available free online.The items on this list are in three categories:- Vascular Dementia and Vascular Cognitive Impairment - CADASIL-a rare, inherited form of vascular dementia - Binswanger's Disease-also called Subcortical Vascular Dementia",
+    "https://www.nia.nih.gov/health/topics/dementia"
+  ],
+  [
+    "Sleep apnea (Treatment): For milder cases of sleep apnea, your doctor may recommend only lifestyle changes, such as losing weight or quitting smoking. And if you have nasal allergies, your doctor will recommend treatment for your allergies. If these measures don't improve your signs and symptoms or if your apnea is moderate to severe, a number of other treatments are available. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary. Treatments for obstructive sleep apnea may include: Therapies - Continuous positive airway pressure (CPAP). If you have moderate to severe sleep apnea, you may benefit from a machine that delivers air pressure through a mask placed over your nose while you sleep. With CPAP (SEE-pap), the air pressure is somewhat greater than that of the surrounding air, and is just enough to keep your upper airway passages open, preventing apnea and snoring. Although CPAP is the most common and reliable method of treating sleep apnea, some people find it cumbersome or uncomfortable. Some people give up on CPAP, but with some practice, most people learn to adjust the tension of the straps to obtain a comfortable and secure fit. You may need to try more than one type of mask to find one that's comfortable. Some people benefit from also using a humidifier along with their CPAP systems. Don't just stop using the CPAP machine if you experience problems. Check with your doctor to see what modifications can be made to make you more comfortable. Additionally, contact your doctor if you are still snoring despite treatment or begin snoring again. If your weight changes, the pressure settings of the CPAP machine may need to be adjusted. - Other airway pressure devices. If CPAP continues to be a problem for you, you may be able to use a different type of airway pressure device that automatically adjusts the pressure while you're sleeping (Auto-CPAP). Units that supply bilevel positive airway pressure (BiPAP) are also available. These provide more pressure when you inhale and less when you exhale. - Expiratory positive airway pressure (EPAP). These small, single-use devices are placed over each nostril before you go to sleep. The device is a valve that allows air to move freely in, but when you exhale, air must go through small holes in the valve. This increases pressure in the airway and keeps it open. The device may help reduce snoring and daytime sleepiness in people with mild obstructive sleep apnea. And it may be an option for some who can't tolerate CPAP. - Oral appliances. Another option is wearing an oral appliance designed to keep your throat open. CPAP is more reliably effective than oral appliances, but oral appliances may be easier to use. Some are designed to open your throat by bringing your jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea. A number of devices are available from your dentist. You may need to try different devices before finding one that works for you. Once you find the right fit, you'll still need to follow up with your dentist repeatedly during the first year and then regularly after that to ensure that the fit is still good and to reassess your signs and symptoms. Surgery Surgery is usually only an option after other treatments have failed. Generally, at least a three-month trial of other treatment options is suggested before considering surgery. However, for those few people with certain jaw structure problems, it's a good first option. The goal of surgery for sleep apnea is to enlarge the airway through your nose or throat that may be vibrating and causing you to snore or that may be blocking your upper air passages and causing sleep apnea. Surgical options may include: - Tissue removal. During this procedure, which is called uvulopalatopharyngoplasty, your doctor removes tissue from the rear of your mouth and top of your throat. Your tonsils and adenoids usually are removed as well. This type of surgery may be successful in stopping throat structures from vibrating and causing snoring. It's less effective than CPAP, and isn't considered a reliable treatment for obstructive sleep apnea. Removing tissues in the back of your throat with radiofrequency energy (radiofrequency ablation) may be an option for people who can't tolerate CPAP or oral appliances. - Jaw repositioning. In this procedure, your jaw is moved forward from the remainder of your face bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. This procedure is known as maxillomandibular advancement. - Implants. Plastic rods are surgically implanted into the soft palate after you've received local anesthetic. - Creating a new air passageway (tracheostomy). You may need this form of surgery if other treatments have failed and you have severe, life-threatening sleep apnea. In this procedure, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe. You keep the opening covered during the day. But at night you uncover it to allow air to pass in and out of your lungs, bypassing the blocked air passage in your throat. Other types of surgery may help reduce snoring and contribute to the treatment of sleep apnea by clearing or enlarging air passages: - Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated nasal septum) - Surgery to remove enlarged tonsils or adenoids - Weight-loss surgery Treatments for central and complex sleep apnea may include: Therapies - Treatment for associated medical problems. Possible causes of central sleep apnea include heart or neuromuscular disorders, and treating those conditions may help. For example, optimizing therapy for heart failure may eliminate central sleep apnea. - Supplemental oxygen. Using supplemental oxygen while you sleep may help if you have central sleep apnea. Various forms of oxygen are available as well as different devices to deliver oxygen to your lungs. - Adaptive servo-ventilation (ASV). This more recently approved airflow device learns your normal breathing pattern and stores the information in a built-in computer. After you fall asleep, the machine uses pressure to normalize your breathing pattern and prevent pauses in your breathing. ASV appears to be more successful than other forms of positive airway pressure at treating complex sleep apnea in some people. - Continuous positive airway pressure (CPAP). This method, also used in obstructive sleep apnea, involves wearing a pressurized mask over your nose while you sleep. CPAP may eliminate snoring and prevent sleep apnea. As with obstructive sleep apnea, it's important that you use the device as directed. If your mask is uncomfortable or the pressure feels too strong, talk with your doctor so that adjustments can be made. - Bilevel positive airway pressure (BiPAP). Unlike CPAP, which supplies steady, constant pressure to your upper airway as you breathe in and out, BiPAP builds to a higher pressure when you inhale and decreases to a lower pressure when you exhale. The goal of this treatment is to assist the weak breathing pattern of central sleep apnea. Some BiPAP devices can be set to automatically deliver a breath if the device detects you haven't taken one after so many seconds. Along with these treatments, you may read, hear or see TV ads about different treatments for sleep apnea. Talk with your doctor about any treatment before you try it to find out how useful it might be.",
+    "https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631"
+  ],
+  [
+    "Do I need to see a doctor for Obstructive sleep apnea - adults?: Call your health care provider if: - You feel very tired and sleepy during the day - You or your family notice symptoms of obstructive sleep apnea - Symptoms do not improve with treatment, or new symptoms develop",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000811.htm"
+  ],
+  [
+    "Central sleep apnea (Treatment): Treating the condition that is causing central sleep apnea can help manage symptoms. For example, if central sleep apnea is due to heart failure, the goal is to treat the heart failure itself. Devices used during sleep to aid breathing may be recommended. These include nasal continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP) or adaptive servo-ventilation (ASV). Some types of central sleep apnea are treated with medicines that stimulate breathing. Oxygen treatment may help ensure the lungs get enough oxygen while sleeping. If narcotic medicine is causing the apnea, the dosage may need to be lowered or the medicine changed.",
+    "https://medlineplus.gov/ency/article/003997.htm"
+  ],
+  [
+    "Obstructive sleep apnea (Treatment): Lifestyle changes For milder cases of obstructive sleep apnea, your doctor may recommend lifestyle changes: - Lose weight if you're overweight. - Exercise regularly. - Drink alcohol moderately, if at all, and don't drink several hours before bedtime. - Quit smoking. - Use a nasal decongestant or allergy medications. - Don't sleep on your back. If these measures don't improve your sleep or if your apnea is moderate to severe, then your doctor may recommend other treatments. Certain devices can help open up a blocked airway. In other cases, surgery may be necessary. Therapies - Positive airway pressure. If you have obstructive sleep apnea, you may benefit from positive airway pressure. In this treatment, a machine delivers air pressure through a piece that fits into your nose or is placed over your nose and mouth while you sleep. Positive airway pressure reduces the number of respiratory events that occur as you sleep, reduces daytime sleepiness and improves your quality of life. The most common type is called continuous positive airway pressure, or CPAP (SEE-pap). With this treatment, the pressure of the air breathed is continuous, constant and somewhat greater than that of the surrounding air, which is just enough to keep your upper airway passages open. This air pressure prevents obstructive sleep apnea and snoring. Although CPAP is the most consistently successful and most commonly used method of treating obstructive sleep apnea, some people find the mask cumbersome, uncomfortable or loud. However, newer machines are smaller and less noisy than older machines. Also, with some practice, most people learn to adjust the mask to obtain a comfortable and secure fit. You may need to try different types to find a suitable mask. Several options are available, such as nasal masks, nasal pillows or face masks. If you're having particular difficulties tolerating pressure, some machines have special adaptive pressure functions to improve comfort. You also may benefit from using a humidifier along with your CPAP system. CPAP may be given at a continuous (fixed) pressure or varied (autotitrating) pressure. In fixed CPAP, the pressure stays constant. In autotitrating CPAP, the levels of pressure are adjusted if the device senses increased airway resistance. Bilevel positive airway pressure (BiPAP), another type of positive airway pressure, delivers a preset amount of pressure when you breathe in and a different amount of pressure when you breathe out. CPAP is more commonly used because it's been well-studied for obstructive sleep apnea and has been shown to effectively treat obstructive sleep apnea. However, for people who have difficulty tolerating fixed CPAP, BiPAP or autotitrating CPAP may be worth a try. Don't stop using your positive airway pressure machine if you have problems. Check with your doctor to see what adjustments you can make to improve its comfort. In addition, contact your doctor if you still snore despite treatment, if you begin snoring again or if your weight changes. - Mouthpiece (oral device). Though positive airway pressure is often an effective treatment, oral appliances are an alternative for some people with mild or moderate obstructive sleep apnea. These devices may reduce your sleepiness and improve your quality of life. These devices are designed to keep your throat open. Some devices keep your airway open by bringing your jaw forward, which can sometimes relieve snoring and obstructive sleep apnea. Other devices hold your tongue in a different position. If you and your doctor decide to explore this option, you'll need to see a dentist experienced in dental sleep medicine appliances for the fitting and follow-up therapy. A number of devices are available. Close follow-up is needed to ensure successful treatment. Surgery or other procedures Surgery is usually considered only if other therapies haven't been effective or haven't been appropriate options for you. Surgical options may include: - Surgical removal of tissue. Uvulopalatopharyngoplasty (UPPP) is a procedure in which your doctor removes tissue from the back of your mouth and top of your throat. Your tonsils and adenoids may be removed as well. UPPP usually is performed in a hospital and requires a general anesthetic. Doctors sometimes remove tissue from the back of the throat with a laser (laser-assisted uvulopalatoplasty) or with radiofrequency energy (radiofrequency ablation) to treat snoring. These procedures don't treat obstructive sleep apnea, but they may reduce snoring. - Upper airway stimulation. This new device is approved for use in people with moderate to severe obstructive sleep apnea who can't tolerate CPAP or BiPAP. A small, thin impulse generator is implanted under the skin in the upper chest. The device detects your breathing patterns and when necessary, stimulates the nerve that controls movement of the tongue. A study on the device found that it led to significant improvement in obstructive sleep apnea symptoms and improvements in quality of life. - Jaw surgery. In this procedure, called maxillomandibular advancement, the upper and lower parts of your jaw are moved forward from the rest of your facial bones. This enlarges the space behind the tongue and soft palate, making obstruction less likely. - Surgical opening in the neck. You may need this form of surgery if other treatments have failed and you have severe, life-threatening obstructive sleep apnea. In this procedure, called a tracheostomy, your surgeon makes an opening in your neck and inserts a metal or plastic tube through which you breathe. Air passes in and out of your lungs, bypassing the blocked air passage in your throat. - Implants. This minimally invasive treatment involves placement of three tiny polyester rods in the soft palate. These inserts stiffen and support the tissue of the soft palate and reduce upper airway collapse and snoring. This treatment is recommended only for people with mild obstructive sleep apnea. Other types of surgery may help reduce snoring and sleep apnea by clearing or enlarging air passages, including: - Nasal surgery to remove polyps or straighten a crooked partition between your nostrils (deviated septum) - Surgery to remove enlarged tonsils or adenoids",
+    "https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090"
+  ],
+  [
+    "Sleep Apnea (Treatment): There are a variety of treatments for sleep apnea, depending on an individual\u2019s medical history and the severity of the disorder.\u00a0 Most treatment regimens begin with lifestyle changes, such as avoiding alcohol and medications that relax the central nervous system (for example, sedatives and muscle relaxants), losing weight, and quitting smoking.\u00a0 Some people are helped by special pillows or devices that keep them from sleeping on their backs, or oral appliances to keep the airway open during sleep.\u00a0 If these conservative methods are inadequate, doctors often recommend continuous positive airway pressure (CPAP), in which a face mask is attached to a tube and a machine that blows pressurized air into the mask and through the airway to keep it open.\u00a0 Also available are machines that offer variable positive airway pressure (VPAP) and automatic positive airway pressure (APAP). \u00a0There are also surgical procedures that can be used to remove tissue and widen the airway.\u00a0 Some individuals may need a combination of therapies to successfully treat their sleep apnea.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Sleep-Apnea-Information-Page"
+  ],
+  [
+    "Obstructive sleep apnea - adults (Treatment): Treatment helps keep your airway open while you sleep so your breathing does not stop. Lifestyle changes may help relieve symptoms in people with mild sleep apnea, such as: - Avoid alcohol or medicines that make you sleepy before bedtime. They can make symptoms worse. - Avoid sleeping on your back. - Lose excess weight. Continuous positive airway pressure (CPAP) devices work best to treat obstructive sleep apnea in most people. - You wear a mask over your nose while you sleep. - The mask is connected by a hose to a small machine that sits at the side of your bed. - The machine pumps air under pressure through the hose and mask and into your airway while you sleep. This helps keep your airway open. It can take some time to get used to sleeping with CPAP therapy. Good follow-up and support from a sleep center can help you overcome any problems using CPAP. Dental devices may help some people. You wear them in your mouth while you sleep to keep your jaw forward and the airway open. Other treatments may be available, but there is less evidence that they work. It is best to talk with a doctor who specializes in sleep problems before trying them. Surgery may be an option for some people. It is often a last resort if other treatments did not work and you have severe symptoms. Surgery may be used to: - Remove extra tissue at the back of the throat. - Correct problems with the structures in the face. - Create an opening in the windpipe to bypass the blocked airway if there are physical problems. - Remove the tonsils and adenoids. Surgery may not completely cure obstructive sleep apnea and may have long-term side effects.",
+    "https://medlineplus.gov/ency/article/000811.htm"
+  ],
+  [
+    "Sleep Apnea: Espa\u00f1ol Sleep apnea (AP-ne-ah) is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They may occur 30\u00a0times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound. Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When your breathing pauses or becomes shallow, you\u2019ll often move out of deep sleep and into light sleep. As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness. Overview Sleep apnea often goes undiagnosed. Doctors usually can't detect the condition during routine office visits. Also, no blood test can help diagnose the condition. Most people who have sleep apnea don't know they have it because it only occurs during sleep. A family member or bed partner might be the first to notice signs of sleep apnea. The most common type of sleep apnea is obstructive sleep apnea. In this condition, the airway collapses or becomes blocked during sleep. This causes shallow breathing or breathing pauses. When you try to breathe, any air that squeezes past the blockage can cause loud snoring. Obstructive sleep apnea is more common in people who are overweight, but it can affect anyone. For example, small children who have enlarged tonsil tissues in their throats may have obstructive sleep apnea. The animation below shows how obstructive sleep apnea occurs. Click the \"start\" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames. The animation shows how the airway can collapse and block air flow to the lungs, causing sleep apnea. Central sleep apnea is a less common type of sleep apnea. This disorder occurs if the area of your brain that controls your breathing doesn't send the correct signals to your breathing muscles. As a result, you'll make no effort to breathe for brief periods. Central sleep apnea can affect anyone. However, it's more common in people who have certain medical conditions or use certain medicines. Central sleep apnea can occur with obstructive sleep apnea or alone. Snoring typically doesn't happen with central sleep apnea. This article mainly focuses on obstructive sleep apnea. Outlook Untreated sleep apnea can: Increase the risk of high blood pressure, heart attack, stroke, obesity, and diabetes Increase the risk of, or worsen, heart failure Make arrhythmias (ah-RITH-me-ahs), or irregular heartbeats, more likely Increase the chance of having work-related or driving accidents Sleep apnea is a chronic condition that requires long-term management. Lifestyle changes, mouthpieces, surgery, and breathing devices can successfully treat sleep apnea in many people. Central sleep apnea Obstructive sleep apnea Sleep-disordered breathing When you're awake, throat muscles help keep your airway stiff and open so air can flow into your lungs. When you sleep, these muscles relax, which narrows your throat. Normally, this narrowing doesn\u2019t prevent air from flowing into and out of your lungs. But if you have sleep apnea, your airway can become partially or fully blocked because: Your throat muscles and tongue relax more than normal. Your tongue and tonsils (tissue masses in the back of your mouth) are large compared with the opening into your windpipe. You're overweight. The extra soft fat tissue can thicken the wall of the windpipe. This narrows the inside of the windpipe, which makes it harder to keep open. The shape of your head and neck (bony structure) may cause a smaller airway size in the mouth and throat area. The aging process limits your brain signals' ability to keep your throat muscles stiff during sleep. Thus, your airway is more likely to narrow or collapse. Not enough air flows into your lungs if your airway is partially or fully blocked during sleep. As a result, loud snoring and a drop in your blood oxygen level can occur. If the oxygen drops to a dangerous level, it triggers your brain to disturb your sleep. This helps tighten the upper airway muscles and open your windpipe. Normal breathing then starts again, often with a loud snort or choking sound. Frequent drops in your blood oxygen level and reduced sleep quality can trigger the release of stress hormones. These hormones raise your heart rate and increase your risk for high blood pressure, heart attack, stroke, and arrhythmias (irregular heartbeats). The hormones also can raise your risk for, or worsen, heart failure. Untreated sleep apnea also can lead to changes in how your body uses energy. These changes increase your risk for obesity and diabetes. Obstructive sleep apnea is a common condition. About half of the people who have this condition are overweight. Men are more likely than women to have sleep apnea. Although the condition can occur at any age, the risk increases as you get older. \u00a0A family history of sleep apnea also increases your risk for the condition. People who have small airways in their noses, throats, or mouths are more likely to have sleep apnea. Small airways might be due to the shape of these structures or allergies or other conditions that cause congestion. Small children might have enlarged tonsil tissues in their throats. Enlarged tonsil tissues raise a child\u2019s risk for sleep apnea. Overweight children also might be at increased risk for sleep apnea. About half of the people who have sleep apnea also have high blood pressure. Sleep apnea also is linked to smoking, metabolic syndrome, diabetes, and risk factors for stroke and heart failure. Race and ethnicity might play a role in the risk of developing sleep apnea. However, more research is needed. Major Signs and Symptoms One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses. The snoring usually is loudest when you sleep on your back; it might be less noisy when you turn on your side. You might not snore every night. Over time, however, the snoring can happen more often and get louder. You're asleep when the snoring or gasping happens. You likely won't know that you're having problems breathing or be able to judge how severe the problem is. A family member or bed partner often will notice these problems before you do. Not everyone who snores has sleep apnea. Another common sign of sleep apnea is fighting sleepiness during the day, at work, or while driving. You may find yourself rapidly falling asleep during the quiet moments of the day when you're not active. Even if you don't have daytime sleepiness, talk with your doctor if you have problems breathing during sleep. Other Signs and Symptoms Others signs and symptoms of sleep apnea include: Morning headaches Memory or learning problems and not being able to concentrate Feeling irritable, depressed, or having mood swings or personality changes Waking up frequently to urinate Dry mouth or sore throat when you wake up In children, sleep apnea can cause hyperactivity, poor school performance, and angry or hostile behavior. Children who have sleep apnea also may breathe through their mouths instead of their noses during the day. Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and sleep study results. Your primary care doctor may evaluate your symptoms first. He or she will then decide whether you need to see a sleep specialist. Sleep specialists are doctors who diagnose and treat people who have sleep problems. Examples of such doctors include lung and nerve specialists and ear, nose, and throat specialists. Other types of doctors also can be sleep specialists. Medical and Family Histories If you think you have a sleep problem, consider keeping a sleep diary for 1 to 2 weeks. Bring the diary with you to your next medical appointment. Write down when you go to sleep, wake up, and take naps. Also write down how much you sleep each night, how alert and rested you feel in the morning, and how sleepy you feel at various times during the day. This information can help your doctor figure out whether you have a sleep disorder. You can find a sample sleep diary in the National Heart, Lung, and Blood Institute's \"Your Guide to Healthy Sleep.\" At your appointment, your doctor will ask you questions about how you sleep and how you function during the day. Your doctor also will want to know how loudly and often you snore or make gasping or choking sounds during sleep. Often you're not aware of such symptoms and must ask a family member or bed partner to report them. Let your doctor know if anyone in your family has been diagnosed with sleep apnea or has had symptoms of the disorder. Many people aren't aware of their symptoms and aren't diagnosed. If you're a parent of a child who may have sleep apnea, tell your child's doctor about your child's signs and symptoms. Physical Exam Your doctor will check your mouth, nose, and throat for extra or large tissues. Children who have sleep apnea might have enlarged tonsils. Doctors may need only a physical exam and medical history to diagnose sleep apnea in children. Adults who have sleep apnea may have an enlarged uvula (U-vu-luh) or soft palate. The uvula is the tissue that hangs from the middle of the back of your mouth. The soft palate is the roof of your mouth in the back of your throat. Sleep Studies Sleep studies are tests that measure how well you sleep and how your body responds to sleep problems. These tests can help your doctor find out whether you have a sleep disorder and how severe it is. Sleep studies are the most accurate tests for diagnosing sleep apnea. There are different kinds of sleep studies. If your doctor thinks you have sleep apnea, he or she may recommend a polysomnogram (poly-SOM-no-gram; also called a PSG) or a home-based portable monitor. Polysomnogram A PSG is the most common sleep study for diagnosing sleep apnea. This study records brain activity, eye movements, heart rate, and blood pressure. A PSG also records the amount of oxygen in your blood, air movement through your nose while you breathe, snoring, and chest movements. The chest movements show whether you're making an effort to breathe. PSGs often are done at sleep centers or sleep labs. The test is painless. You'll go to sleep as usual, except you'll have sensors attached to your scalp, face, chest, limbs, and a finger. The staff at the sleep center will use the sensors to check on you throughout the night. A sleep specialist will review the results of your PSG to see whether you have sleep apnea and how severe it is. He or she will use the results to plan your treatment. Your doctor also may use a PSG to find the best setting for you on a CPAP (continuous positive airway pressure) machine. CPAP is the most common treatment for sleep apnea. A CPAP machine uses mild air pressure to keep your airway open while you sleep. If your doctor thinks that you have sleep apnea, he or she may schedule a split-night sleep study. During the first half of the night, your sleep will be checked without a CPAP machine. This will show whether you have sleep apnea and how severe it is. If the PSG shows that you have sleep apnea, you\u2019ll use a CPAP machine during the second half of the split-night study. The staff at the sleep center will adjust the flow of air from the CPAP machine to find the setting that works best for you. Home-Based Portable Monitor Your doctor may recommend a home-based sleep test with a portable monitor. The portable monitor will record some of the same information as a PSG. For example, it may record: The amount of oxygen in your blood Air movement through your nose while you breathe Your heart rate Chest movements that show whether you're making an effort to breathe A sleep specialist may use the results from a home-based sleep test to help diagnose sleep apnea. He or she also may use the results to decide whether you need a full PSG study in a sleep center. Sleep apnea is treated with lifestyle changes, mouthpieces, breathing devices, and surgery. Medicines typically aren't used to treat the condition. The goals of treating sleep apnea are to: Restore regular breathing during sleep Relieve symptoms such as loud snoring and daytime sleepiness Treatment may improve other medical problems linked to sleep apnea, such as high blood pressure. Treatment also can reduce your risk for heart disease,\u00a0stroke, and diabetes. If you have sleep apnea, talk with your doctor or sleep specialist about the treatment options that will work best for you. Lifestyle changes and/or mouthpieces may relieve mild sleep apnea. People who have moderate or severe sleep apnea may need breathing devices or surgery. If you continue to have daytime sleepiness despite treatment, your doctor may ask whether you're getting enough sleep. (Adults should get at least 7 to 8 hours of sleep; children and teens need more. For more information, go to the Health Topics Sleep Deprivation and Deficiency article.) If treatment and enough sleep don't relieve your daytime sleepiness, your doctor will consider other treatment options. Lifestyle Changes If you have mild sleep apnea, some changes in daily activities or habits might be all the treatment you need. Avoid alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep. Lose weight if you're overweight or obese. Even a little weight loss can improve your symptoms. Sleep on your side instead of your back to help keep your throat open. You can sleep with special pillows or shirts that prevent you from sleeping on your back. Keep your nasal passages open at night with nasal sprays or allergy medicines, if needed. Talk with your doctor about whether these treatments might help you. If you smoke, quit. Talk with your doctor about programs and products that can help you quit smoking. Mouthpieces A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. Your doctor also may recommend a mouthpiece if you snore loudly but don't have sleep apnea. A dentist or orthodontist can make a custom-fit plastic mouthpiece for treating sleep apnea. (An orthodontist specializes in correcting teeth or jaw problems.) The mouthpiece will adjust your lower jaw and your tongue to help keep your airways open while you sleep. If you use a mouthpiece, tell your doctor if you have discomfort or pain while using the device. You may need periodic office visits so your doctor can adjust your mouthpiece to fit better. Breathing Devices CPAP (continuous positive airway pressure) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gently blows air into your throat. The pressure from the air helps keep your airway open while you sleep. Treating sleep apnea may help you stop snoring. But not snoring doesn't mean that you no longer have sleep apnea or can stop using CPAP. Your sleep apnea will return if you stop using your CPAP machine or don\u2019t use it correctly. Usually, a technician will come to your home to bring the CPAP equipment. The technician will set up the CPAP machine and adjust it based on your doctor's prescription. After the initial setup, you may need to have the CPAP adjusted from time to time for the best results. CPAP treatment may cause side effects in some people. These side effects include a dry or stuffy nose, irritated skin on your face, dry mouth, and headaches. If your CPAP isn't adjusted properly, you may get stomach bloating and discomfort while wearing the mask. If you're having trouble with CPAP side effects, work with your sleep specialist, his or her nursing staff, and the CPAP technician. Together, you can take steps to reduce the side effects. For example, the CPAP settings or size/fit of the mask might need to be adjusted. Adding moisture to the air as it flows through the mask or using nasal spray can help relieve a dry, stuffy, or runny nose. There are many types of CPAP machines and masks. Tell your doctor if you're not happy with the type you're using. He or she may suggest switching to a different type that might work better for you. People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP. Surgery Some people who have sleep apnea might benefit from surgery. The type of surgery and how well it works depend on the cause of the sleep apnea. Surgery is done to widen breathing passages. It usually involves shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw. Surgery to shrink or stiffen excess tissue is done in a doctor's office or a hospital. Shrinking tissue may involve small shots or other treatments to the tissue. You may need a series of treatments to shrink the excess tissue. To stiffen excess tissue, the doctor makes a small cut in the tissue and inserts a piece of stiff plastic. Surgery to remove excess tissue is done in a hospital. You're given medicine to help you sleep during the surgery. After surgery, you may have throat pain that lasts for 1 to 2 weeks. Surgery to remove the tonsils, if they're blocking the airway, might be helpful for some children. Your child's doctor may suggest waiting some time to see whether these tissues shrink on their own. This is common as small children grow. Sleep apnea can be very serious. However, following an effective treatment plan often can improve your quality of life quite a bit. Treatment can improve your sleep and relieve daytime sleepiness. Treatment also might lower your risk for high blood pressure, heart disease, and other health problems linked to sleep apnea. Treatment may improve your overall health and happiness as well as your quality of sleep (and possibly your family's quality of sleep). Ongoing Health Care Needs Follow up with your doctor regularly to make sure your treatment is working. Tell him or her if the treatment is causing bothersome side effects. Ongoing care is important if you're getting CPAP (continuous positive airway pressure) treatment. It may take a while before you adjust to using CPAP. If you aren't comfortable with your CPAP device, or if it doesn't seem to be working, let your doctor know. You may need to switch to a different device or mask. Or, you may need treatment to relieve CPAP side effects. Try not to gain weight. Weight gain can worsen sleep apnea and require adjustments to your CPAP device. In contrast, weight loss may relieve your sleep apnea. Until your sleep apnea is properly treated, know the dangers of driving or operating heavy machinery while sleepy. If you're having any type of surgery that requires medicine to put you to sleep, let your surgeon and doctors know you have sleep apnea. They might have to take extra steps to make sure your airway stays open during the surgery. If you're using a mouthpiece to treat your sleep apnea, you may need to have routine checkups with your dentist. How Can Family Members Help? Often, people who have sleep apnea don't know they have it. They're not aware that their breathing stops and starts many times while they're sleeping. Family members or bed partners usually are the first to notice signs of sleep apnea. Family members can do many things to help a loved one who has sleep apnea. Let the person know if he or she snores loudly during sleep or has breathing stops and starts. Encourage the person to get medical help. Help the person follow the doctor's treatment plan, including CPAP treatment. Provide emotional support.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea"
+  ],
+  [
+    "Central sleep apnea: Central sleep apnea is a sleep disorder in which breathing stops over and over during sleep. Central sleep apnea results when the brain temporarily stops sending signals to the muscles that control breathing. The condition often occurs in people who have certain medical problems. For example, it can develop in someone who has a problem with the brainstem, which controls breathing. Conditions that can cause or lead to central sleep apnea include: - Problems that affect the brainstem, including brain infection, stroke, or conditions of the cervical spine (neck) - Severe obesity - Certain medicines, such as narcotic painkillers If the apnea is not associated with another disease, it is called idiopathic central sleep apnea. A condition called Cheyne-Stokes respiration can affect people with severe heart failure and can be associated with central sleep apnea. The breathing pattern involves alternating deep and heavy breathing with shallow, or even no\u00a0breathing, usually while sleeping. Central sleep apnea is not the same as obstructive sleep apnea. With obstructive sleep apnea, breathing stops and starts because the airway is narrowed or blocked. But a person can have both conditions, such as with a medical problem called obesity hypoventilation syndrome. People with central sleep apnea have episodes of disrupted breathing during sleep. Other symptoms may include: - Chronic fatigue - Daytime sleepiness - Morning headaches - Restless sleep Other symptoms may occur if the apnea is due to a problem with the nervous system. Symptoms depend on\u00a0the\u00a0parts of the nervous system that are affected,\u00a0and may include: - Shortness of breath - Swallowing problems - Voice changes - Weakness or numbness throughout the body The health care provider will perform a physical exam. Tests will be done to diagnose an underlying medical condition. A sleep study (polysomnography) can confirm sleep apnea. Other tests that may be done include: - Echocardiogram - Lung function\u00a0testing - MRI of the spine or neck Treating the condition that is causing central sleep apnea can help manage symptoms. For example, if central sleep apnea is due to heart failure, the goal is to treat the heart failure itself. Devices used during sleep to aid breathing may be recommended. These include nasal continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP) or adaptive servo-ventilation (ASV). Some types of central sleep apnea are treated with medicines that stimulate breathing. Oxygen treatment may help ensure the lungs get enough oxygen while sleeping. If narcotic medicine is causing the apnea, the dosage may need to be lowered or the medicine changed. How well a patient does depends on the medical condition causing central sleep apnea. The outlook is usually favorable for persons with idiopathic central sleep apnea. Complications may result from the underlying disease causing the central sleep apnea. Call your provider if you have symptoms of sleep apnea. Central sleep apnea is usually diagnosed in people who are already severely ill. Updated by: Allen J. Blaivas, DO, Division of Pulmonary, Critical Care, and Sleep Medicine, VA New Jersey Health Care System, Clinical Assistant Professor, Rutger's New Jersey Medical School, East Orange, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003997.htm"
+  ],
+  [
+    "Diarrhea (Symptoms and Causes): Acute and persistent diarrhea may have causes that are different from those of chronic diarrhea. In many cases, doctors do not find the cause of diarrhea. Most diarrhea goes away on its own within 4 days, and finding the cause is not necessary.The most common causes of acute and persistent diarrhea are infections, travelers\u2019 diarrhea, and side effects of medicines.InfectionsThree types of infections that cause diarrhea includeViral infections. Many viruses cause diarrhea, including norovirus and rotavirus. Viral gastroenteritis is a common cause of acute diarrhea. Bacterial infections. Several types of bacteria can enter your body through contaminated food or water and cause diarrhea. Common bacteria that cause diarrhea include Campylobacter, Escherichia coli (E. coli), Salmonella, and Shigella. Parasitic infections. Parasites can enter your body through food or water and settle in your digestive tract. Parasites that cause diarrhea include Cryptosporidium enteritis, Entamoeba histolytica, and Giardia lamblia.Infections in the digestive tract that spread through foods or drinks are called foodborne illnesses.Infections lasting more than 2 weeks and less than 4 weeks can cause persistent diarrhea.Travelers\u2019 diarrheaTravelers\u2019 diarrhea is caused by eating food or drinking water contaminated with bacteria, viruses, or parasites. Travelers\u2019 diarrhea is most often acute. However, some parasites cause diarrhea that lasts longer. Travelers\u2019 diarrhea can be a problem for people traveling to developing countries.Side effects of medicinesMany medicines may cause diarrhea. Medicines that may cause diarrhea include antibiotics, antacids containing magnesium, and medicines used to treat cancer.Some infections, food allergies and intolerances, digestive tract problems, abdominal surgery, and long-term use of medicines can cause chronic diarrhea.InfectionsSome infections from bacteria and parasites that cause diarrhea do not go away quickly without treatment. Also, after an infection, people may have problems digesting carbohydrates such as lactose or proteins in foods such as cow\u2019s milk, milk products, or soy. Problems digesting carbohydrates or proteins can prolong diarrhea.Food allergies and intolerancesAllergies to foods such as cow\u2019s milk, soy, cereal grains, eggs, and seafood may cause chronic diarrhea.Lactose intolerance is a common condition that may cause diarrhea after eating foods or drinking liquids that contain milk or milk products.Fructose intolerance is a condition that may cause diarrhea after eating foods or drinking liquids that contain fructose, a sugar found in fruits, fruit juices, and honey. Fructose is added to many foods and soft drinks as a sweetener called high-fructose corn syrup.Sugar alcohols such as sorbitol, mannitol, and xylitol may cause diarrhea in some people. Sugar-free candies and gum often include these sugar alcohols.Digestive tract problemsDigestive tract problems that may cause chronic diarrhea includeceliac disease Crohn\u2019s disease irritable bowel syndrome and other functional gastrointestinal (GI) disorders small intestinal bacterial overgrowth ulcerative colitisAbdominal surgeryYou may develop chronic diarrhea after abdominal surgery. Abdominal surgery is an operation on the appendix, gallbladder, large intestine, liver, pancreas, small intestine, spleen, or stomach.Long-term use of medicinesMedicines that must be taken for a long time may cause chronic diarrhea. Some medicines, such as antibiotics, can change the normal gut flora and increase your chances of infection with Clostridium difficile, a bacterium that can cause chronic diarrhea.",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea"
+  ],
+  [
+    "What are the treatments for Chronic Diarrhea in Children?: The treatment for chronic diarrhea will depend on the cause. Some common causes of chronic diarrhea are treated as follows: - Infections. If a child has prolonged problems digesting certain carbohydrates or proteins after an acute infection, a health care provider may recommend changes in diet. A child may need antibiotics or medications that target parasites to treat infections that do not go away on their own. A health care provider may also prescribe antibiotics to treat small intestinal bacterial overgrowth. - Functional GI disorders. For toddlers diarrhea, treatment is usually not needed. Most children outgrow toddlers diarrhea by the time they start school. In many children, limiting fruit juice intake and increasing the amount of fiber and fat in the diet may improve symptoms of toddlers diarrhea. A health care provider may treat IBS with - changes in diet. - medication. - probioticslive microorganisms, usually bacteria, that are similar to microorganisms normally found in the GI tract. Studies have found that probiotics, specifically Bifidobacteria and certain probiotic combinations, improve symptoms of IBS when taken in large enough amounts. However, researchers are still studying the use of probiotics to treat IBS. - psychological therapy. 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. - Food allergies and intolerances. A health care provider will recommend changes in diet to manage symptoms of food allergies and intolerances. To treat food allergies, the childs parent or caretaker should remove the food that triggers the allergy from the childs diet. For children with celiac disease, following a gluten-free diet will stop symptoms, heal existing intestinal damage, and prevent further damage. The childs parent or caretaker can manage the symptoms of lactose intolerance with changes in the childs diet and by using products that contain the lactase enzyme. Most children with lactose intolerance can tolerate some amount of lactose in their diet. The amount of change needed in the diet depends on how much lactose a child can consume without symptoms. For children with dietary fructose intolerance, reducing the amount of fructose in the diet can relieve symptoms. - IBD. A health care provider may use medications, surgery, and changes in diet to treat IBD.",
+    "http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/diarrhea/Pages/diarrhea-in-children-facts.aspx"
+  ],
+  [
+    "Diarrhea (Symptoms): Signs and symptoms associated with diarrhea may include: - Loose, watery stools - Abdominal cramps - Abdominal pain - Fever - Blood in the stool - Bloating - Nausea - Urgent need to have a bowel movement If you're an adult, see your doctor if: - Your diarrhea persists beyond two days - You become dehydrated - You have severe abdominal or rectal pain - You have bloody or black stools - You have a fever above 102 F (39 C) In children, particularly young children, diarrhea can quickly lead to dehydration. Call your doctor if your child's diarrhea doesn't improve within 24 hours or if your baby: - Becomes dehydrated - Has a fever above 102 F (39 C) - Has bloody or black stools",
+    "https://www.mayoclinic.org/diseases-conditions/diarrhea/symptoms-causes/syc-20352241"
+  ],
+  [
+    "Trichohepatoenteric syndrome (Symptoms): Trichohepatoenteric syndrome is named after the three main body systems that it affects: hair (tricho), liver (hepato), and intestines (enteric). The hair of people who have trichohepatoenteric syndrome may be wooly, patchy, or brittle. The hair may easily fall out due to each strand of hair having many thickened points surrounded by weak points ( trichorrhexis nodosa). [3] Trichohepatoenteric syndrome is also characterized by liver disease such as cirrhosis (chronic liver damage) or hepatomegaly (swollen liver). The intestinal problems associated with the condition are most characteristic of the disease. These problems include chronic diarrhea beginning in the first 6 months of life. [2] Other symptoms associated with trichohepatoenteric syndrome include characteristic facial features such as widely spaced eyes, a broad nose, and a wide forehead. [3] People with trichohepatoenteric syndrome may also have a weakened immune system that makes it more difficult to fight infection. Some people may have skin abnormalities such as lightly-colored spots ( caf\u00e9-au-lait macules), dry skin ( xerosis), or skin that has a rubbery texture. [2] Less commonly, some people with trichohepatoenteric syndrome have been born with heart abnormalities. About half of people affected by trichohepatoenteric syndrome have intellectual disability .",
+    "https://rarediseases.info.nih.gov/diseases/5258/trichohepatoenteric-syndrome"
+  ],
+  [
+    "Antibiotic-associated diarrhea (Symptoms): For most people, antibiotic-associated diarrhea causes mild signs and symptoms, such as: - Loose stools - More-frequent bowel movements Antibiotic-associated diarrhea is likely to begin about a week after you start taking an antibiotic. Sometimes, however, diarrhea and other symptoms don't appear until days or even weeks after you've finished antibiotic treatment. C. difficile is a toxin-producing bacteria that causes antibiotic-associated colitis, which can occur after the antibiotic therapy upsets the balance of good and bad bacteria in your intestinal tract. Besides loose stools, C. difficile infection can cause: - Lower abdominal pain and cramping - Low-grade fever - Nausea - Loss of appetite Call your doctor right away if you have serious signs and symptoms of antibiotic-associated diarrhea. These signs and symptoms are common to a number of conditions, so your doctor might recommend tests to determine the cause.",
+    "https://www.mayoclinic.org/diseases-conditions/antibiotic-associated-diarrhea/symptoms-causes/syc-20352231"
+  ],
+  [
+    "Diarrhea (Summary): Summary What is diarrhea? Diarrhea is loose, watery stools (bowel movements). You have diarrhea if you have loose stools three or more times in one day. Acute diarrhea is diarrhea that lasts a short time. It is a common problem. It usually lasts about one or two days, but it may last longer. Then it goes away on its own. Diarrhea lasting more than a few days may be a sign of a more serious problem. Chronic diarrhea -- diarrhea that lasts at least four weeks -- can be a symptom of a chronic disease. Chronic diarrhea symptoms may be continual, or they may come and go. Who gets diarrhea? People of all ages can get diarrhea. On average, adults In the United States have acute diarrhea once a year. Young children have it an average of twice a year. People who visit developing countries are at risk for traveler's diarrhea. It is caused by consuming contaminated food or water. What causes diarrhea? The most common causes of diarrhea include - Bacteria from contaminated food or water - Viruses such as the flu, norovirus, or rotavirus . Rotavirus is the most common cause of acute diarrhea in children. - Parasites, which are tiny organisms found in contaminated food or water - Medicines such as antibiotics, cancer drugs, and antacids that contain magnesium - Food intolerances and sensitivities, which are problems digesting certain ingredients or foods. An example is lactose intolerance. - Diseases that affect the stomach, small intestine, or colon, such as Crohn's disease - Problems with how the colon functions, such as irritable bowel syndrome Some people also get diarrhea after stomach surgery, because sometimes the surgeries can cause food to move through your digestive system more quickly. Sometimes no cause can be found. If your diarrhea goes away within a few days, finding the cause is usually not necessary. What other symptoms might I have with diarrhea? Other possible symptoms of diarrhea include - Cramps or pain in the abdomen - An urgent need to use the bathroom - Loss of bowel control If a virus or bacteria is the cause of your diarrhea, you may also have a fever, chills, and bloody stools. Diarrhea can cause dehydration, which means that your body does not have enough fluid to work properly. Dehydration can be serious, especially for children, older adults, and people with weakened immune systems. When should I see a doctor for diarrhea? Although it is usually not harmful, diarrhea can become dangerous or signal a more serious problem. Contact your health care provider if you have - Signs of dehydration - Diarrhea for more than 2 days, if you are an adult. For children, contact the provider if it lasts more than 24 hours. - Severe pain in your abdomen or rectum (for adults) - A fever of 102 degrees or higher - Stools containing blood or pus - Stools that are black and tarry If children have diarrhea, parents or caregivers should not hesitate to call a health care provider. Diarrhea can be especially dangerous in newborns and infants. How is the cause of diarrhea diagnosed? To find the cause of diarrhea, your health care provider may - Do a physical exam - Ask about any medicines you are taking - Test your stool or blood to look for bacteria, parasites, or other signs of disease or infection - Ask you to stop eating certain foods to see whether your diarrhea goes away If you have chronic diarrhea, your health care provider may perform other tests to look for signs of disease. What are the treatments for diarrhea? Diarrhea is treated by replacing lost fluids and electrolytes to prevent dehydration. Depending on the cause of the problem, you may need medicines to stop the diarrhea or treat an infection. Adults with diarrhea should drink water, fruit juices, sports drinks, sodas without caffeine, and salty broths. As your symptoms improve, you can eat soft, bland food. Children with diarrhea should be given oral rehydration solutions to replace lost fluids and electrolytes. Can diarrhea be prevented? Two types of diarrhea can be prevented - rotavirus diarrhea and traveler's diarrhea. There are vaccines for rotavirus. They are given to babies in two or three doses. You can help prevent traveler's diarrhea by being careful about what you eat and drink when you are in developing countries: - Use only bottled or purified water for drinking, making ice cubes, and brushing your teeth - If you do use tap water, boil it or use iodine tablets - Make sure that the cooked food you eat is fully cooked and served hot - Avoid unwashed or unpeeled raw fruits and vegetables NIH: National Institute of Diabetes and Digestive and Kidney Diseases",
+    "#"
+  ],
+  [
+    "Uveitis: Uveitis is a form of eye inflammation. It affects the middle layer of tissue in the eye wall (uvea). Uveitis (u-vee-I-tis) warning signs often come on suddenly and get worse quickly. They include eye redness, pain and blurred vision. The condition can affect one or both eyes. It primarily affects people ages 20 to 50, but it may also affect children. Possible causes of uveitis are infection, injury, or an autoimmune or inflammatory disease. Many times a cause can't be identified. Uveitis can be serious, leading to permanent vision loss. Early diagnosis and treatment are important to prevent the complications of uveitis. The signs, symptoms and characteristics of uveitis include: - Eye redness - Eye pain - Light sensitivity - Blurred vision - Dark, floating spots in your field of vision (floaters) - Decreased vision Symptoms may occur suddenly and get worse quickly, though in some cases, they develop gradually. They may affect one or both eyes. The uvea is the middle layer of tissue in the wall of the eye. It consists of the iris, the ciliary body and the choroid. The choroid is sandwiched between the retina and the sclera. The retina is located at the inside wall of the eye and the sclera is the outer white part of the eye wall. The uvea provides blood flow to the deep layers of the retina. The type of uveitis you have depends on which part or parts of the eye are inflamed: - Iritis (anterior uveitis) affects the front of your eye and is the most common type. - Cyclitis (intermediate uveitis) affects the ciliary body. - Choroiditis and retinitis (posterior uveitis) affect the back of your eye. - Diffuse uveitis (panuveitis) occurs when all layers of the uvea are inflamed. In any of these conditions, the jelly-like material in the center of your eye (vitreous) can become inflamed and infiltrated with inflammatory cells. When to seek medical advice Contact your doctor if you think you have the warning signs of uveitis. He or she may refer you to an eye specialist (ophthalmologist). If you're having significant eye pain and unexpected vision problems, seek immediate medical attention. In about half of all cases, the specific cause of uveitis isn't clear. If a cause can be determined, it may be one of the following: - Eye injury or surgery - An autoimmune disorder, such as sarcoidosis or ankylosing spondylitis - An inflammatory disorder, such as Crohn's disease or ulcerative colitis - An infection, such as cat-scratch disease, herpes zoster, syphilis, toxoplasmosis, tuberculosis, Lyme disease or West Nile virus - A cancer that affects the eye, such as lymphoma People with changes in certain genes may be more likely to develop uveitis. In addition, a recent study shows a significant association between uveitis and cigarette smoking. When you visit an eye specialist (ophthalmologist), he or she will likely conduct a complete eye exam and gather a thorough health history. You may also need these tests: - Blood tests - Analysis of fluid from the eye - Photography to evaluate the retinal blood flow (angiography) - Photography to measure the thickness of the retinal tissue and to determine the presence or absence of fluid in or under the retina. If the ophthalmologist thinks an underlying condition may be the cause of your uveitis, you may be referred to another doctor for a general medical examination and laboratory tests. Sometimes, it's difficult to find a specific cause for uveitis. However, your doctor will try to determine whether your uveitis is caused by an infection or another condition. If uveitis is caused by an underlying condition, treatment will focus on that specific condition. The goal of treatment is to reduce the inflammation in your eye. Several treatment options are available. Medications - Drugs that reduce inflammation. Your doctor may first prescribe eyedrops with an anti-inflammatory medication, such as a corticosteroid. If those don't help, a corticosteroid pill or injection may be the next step. - Drugs that fight bacteria or viruses. If uveitis is caused by an infection, your doctor may prescribe antibiotics, antiviral medications or other medicines, with or without corticosteroids, to bring the infection under control. - Drugs that affect the immune system or destroy cells. You may need immunosuppressive or cytotoxic drugs if your uveitis affects both eyes, doesn't respond well to corticosteroids or becomes severe enough to threaten your vision. Some of these medications can have serious side effects, such as glaucoma and cataracts. You may need to visit your doctor for follow-up examinations and blood tests every 1 to 3 months. Surgical and other procedures - Vitrectomy. Surgery to remove some of the vitreous in your eye (vitrectomy) may be necessary to manage the condition. - Surgery that implants a device into the eye to provide a slow and sustained release of a medication. For people with difficult-to-treat posterior uveitis, a device that's implanted in the eye may be an option. This device slowly releases corticosteroid medication into the eye for two to three years. Possible side effects of this treatment include cataracts and glaucoma. The speed of your recovery depends in part on the type of uveitis you have and the severity of your symptoms. Uveitis that affects the back of your eye (choroiditis) tends to heal more slowly than uveitis in the front of the eye (iritis). Severe inflammation takes longer to clear up than mild inflammation does. Uveitis can come back. Make an appointment with your doctor if any of your symptoms reappear after successful treatment. Some alternative medicine treatments have anti-inflammatory properties, but they haven't been well-studied for the treatment of uveitis. Let your doctor know if you plan on using any alternative supplements or treatments, because some may interact with treatments you're receiving or cause adverse reactions.",
+    "https://www.mayoclinic.org/diseases-conditions/uveitis/symptoms-causes/syc-20378734"
+  ],
+  [
+    "What are Autoimmune Diseases?: Your body's immune system protects you from disease and infection. But if you have an autoimmune disease, your immune system attacks healthy cells in your body by mistake. Autoimmune diseases can affect many parts of the body. No one is sure what causes autoimmune diseases. They do tend to run in families. Women - particularly African-American, Hispanic-American, and Native-American women - have a higher risk for some autoimmune diseases. There are more than 80 types of autoimmune diseases, and some have similar symptoms. This makes it hard for your health care provider to know if you really have one of these diseases, and if so, which one. Getting a diagnosis can be frustrating and stressful. Often, the first symptoms are fatigue, muscle aches and a low fever. The classic sign of an autoimmune disease is inflammation, which can cause redness, heat, pain and swelling. The diseases may also have flare-ups, when they get worse, and remissions, when symptoms get better or disappear. Treatment depends on the disease, but in most cases one important goal is to reduce inflammation. Sometimes doctors prescribe corticosteroids or other drugs that reduce your immune response.",
+    "https://www.nlm.nih.gov/medlineplus/autoimmunediseases.html"
+  ],
+  [
+    "Facts About Uveitis (What is\u00a0Uveitis?): Uveitis is a general term describing a group of inflammatory diseases that produces swelling and destroys eye tissues. These diseases can slightly reduce vision or lead to severe vision\u00a0loss. The term \u201cuveitis\u201d is used because the diseases often affect a part of the eye called the uvea. Nevertheless, uveitis is not limited to the uvea. These diseases also affect the lens, retina, optic nerve, and vitreous, producing reduced vision or\u00a0blindness. Uveitis may be caused by problems or diseases occurring in the eye or it can be part of an inflammatory disease affecting other parts of the\u00a0body. It can happen at all ages and primarily affects people between 20 \u00f1 60 years\u00a0old. Uveitis can last for a short (acute) or a long (chronic) time. The severest forms of uveitis reoccur many\u00a0times. Eye care professionals may describe the disease more specifically\u00a0as: - Anterior\u00a0uveitis - Intermediate\u00a0uveitis - Posterior\u00a0uveitis - Panuveitis\u00a0uveitis Eye care professionals may also describe the disease as infectious or noninfectious\u00a0uveitis.",
+    "https://nei.nih.gov/health/uveitis/uveitis"
+  ],
+  [
+    "Facts About Uveitis (What Causes\u00a0Uveitis?): Uveitis is caused by inflammatory responses inside the\u00a0eye. Inflammation is the body\u2019s natural response to tissue damage, germs, or toxins. It produces swelling, redness, heat, and destroys tissues as certain white blood cells rush to the affected part of the body to contain or eliminate the\u00a0insult. Uveitis may be caused\u00a0by: - An attack from the body\u2019s own immune system\u00a0(autoimmunity). - Infections or tumors occurring within the eye or in other parts of the\u00a0body. - Bruises to the\u00a0eye. - Toxins that may penetrate the\u00a0eye. The disease will cause symptoms, such as decreased vision, pain, light sensitivity, and increased floaters. In many cases the cause is\u00a0unknown. Uveitis is usually classified by where it occurs in the\u00a0eye.",
+    "https://nei.nih.gov/health/uveitis/uveitis"
+  ],
+  [
+    "Uveitis: Uveitis is swelling and irritation of the uvea. The uvea is the middle layer of the eye. The uvea provides most of the blood supply to the retina. Uveitis can be caused by autoimmune disorders. These diseases occur when the body's immune system attacks and destroys healthy body tissue by mistake. Examples are: - Ankylosing spondylitis - Psoriasis - Reactive arthritis - Rheumatoid arthritis - Sarcoidosis - Ulcerative colitis Uveitis can also be caused by infections such as: - AIDS - Cytomegalovirus (CMV) retinitis - Herpes zoster infection - Histoplasmosis - Kawasaki disease - Syphilis - Toxoplasmosis - Tuberculosis Exposure to toxins or injury can also cause uveitis. In many cases, the cause is unknown. The most common form of uveitis involves inflammation the front part of the eye. It is often called iritis because it most often only affects the iris. The iris is the colored part of the eye. In most cases, it occurs in healthy people. The disorder may affect only one eye. It is most common in young and middle-aged people. Posterior uveitis affects the back part of the eye. It involves primarily the choroid.\u00a0This is the layer of blood vessels and connective tissue in the middle layer of the eye. This type of uveitis is called choroiditis. If the retina is also involved, it is called chorioretinitis. Another form of uveitis is pars planitis. Changes involve the narrowed area (pars plana) between the colored part of the eye (iris) and the choroid. Pars planitis most often occurs in young men. It is generally not associated with any other disease. However, it may be linked to Crohn disease and possibly multiple sclerosis. Uveitis can affect one or both eyes. Symptoms may develop rapidly and can include: - Blurred vision - Dark, floating spots in the vision - Eye pain - Redness of the eye - Sensitivity to light The health care provider will take a complete medical history and do an eye exam. Lab tests may be done to rule out infection or a weak immune system. If you are over age 25 and have pars planitis, your provider will suggest a brain and spine MRI. This will rule out multiple sclerosis. Iritis (anterior uveitis) is most often mild. Treatment may involve: - Dark glasses - Eye drops that dilate the pupil to relieve pain - Steroid eye drops Pars planitis is often treated with steroid eye drops. Other medicines, including steroids taken by mouth, may be used to help suppress the immune system. Posterior uveitis treatment depends on the underlying cause. It almost always includes steroids taken by mouth. If the uveitis is caused by a body-wide (systemic) infection, you may be given antibiotics. You may also be given powerful anti-inflammatory medicines called corticosteroids. With proper treatment, most attacks of anterior uveitis go away in a few days to weeks. However, the problem often returns. Posterior uveitis may last from months to years. It may cause permanent vision damage, even with treatment. Complications may include: - Cataracts - Fluid within the retina - Glaucoma - Irregular pupil - Retinal detachment - Vision loss Symptoms that need urgent medical care are: - Eye pain - Reduced vision If you have a body-wide (systemic) infection or disease, treating the condition will prevent uveitis. Updated by: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/001005.htm"
+  ],
+  [
+    "Facts About Uveitis (What is\u00a0Pan-Uveitis?): Pan-uveitis is a term used when all three major parts of the eye are affected by inflammation. Behcet\u2019s disease is one of the most well-known forms of pan-uveitis and it greatly damages the\u00a0retina. Intermediate, posterior, and pan-uveitis are the most severe and highly recurrent forms of uveitis. They often cause blindness if left\u00a0untreated.",
+    "https://nei.nih.gov/health/uveitis/uveitis"
+  ],
+  [
+    "Facts About Uveitis (What is Posterior\u00a0Uveitis?): Posterior uveitis is the least common form of uveitis. It primarily occurs in the back of the eye, often involving both the retina and the choroid. It is often called choroditis or chorioretinitis. There are many infectious and non-infectious causes to posterior\u00a0uveitis.",
+    "https://nei.nih.gov/health/uveitis/uveitis"
+  ],
+  [
+    "Facts About Uveitis (What is Anterior\u00a0Uveitis?): Anterior uveitis occurs in the front of the eye. It is the most common form of uveitis, predominantly occurring in young and middle-aged people. Many cases occur in healthy people and may only affect one eye but some are associated with rheumatologic, skin, gastrointestinal, lung and infectious\u00a0diseases.",
+    "https://nei.nih.gov/health/uveitis/uveitis"
+  ],
+  [
+    "Facts About Uveitis (How is uveitis\u00a0detected?): Diagnosis of uveitis includes a thorough examination and the recording of the patient\u2019s complete medical history. Laboratory tests may be done to rule out an infection or an autoimmune\u00a0disorder. A central nervous system evaluation will often be performed on patients with a subgroup of intermediate uveitis, called pars planitis, to determine whether they have multiple sclerosis which is often associated with pars\u00a0planitis. The eye exams used,\u00a0include: An Eye Chart or Visual Acuity Test: This test measures whether a patient\u2019s vision has\u00a0decreased. A Funduscopic Exam: The pupil is widened (dilated) with eye drops and then a light is shown through with an instrument called an ophthalmoscope to noninvasively inspect the back, inside part of the\u00a0eye. Ocular Pressure: An instrument, such a tonometer or a tonopen, measures the pressure inside the eye. Drops that numb the eye may be used for this\u00a0test. A Slit Lamp Exam: A slit lamp noninvasively inspects much of the eye. It can inspect the front and back parts of the eye and some lamps may be equipped with a tonometer to measure eye pressure. A dye called fluorescein, which makes blood vessels easier to see, may be added to the eye during the examination. The dye only temporarily stains the\u00a0eye.",
+    "https://nei.nih.gov/health/uveitis/uveitis"
+  ],
+  [
+    "Facts About Uveitis (Diseases Associated with\u00a0Uveitis): Uveitis can be associated with many diseases\u00a0including: - AIDS - Ankylosing\u00a0spondylitis - Behcet\u2019s\u00a0syndrome - CMV\u00a0retinitis - Herpes zoster\u00a0infection - Histoplasmosis - Kawasaki\u00a0disease - Multiple\u00a0sclerosis - Psoriasis - Reactive\u00a0arthritis - Rheumatoid\u00a0arthritis - Sarcoidosis - Syphilis - Toxoplasmosis - Tuberculosis - Ulcerative\u00a0colitis - Vogt Koyanagi Harada\u2019s\u00a0disease",
+    "https://nei.nih.gov/health/uveitis/uveitis"
+  ],
+  [
+    "HCG in urine: This type of human chorionic gonadotropin (HCG) test measures the specific level of HCG in the urine. HCG is a hormone produced in the body during pregnancy. Other HCG tests include: - HCG in blood serum - qualitative - HCG in blood serum - quantitative - Pregnancy test To collect a urine sample, you urinate into a special (sterile) cup. Home pregnancy tests require the test strip to be dipped into the urine sample or passed through the urine stream while urinating. Carefully follow package directions. In most cases, a urine sample taken the first time you urinate in the morning is best. This is when urine is the most concentrated and has enough HCG to be detected. No special preparation is needed. The test involves urinating into a cup or onto a test strip. Urine HCG tests are a common method of determining if a woman is pregnant. The best time to test for pregnancy at home is after you miss your period. The test result will be reported as negative or positive. - The test is negative if you are not pregnant. - The test is positive if you are pregnant. A pregnancy test, including a properly performed home pregnancy test, is considered to be very accurate. Positive results are more likely to be accurate than negative results. When the test is negative but pregnancy is still suspected, the test should be repeated in 1 week. There are no risks, except for false positive or false negative results. Updated by: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003619.htm"
+  ],
+  [
+    "What is bladder cancer?: Bladder cancer is a disease in which certain cells in the bladder become abnormal and multiply without control or order. The bladder is a hollow, muscular organ in the lower abdomen that stores urine until it is ready to be excreted from the body. The most common type of bladder cancer begins in cells lining the inside of the bladder and is called transitional cell carcinoma (TCC). Bladder cancer may cause blood in the urine, pain during urination, frequent urination, or the feeling that one needs to urinate without results. These signs and symptoms are not specific to bladder cancer, however. They also can be caused by noncancerous conditions such as infections.",
+    "https://ghr.nlm.nih.gov/condition/bladder-cancer"
+  ],
+  [
+    "Urine culture: A urine culture is a lab test to check for bacteria or other germs in a urine sample. It can be used to check for a urinary tract infection in adults and children. Most of the time, the sample will be collected as a clean catch urine sample in your health care provider's office or your home. You will use a special kit to collect the urine. A urine sample can also be taken by inserting a thin rubber tube (catheter) through the urethra into the bladder. This is done by someone in your provider's office or at the hospital. The urine drains into a sterile container, and the catheter is removed. Rarely, your provider may collect a urine sample by inserting a needle through the skin of your lower abdomen into your bladder. The urine is taken to a lab to determine which, if any, bacteria or yeast are present in the urine. This takes 24 to 48 hours. If possible, collect the sample when urine has been in your bladder for 2 to 3 hours. When the catheter is inserted, you may feel pressure. A special gel is used to numb the urethra. Your provider may order this test if you have symptoms of a urinary tract infection or bladder infection, such as pain or burning when urinating. You also may have a urine culture after you have been treated for an infection. This is to make sure that all of the bacteria are gone. \"Normal growth\" is a normal result. This means that there is no infection. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results. A \"positive\" or abnormal test is when bacteria or yeast are found in the culture. This likely means that you have a urinary tract infection or bladder infection. Other tests may help your provider know which bacteria or yeast are causing the infection and which antibiotics will best treat it. Sometimes more than one type of bacteria, or only a small amount, may be found in the culture. There is a very rare risk of a hole (perforation) in the urethra or bladder if your provider uses a catheter. You may have a false-negative urine culture if you have been taking antibiotics. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003751.htm"
+  ],
+  [
+    "Urine - bloody: Blood in your urine is called hematuria. The amount may be very small and only detected with urine tests or under a microscope. In other cases, the blood is visible. It often turns the toilet water red or pink. Or, you may see spots of blood in the water after urinating. There are many possible causes of blood in the urine. Bloody urine may be due to a problem in your kidneys or other parts of the urinary tract, such as: - Cancer of the bladder or kidney - Infection of the bladder, kidney, prostate, or urethra - Inflammation of the bladder, urethra, prostate, or kidney (glomerulonephritis) - Injury to the bladder or kidney - Kidney or bladder stones - Kidney disease after strep throat (post-streptococcal glomerulonephritis), a common cause of blood in the urine in children - Kidney failure - Polycystic kidney disease - Recent urinary tract procedure such as catheterization, circumcision, surgery, or kidney biopsy If there is no structural or anatomical problem with your kidneys, urinary tract, prostate, or genitals, your doctor may check to see if you have a bleeding disorder. Causes may include: - Bleeding disorders (such as hemophilia) - Blood clot in the kidneys - Blood thinning medicines (such as aspirin or warfarin) - Sickle cell disease - Thrombocytopenia (low numbers of platelets) Blood that looks like it is in the urine may actually be coming from other sources, such as: - The vagina (in women) - Ejaculation, often due to a prostate problem (in men) - A bowel movement The urine can also turn a red color from certain drugs, beets, or other foods. You may not see blood in your urine because it is a small amount and is microscopic. Your health care provider may find it while checking your urine during a routine exam. Never ignore blood you see in the urine. Get checked by your provider, especially if you also have: - Discomfort with urination - Frequent urination - Unexplained weight loss - Urgent urination Call your provider right away if: - You have fever, nausea, vomiting, shaking chills, or pain in your abdomen, side, or back - You are unable to urinate - You are passing blood clots in your urine Also call if: - You have pain with sexual intercourse or heavy menstrual bleeding. This may be due to a problem related to your reproductive system. - You have urine dribbling, nighttime urination, or difficulty starting your urine flow. This may be from a prostate problem. Your provider will perform a physical exam and ask questions such as: - When did you first notice blood in your urine? Has the amount of your urine increased or decreased? - What is the color of your urine? Does your urine have an odor? - Do you have any pain with urination or other symptoms of infection? - Are you urinating more often, or is the need to urinate more urgent? - What medicines are you taking? - Have you had urinary or kidney problems in the past, or recently had surgery or an injury? - Have you recently eaten foods that may cause a change in color, like beets, berries, or rhubarb? Tests that may be done include: - Abdominal ultrasound - Antinuclear antibody test for lupus - Blood creatinine level - Complete blood count (CBC) - CT scan of the abdomen - Cystoscopy - Kidney biopsy - Strep test - Tests for sickle cell, bleeding problems, and other blood disorders - Urinalysis - Urinary cytology - Urine culture - 24-hour urine collection for creatinine, protein, calcium - Blood tests such as PT, PTT or INR tests The treatment will depend on the cause of blood in the urine. Updated by: Jennifer Sobol, DO, urologist at the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003138.htm"
+  ],
+  [
+    "Urine chemistry: Urine chemistry is a group of one or more tests done to check the chemical content of a urine sample. For this test, a clean catch (midstream) urine sample is needed. Some tests require that you collect all of your urine for 24 hours. Your health care provider will order certain tests, which will be done on the urine sample in a lab. For detailed information about how to prepare for the test, how the test will feel, risks with the test, and normal and abnormal values, please see the test your health care provider ordered: - 24-hour urinary aldosterone excretion rate - 24-hour urine protein - Acid loading test (pH) - Adrenalin - urine test - Amylase - urine - Bilirubin - urine - Calcium - urine - Citric acid urine test - Cortisol - urine - Creatinine - urine - Cytology exam of urine - Dopamine - urine test - Electrolytes - urine - Epinephrine - urine test - Glucose - urine - HCG (qualitative - urine) - Homovanillic acid (HVA) - Immunoelectrophoresis - urine - Immunofixation - urine - Ketones - urine - Leucine aminopeptidase - urine - Myoglobin - urine - Norepinephrine - urine test - Normetanephrine - Osmolality - urine - Porphyrins - urine - Potassium - urine - Protein electrophoresis - urine - Protein - urine - RBC - urine - Sodium - urine - Urea nitrogen - urine - Uric acid - urine - Urinalysis - Urine Bence-Jones protein - Urinary casts - Urine amino acids - Urine concentration test - Urine culture (catheterized specimen) - Urine culture (clean catch) - Urine dermatan sulfate - Urine - hemoglobin - Urine metanephrine - Urine pH - Urine specific gravity - Vanillylmandelic acid (VMA) Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your\u00a0doctor about the meaning of your specific test results. Updated by: Walead Latif, MD, nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003342.htm"
+  ],
+  [
+    "Urine - abnormal color: The usual color of urine is straw-yellow. Abnormally colored urine may be cloudy, dark, or blood-colored. Abnormal urine color may be caused by infection, disease, medicines, or food you eat. Cloudy or milky urine is a sign of a urinary tract infection, which may also cause a bad smell. Milky urine may also be caused by bacteria, crystals, fat, white or red blood cells, or mucus in the urine. Dark brown but clear urine is a sign of a liver disorder such as acute viral hepatitis or cirrhosis, which causes excess bilirubin in the urine. Pink, red, or lighter brown urine can be caused by: - Beets, blackberries, or certain food colorings - Hemolytic anemia - Injury to the kidneys or urinary tract - Medicine - Porphyria - Urinary tract disorders that cause bleeding - Blood from vaginal bleeding Dark yellow or orange urine can be caused by: - B complex vitamins or carotene - Medicines such as phenazopyridine (used to treat urinary tract infections), rifampin, and warfarin - Recent laxative use Green or blue urine is due to: - Artificial colors in foods or drugs - Bilirubin - Medicines, including methylene blue - Urinary tract infections See your health care provider if you have: - Abnormal urine color that cannot be explained and does not go away - Blood in your urine, even once - Clear, dark-brown urine - Pink, red, or smoky-brown urine that is not due to a food or drug The provider will perform a physical exam. This may include a rectal or pelvic exam. The provider will ask you questions about your symptoms such as: - When did you first notice a change in urine color and how long have you had the problem? - What color is your urine and does the color change during the day? Do you see blood in the urine? - Are there things that make the problem worse? - What types of foods have you been eating and what medicines do you take? - Have you had urinary or kidney problems in the past? - Are you having any other symptoms (such as pain, fever, or increase in thirst)? Tests that may be done include: - Blood tests, including liver function tests - Ultrasound of kidneys and bladder - Urinalysis - Urine culture for infection Updated by: Jennifer Sobol, DO, urologist at the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003139.htm"
+  ],
+  [
+    "Immunoelectrophoresis - urine: Urine immunoelectrophoresis is a lab test that measures immunoglobulins in a urine sample. Immunoglobulins are proteins that function as antibodies, which fight infection. There are various types of these proteins. Some can be abnormal and may be due to cancer. Immunoglobulins can also be measured in the blood. A clean-catch urine sample is needed. The clean-catch method is used to prevent germs from the penis or vagina from getting into a urine sample. To collect your urine, the health care provider may give you a special clean-catch kit that contains a cleansing solution and sterile wipes. Follow instructions exactly. After you provide a urine sample, it is sent to the laboratory. There, the laboratory specialist will place the urine sample on special paper and apply an electric current. The various proteins move and form visible bands, which reveal the general amounts of each protein. Your provider may ask you to collect the first morning urine, which is the most concentrated. If you are taking the collection from an infant, you may need extra collection bags. The test involves only normal urination, and there is no discomfort. This test is used to measure the amounts of various immunoglobulins in urine. Most often, it is done after a large amount of protein is found in the urine. Normally there is no protein, or only a small amount of protein in the urine. When there is protein in the urine, it normally consists of mainly albumin. Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results. Immunoglobulin in the urine can result from: - An abnormal buildup of proteins in tissues and organs (amyloidosis) - Leukemia - Blood cancer called multiple myeloma - Kidney disorders such as IgA nephropathy or IgM nephropathy - White blood cell cancer called Waldenstr\u00f6m macroglobulinemia Some people have monoclonal immunoglobulins, but do not have cancer. This is called monoclonal gammopathy of unknown significance, or MGUS. Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists and Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003592.htm"
+  ],
+  [
+    "Urine odor: Urine odor refers to the smell from your urine. Urine odor varies. Most of the time, urine does not have a strong smell if you are healthy and drink plenty of fluids. Most changes in urine odor are not a sign of disease and go away in time. Some foods and medicines, including vitamins, may affect your urine's odor. For example, eating asparagus causes a distinct urine odor. Foul-smelling urine may be due to bacteria. Sweet-smelling urine may be a sign of uncontrolled diabetes or a rare disease of metabolism. Liver disease and certain metabolic disorders may cause musty-smelling urine. Some conditions that can cause changes in urine odor include: - Bladder fistula - Bladder infection - Body is low on fluids (concentrated urine can smell like ammonia) - Poorly controlled diabetes (sweet smelling urine) - Liver failure - Ketonuria Call your health care provider if you have signs of a urinary tract infection with abnormal urine odor. These include: - Fever - Chills - Burning pain with urination - Back pain You may have the following tests: - Urinalysis - Urine culture Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007298.htm"
+  ],
+  [
+    "Amlodipine (How should this medicine be used?): Amlodipine comes as a tablet to take by mouth. It is usually taken once a day. To help you remember to take amlodipine, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amlodipine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor will probably start you on a low dose of amlodipine and gradually increase your dose. Amlodipine controls high blood pressure and chest pain (angina) but does not cure them. Continue to take amlodipine even if you feel well. Do not stop taking amlodipine without talking to your doctor.",
+    "https://medlineplus.gov/druginfo/meds/a692044.html"
+  ],
+  [
+    "Amlodipine: Amlodipine is used alone or in combination with other medications to treat high blood pressure and chest pain (angina). Amlodipine is in a class of medications called calcium channel blockers. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. It controls chest pain by increasing the supply of blood to the heart. If taken regularly, amlodipine controls chest pain, but it does not stop chest pain once it starts. Your doctor may prescribe a different medication to take when you have chest pain. High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation. Amlodipine comes as a tablet to take by mouth. It is usually taken once a day. To help you remember to take amlodipine, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amlodipine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor will probably start you on a low dose of amlodipine and gradually increase your dose. Amlodipine controls high blood pressure and chest pain (angina) but does not cure them. Continue to take amlodipine even if you feel well. Do not stop taking amlodipine without talking to your doctor. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before taking amlodipine, - tell your doctor and pharmacist if you are allergic to amlodipine, any other medications, or any ingredients in amlodipine tablets. Ask your pharmacist for a list of the ingredients. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: certain medications for seizures such as carbamazepine (Carbatrol, Equetro, Tegretol), phenytoin (Dilantin, Phenytek), and phenobarbital; clarithromycin (Biaxin, in Prevpac); cyclosporine (Neoral, Sandimmune); efavirenz (Sustiva); indinavir (Crixivan); itraconazole (Onmel, Sporanox); ketoconazole (Nizoral); lovastatin (Altoprev, in Advicor); nefazodone;nelfinavir (Viracept); nevirapine (Viramune); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane, in Rifamate), ritonavir (Norvir, in Kaletra), simvastatin (Zocor, in Simcor, in Vytorin), and tacrolimus (Astragraf SL, Prograf). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor if you have or have ever had heart failure or heart or liver disease. - tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking amlodipine, call your doctor. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully. Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Amlodipine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - swelling of the hands, feet, ankles, or lower legs - headache - upset stomach - stomach pain - dizziness or lightheadedness - drowsiness - excessive tiredness - flushing Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment: - more frequent or more severe chest pain - rapid, pounding, or irregular heartbeat - fainting If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of overdose may include: - dizziness - fainting - rapid heartbeat Keep all appointments with your doctor. Your blood pressure should be checked regularly to determine your response to amlodipine. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Amvaz\u00ae\u00b6 - Norvasc\u00ae - Amturnide\u00ae (containing Aliskiren, Amlodipine, Hydrochlorothiazide) - Azor\u00ae (containing Amlodipine, Olmesartan) - Caduet\u00ae (containing Amlodipine, Atorvastatin) - Exforge\u00ae (containing Amlodipine, Valsartan) - Exforge\u00ae HCT (containing Amlodipine, Hydrochlorothiazide, Valsartan) - Prestalia\u00ae (containing Amlodipine, Perindopril) - Tekamlo\u00ae (containing Aliskiren, Amlodipine) - Tribenzor\u00ae (containing Amlodipine, Hydrochlorothiazide, Olmesartan) - Twynsta\u00ae (containing Amlodipine, Telmisartan)",
+    "https://medlineplus.gov/druginfo/meds/a692044.html"
+  ],
+  [
+    "Amlodipine (What special precautions should I follow?): Before taking amlodipine, - tell your doctor and pharmacist if you are allergic to amlodipine, any other medications, or any ingredients in amlodipine tablets. Ask your pharmacist for a list of the ingredients. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: certain medications for seizures such as carbamazepine (Carbatrol, Equetro, Tegretol), phenytoin (Dilantin, Phenytek), and phenobarbital; clarithromycin (Biaxin, in Prevpac); cyclosporine (Neoral, Sandimmune); efavirenz (Sustiva); indinavir (Crixivan); itraconazole (Onmel, Sporanox); ketoconazole (Nizoral); lovastatin (Altoprev, in Advicor); nefazodone;nelfinavir (Viracept); nevirapine (Viramune); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane, in Rifamate), ritonavir (Norvir, in Kaletra), simvastatin (Zocor, in Simcor, in Vytorin), and tacrolimus (Astragraf SL, Prograf). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor if you have or have ever had heart failure or heart or liver disease. - tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking amlodipine, call your doctor.",
+    "https://medlineplus.gov/druginfo/meds/a692044.html"
+  ],
+  [
+    "Amlodipine (Brand names of combination products): - Amturnide\u00ae (containing Aliskiren, Amlodipine, Hydrochlorothiazide) - Azor\u00ae (containing Amlodipine, Olmesartan) - Caduet\u00ae (containing Amlodipine, Atorvastatin) - Exforge\u00ae (containing Amlodipine, Valsartan) - Exforge\u00ae HCT (containing Amlodipine, Hydrochlorothiazide, Valsartan) - Prestalia\u00ae (containing Amlodipine, Perindopril) - Tekamlo\u00ae (containing Aliskiren, Amlodipine) - Tribenzor\u00ae (containing Amlodipine, Hydrochlorothiazide, Olmesartan) - Twynsta\u00ae (containing Amlodipine, Telmisartan)",
+    "https://medlineplus.gov/druginfo/meds/a692044.html"
+  ],
+  [
+    "Amlodipine and Benazepril: Do not take amlodipine and benazepril if you are pregnant. If you become pregnant while taking amlodipine and benazepril, call your doctor immediately. Amlodipine and benazepril may harm the fetus. The combination of amlodipine and benazepril is used to treat high blood pressure. Amlodipine is in a class of medications called calcium channel blockers. It works by relaxing the blood vessels so the heart does not have to pump as hard. Benazepril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly. High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation. The combination of amlodipine and benazepril comes as a capsule to take by mouth. It is usually taken once a day. To help you remember to take amlodipine and benazepril, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amlodipine and benazepril exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Amlodipine and benazepril controls high blood pressure but does not cure it. Continue to take amlodipine and benazepril even if you feel well. Do not stop taking amlodipine and benazepril without talking to your doctor. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before taking amlodipine and benazepril, - tell your doctor and pharmacist if you are allergic to amlodipine (Norvasc, in Caduet, others), benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec, in Vaseretic), fosinopril, lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), trandolapril (Mavik), any other medications, or or any of the ingredients in amlodipine and benazepril capsules. Ask your pharmacist for a list of the ingredients. - tell your doctor or pharmacist if you are taking valsartan and sacubitril (Entresto) or if you have stopped taking it within the last 36 hours. Your doctor will probably tell you not to take amlodipine and benazepril, if you are also taking valsartan and sacubitril. Also, tell your doctor if you have diabetes and you are taking aliskiren (Tekturna, in Amturnide, Tekamlo, Tekturna HCT). Your doctor will probably tell you not to take amlodipine and benazepril if you have diabetes and you are also taking aliskiren. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: diuretics ('water pills'), lithium (Lithobid), and potassium supplements. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor if you have recently had severe diarrhea or vomiting and if you have or have ever had diabetes; heart failure; lupus; scleroderma (a condition in which extra tissue grows on the skin and some organs); or heart, liver, or kidney disease. - tell your doctor if you are breast-feeding. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking amlodipine and benazepril. Talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully. Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Amlodipine and benazepril may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - cough - headache - dizziness - swelling of the hands, feet, ankles, or lower legs Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment: - swelling of the face, throat, tongue, lips, or eyes - hoarseness - difficulty swallowing or breathing - fainting - severe skin rash - yellowing of the skin or eyes - more frequent or more severe chest pain Amlodipine and benazepril may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly to determine your response to amlodipine and benazepril. Your doctor may order certain lab tests to check your body's response to amlodipine and benazepril. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Amlobenz\u00ae (containing Amlodipine, Benazepril)\u00b6 - Lotrel\u00ae (containing Amlodipine, Benazepril)",
+    "https://medlineplus.gov/druginfo/meds/a601018.html"
+  ],
+  [
+    "Amlodipine and Benazepril (What other information should I know?): Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly to determine your response to amlodipine and benazepril. Your doctor may order certain lab tests to check your body's response to amlodipine and benazepril. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.",
+    "https://medlineplus.gov/druginfo/meds/a601018.html"
+  ],
+  [
+    "Shingles (Should You Get the Shingles Vaccine?): The shingles vaccine is a safe and easy, one-time shot that may keep you from getting shingles. Most people age 60 and older should get vaccinated. You should get the shot even if you have already had shingles or don't remember having chickenpox. However, if you have a weak immune system or allergies to certain medicines, make sure to check with your doctor first.You can get the shingles vaccine at your doctor's office and at some pharmacies. All Medicare Part D plans and most private health insurance plans will cover the cost.",
+    "https://www.nia.nih.gov/health/topics/shingles"
+  ],
+  [
+    "What are the treatments for Shingles?: The severity and duration of an attack of shingles can be significantly reduced by immediate treatment with antiviral drugs, which include acyclovir, valcyclovir, or famcyclovir. Antiviral drugs may also help stave off the painful after-effects of shingles known as postherpetic neuralgia. Other treatments for postherpetic neuralgia include steroids, antidepressants, anticonvulsants (including pregabalin and gabapentin enacarbil), and topical agents. The varicella zoster virus vaccine (Zostavax) has been approved by teh food and Drug Administration for adults age 50 and older. Researchers found that giving older adults the vaccine reduced the expected number of later cases of shingles by half. And in people who still got the disease despite immunization, the severity and complications of shingles were dramatically reduced. The shingles vaccine is a preventive therapy and not a treatment for those who already have shingles or long-lasting nerve pain (postherpetic neuralgia).",
+    "http://www.ninds.nih.gov/disorders/shingles/shingles.htm"
+  ],
+  [
+    "Shingles: Shingles is a disease that affects your nerves. It can cause burning, shooting pain, tingling, and/or itching, as well as a rash and blisters.You may recall having chickenpox as a child. Shingles is caused by the same virus, the varicella-zoster virus (VZV). After you recover from chickenpox, the virus continues to live in some of your nerve cells. It is usually inactive, so you don't even know it's there.In fact, most adults live with VZV in their bodies and never get shingles. But, for about one in three adults, the virus will become active again. Instead of causing another case of chickenpox, it produces shingles. We do not totally understand what makes the virus go from inactive to active.Having shingles doesn't mean you have any other underlying disease. Everyone who has had chickenpox has VZV in their body and is at risk for getting shingles. Right now, there is no way of knowing who will get the disease. But, some things make it more likely:- Advanced age. The risk of getting shingles increases as you age. People may have a harder time fighting off infections as they get older. About half of all shingles cases are in adults age 60 or older. The chance of getting shingles becomes much greater by age 70. - Trouble fighting infections. Your immune system is the part of your body that responds to infections. Age can affect your immune system. So can an HIV infection, cancer, cancer treatments, too much sun, or organ transplant drugs. Even stress or a cold can weaken your immune system for a short time. These all can put you at risk for shingles. Shingles is not contagious. You can't catch it from someone. But, you can catch chickenpox from someone with shingles. So, if you've never had chickenpox, try to stay away from anyone who has shingles.If you have shingles, try to stay away from anyone who has not had chickenpox or who might have a weak immune system. Usually, shingles develops only on one side of the body or face and in a small area rather than all over. The most common place for shingles is a band that goes around one side of your waistline.Most people have some of the following shingles symptoms:- Burning, tingling, or numbness of the skin - Feeling sick-chills, fever, upset stomach, or headache - Fluid-filled blisters - Skin that is sensitive to touch - Mild itching to strong painDepending on where shingles develops, it could also cause symptoms like hiccups or even loss of vision.For some people, the symptoms of shingles are mild. They might just have some itching. For others, shingles can cause intense pain that can be felt from the gentlest touch or breeze. Most cases of shingles last 3 to 5 weeks. Shingles follows a pattern:- The first sign is often burning or tingling pain; sometimes, it includes numbness or itching on one side of the body. - Somewhere between 1 and 5 days after the tingling or burning feeling on the skin, a red rash will appear. - A few days later, the rash will turn into fluid-filled blisters. - About a week to 10 days after that, the blisters dry up and crust over. - A couple of weeks later, the scabs clear up.Most people get shingles only one time. But, it is possible to have it more than once. After the shingles rash goes away, some people may be left with ongoing pain called post-herpetic neuralgia or PHN. The pain is felt in the area where the rash had been. For some people, PHN is the longest lasting and worst part of shingles. The older you are when you get shingles, the greater your chance of developing PHN.The PHN pain can cause depression, anxiety, sleeplessness, and weight loss. Some people with PHN find it hard to go about their daily activities, like dressing, cooking, and eating. Talk with your doctor if you have any of these problems.There are medicines that may help with PHN. Steroids may lessen the pain and shorten the time you're sick. Analgesics, antidepressants, and anticonvulsants may also reduce the pain. Usually, PHN will get better over time.Some people have other problems that last after shingles has cleared up. For example, the blisters caused by shingles can become infected. They may also leave a scar. It is important to keep the area clean and try not to scratch the blisters. Your doctor can prescribe an antibiotic treatment if needed.See your doctor right away if you notice blisters on your face-this is an urgent problem. Blisters near or in the eye can cause lasting eye damage or blindness. Hearing loss, a brief paralysis of the face, or, very rarely, swelling of the brain (encephalitis) can also occur. If you think you might have shingles, talk to your doctor as soon as possible. It's important to see your doctor no later than 3 days after the rash starts. The doctor will confirm whether or not you have shingles and can make a treatment plan. Although there is no cure for shingles, early treatment with drugs that fight the virus can help the blisters dry up faster and limit severe pain. Shingles can often be treated at home. People with shingles rarely need to stay in a hospital. The shingles vaccine is a safe and easy, one-time shot that may keep you from getting shingles. Most people age 60 and older should get vaccinated. You should get the shot even if you have already had shingles or don't remember having chickenpox. However, if you have a weak immune system or allergies to certain medicines, make sure to check with your doctor first.You can get the shingles vaccine at your doctor's office and at some pharmacies. All Medicare Part D plans and most private health insurance plans will cover the cost. If you have shingles, here are some tips that might help you feel better:- Get plenty of rest and eat well-balanced meals. - Try simple exercises like stretching or walking. Check with your doctor before starting a new exercise routine. - Apply a cool washcloth to your blisters to ease the pain and help dry the blisters. - Do things that take your mind off your pain. For example, watch TV, read, talk with friends, listen to relaxing music, or work on a hobby you like. - Avoid stress. It can make the pain worse. - Wear loose-fitting, natural-fiber clothing. - Take an oatmeal bath or use calamine lotion to see if it soothes your skin. - Share your feelings about your pain with family and friends. Ask for their understanding.Also, you can limit spreading the virus by:- Keeping the rash covered - Not touching or scratching the rash - Washing your hands oftenRead about this topic in Spanish. Lea sobre este tema en espanol.",
+    "https://www.nia.nih.gov/health/topics/shingles"
+  ],
+  [
+    "What are the treatments for Shingles?: If You Suspect Shingles If you suspect you have shingles, see your healthcare provider within 72 hours of the first sign of the rash.Treatment with antiviral medications can reduce the severity of the nerve damage and speed healing. But to be effective, they must be started as soon as possible after the rash appears. (Watch the video to learn more about shingles treatments. To enlarge the video, click the brackets in the lower right-hand corner. To reduce the video, press the Escape (Esc) button on your keyboard.) Antivirals and Other Treatments At the early stage of shingles, a healthcare provider will usually prescribe antiviral pills. These antiviral medicines include acyclovir, valacyclovir, or famcyclovir, Your healthcare provider, may also prescribe drugs to relieve pain. Wet compresses, calamine lotion, and colloidal oatmeal baths may help relieve some of the itching. Patients with long-term pain may also be treated with numbing patches, tricyclic antidepressants, and gabapentin, an anti-seizure medication. While these treatments can reduce the symptoms of shingles, they are not a cure. The antivirals do weaken the virus and its effects, but the outbreak still tends to run its course. Good hygiene, including daily bathing, can help prevent bacterial infections. It is a good idea to keep fingernails clean and well-trimmed to reduce scratching. Shingles Vaccine The shingles vaccine is NOT recommended if you have active shingles or pain that continues after the rash is gone. To learn more about the shingles vaccine, see the chapter on \"Prevention.\"",
+    "http://nihseniorhealth.gov/shingles/toc.html"
+  ],
+  [
+    "Shingles (Risk factors): Anyone who has ever had chickenpox can develop shingles. Most adults in the United States had chickenpox when they were children, before the advent of the routine childhood vaccination that now protects against chickenpox. Factors that may increase your risk of developing shingles include: - Being older than 50. Shingles is most common in people older than 50. The risk increases with age. Some experts estimate that half the people age 80 and older will have shingles. - Having certain diseases. Diseases that weaken your immune system, such as HIV/AIDS and cancer, can increase your risk of shingles. - Undergoing cancer treatments. Radiation or chemotherapy can lower your resistance to diseases and may trigger shingles. - Taking certain medications. Drugs designed to prevent rejection of transplanted organs can increase your risk of shingles - as can prolonged use of steroids, such as prednisone.",
+    "https://www.mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054"
+  ],
+  [
+    "Shingles (Causes): After you get chickenpox, the virus remains inactive (becomes dormant) in certain nerves in the body. Shingles occurs after the virus becomes active again in these nerves after many years. Many people had such a mild case of chickenpox that they\u00a0do not\u00a0realize they have had the infection. The reason the virus suddenly becomes active again is not clear. Often only one attack occurs. Shingles can develop in any age group. You are more likely to develop the condition if: - You are older than age 60 - You had chickenpox before age 1 - Your immune system is weakened by medicines or disease If an adult or child has direct contact with the shingles rash and did not have chickenpox as a child or get\u00a0the chickenpox vaccine, they can develop chickenpox, not shingles.",
+    "https://medlineplus.gov/ency/article/000858.htm"
+  ],
+  [
+    "What are the treatments for Shingles?: Your health care provider may prescribe a medicine that fights the virus, called an antiviral drug. This drug helps reduce pain, prevent complications, and shorten the course of the disease. The medicines should be started within72 hours of when you first feel pain or burning. It is best to start taking them before the blisters appear. The medicines are usually given in pill form. Some people may need to receive the medicine through a vein (by IV). Strong anti-inflammatory medicines called corticosteroids, such as prednisone, may be used to reduce swelling and pain. These medicines do not work in all patients. Other medicines may include: - Antihistamines to reduce itching (taken by mouth or applied to the skin) - Pain medicines - Zostrix, a cream containing capsaicin (an extract of pepper) to reduce pain Follow your health care provider's instructions about how to care for yourself at home. Other measures may include: - Caring for your skin by applying cool, wet compresses to reduce pain, and taking soothing baths - Resting in bed until the fever goes down Stay away from people while your sores are oozing to avoid infecting those who have never had chickenpox -- especially pregnant women.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000858.htm"
+  ],
+  [
+    "Shingles: Shingles is a viral infection that causes a painful rash. Although shingles can occur anywhere on your body, it most often appears as a single stripe of blisters that wraps around either the left or the right side of your torso. Shingles is caused by the varicella-zoster virus - the same virus that causes chickenpox. After you've had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles. While it isn't a life-threatening condition, shingles can be very painful. Vaccines can help reduce the risk of shingles, while early treatment can help shorten a shingles infection and lessen the chance of complications. The signs and symptoms of shingles usually affect only a small section of one side of your body. These signs and symptoms may include: - Pain, burning, numbness or tingling - Sensitivity to touch - A red rash that begins a few days after the pain - Fluid-filled blisters that break open and crust over - Itching Some people also experience: - Fever - Headache - Sensitivity to light - Fatigue Pain is usually the first symptom of shingles. For some, it can be intense. Depending on the location of the pain, it can sometimes be mistaken for a symptom of problems affecting the heart, lungs or kidneys. Some people experience shingles pain without ever developing the rash. Most commonly, the shingles rash develops as a stripe of blisters that wraps around either the left or right side of your torso. Sometimes the shingles rash occurs around one eye or on one side of the neck or face. Contact your doctor promptly if you suspect shingles, but especially in the following situations: - The pain and rash occur near an eye. If left untreated, this infection can lead to permanent eye damage. - You're 60 or older, because age significantly increases your risk of complications. - You or someone in your family has a weakened immune system (due to cancer, medications or chronic illness). - The rash is widespread and painful. Shingles is caused by the varicella-zoster virus - the same virus that causes chickenpox. Anyone who's had chickenpox may develop shingles. After you recover from chickenpox, the virus can enter your nervous system and lie dormant for years. Eventually, it may reactivate and travel along nerve pathways to your skin - producing shingles. But, not everyone who's had chickenpox will develop shingles. The reason for shingles is unclear. But it may be due to lowered immunity to infections as you grow older. Shingles is more common in older adults and in people who have weakened immune systems. Varicella-zoster is part of a group of viruses called herpes viruses, which includes the viruses that cause cold sores and genital herpes. Because of this, shingles is also known as herpes zoster. But the virus that causes chickenpox and shingles is not the same virus responsible for cold sores or genital herpes, a sexually transmitted infection. A person with shingles can pass the varicella-zoster virus to anyone who isn't immune to chickenpox. This usually occurs through direct contact with the open sores of the shingles rash. Once infected, the person will develop chickenpox, however, not shingles. Chickenpox can be dangerous for some people. Until your shingles blisters scab over, you are contagious and should avoid physical contact with anyone who hasn't yet had chickenpox or the chickenpox vaccine, especially people with weakened immune systems, pregnant women and newborns. Anyone who has ever had chickenpox can develop shingles. Most adults in the United States had chickenpox when they were children, before the advent of the routine childhood vaccination that now protects against chickenpox. Factors that may increase your risk of developing shingles include: - Being older than 50. Shingles is most common in people older than 50. The risk increases with age. Some experts estimate that half the people age 80 and older will have shingles. - Having certain diseases. Diseases that weaken your immune system, such as HIV/AIDS and cancer, can increase your risk of shingles. - Undergoing cancer treatments. Radiation or chemotherapy can lower your resistance to diseases and may trigger shingles. - Taking certain medications. Drugs designed to prevent rejection of transplanted organs can increase your risk of shingles - as can prolonged use of steroids, such as prednisone. Complications from shingles can include: - Postherpetic neuralgia. For some people, shingles pain continues long after the blisters have cleared. This condition is known as postherpetic neuralgia, and it occurs when damaged nerve fibers send confused and exaggerated messages of pain from your skin to your brain. - Vision loss. Shingles in or around an eye (ophthalmic shingles) can cause painful eye infections that may result in vision loss. - Neurological problems. Depending on which nerves are affected, shingles can cause an inflammation of the brain (encephalitis), facial paralysis, or hearing or balance problems. - Skin infections. If shingles blisters aren't properly treated, bacterial skin infections may develop. Shingles is usually diagnosed based on the history of pain on one side of your body, along with the telltale rash and blisters. Your doctor may also take a tissue scraping or culture of the blisters for examination in the laboratory. There's no cure for shingles, but prompt treatment with prescription antiviral drugs can speed healing and reduce your risk of complications. These medications include: - Acyclovir (Zovirax) - Valacyclovir (Valtrex) Shingles can cause severe pain, so your doctor also may prescribe: - Capsaicin topical patch (Qutenza) - Anticonvulsants, such as gabapentin (Neurontin) - Tricyclic antidepressants, such as amitriptyline - Numbing agents, such as lidocaine, delivered via a cream, gel, spray or skin patch - Medications that contain narcotics, such as codeine - An injection including corticosteroids and local anesthetics Shingles generally lasts between two and six weeks. Most people get shingles only once, but it is possible to get it two or more times. Taking a cool bath or using cool, wet compresses on your blisters may help relieve the itching and pain. And, if possible, try to reduce the amount of stress in your life.",
+    "https://www.mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054"
+  ],
+  [
+    "Shingles (Prevention): Do not touch the rash and blisters on people with shingles or chickenpox if you have never had chickenpox or the chickenpox vaccine. A shingles vaccine is available. It is different than the chickenpox vaccine. Older adults who receive the herpes zoster vaccine are less likely to have complications from shingles.",
+    "https://medlineplus.gov/ency/article/000858.htm"
+  ],
+  [
+    "Shingles (Possible Complications): Complications may include: - Another attack of shingles - Bacterial skin infections - Blindness (if shingles occurs in the eye) - Deafness - Infection, including encephalitis of sepsis (blood infection) in people with a weakened immune system - Ramsay Hunt syndrome if shingles affects the nerves of the face or ear",
+    "https://medlineplus.gov/ency/article/000858.htm"
+  ],
+  [
+    "Child safety seats: Child safety seats are proven to save children's lives in accidents. In the United States, all states require children to be secured in a car seat or booster seat until they reach certain height or weight requirements. These vary by state. Most children grow big enough to move to a regular seat belt between 8 and 12 years old. To keep your child safe, keep these tips in mind when using a car safety seat. - When your child is born, you must have a car seat to bring the baby home from the hospital. - Always secure your child in a car seat whenever riding in a vehicle. Make sure the harness is fastened snugly. - Read the car seat manufacturer's instructions for the proper way to use the seat. Read your vehicle owner's manual, too. - Car seats and booster seats should always be used on the back seat of a vehicle. If there is no back seat, the car seat can be secured on the front passenger seat. This can ONLY be done when there is no front or side air bag, or the air bag has been switched off. - Even after children are big enough to wear a seat belt, riding in the back seat is safest. When you are selecting a child safety seat for the first time: - The seat must fit your child's size and be able to be properly installed in your vehicle. - It is best to use a new car seat. Used car seats often do not have instructions. They may have cracks or other problems that make the seat unsafe. For example, the seat may have been damaged during a car accident. - Try the seat before buying it. Install the seat in your vehicle. Put your child in the car seat. Secure the harness and buckle. Check that the seat fits your vehicle and child. - DO NOT use a car seat past its expiration date. The seat frame may no longer be strong enough to support your child safely. The expiration date is usually on the bottom of the seat. - DO NOT use a seat that has been recalled. Fill out and send in the registration card that comes with the new car seat. The manufacturer can contact you if the seat is recalled. You can find out about recalls by contacting the manufacturer, or by looking up safety complaints records on your child's safety seat at www.safercar.gov/parents/CarSeats/Car-Seat-Safety.htm. The types of child safety seats and restraints include: - Rear-facing seats - Forward-facing seats - Booster seats - Car beds - Built-in car seats - Travel vests REAR-FACING SEATS A rear-facing seat is one in which your child faces the back of the vehicle. The seat should be installed in the back seat of your vehicle. The two types of rear-facing seats are the infant-only seat and the convertible seat. Infant-only rear-facing seats. These seats are for babies who weigh up to 22 to 30 pounds (10 to 13.5 kilograms), depending on the car seat. You will need a new seat when your child gets bigger. Many children grow out of these seats by age 8 to 9 months. Infant-only seats have handles so you can carry the seat to and from the car. Some have a base you can leave installed in the car. This lets you click the car seat into place each time you use it. Follow manufacturer's instructions on how the seat should be reclined so your baby's head does not shift around while you are driving. Convertible seats. These seats are to be placed in the rear-facing position and are for infants and toddlers. When your child is older and bigger, the seat can be switched to the forward-facing position. Experts recommend keeping your child rear-facing until at least age 3 and until your child outgrows the weight or height allowed by the seat. FORWARD-FACING SEATS A forward-facing seat should be installed on the back seat of your vehicle, although it allows your child to face the front of the car. These seats are used only after your child is too big for a rear-facing seat. A combination forward-facing booster seat may also be used. For younger children, the booster seat's harness straps should be used. After your child reaches the upper height and weight limit for the harness (based on the seat's instructions), the vehicle's own lap and shoulder belts can be used to keep your child strapped in. BOOSTER SEATS A booster seat raises your child up so the vehicle's own lap and shoulder belts fit correctly. The lap belt should fall across your child's upper thighs. The shoulder belt should go across the middle of your child's shoulder and chest. Use booster seats for older children until they are big enough to fit into a seat belt properly. The lap belt should fit low and tight across the upper thighs, and the shoulder belt should fit snug across the shoulder and chest and not cross the neck or face. A child's legs must be long enough so the feet can be flat on the floor. Most children can wear a seatbelt sometime between ages 8 and 12 years. CAR BEDS These seats are also called flat car seats. They are used for premature or other special-needs babies. The American Academy of Pediatrics recommends having a health care provider look at how your preterm baby fits and breathes in a car seat before leaving the hospital. BUILT-IN SEATS Some vehicles have built-in car seats. Weight and height limits vary. You can get more details on these seats by reading the vehicle owner's manual or calling the vehicle manufacturer. TRAVEL VESTS Special vests can be worn by older children who have outgrown forward-facing safety seats. The vests can be used instead of booster seats. The vests are used with the vehicle's lap and seat belts. As with car seats, children should be sitting in the back seat when using the vest. Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000670.htm"
+  ],
+  [
+    "Who is at risk for Lyme disease blood test??: Veins and arteries vary in size, so it may be harder to take a blood sample from one person than another. Other slight risks from having blood drawn may include: - Excessive bleeding - Fainting or feeling lightheaded - Hematoma (blood accumulating under the skin) - Infection (a slight risk any time the skin is broken)",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/003554.htm"
+  ],
+  [
+    "Child safety seats (Review Date 2/16/2017): Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000670.htm"
+  ],
+  [
+    "Blood Transfusion: A blood transfusion is a safe, common procedure in which blood is given to you through an intravenous (IV) line in one of your blood vessels. Blood transfusions are done to replace blood lost during surgery or due to a serious injury. A transfusion also may be done if your body can't make blood properly because of an illness. During a blood transfusion, a small needle is used to insert an IV line into one of your blood vessels. Through this line, you receive healthy blood. The procedure usually takes 1 to 4 hours, depending on how much blood you need. Blood transfusions are very common. Each year, almost 5 million Americans need a blood transfusion. Most blood transfusions go well. Mild complications can occur. Very rarely, serious problems develop. Important Information About Blood The heart pumps blood through a network of arteries and veins throughout the body. Blood has many vital jobs. It carries oxygen and other nutrients to your body's organs and tissues. Having a healthy supply of blood is important to your overall health. Blood is made up of various parts, including red blood cells, white blood cells, platelets (PLATE-lets), and plasma. Blood is transfused either as whole blood (with all its parts) or, more often, as individual parts. Blood Types Every person has one of the following blood types: A, B, AB, or O. Also, every person's blood is either Rh-positive or Rh-negative. So, if you have type A blood, it's either A positive or A negative. The blood used in a transfusion must work with your blood type. If it doesn't, antibodies (proteins) in your blood attack the new blood and make you sick. Type O blood is safe for almost everyone. About 40 percent of the population has type O blood. People who have this blood type are called universal donors. Type O blood is used for emergencies when there's no time to test a person's blood type. People who have type AB blood are called universal recipients. This means they can get any type of blood. If you have Rh-positive blood, you can get Rh-positive or Rh-negative blood. But if you have Rh-negative blood, you should only get Rh-negative blood. Rh-negative blood is used for emergencies when there's no time to test a person's Rh type. Blood Banks Blood banks collect, test, and store blood. They carefully screen all donated blood for possible infectious agents, such as viruses, that could make you sick. (For more information, see \"What Are the Risks of a Blood Transfusion?\") Blood bank staff also screen each blood donation to find out whether it's type A, B, AB, or O and whether it's Rh-positive or Rh-negative. Getting a blood type that doesn't work with your own blood type will make you very sick. That's why blood banks are very careful when they test the blood. To prepare blood for a transfusion, some blood banks remove white blood cells. This process is called white cell or leukocyte (LU-ko-site) reduction. Although rare, some people are allergic to white blood cells in donated blood. Removing these cells makes allergic reactions less likely. Not all transfusions use blood donated from a stranger. If you're going to have surgery, you may need a blood transfusion because of blood loss during the operation. If it's surgery that you're able to schedule months in advance, your doctor may ask whether you would like to use your own blood, rather than donated blood. If you choose to use your own blood, you will need to have blood drawn one or more times prior to the surgery. A blood bank will store your blood for your use. Alternatives to Blood Transfusions Researchers are trying to find ways to make blood. There's currently no man-made alternative to human blood. However, researchers have developed medicines that may help do the job of some blood parts. For example, some people who have kidney problems can now take a medicine called erythropoietin that helps their bodies make more red blood cells. This means they may need fewer blood transfusions. Surgeons try to reduce the amount of blood lost during surgery so that fewer patients need blood transfusions. Sometimes they can collect and reuse the blood for the patient. Blood is transfused either as whole blood (with all its parts) or, more often, as individual parts. The type of blood transfusion you need depends on your situation. For example, if you have an illness that stops your body from properly making a part of your blood, you may need only that part to treat the illness. Red Blood Cell Transfusions Red blood cells are the most commonly transfused part of the blood. These cells carry oxygen from the lungs to your body's organs and tissues. They also help your body get rid of carbon dioxide and other waste products. You may need a transfusion of red blood cells if you've lost blood due to an injury or surgery. You also may need this type of transfusion if you have severe anemia (uh-NEE-me-uh) due to disease or blood loss. Anemia is a condition in which your blood has a lower than normal number of red blood cells. Anemia also can occur if your red blood cells don't have enough hemoglobin (HEE-muh-glow-bin). Hemoglobin is an iron-rich protein that gives blood its red color. This protein carries oxygen from the lungs to the rest of the body. Platelets and Clotting Factor Transfusions Platelets and clotting factors help stop bleeding, including internal bleeding that you can't see. Some illnesses may cause your body to not make enough platelets or clotting factors. You may need regular transfusions of these parts of your blood to stay healthy. For example, if you have hemophilia (heem-o-FILL-ee-ah), you may need a special clotting factor to replace the clotting factor you're lacking. Hemophilia is a rare, inherited bleeding disorder in which your blood doesn't clot normally. If you have hemophilia, you may bleed for a longer time than others after an injury or accident. You also may bleed internally, especially in the joints (knees, ankles, and elbows). Plasma Transfusions Plasma is the liquid part of your blood. It's mainly water, but also contains proteins, clotting factors, hormones, vitamins, cholesterol, sugar, sodium, potassium, calcium, and more. If you have been badly burned or have liver failure or a severe infection, you may need a plasma transfusion. Blood transfusions are very common. Each year, almost 5 million Americans need blood transfusions. This procedure is used for people of all ages. Many people who have surgery need blood transfusions because they lose blood during their operations. For example, about one-third of all heart surgery patients have a transfusion. Some people who have serious injuries\u2014such as from car crashes, war, or natural disasters\u2014need blood transfusions to replace blood lost during the injury. Some people need blood or parts of blood because of illnesses. You may need a blood transfusion if you have: A severe infection or liver disease that stops your body from properly making blood or some parts of blood. An illness that causes anemia, such as kidney disease or cancer. Medicines or radiation used to treat a medical condition also can cause anemia. There are many types of anemia, including aplastic, Fanconi, hemolytic, iron-deficiency, and sickle cell anemias and thalassemia (thal-ah-SE-me-ah). A bleeding disorder, such as hemophilia or thrombocytopenia (THROM-bo-si-to-PE-ne-ah). Before a blood transfusion, a technician tests your blood to find out what blood type you have (that is, A, B, AB, or O and Rh-positive or Rh-negative). He or she pricks your finger with a needle to get a few drops of blood or draws blood from one of your veins. The blood type used in your transfusion must work with your blood type. If it doesn't, antibodies (proteins) in your blood attack the new blood and make you sick. Some people have allergic reactions even when the blood given does work with their own blood type. To prevent this, your doctor may prescribe a medicine to stop allergic reactions. (For more information, see \"What Are the Risks of a Blood Transfusion?\") If you have allergies or have had an allergic reaction during a past transfusion, your doctor will make every effort to make sure you're safe. Most people don't need to change their diets or activities before or after a blood transfusion. Your doctor will let you know whether you need to make any lifestyle changes prior to the procedure. Blood transfusions take place in either a doctor's office or a hospital. Sometimes they're done at a person's home, but this is less common. Blood transfusions also are done during surgery and in emergency rooms. A needle is used to insert an intravenous (IV) line into one of your blood vessels. Through this line, you receive healthy blood. The procedure usually takes 1 to 4 hours. The time depends on how much blood you need and what part of the blood you receive. During the blood transfusion, a nurse carefully watches you, especially for the first 15 minutes. This is when allergic reactions are most likely to occur. The nurse continues to watch you during the rest of the procedure as well. After a blood transfusion, your vital signs are checked (such as your temperature, blood pressure, and heart rate). The intravenous (IV) line is taken out. You may have some bruising or soreness for a few days at the site where the IV was inserted. You may need blood tests that show how your body is reacting to the transfusion. Your doctor will let you know about signs and symptoms to watch for and report. Most blood transfusions go very smoothly. However, mild problems and, very rarely, serious problems can occur. Allergic Reactions Some people have allergic reactions to the blood given during transfusions. This can happen even when the blood given is the right blood type. Allergic reactions can be mild or severe. Symptoms can include: Anxiety Chest and/or back pain Trouble breathing Fever, chills, flushing, and clammy skin A quick pulse or low blood pressure Nausea (feeling sick to the stomach) A nurse or doctor will stop the transfusion at the first signs of an allergic reaction. The health care team determines how mild or severe the reaction is, what treatments are needed, and whether the transfusion can safely be restarted. Viruses and Infectious Diseases Some infectious agents, such as HIV, can survive in blood and infect the person receiving the blood transfusion. To keep blood safe, blood banks carefully screen donated blood. The risk of catching a virus from a blood transfusion is very low. HIV. Your risk of getting HIV from a blood transfusion is lower than your risk of getting killed by lightning. Only about 1 in 2 million donations might carry HIV and transmit HIV if given to a patient. Hepatitis B and C. The risk of having a donation that carries hepatitis B is about 1 in 205,000. The risk for hepatitis C is 1 in 2 million. If you receive blood during a transfusion that contains hepatitis, you'll likely develop the virus. Variant Creutzfeldt-Jakob disease (vCJD). This disease is the human version of Mad Cow Disease. It's a very rare, yet fatal brain disorder. There is a possible risk of getting vCJD from a blood transfusion, although the risk is very low. Because of this, people who may have been exposed to vCJD aren't eligible blood donors. Fever You may get a sudden fever during or within a day of your blood transfusion. This is usually your body's normal response to white blood cells in the donated blood. Over-the-counter fever medicine usually will treat the fever. Some blood banks remove white blood cells from whole blood or different parts of the blood. This makes it less likely that you will have a reaction after the transfusion. Iron Overload Getting many blood transfusions can cause too much iron to build up in your blood (iron overload). People who have a blood disorder like thalassemia, which requires multiple transfusions, are at risk for iron overload. Iron overload can damage your liver, heart, and other parts of your body. If you have iron overload, you may need iron chelation (ke-LAY-shun) therapy. For this therapy, medicine is given through an injection or as a pill to remove the extra iron from your body. Lung Injury Although it's unlikely, blood transfusions can damage your lungs, making it hard to breathe. This usually occurs within about 6 hours of the procedure. Most patients recover. However, 5 to 25 percent of patients who develop lung injuries die from the injuries. These people usually were very ill before the transfusion. Doctors aren't completely sure why blood transfusions damage the lungs. Antibodies (proteins) that are more likely to be found in the plasma of women who have been pregnant may disrupt the normal way that lung cells work. Because of this risk, hospitals are starting to use men's and women's plasma differently. Acute Immune Hemolytic Reaction Acute immune hemolytic reaction is very serious, but also very rare. It occurs if the blood type you get during a transfusion doesn't match or work with your blood type. Your body attacks the new red blood cells, which then produce substances that harm your kidneys. The symptoms include chills, fever, nausea, pain in the chest or back, and dark urine. The doctor will stop the transfusion at the first sign of this reaction. Delayed Hemolytic Reaction This is a much slower version of acute immune hemolytic reaction. Your body destroys red blood cells so slowly that the problem can go unnoticed until your red blood cell level is very low. Both acute and delayed hemolytic reactions are most common in patients who have had a previous transfusion. Graft-Versus-Host Disease Graft-versus-host disease (GVHD) is a condition in which white blood cells in the new blood attack your tissues. GVHD usually is fatal. People who have weakened immune systems are the most likely to get GVHD. Symptoms start within a month of the blood transfusion. They include fever, rash, and diarrhea. To protect against GVHD, people who have weakened immune systems should receive blood that has been treated so the white blood cells can't cause GVHD.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/bt"
+  ],
+  [
+    "Stroke: Stroke is a leading cause of disability and death in the United States. Strokes leave many people with long-term physical and cognitive difficulties; rehabilitation after stroke is an important goal. The NICHD is one of many federal agencies and NIH Institutes working to understand stroke and how to improve methods of post-stroke rehabilitation. What is stroke? A stroke occurs when a blocked vessel or artery prevents blood from getting to part of the brain, or when a vessel or artery bursts and spills blood into the brain. The blood supplies the brain with the oxygen and nutrients it needs to work properly. When part of the brain cannot get the blood it needs, it becomes damaged or dies. The sudden flooding of blood into the brain also can cause damage or death to the brain cells (neurons). There are two types of stroke: - Ischemic stroke Ischemic (pronounced ih-SKEE-mik) stroke happens when an artery carrying blood to the brain becomes blocked and cannot supply enough blood to the brain. Usually a blood clot causes the blockage. Sometimes the blockage occurs when an artery becomes too narrow for enough blood to pass through it. This narrowing is called stenosis (sti-NOH-sis). Stenosis is caused by a buildup of plaque (plak)\u2014a mixture of fatty substances, including cholesterol\u2014that forms on the inner walls of the artery. - Hemorrhagic stroke Hemorrhagic (prounounced hem-uh-RAJ-ik) stroke occurs when an artery bursts and spills blood into part of the brain. In a healthy brain, the blood remains in the arteries and does not come into contact with neurons. When blood bursts into the brain during a hemorrhagic stroke, the normal flow of blood to the brain is upset, and the blood interferes with the normal chemical balance that neurons need to function. Transient Ischemic Attack Sometimes called a mini-stroke, a transient ischemic attack (TIA) starts with the same symptoms of a full stroke but does not progress and cause the damage of a full stroke. A TIA is a warning that a person is at risk for a more serious stroke in the future. What are common symptoms? \u00bb Stroke symptoms come on suddenly and include: - Numbness or weakness of the face, arm, or leg, especially on one side of the body - Confusion, trouble talking, or trouble understanding what others are saying - Dizziness, trouble walking, or loss of balance or coordination - Trouble seeing in one or both eyes - Sudden severe headache with no known cause If you believe you or someone you know is having any of these symptoms, do not wait. Call 911 immediately. A person suffering a stroke must receive medications as soon as possible at a hospital to prevent or minimize brain damage. The symptoms of a transient ischemic attack (TIA) are similar to those of a more serious stroke, but unlike a serious stroke, a TIA usually lasts only a few minutes and goes away within an hour. However, it is impossible to tell the difference between the symptoms of a TIA and a more serious stroke. You should not wait to see if the symptoms go away. Assume that all stroke symptoms signal an emergency. The National Institute of Neurological Disorders and Stroke (NINDS) provides detailed information about stroke and stroke symptoms at http://www.ninds.nih.gov/disorders/stroke/stroke.htm. \u00ab Condition Information How many people are affected/at risk? \u00bb Each year, about 795,000 people in the United States have strokes, and of these incidents, 137,000 of the people die. About 610,000 of these cases are first strokes, and 185,000 people who survive a stroke will have another stroke within 5 years. Ischemic strokes make up about 87% of all strokes. Hemorrhagic strokes make up the remaining 13%. Stroke is a leading cause of death and disability in the United States. People of all ages and backgrounds can have a stroke. However, some demographic factors put certain people at higher risk of stroke or death from stroke. These include: - Race/ethnicity. African Americans have almost two times the risk of white people of having a first stroke. Hispanic Americans and American Indian/Alaska Natives are at greater risk than whites are for having a stroke but are at less risk than African Americans. African Americans and Hispanics are more likely than whites to die after having a stroke. - Age. Stroke risk increases with age. Three-quarters of strokes occur in people ages 65 and older. - Geography. The highest U.S. death rates from stroke occur in the southeastern United States. - Gender. Men are more likely than women to have a stroke. Certain lifestyle factors and conditions also increase the risk for stroke. The most important of these include: - High blood pressure - Diabetes - Heart disease (such as atrial fibrillation) - Previous stroke or transient ischemic attack - Cigarette smoking Additional risk factors include: - Physical inactivity - Overweight or obesity - High cholesterol - Sickle cell disease - Drinking too much alcohol - Family history of stroke - Drug abuse - Genetic conditions, such as blood-clotting or vascular disorders (for example, Factor V Leiden or CADASIL) - Certain medications (such as hormonal birth control pills) - Being pregnant - Menopause Lesser risk factors include: - Head and neck injuries - Recent viral or bacterial infections Amplification of risk occurs when a person has more than one of the risk factors listed above. This means that the combined risk of two or more risk factors is greater than simply adding their effects. \u00ab What are common symptoms? What causes it? \u00bb Ischemic Stroke Ischemic stroke is caused by a blockage in an artery carrying blood to the brain. The blocked artery cuts off the blood supply to part of the brain. Usually a blood clot causes the blockage. Sometimes the blockage occurs when an artery becomes too narrow for enough blood to pass through it. This narrowing is called stenosis (pronounced sti-NOH-sis). Stenosis is caused by a buildup of blood clots and plaque\u2014a mixture of fatty substances, including cholesterol\u2014on the inner walls of the artery. Problems with blood clotting become more frequent as people age. Certain medications, such as hormonal birth control pills, also can increase the risk of blood clots. Stenosis is caused most commonly by a blood vessel disease called atherosclerosis (pronounced ath-uh-roh-skluh-ROH-sis). In atherosclerosis, plaque builds up on the inner walls of arteries. This causes the artery walls to become thick, hard, and less flexible, and decreases blood flow. The presence of plaque also leads to the formation of blood clots. Eating foods high in saturated fat and cholesterol can make the amount of cholesterol in the body too high. Having high cholesterol can lead to its buildup in plaque in the artery walls. High blood pressure also contributes to atherosclerosis. Hemorrhagic Stroke Hemorrhagic stroke is caused by a burst artery that spills blood into part of the brain. In a healthy brain, the blood remains in the arteries and does not come into contact with neurons. When blood bursts into the brain during a hemorrhagic stroke, the normal flow of blood to the brain is upset, and the blood interferes with the normal chemical balance that neurons need to function. High blood pressure can weaken artery walls and make them more likely to break or burst. Poor blood clotting also can increase the risk of bleeding in a hemorrhagic stroke. Poor blood clotting may be caused by blood disorders or medications that decrease clotting. Another cause of hemorrhagic stroke is abnormalities in the structure of blood vessels that form during brain development. \u00ab How many people are affected/at risk? What are the outcomes and treatments? \u00bb Recovery from a stroke may take months or years. Many people who have had a stroke never fully recover. A person who has had a stroke may have the following temporary or permanent symptoms: - Inability to move on one side of the body - Weakness on one side of the body - Problems with thinking, awareness, attention, learning, judgment, and memory - Problems understanding or forming speech - Problems with controlling or expressing emotions - Numbness or strange sensations - Pain in the hands and feet that worsens with movement and temperature changes - Depression Types of Treatment for Stroke Stroke treatment includes: - Emergency treatment - Preventing another stroke - Rehabilitation Emergency Treatment When a person is able to get to the hospital within a few hours of having a stroke, health care providers will treat a stroke with medications, surgery, or both, depending on the type of stroke. Medication for Ischemic Stroke - Thrombolytic (pronounced throm-buh-LIT-ik) agents These medications are used to treat an ongoing ischemic stroke caused by a blocked artery. They stop the stroke by dissolving the blood clot that has blocked blood flow to the brain. - Blood-thinning medications These drugs include antiplatelet (pronounced anti-PLEYT-lit) drugs and anticoagulants (pronounced anti-koh-AG-yuh-luhnts) and work to prevent blood clotting that causes ischemic stroke. Surgery In the case of ischemic stroke, a surgeon can clear out the clogged artery to allow blood to resume flowing to the affected part of the brain. Surgery can also repair structural abnormalities in arteries in the case of hemorrhagic stroke. [top] Preventing Another Stroke A patient who has had a stroke may continue taking blood-thinning medications, referred to as blood thinners, to prevent another stroke. Surgery performed to treat a stroke may also help to prevent another stroke. Health care providers will also advise stroke survivors to make lifestyle changes, such as eating a healthy diet, exercising, and treating related medical conditions. For more information on preventing stroke, see the Other FAQs within the Stroke topic. [top] Rehabilitation Stroke is the leading cause of serious adult disability in the United States. Several types of therapies can help a stroke survivor regain some or all of the functions damaged by the stroke. These therapies include: - Physical therapy A physical therapist uses training and exercises to help a patient relearn physical activities such as walking, sitting, standing, and lying down. A special type of physical therapy called constraint-induced movement therapy (CIMT) can improve the use of a weakened or paralyzed arm. CIMT involves training and exercise for the affected arm while the unaffected arm is restrained by a special mitt. - Occupational therapy Occupational therapy involves exercise and training to help a patient relearn daily activities such as eating, drinking, dressing, bathing, cooking, reading, writing, and using a toilet. - Speech therapy Speech therapy helps patients relearn language and speaking, including swallowing. - Psychological therapy Stroke survivors may suffer from depression, anxiety, frustration, and anger. Talk therapy, medications, or both can treat these symptoms. [top] \u00ab What causes it? Other FAQs \u00bb Can stroke be prevented? Making healthy choices and managing medical conditions can diminish your risk of stroke. These include: - Eating a healthy diet, which includes plenty of fruits and vegetables and foods low in saturated fat, cholesterol, and sodium - Maintaining a healthy weight - Staying physically active - Not smoking - Limiting alcohol use - Checking your cholesterol - Monitoring your blood pressure - Managing diabetes - Taking medication to treat high cholesterol, high blood pressure, or diabetes - Talking to your health care provider regularly about preventing or treating the medical conditions that lead to heart disease or increase your risk of stroke \u00ab What are the outcomes and treatments?",
+    "https://www.nichd.nih.gov/health/topics/stroke"
+  ],
+  [
+    "IMH \u00bb HIV/AIDS and Mental Health (HIV-Associated Neurocognitive Disorders (HAND)): HAND represents the range of neurocognitive complications associated with HIV infection.\u00a0 Although there is currently no cure for HAND, combination antiretroviral therapy has been shown to be the only option in preventing or delaying the progression of HAND. There are three major types of HAND: - Asymptomatic Neurocognitive Impairment (ANI) is diagnosed if testing shows HIV-associated impairment in cognitive function, but everyday functioning is not affected. - Mild Neurocognitive Disorder (MND) is diagnosed if testing shows HIV-associated impairment in cognitive function, and mild interference in everyday functioning. - HIV-associated Dementia (HAD) is diagnosed if testing shows marked impairment in cognitive function, especially in learning of new information, information processing, and attention or concentration. This impairment significantly limits your ability to function day-to-day at work, home, and during social activities. Although a significant proportion of people living with HIV are affected by a mild form of HAND, there has been significant progress in the treatment of HAND.\u00a0 Since the start of the epidemic, severe cases of HAND have been on the decline and the most severe form, HAD, is rare.\u00a0 The majority of people experience more subtle abnormalities in memory and cognition. Experienced clinicians can diagnose HAND after carefully ruling out other possible causes of the symptoms. They may conduct a thorough neurological exam and history, neuropsychological testing, brain MRI scan, and sometimes lumbar puncture to evaluate the cerebrospinal fluid to obtain information about the nature and severity of HAND.",
+    "https://www.nimh.nih.gov/health/topics/hiv-aids/index.shtml"
+  ],
+  [
+    "How and when to get rid of unused medicines (How to Dispose of Expired Medicines Safely): Disposing medicines safely prevents others from using them accidentally or intentionally. It also prevents harmful residues from getting into the environment. Look for disposal instructions on the label or information booklet. DO NOT FLUSH UNUSED MEDICINES You should not flush most medicines or pour them down the drain. Medicines contain chemicals that may not break down in the environment. When flushed down the toilet or sink, these residues can pollute our water resources. This may affect fish and other marine life. These residues can also end up in our drinking water. However, some medicines must be disposed of as soon as possible to reduce their potential harm. You can flush them to prevent someone from using them. These include opioids or narcotics usually prescribed for pain. You should ONLY flush medicines when it specifically says to do so on the label. DRUG TAKE-BACK PROGRAMS The best way to dispose of your medicines is to bring them to drug take-back programs. These programs safely dispose of medicines by burning them up. Drug take-back programs are organized from time to time in most communities. Or, your town may have special days when you can bring hazardous household items such as unused medicines to a specific location for disposal. Contact your local trash and recycling service to find out when the next event is scheduled in your community. Medicines NOT accepted by most drug take-back programs include: - Liquid medicines - Needles - Sprays - Inhalers - Creams HOUSEHOLD DISPOSAL If you don't have a take-back program available, you can throw your medicines out with your household trash. To do so safely: - Take the medicine out of its container and mix it with other unpleasant garbage such as kitty litter or used coffee grounds. DO NOT crush pills or capsules. - Place the mixture into a sealable plastic bag or sealed contain that won't leak. - Be sure to remove your Rx number and all personal information from the medicine bottle. Scratch it off or cover it with a permanent marker or duct tape. - Throw the container and pill bottles out with the rest of your trash.",
+    "https://medlineplus.gov/ency/patientinstructions/000943.htm"
+  ],
+  [
+    "Do you have information about Hydrogen peroxide poisoning: Summary : Hydrogen peroxide is a liquid commonly used to fight germs. Hydrogen peroxide poisoning occurs when large amounts of the liquid are swallowed or get in the lungs or eyes. This is for information only and not for use in the treatment or management of an actual overdose. DO NOT use it to treat or manage an actual overdose. If you or someone you are with overdoses, call your local emergency number (such as 911), or your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. Poisonous Ingredient : Hydrogen peroxide can be poisonous if it is not used correctly. Where Found : Hydrogen peroxide is used in these products: - Hydrogen peroxide - Hair bleach - Some contact lens cleaners Note: Household hydrogen peroxide has a 3% concentration. That means it contains 97% water and 3% hydrogen peroxide. Hair bleaches are stronger. They usually have a concentration of more than 6%. Some industrial-strength solutions contain more than 10% hydrogen peroxide. Symptoms : Symptoms of a hydrogen peroxide poisoning include: - Abdominal pain and cramping - Breathing difficulty (if large concentrations are swallowed) - Body aches - Burns in the mouth and throat (if swallowed) - Chest pain - Eye burns (if it gets in the eyes) - Seizures (rare) - Stomach swelling - Temporary white color to the skin - Vomiting (sometimes with blood) Home Care : Seek medical help right away. Do NOT make the person throw up unless poison control or a health care provider tells you to do so. If the chemical is on the skin or in the eyes, flush with lots of water for at least 15 minutes. Before Calling Emergency : Have this information ready: - Person's age, weight, and condition - Name of the product (ingredients and strength, if known) - Time it was swallowed or got into eyes or on skin - Amount swallowed, in eyes, or on skin Poison Control : Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions. This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week. What to Expect at the Emergency Room : Take the container with you to the hospital, if possible. The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. The person may receive: - Blood and urine tests - Chest x-ray - EKG (electrocardiogram, or heart tracing) - Fluids through a vein (by IV) - Medicines to treat symptoms - Tube down the throat into the stomach (gastric tube) to relieve gas pressure Outlook (Prognosis) : Most contact with household-strength hydrogen peroxide is fairly harmless. Exposure to industrial-strength hydrogen peroxide can be dangerous. Passing a tube with a camera through the mouth into the stomach (endoscopy) may be required to stop internal bleeding.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/002652.htm"
+  ],
+  [
+    "Swan-Ganz - right heart catheterization: Swan-Ganz catheterization is the passing of a thin tube (catheter) into the right side of the heart and the arteries leading to the lungs. It is done to monitor the heart's function and blood flow and pressures in and around the heart. This test is most often done in people who are very ill. The test can be done while you are in bed in an intensive care unit (ICU) of a hospital. It can also be done in special procedure areas such as a cardiac catheterization laboratory. Before the test starts, you may be given medicine (sedative) to help you relax. You will lie on a padded table. Your doctor will make a small surgical cut near the groin or in your neck. A flexible tube (catheter or sheath) is placed through the cut into a vein. Sometimes, it will be placed in your leg or your arm. You will be awake during the procedure. A longer catheter is inserted. It is then carefully moved into the upper chamber of the right side of the heart. X-ray images may be used to help the health care provider see where the catheter should be placed. Blood may be removed from the catheter. This blood is tested to measure the amount of oxygen in the blood. During the procedure, your heart's rhythm will be constantly watched using an electrocardiogram (ECG). You should not eat or drink anything for 8 hours before the test starts. You may need to stay in the hospital the night before the test. Otherwise, you will check in to the hospital the morning of the test. You will wear a hospital gown. You must sign a consent form before the test. Your provider will explain the procedure and its risks. You may be given medicine to help you relax before the procedure. You will be awake and able to follow instructions during the test. You may feel some discomfort when the IV is placed into your arm. You may also feel some pressure at the site when the catheter is inserted. In people who are critically ill, the catheter may stay in place for several days. You may feel discomfort when the area of the vein is numbed with anesthetic. The procedure is done to evaluate how the blood moves (circulates) in people who have: - Abnormal pressures in the heart arteries - Burns - Congenital heart disease - Heart failure - Kidney disease - Leaky heart valves - Lung problems - Shock It may also be done to monitor for complications of a\u00a0heart attack. It also shows how well certain heart medicines are working. Swan-Ganz catheterization can also be used to detect abnormal blood flow between two areas of the heart that are not normally connected. Conditions that can also be diagnosed or evaluated with Swan-Ganz catheterization include: - Cardiac tamponade - Pulmonary hypertension - Restrictive cardiomyopathy Normal results for this test are: - Cardiac index is 2.8 to 4.2 liters per minute per square meter (of body surface area) - Pulmonary artery systolic pressure is 17 to 32 millimeters of mercury (mm Hg) - Pulmonary artery mean pressure is 9 to 19 mm Hg - Pulmonary diastolic pressure is 4 to 13 mm Hg - Pulmonary capillary wedge pressure is 4 to 12 mm Hg - Right atrial pressure is 0 to 7 mm Hg Abnormal results may be due to: - Blood flow problems, such as heart failure or shock - Heart valve disease - Lung disease - Structural problems with the heart, such as a shunt from an atrial or ventricular septal defect Risks of the procedure include: - Bruising around the area where the catheter was inserted - Injury to the vein - Puncture to the lung if the neck or chest veins are used, causing lung collapse (pneumothorax) Very rare complications include: - Cardiac arrhythmias requiring treatment - Cardiac tamponade - Embolism caused by blood clots at the tip of the catheter - Infection - Low blood pressure Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003870.htm"
+  ],
+  [
+    "Swan-Ganz - right heart catheterization (Why the Test is Performed): The procedure is done to evaluate how the blood moves (circulates) in people who have: - Abnormal pressures in the heart arteries - Burns - Congenital heart disease - Heart failure - Kidney disease - Leaky heart valves - Lung problems - Shock It may also be done to monitor for complications of a\u00a0heart attack. It also shows how well certain heart medicines are working. Swan-Ganz catheterization can also be used to detect abnormal blood flow between two areas of the heart that are not normally connected. Conditions that can also be diagnosed or evaluated with Swan-Ganz catheterization include: - Cardiac tamponade - Pulmonary hypertension - Restrictive cardiomyopathy",
+    "https://medlineplus.gov/ency/article/003870.htm"
+  ],
+  [
+    "Hydrogen peroxide poisoning (Where Found): Hydrogen peroxide is used in these products: - Hydrogen peroxide - Hair bleach - Some contact lens cleaners Note: Household hydrogen peroxide has a 3% concentration. That means it contains 97% water and 3% hydrogen peroxide. Hair bleaches are stronger. They usually have a concentration of more than 6%. Some industrial-strength solutions contain more than 10% hydrogen peroxide.",
+    "https://medlineplus.gov/ency/article/002652.htm"
+  ],
+  [
+    "Benzoyl Peroxide Topical: Benzoyl peroxide is used to treat mild to moderate acne. Benzoyl peroxide comes in cleansing liquid or bar, lotion, cream, and gel for use on the skin. Benzoyl peroxide usually is used one or two times daily. Start with once daily to see how your skin reacts to this medication. Follow the directions on the package or on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use benzoyl peroxide exactly as directed. Do not use more or less of it or use it more often than directed by your doctor. Apply a small amount of the benzoyl peroxide product to one or two small areas you want to treat for 3 days when you begin to use this medication for the first time. If no reaction or discomfort occurs, use the product as directed on the package or on your prescription label. The cleansing liquid and bar are used to wash the affected area as directed. To use the lotion, cream, or gel, first wash the affected skin areas and gently pat dry with a towel. Then apply a small amount of benzoyl Peroxide, rub it in gently. Avoid anything that may irritate your skin (e.g., abrasive soaps or cleansers, alcohol-containing products, cosmetics or soaps that dry the skin, medicated cosmetics, sunlight, and sunlamps) unless directed otherwise by your doctor. It may take 4 to 6 weeks to see the effects of this medication. If your acne does not improve after this time, call your doctor. Do not allow medication to get into your eyes, mouth, and nose. Do not use benzoyl peroxide on children less than 12 years of age without talking to a doctor. Before using benzoyl peroxide, - tell your doctor and pharmacist if you are allergic to benzoyl peroxide, any other medications, or any of the ingredients in benzoyl peroxide products. Ask your pharmacist or check the package label for a list of the ingredients. - tell your doctor and pharmacist what prescription and nonprescription medications you are taking, including vitamins. - tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using benzoyl peroxide, call your doctor. Apply the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not apply a double dose to make up for a missed one. Benzoyl peroxide may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - dryness or peeling of skin - feeling of warmth - tingling - slight stinging Some side effects may be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment: - burning, blistering, redness, or swelling of the area of the treated area - rash If you experience any of the following symptoms, stop using benzoyl peroxide and call your doctor immediately or get emergency medical help: - hives - itching - throat tightness - difficulty breathing - feeling faint - swelling of the eyes, face, lips, or tongue If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org Keep all appointments with your doctor. Benzoyl peroxide is for external use only. Do not let benzoyl peroxide get into your eyes, nose, or mouth, and do not swallow it. Do not apply dressings, bandages, cosmetics, lotions, or other skin medications to the area being treated unless your doctor tells you. Keep benzoyl peroxide away from your hair and colored fabrics because it may bleach them. Do not let anyone else use your medication. Tell your doctor if your skin condition gets worse or does not go away. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Acne-Clear\u00ae - Acnigel\u00ae - Ben-Aqua\u00ae - Benzac\u00ae - Benzagel\u00ae - Benzashave\u00ae - BenzEFoam\u00ae - Benziq\u00ae - Binora\u00ae - Brevoxyl\u00ae - Clear By Design\u00ae - Clearasil\u00ae - Clearplex\u00ae - Clearskin\u00ae - Clinac BPO\u00ae - Del-Aqua\u00ae - Desquam\u00ae - Ethexderm BPW\u00ae - Fostex\u00ae - Inova\u00ae - Lavoclen\u00ae - Loroxide\u00ae - NeoBenz\u00ae - Neutrogena\u00ae - Oscion\u00ae - Oxy 10\u00ae - Pacnex\u00ae - PanOxyl\u00ae - Peroderm\u00ae - Peroxin A\u00ae - Persa-Gel\u00ae - Seba-Gel\u00ae - Soluclenz\u00ae - Theroxide\u00ae - Triaz\u00ae - Vanoxide\u00ae - Zaclir\u00ae - Zeroxin\u00ae - ZoDerm\u00ae - Acanya\u00ae (containing Benzoyl Peroxide, Clindamycin) - Bencort\u00ae (containing Benzoyl Peroxide, Hydrocortisone) - Benzaclin\u00ae (containing Benzoyl Peroxide, Clindamycin) - Benzamycin\u00ae (containing Benzoyl Peroxide, Erythromycin) - Duac\u00ae (containing Benzoyl Peroxide, Clindamycin) - Epiduo\u00ae (containing Benzoyl Peroxide, Adapalene) - Face Up\u00ae (containing Benzoyl Peroxide, Sulfur) - Inova 8-2\u00ae (containing Benzoyl Peroxide, Salicylic Acid) - NuOx\u00ae (containing Benzoyl Peroxide, Sulfur) - Sulfoxyl\u00ae (containing Benzoyl Peroxide, Sulfur) - Vanoxide-HC\u00ae (containing Benzoyl Peroxide, Hydrocortisone)",
+    "https://medlineplus.gov/druginfo/meds/a601026.html"
+  ],
+  [
+    "TARDBP gene: The TARDBP gene provides instructions for making a protein called transactive response DNA binding protein 43 kDa (TDP-43). This protein is found within the cell nucleus in most tissues and is involved in many of the steps of protein production. The TDP-43 protein attaches (binds) to DNA and regulates an activity called transcription, which is the first step in the production of proteins from genes. This protein can also bind to RNA, a chemical cousin of DNA, to ensure the RNA's stability. The TDP-43 protein is involved in processing molecules called messenger RNA (mRNA), which serve as the genetic blueprints for making proteins. By cutting and rearranging mRNA molecules in different ways, the TDP-43 protein controls the production of different versions of certain proteins. This process is known as alternative splicing. The TDP-43 protein can influence various functions of a cell by regulating protein production. The TARDBP gene is particularly active (expressed) during early development before birth when new tissues are forming. Many of the proteins whose production is influenced by the TDP-43 protein are involved in nervous system and organ development. At least 60 mutations in the TARDBP gene have been found to cause amyotrophic lateral sclerosis (ALS), a condition characterized by progressive muscle weakness, a loss of muscle mass, and an inability to control movement. Most mutations change single protein building blocks (amino acids) in the TDP-43 protein. The majority of these changes affect the region of the protein involved in mRNA processing, likely disrupting the production of other proteins. Changes to the TDP-43 protein cause the protein to misfold and form protein clumps (aggregates), which have been found in nerve cells that control muscle movement (motor neurons) in some people with ALS. It is unclear whether TDP-43 protein aggregates causes the nerve cell death that leads to ALS or if they are a byproduct of a dying cell. Some people with ALS caused by TARDBP gene mutations also develop a condition called frontotemporal dementia (FTD), which is a progressive brain disorder that affects personality, behavior, and language. It is unclear why some people with TARDBP gene mutations develop FTD and others do not. Individuals who develop both conditions are diagnosed as having ALS-FTD. At least 60 mutations in the TARDBP gene have been found to cause amyotrophic lateral sclerosis (ALS), a condition characterized by progressive muscle weakness, a loss of muscle mass, and an inability to control movement. Most mutations change single protein building blocks (amino acids) in the TDP-43 protein. The majority of these changes affect the region of the protein involved in mRNA processing, likely disrupting the production of other proteins. Changes to the TDP-43 protein cause the protein to misfold and form protein clumps (aggregates), which have been found in nerve cells that control muscle movement (motor neurons) in some people with ALS. It is unclear whether TDP-43 protein aggregates causes the nerve cell death that leads to ALS or if they are a byproduct of a dying cell. Some people with ALS caused by TARDBP gene mutations also develop a condition called frontotemporal dementia (FTD), which is a progressive brain disorder that affects personality, behavior, and language. It is unclear why some people with TARDBP gene mutations develop FTD and others do not. Individuals who develop both conditions are diagnosed as having ALS-FTD. Mutations in the TARDBP gene have been found to cause frontotemporal dementia (FTD) without features of amyotrophic lateral sclerosis (ALS, described above). FTD caused by TARDBP gene mutations is characterized by a gradual loss of problem-solving skills and language comprehension. Affected individuals often have changes in personality and behavior that may make it difficult to interact with others in a socially appropriate manner. Most TARDBP gene mutations that cause FTD change single amino acids in the TDP-43 protein. These mutations are thought to affect only part of the protein, leaving other parts of the protein functional. Because these TARDBP gene mutations result in a protein with some residual function, the features of the condition tend to appear later in life, in one's late sixties or early seventies. Some people who inherit the altered TARDBP gene never develop FTD, a situation known as reduced penetrance. Borroni B, Archetti S, Del Bo R, Papetti A, Buratti E, Bonvicini C, Agosti C, Cosseddu M, Turla M, Di Lorenzo D, Pietro Comi G, Gennarelli M, Padovani A. TARDBP mutations in frontotemporal lobar degeneration: frequency, clinical features, and disease course. Rejuvenation Res. 2010 Oct;13(5):509-17. doi: 10.1089/rej.2010.1017. Epub 2010 Jul 20.",
+    "https://ghr.nlm.nih.gov/gene/TARDBP"
+  ],
+  [
+    "Swan-Ganz - right heart catheterization (Normal Results): Normal results for this test are: - Cardiac index is 2.8 to 4.2 liters per minute per square meter (of body surface area) - Pulmonary artery systolic pressure is 17 to 32 millimeters of mercury (mm Hg) - Pulmonary artery mean pressure is 9 to 19 mm Hg - Pulmonary diastolic pressure is 4 to 13 mm Hg - Pulmonary capillary wedge pressure is 4 to 12 mm Hg - Right atrial pressure is 0 to 7 mm Hg",
+    "https://medlineplus.gov/ency/article/003870.htm"
+  ],
+  [
+    "How and when to get rid of unused medicines: Many people have unused or expired prescription or over-the-counter (OTC) medicines at home. Learn when you should get rid of unused medicines and how to dispose of them safely. You should get rid of a medicine when: - Your health care provider changes your prescription but you still have some medicine left - You feel better and your provider says you should stop taking the medicine - You have OTC medicines that you no longer need - You have medicines that are past their expiration dates DO NOT take expired medicines. They may not be as effective or the ingredients of the medicine may have changed. This can make them unsafe for use. Read the labels regularly to check the expiration date of a medicine. Discard any that have expired and those you no longer need. Storing expired or unwanted medicines can increase the risk of: - Taking the wrong medicine due to mix-ups - Accidental poisoning in children or pets - Overdose - Misuse or illegal abuse Disposing medicines safely prevents others from using them accidentally or intentionally. It also prevents harmful residues from getting into the environment. Look for disposal instructions on the label or information booklet. DO NOT FLUSH UNUSED MEDICINES You should not flush most medicines or pour them down the drain. Medicines contain chemicals that may not break down in the environment. When flushed down the toilet or sink, these residues can pollute our water resources. This may affect fish and other marine life. These residues can also end up in our drinking water. However, some medicines must be disposed of as soon as possible to reduce their potential harm. You can flush them to prevent someone from using them. These include opioids or narcotics usually prescribed for pain. You should ONLY flush medicines when it specifically says to do so on the label. DRUG TAKE-BACK PROGRAMS The best way to dispose of your medicines is to bring them to drug take-back programs. These programs safely dispose of medicines by burning them up. Drug take-back programs are organized from time to time in most communities. Or, your town may have special days when you can bring hazardous household items such as unused medicines to a specific location for disposal. Contact your local trash and recycling service to find out when the next event is scheduled in your community. Medicines NOT accepted by most drug take-back programs include: - Liquid medicines - Needles - Sprays - Inhalers - Creams HOUSEHOLD DISPOSAL If you don't have a take-back program available, you can throw your medicines out with your household trash. To do so safely: - Take the medicine out of its container and mix it with other unpleasant garbage such as kitty litter or used coffee grounds. DO NOT crush pills or capsules. - Place the mixture into a sealable plastic bag or sealed contain that won't leak. - Be sure to remove your Rx number and all personal information from the medicine bottle. Scratch it off or cover it with a permanent marker or duct tape. - Throw the container and pill bottles out with the rest of your trash. Call your provider if: - Someone consumes expired medicines accidentally or on purpose - You have an allergic reaction to a medicine Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000943.htm"
+  ],
+  [
+    "congenital diaphragmatic hernia: Congenital diaphragmatic hernia is a defect in the diaphragm. The diaphragm, which is composed of muscle and other fibrous tissue, separates the organs in the abdomen from those in the chest. Abnormal development of the diaphragm before birth leads to defects ranging from a thinned area in the diaphragm to its complete absence. An absent or partially formed diaphragm results in an abnormal opening (hernia) that allows the stomach and intestines to move into the chest cavity and crowd the heart and lungs. This crowding can lead to underdevelopment of the lungs (pulmonary hypoplasia), potentially resulting in life-threatening breathing difficulties that are apparent from birth. In 5 to 10 percent of affected individuals, signs and symptoms of congenital diaphragmatic hernia appear later in life and may include breathing problems or abdominal pain from protrusion of the intestine into the chest cavity. In about 1 percent of cases, congenital diaphragmatic hernia has no symptoms; it may be detected incidentally when medical imaging is done for other reasons. Congenital diaphragmatic hernias are often classified by their position. A Bochdalek hernia is a defect in the side or back of the diaphragm. Between 80 and 90 percent of congenital diaphragmatic hernias are of this type. A Morgnani hernia is a defect involving the front part of the diaphragm. This type of congenital diaphragmatic hernia, which accounts for approximately 2 percent of cases, is less likely to cause severe symptoms at birth. Other types of congenital diaphragmatic hernia, such as those affecting the central region of the diaphragm, or those in which the diaphragm muscle is absent with only a thin membrane in its place, are rare. Congenital diaphragmatic hernia affects approximately 1 in 2,500 newborns. Congenital diaphragmatic hernia has many different causes. In 10 to 15 percent of affected individuals, the condition appears as a feature of a disorder that affects many body systems, called a syndrome. Donnai-Barrow syndrome, Fryns syndrome, and Pallister-Killian mosaic syndrome are among several syndromes in which congenital diaphragmatic hernia may occur. Some of these syndromes are caused by changes in single genes, and others are caused by chromosomal abnormalities that affect several genes. About 25 percent of individuals with congenital diaphragmatic hernia that is not associated with a known syndrome also have abnormalities of one or more major body systems. Affected body systems can include the heart, brain, skeleton, intestines, genitals, kidneys, or eyes. In these individuals, the multiple abnormalities likely result from a common underlying disruption in development that affects more than one area of the body, but the specific mechanism responsible for this disruption is not clear. Approximately 50 to 60 percent of congenital diaphragmatic hernia cases are isolated, which means that affected individuals have no other major malformations. More than 80 percent of individuals with congenital diaphragmatic hernia have no known genetic syndrome or chromosomal abnormality. In these cases, the cause of the condition is unknown. Researchers are studying changes in several genes involved in the development of the diaphragm as possible causes of congenital diaphragmatic hernia. Some of these genes are transcription factors, which provide instructions for making proteins that help control the activity of particular genes (gene expression). Others provide instructions for making proteins involved in cell structure or the movement (migration) of cells in the embryo. Environmental factors that influence development before birth may also increase the risk of congenital diaphragmatic hernia, but these environmental factors have not been identified. Isolated congenital diaphragmatic hernia is rarely inherited. In almost all cases, there is only one affected individual in a family. When congenital diaphragmatic hernia occurs as a feature of a genetic syndrome or chromosomal abnormality, it may cluster in families according to the inheritance pattern for that condition. Bielinska M, Jay PY, Erlich JM, Mannisto S, Urban Z, Heikinheimo M, Wilson DB. Molecular genetics of congenital diaphragmatic defects. Ann Med. 2007;39(4):261-74. Review.",
+    "https://ghr.nlm.nih.gov/condition/congenital-diaphragmatic-hernia"
+  ],
+  [
+    "Is congenital diaphragmatic hernia inherited?: Isolated congenital diaphragmatic hernia is rarely inherited. In almost all cases, there is only one affected individual in a family. When congenital diaphragmatic hernia occurs as a feature of a genetic syndrome or chromosomal abnormality, it may cluster in families according to the inheritance pattern for that condition.",
+    "https://ghr.nlm.nih.gov/condition/congenital-diaphragmatic-hernia"
+  ],
+  [
+    "congenital diaphragmatic hernia (Genetic Changes): Congenital diaphragmatic hernia has many different causes. In 10 to 15 percent of affected individuals, the condition appears as a feature of a disorder that affects many body systems, called a syndrome. Donnai-Barrow syndrome, Fryns syndrome, and Pallister-Killian mosaic syndrome are among several syndromes in which congenital diaphragmatic hernia may occur. Some of these syndromes are caused by changes in single genes, and others are caused by chromosomal abnormalities that affect several genes. About 25 percent of individuals with congenital diaphragmatic hernia that is not associated with a known syndrome also have abnormalities of one or more major body systems. Affected body systems can include the heart, brain, skeleton, intestines, genitals, kidneys, or eyes. In these individuals, the multiple abnormalities likely result from a common underlying disruption in development that affects more than one area of the body, but the specific mechanism responsible for this disruption is not clear. Approximately 50 to 60 percent of congenital diaphragmatic hernia cases are isolated, which means that affected individuals have no other major malformations. More than 80 percent of individuals with congenital diaphragmatic hernia have no known genetic syndrome or chromosomal abnormality. In these cases, the cause of the condition is unknown. Researchers are studying changes in several genes involved in the development of the diaphragm as possible causes of congenital diaphragmatic hernia. Some of these genes are transcription factors, which provide instructions for making proteins that help control the activity of particular genes (gene expression). Others provide instructions for making proteins involved in cell structure or the movement (migration) of cells in the embryo. Environmental factors that influence development before birth may also increase the risk of congenital diaphragmatic hernia, but these environmental factors have not been identified.",
+    "https://ghr.nlm.nih.gov/condition/congenital-diaphragmatic-hernia"
+  ],
+  [
+    "congenital diaphragmatic hernia (Frequency): Congenital diaphragmatic hernia affects approximately 1 in 2,500 newborns.",
+    "https://ghr.nlm.nih.gov/condition/congenital-diaphragmatic-hernia"
+  ],
+  [
+    "congenital diaphragmatic hernia (Sources for This Page): Bielinska M, Jay PY, Erlich JM, Mannisto S, Urban Z, Heikinheimo M, Wilson DB. Molecular genetics of congenital diaphragmatic defects. Ann Med. 2007;39(4):261-74. Review.",
+    "https://ghr.nlm.nih.gov/condition/congenital-diaphragmatic-hernia"
+  ],
+  [
+    "Congenital diaphragmatic hernia (Cause): Congenital diaphragmatic hernia (CDH) can occur as an isolated finding, as part of a genetic syndrome or chromosome abnormality , or with additional birth defects of unknown cause. [5] Some cases have been linked to in utero exposures. [6] In the majority of cases, the cause is not known. [5]",
+    "https://rarediseases.info.nih.gov/diseases/1481/congenital-diaphragmatic-hernia"
+  ],
+  [
+    "Congenital diaphragmatic hernia (Symptoms): The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Congenital diaphragmatic hernia Very frequent Multifactorial inheritance -",
+    "https://rarediseases.info.nih.gov/diseases/1481/congenital-diaphragmatic-hernia"
+  ],
+  [
+    "Congenital diaphragmatic hernia (Prognosis): The long-term outlook ( prognosis ) for those with congenital diaphragmatic hernia (CDH) depends on a number of factors and is hard to predict. A large defect is more likely to result in pulmonary hypoplasia (underdevelopment of the lungs) and death than a small defect. [6] Other factors associated with decreased survival include: premature birth having a chromosome abnormality or\u00a0 single gene disorder the presence of other severe birth defects such as a heart defect having a right-sided defect or bilateral CDH (on both sides) liver herniation a lower fetal lung volume[5][6][4] persistent pulmonary hypertension of the newbornhemorrhagechylothoraxtertiary",
+    "https://rarediseases.info.nih.gov/diseases/1481/congenital-diaphragmatic-hernia"
+  ],
+  [
+    "Shingles: Shingles (herpes zoster) is an outbreak of rash or blisters on the skin that is caused by the same virus that causes chickenpox \u2014 the varicella-zoster virus. The first sign of shingles is often burning or tingling pain (which can be severe), or sometimes numbness or itch,generally on one side of the body. After several days or a week, a rash of fluid-filled blisters, similar to chickenpox, appears in one area on one side of the body. Shingles pain can be mild or intense. \u00a0Some people have mostly itching; some feel pain from the gentlest touch or breeze. \u00a0The most common location for shingles is a band, called a dermatome, spanning one side of the trunk around the waistline. Anyone who has had chickenpox is at risk for shingles.\u00a0 Scientists think that some of the virus particles from the original exposure to the varicella-zoster virus,leave the skin blisters and move into the nervous system.\u00a0 When the varicella-zoster virus reactivates, the virus moves back down the long nerve fibers that extend from the sensory cell bodies to the skin. \u00a0The viruses multiply, the tell-tale rash erupts, and the person now has shingles. The severity and duration of an attack of shingles can be significantly reduced by immediate treatment with antiviral drugs, which include acyclovir, valcyclovir, or famcyclovir. Antiviral drugs may also help stave off the painful after-effects of shingles known as\u00a0postherpetic neuralgia. Other treatments for postherpetic neuralgia include steroids, antidepressants, anticonvulsants (including pregabalin and gabapentin enacarbil), and topical agents. \u00a0The varicella zoster virus vaccine (Zostavax) has been approved by the food and Drug Administration for adults age 50 and older. \u00a0Researchers found that giving older adults the vaccine reduced the expected number of later cases of shingles by half. \u00a0And in people who still got the disease despite immunization, the severity and complications of shingles were dramatically reduced. The shingles vaccine is a preventive therapy and not a treatment for those who already have shingles or long-lasting nerve pain (postherpetic neuralgia). For most healthy people who receive treatment soon after the outbreak of blisters, the lesions heal, the pain subsides within 3 to 5 weeks, and the blisters often leave no scars.\u00a0 However, shingles is a serious threat in immunosuppressed individuals \u2014 for example, those with HIV infection or who are receiving cancer treatments that can weaken their immune systems.\u00a0 People who receive organ transplants are also vulnerable to shingles because they are given drugs that suppress the immune system. \u00a0 A person with a shingles rash can pass the virus to someone, usually a child, who has never had chickenpox, but the child will develop chickenpox, not shingles. \u00a0A person with chickenpox cannot give shingles to someone else. \u00a0Shingles comes from the virus hiding inside the person's body, not from an outside source.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Herpes-Zoster-Information-Page"
+  ],
+  [
+    "Shingles: Shingles is a viral infection that causes a painful rash. Although shingles can occur anywhere on your body, it most often appears as a single stripe of blisters that wraps around either the left or the right side of your torso. Shingles is caused by the varicella-zoster virus - the same virus that causes chickenpox. After you've had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles. While it isn't a life-threatening condition, shingles can be very painful. Vaccines can help reduce the risk of shingles, while early treatment can help shorten a shingles infection and lessen the chance of complications. The signs and symptoms of shingles usually affect only a small section of one side of your body. These signs and symptoms may include: - Pain, burning, numbness or tingling - Sensitivity to touch - A red rash that begins a few days after the pain - Fluid-filled blisters that break open and crust over - Itching Some people also experience: - Fever - Headache - Sensitivity to light - Fatigue Pain is usually the first symptom of shingles. For some, it can be intense. Depending on the location of the pain, it can sometimes be mistaken for a symptom of problems affecting the heart, lungs or kidneys. Some people experience shingles pain without ever developing the rash. Most commonly, the shingles rash develops as a stripe of blisters that wraps around either the left or right side of your torso. Sometimes the shingles rash occurs around one eye or on one side of the neck or face. Contact your doctor promptly if you suspect shingles, but especially in the following situations: - The pain and rash occur near an eye. If left untreated, this infection can lead to permanent eye damage. - You're 60 or older, because age significantly increases your risk of complications. - You or someone in your family has a weakened immune system (due to cancer, medications or chronic illness). - The rash is widespread and painful. Shingles is caused by the varicella-zoster virus - the same virus that causes chickenpox. Anyone who's had chickenpox may develop shingles. After you recover from chickenpox, the virus can enter your nervous system and lie dormant for years. Eventually, it may reactivate and travel along nerve pathways to your skin - producing shingles. But, not everyone who's had chickenpox will develop shingles. The reason for shingles is unclear. But it may be due to lowered immunity to infections as you grow older. Shingles is more common in older adults and in people who have weakened immune systems. Varicella-zoster is part of a group of viruses called herpes viruses, which includes the viruses that cause cold sores and genital herpes. Because of this, shingles is also known as herpes zoster. But the virus that causes chickenpox and shingles is not the same virus responsible for cold sores or genital herpes, a sexually transmitted infection. A person with shingles can pass the varicella-zoster virus to anyone who isn't immune to chickenpox. This usually occurs through direct contact with the open sores of the shingles rash. Once infected, the person will develop chickenpox, however, not shingles. Chickenpox can be dangerous for some people. Until your shingles blisters scab over, you are contagious and should avoid physical contact with anyone who hasn't yet had chickenpox or the chickenpox vaccine, especially people with weakened immune systems, pregnant women and newborns. Anyone who has ever had chickenpox can develop shingles. Most adults in the United States had chickenpox when they were children, before the advent of the routine childhood vaccination that now protects against chickenpox. Factors that may increase your risk of developing shingles include: - Being older than 50. Shingles is most common in people older than 50. The risk increases with age. Some experts estimate that half the people age 80 and older will have shingles. - Having certain diseases. Diseases that weaken your immune system, such as HIV/AIDS and cancer, can increase your risk of shingles. - Undergoing cancer treatments. Radiation or chemotherapy can lower your resistance to diseases and may trigger shingles. - Taking certain medications. Drugs designed to prevent rejection of transplanted organs can increase your risk of shingles - as can prolonged use of steroids, such as prednisone. Complications from shingles can include: - Postherpetic neuralgia. For some people, shingles pain continues long after the blisters have cleared. This condition is known as postherpetic neuralgia, and it occurs when damaged nerve fibers send confused and exaggerated messages of pain from your skin to your brain. - Vision loss. Shingles in or around an eye (ophthalmic shingles) can cause painful eye infections that may result in vision loss. - Neurological problems. Depending on which nerves are affected, shingles can cause an inflammation of the brain (encephalitis), facial paralysis, or hearing or balance problems. - Skin infections. If shingles blisters aren't properly treated, bacterial skin infections may develop. Shingles is usually diagnosed based on the history of pain on one side of your body, along with the telltale rash and blisters. Your doctor may also take a tissue scraping or culture of the blisters for examination in the laboratory. There's no cure for shingles, but prompt treatment with prescription antiviral drugs can speed healing and reduce your risk of complications. These medications include: - Acyclovir (Zovirax) - Valacyclovir (Valtrex) Shingles can cause severe pain, so your doctor also may prescribe: - Capsaicin topical patch (Qutenza) - Anticonvulsants, such as gabapentin (Neurontin) - Tricyclic antidepressants, such as amitriptyline - Numbing agents, such as lidocaine, delivered via a cream, gel, spray or skin patch - Medications that contain narcotics, such as codeine - An injection including corticosteroids and local anesthetics Shingles generally lasts between two and six weeks. Most people get shingles only once, but it is possible to get it two or more times. Taking a cool bath or using cool, wet compresses on your blisters may help relieve the itching and pain. And, if possible, try to reduce the amount of stress in your life.",
+    "https://www.mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054"
+  ],
+  [
+    "Shingles: Shingles is a disease that affects your nerves. It can cause burning, shooting pain, tingling, and/or itching, as well as a rash and blisters.You may recall having chickenpox as a child. Shingles is caused by the same virus, the varicella-zoster virus (VZV). After you recover from chickenpox, the virus continues to live in some of your nerve cells. It is usually inactive, so you don't even know it's there.In fact, most adults live with VZV in their bodies and never get shingles. But, for about one in three adults, the virus will become active again. Instead of causing another case of chickenpox, it produces shingles. We do not totally understand what makes the virus go from inactive to active.Having shingles doesn't mean you have any other underlying disease. Everyone who has had chickenpox has VZV in their body and is at risk for getting shingles. Right now, there is no way of knowing who will get the disease. But, some things make it more likely:- Advanced age. The risk of getting shingles increases as you age. People may have a harder time fighting off infections as they get older. About half of all shingles cases are in adults age 60 or older. The chance of getting shingles becomes much greater by age 70. - Trouble fighting infections. Your immune system is the part of your body that responds to infections. Age can affect your immune system. So can an HIV infection, cancer, cancer treatments, too much sun, or organ transplant drugs. Even stress or a cold can weaken your immune system for a short time. These all can put you at risk for shingles. Shingles is not contagious. You can't catch it from someone. But, you can catch chickenpox from someone with shingles. So, if you've never had chickenpox, try to stay away from anyone who has shingles.If you have shingles, try to stay away from anyone who has not had chickenpox or who might have a weak immune system. Usually, shingles develops only on one side of the body or face and in a small area rather than all over. The most common place for shingles is a band that goes around one side of your waistline.Most people have some of the following shingles symptoms:- Burning, tingling, or numbness of the skin - Feeling sick-chills, fever, upset stomach, or headache - Fluid-filled blisters - Skin that is sensitive to touch - Mild itching to strong painDepending on where shingles develops, it could also cause symptoms like hiccups or even loss of vision.For some people, the symptoms of shingles are mild. They might just have some itching. For others, shingles can cause intense pain that can be felt from the gentlest touch or breeze. Most cases of shingles last 3 to 5 weeks. Shingles follows a pattern:- The first sign is often burning or tingling pain; sometimes, it includes numbness or itching on one side of the body. - Somewhere between 1 and 5 days after the tingling or burning feeling on the skin, a red rash will appear. - A few days later, the rash will turn into fluid-filled blisters. - About a week to 10 days after that, the blisters dry up and crust over. - A couple of weeks later, the scabs clear up.Most people get shingles only one time. But, it is possible to have it more than once. After the shingles rash goes away, some people may be left with ongoing pain called post-herpetic neuralgia or PHN. The pain is felt in the area where the rash had been. For some people, PHN is the longest lasting and worst part of shingles. The older you are when you get shingles, the greater your chance of developing PHN.The PHN pain can cause depression, anxiety, sleeplessness, and weight loss. Some people with PHN find it hard to go about their daily activities, like dressing, cooking, and eating. Talk with your doctor if you have any of these problems.There are medicines that may help with PHN. Steroids may lessen the pain and shorten the time you're sick. Analgesics, antidepressants, and anticonvulsants may also reduce the pain. Usually, PHN will get better over time.Some people have other problems that last after shingles has cleared up. For example, the blisters caused by shingles can become infected. They may also leave a scar. It is important to keep the area clean and try not to scratch the blisters. Your doctor can prescribe an antibiotic treatment if needed.See your doctor right away if you notice blisters on your face-this is an urgent problem. Blisters near or in the eye can cause lasting eye damage or blindness. Hearing loss, a brief paralysis of the face, or, very rarely, swelling of the brain (encephalitis) can also occur. If you think you might have shingles, talk to your doctor as soon as possible. It's important to see your doctor no later than 3 days after the rash starts. The doctor will confirm whether or not you have shingles and can make a treatment plan. Although there is no cure for shingles, early treatment with drugs that fight the virus can help the blisters dry up faster and limit severe pain. Shingles can often be treated at home. People with shingles rarely need to stay in a hospital. The shingles vaccine is a safe and easy, one-time shot that may keep you from getting shingles. Most people age 60 and older should get vaccinated. You should get the shot even if you have already had shingles or don't remember having chickenpox. However, if you have a weak immune system or allergies to certain medicines, make sure to check with your doctor first.You can get the shingles vaccine at your doctor's office and at some pharmacies. All Medicare Part D plans and most private health insurance plans will cover the cost. If you have shingles, here are some tips that might help you feel better:- Get plenty of rest and eat well-balanced meals. - Try simple exercises like stretching or walking. Check with your doctor before starting a new exercise routine. - Apply a cool washcloth to your blisters to ease the pain and help dry the blisters. - Do things that take your mind off your pain. For example, watch TV, read, talk with friends, listen to relaxing music, or work on a hobby you like. - Avoid stress. It can make the pain worse. - Wear loose-fitting, natural-fiber clothing. - Take an oatmeal bath or use calamine lotion to see if it soothes your skin. - Share your feelings about your pain with family and friends. Ask for their understanding.Also, you can limit spreading the virus by:- Keeping the rash covered - Not touching or scratching the rash - Washing your hands oftenRead about this topic in Spanish. Lea sobre este tema en espanol.",
+    "https://www.nia.nih.gov/health/topics/shingles"
+  ],
+  [
+    "Shingles (How Do You Get Shingles?): Everyone who has had chickenpox has VZV in their body and is at risk for getting shingles. Right now, there is no way of knowing who will get the disease. But, some things make it more likely:- Advanced age. The risk of getting shingles increases as you age. People may have a harder time fighting off infections as they get older. About half of all shingles cases are in adults age 60 or older. The chance of getting shingles becomes much greater by age 70. - Trouble fighting infections. Your immune system is the part of your body that responds to infections. Age can affect your immune system. So can an HIV infection, cancer, cancer treatments, too much sun, or organ transplant drugs. Even stress or a cold can weaken your immune system for a short time. These all can put you at risk for shingles.",
+    "https://www.nia.nih.gov/health/topics/shingles"
+  ],
+  [
+    "Shingles: Shingles (herpes zoster) is a painful, blistering skin rash. It is caused by the varicella-zoster virus. This is\u00a0the virus that also causes chickenpox. After you get chickenpox, the virus remains inactive (becomes dormant) in certain nerves in the body. Shingles occurs after the virus becomes active again in these nerves after many years. Many people had such a mild case of chickenpox that they\u00a0do not\u00a0realize they have had the infection. The reason the virus suddenly becomes active again is not clear. Often only one attack occurs. Shingles can develop in any age group. You are more likely to develop the condition if: - You are older than age 60 - You had chickenpox before age 1 - Your immune system is weakened by medicines or disease If an adult or child has direct contact with the shingles rash and did not have chickenpox as a child or get\u00a0the chickenpox vaccine, they can develop chickenpox, not shingles. The first symptom is usually pain, tingling, or burning that occurs on one side of the body. The pain and burning may be severe and\u00a0are usually present before any rash appears. Red patches on the skin, followed by small blisters, form in most people: - The blisters break, forming small\u00a0sores that begin to dry and form crusts. The crusts fall off in 2 to 3 weeks. Scarring is rare. - The rash usually involves a narrow area from the spine around to the front of the abdomen or chest. - The rash may involve the\u00a0face, eyes, mouth, and ears. Other symptoms may include: - Fever and chills - General ill feeling - Headache - Joint pain - Swollen glands (lymph nodes) You may also have pain, muscle weakness, and a rash involving different parts of your face if shingles affects a nerve in your face. The symptoms may include: - Difficulty moving some of the muscles in the face - Drooping eyelid (ptosis) - Hearing loss - Loss of eye motion - Taste problems - Vision problems Your health care provider can make the diagnosis by looking at your skin and asking about your medical history. Tests are rarely needed, but may include taking a skin sample to see if the skin is infected with the virus. Blood tests may show an increase in white blood cells and antibodies to the chickenpox virus. But the tests\u00a0cannot confirm that the rash is due to shingles. Your provider may prescribe a medicine that fights the virus, called an antiviral drug. This drug helps reduce pain, prevent complications, and shorten the course of the disease. The medicines are most effective when started within 72 hours of when you first feel pain or burning. It is best to start taking them before the blisters appear. The medicines are usually given in pill form. Some people may need to receive the medicine through a vein (by IV). Strong anti-inflammatory medicines called corticosteroids, such as prednisone, may be used to reduce swelling and pain. These medicines\u00a0do not\u00a0work in all people. Other medicines may include: - Antihistamines to reduce itching (taken by mouth or applied to the skin) - Pain medicines - Zostrix, a cream containing capsaicin (an extract of pepper) to reduce pain Follow your provider's instructions about how to care for yourself at home. Other measures may include: - Caring for your skin by applying cool, wet compresses to reduce pain, and taking soothing baths - Resting in bed until the fever goes down Stay away from people while your sores are oozing to avoid infecting those who have never had chickenpox -- especially pregnant women. Herpes zoster usually clears in 2 to 3 weeks and rarely returns. If the virus affects the nerves that control movement (the motor nerves), you may have temporary or permanent weakness or paralysis. Sometimes the pain in the area where the shingles occurred may last from months to years. This pain is called postherpetic neuralgia. It occurs when the nerves have been damaged after an outbreak of shingles. Pain ranges from mild to very severe. Postherpetic neuralgia is more likely to occur in people over age 60. Complications may include: - Another attack of shingles - Bacterial skin infections - Blindness (if shingles occurs in the eye) - Deafness - Infection, including encephalitis of sepsis (blood infection) in people with a weakened immune system - Ramsay Hunt syndrome if shingles affects the nerves of the face or ear Call your provider if you have symptoms of shingles, particularly if you have a weakened immune system or if your symptoms persist or worsen. Shingles that affects the eye may lead to permanent blindness if you\u00a0do not receive emergency medical care. Do not touch the rash and blisters on people with shingles or chickenpox if you have never had chickenpox or the chickenpox vaccine. A shingles vaccine is available. It is different than the chickenpox vaccine. Older adults who receive the herpes zoster vaccine are less likely to have complications from shingles.\u00a0 Updated by: Arnold Lentnek, MD, Infectious Diseases Medical Practice of NY and Clinical Research Centers of CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000858.htm"
+  ],
+  [
+    "Shingles (Zoster) Vaccine (What is shingles?): Shingles is a painful skin rash, often with blisters. It is also called Herpes Zoster or just Zoster. A shingles rash usually appears on one side of the face or body and lasts from 2 to 4 weeks. Its main symptom is pain, which can be quite severe. Other symptoms of shingles can include fever, headache, chills, and upset stomach. Very rarely, a shingles infection can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis), or death. For about one person in five, severe pain can continue even after the rash clears up. This is called post-herpetic neuralgia. Shingles is caused by the Varicella Zoster virus, the same virus that causes chickenpox. Only someone who has had chickenpox, or rarely, has gotten chickenpox vaccine, can get shingles. The virus stays in your body, and can cause shingles many years later. You can't catch shingles from another person with shingles. However, a person who has never had chickenpox (or chickenpox vaccine) could get chickenpox from someone with shingles. This is not very common. Shingles is far more common in people 50 and older than in younger people. It is also more common in people whose immune systems are weakened because of a disease such as cancer, or drugs such as steroids or chemotherapy. At least 1 million people a year in the United States get shingles.",
+    "https://medlineplus.gov/druginfo/meds/a607025.html"
+  ],
+  [
+    "Shingles (What Are the Symptoms of Shingles?): Usually, shingles develops only on one side of the body or face and in a small area rather than all over. The most common place for shingles is a band that goes around one side of your waistline.Most people have some of the following shingles symptoms:- Burning, tingling, or numbness of the skin - Feeling sick-chills, fever, upset stomach, or headache - Fluid-filled blisters - Skin that is sensitive to touch - Mild itching to strong painDepending on where shingles develops, it could also cause symptoms like hiccups or even loss of vision.For some people, the symptoms of shingles are mild. They might just have some itching. For others, shingles can cause intense pain that can be felt from the gentlest touch or breeze.",
+    "https://www.nia.nih.gov/health/topics/shingles"
+  ],
+  [
+    "Lupus anticoagulants and antiphospholipid antibodies (Treatment): LUPUS ANTICOAGULANT OR APL Often, you will not need treatment if you do not have symptoms or if you have never had a blood clot in the past. Take the following steps to help prevent blood clots from forming: - Avoid most birth control pills or hormone treatments for menopause (women). - DO NOT smoke or use other tobacco products. - Get up and move around during long plane flights or other times when you have to sit or lie down for extended periods. - Move your ankles up and down when you cannot move around. You will be prescribed blood-thinning medicines (such as heparin and warfarin) to help prevent blood clots: - After surgery - After a bone fracture - With active cancer - When you need to set or lie down for long periods of time, such as during a hospital stay or recovering at home You may also need to take blood thinners for 3 to 4 weeks after surgery to lower your risk of blood clots. ANTIPHOSPHOLIPID ANTIBODY SYNDROME (APS) In general, you will need long-term treatment with a blood thinner for a long time if you have the APS. Initial treatment may be heparin, either unfractionated or low-molecular heparin. These medicines are given by injection. In most cases, warfarin (Coumadin), which is given by mouth, is then started. It is necessary to monitor the level of anticoagulation frequently. This is most often done using the INR test. If you have APS and become pregnant, you will need to be followed closely by a provider expert in this condition. You will not take warfarin during pregnancy, but will be given low-molecular weight heparin instead. If you have SLE and APS your provider will also recommend that you take hydroxychloroquine.",
+    "https://medlineplus.gov/ency/article/000547.htm"
+  ],
+  [
+    "What are the genetic changes related to autoimmune polyglandular syndrome, type 1?: Mutations in the AIRE gene cause autoimmune polyglandular syndrome, type 1. The AIRE gene provides instructions for making a protein called the autoimmune regulator. As its name suggests, this protein plays a critical role in regulating certain aspects of immune system function. Specifically, it helps the body distinguish its own proteins and cells from those of foreign invaders (such as bacteria and viruses). This distinction is critical because to remain healthy, a person's immune system must be able to identify and destroy potentially harmful invaders while sparing the body's normal tissues. Mutations in the AIRE gene reduce or eliminate the function of the autoimmune regulator protein. Without enough of this protein, the immune system can turn against itself and attack the body's own organs. This reaction, which is known as autoimmunity, results in inflammation and can damage otherwise healthy cells and tissues. Damage to the adrenal glands, parathyroid glands, and other organs underlies many of the major features of autoimmune polyglandular syndrome, type 1. It remains unclear why people with this condition tend to get candidiasis infections. Although most of the characteristic features of autoimmune polyglandular syndrome, type 1 result from mutations in the AIRE gene, researchers believe that variations in other genes may help explain why the signs and symptoms of this condition can vary among affected individuals.",
+    "https://ghr.nlm.nih.gov/condition/autoimmune-polyglandular-syndrome-type-1"
+  ],
+  [
+    "Schizoaffective disorder (Treatment): People with schizoaffective disorder generally respond best to a combination of medications, psychotherapy and life skills training. Treatment varies, depending on the type and severity of symptoms, and whether the disorder is the depressive or bipolar type. In some cases, hospitalization may be needed. Long-term treatment can help to manage the symptoms. Medications In general, doctors prescribe medications for schizoaffective disorder to relieve psychotic symptoms, stabilize mood and treat depression. These medications may include: - Antipsychotics. The only medication approved by the Food and Drug Administration specifically for the treatment of schizoaffective disorder is the antipsychotic drug paliperidone (Invega). However, doctors may prescribe other antipsychotic drugs to help manage psychotic symptoms such as delusions and hallucinations. - Mood-stabilizing medications. When the schizoaffective disorder is bipolar type, mood stabilizers can help level out the mania highs and depression lows. - Antidepressants. When depression is the underlying mood disorder, antidepressants can help manage feelings of sadness, hopelessness, or difficulty with sleep and concentration. Psychotherapy In addition to medication, psychotherapy, also called talk therapy, may help. Psychotherapy may include: - Individual therapy. Psychotherapy may help to normalize thought patterns and reduce symptoms. Building a trusting relationship in therapy can help people with schizoaffective disorder better understand their condition and learn to manage symptoms. Effective sessions focus on real-life plans, problems and relationships. - Family or group therapy. Treatment can be more effective when people with schizoaffective disorder are able to discuss their real-life problems with others. Supportive group settings can also help decrease social isolation and provide a reality check during periods of psychosis. Life skills training Learning social and vocational skills can help reduce isolation and improve quality of life. - Social skills training. This focuses on improving communication and social interactions and improving the ability to participate in daily activities. New skills and behaviors specific to settings such as the home or workplace can be practiced. - Vocational rehabilitation and supported employment. This focuses on helping people with schizoaffective disorder prepare for, find and keep jobs. Hospitalization During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep, and basic personal care and cleanliness. Electroconvulsive therapy For adults with schizoaffective disorder who do not respond to psychotherapy or medications, electroconvulsive therapy (ECT) may be considered.",
+    "https://www.mayoclinic.org/diseases-conditions/schizoaffective-disorder/symptoms-causes/syc-20354504"
+  ],
+  [
+    "Bipolar disorder (Treatment): The main goal of treatment is to: - Make the episodes less frequent and severe - Help you function well and enjoy your life at home and at work - Prevent self-injury and suicide MEDICINES Medicines are a key part of treating bipolar disorder. Most often, the first medicines used are called mood stabilizers. They help you avoid mood swings and extreme changes in activity and energy levels. With medicines, you may begin to feel better. For some, symptoms of mania may feel good. Or side effects from the medicines may occur. As a result, you may be tempted to stop taking your medicine or change the way you are taking them. But stopping your medicines or taking them in the wrong way can cause symptoms to come back or become much worse. DO NOT stop taking or change the dosages of your medicines. Talk with your provider first, if you have questions about your medicines. Ask family members or friends to help you take medicines the right way. This means taking the right dose at the right time. They can also help make sure that episodes of mania and depression are treated as soon as possible. If mood stabilizers do not help, your provider may suggest other medicines, such as antipsychotics or antidepressants. You will need regular visits with a psychiatrist to talk about your medicines and their possible side effects. Blood tests are often needed too. OTHER TREATMENTS Electroconvulsive therapy (ECT) may be used to treat the manic or depressive phase if it does not respond to medicine. People who are in the middle of a severe manic or depressive episode may need to stay in a hospital until they are stable and their behavior is under control. SUPPORT PROGRAMS AND TALK THERAPY Joining a support group may help you and your loved ones. Involving family members and caregivers in your treatment may help reduce the chance of symptoms returning. Important skills you may learn at such programs include how to: - Cope with symptoms that continue even while you are taking medicines - Get enough sleep and stay away from recreational drugs - Take medicines correctly and manage side effects - Watch for the return of symptoms, and know what to do when they return - Find out what triggers the episodes and avoid these triggers Talk therapy with a mental health provider may be helpful for people with bipolar disorder.",
+    "https://medlineplus.gov/ency/article/000926.htm"
+  ],
+  [
+    "Borderline personality disorder (Treatment): Borderline personality disorder is mainly treated using psychotherapy, but medication may be added. Your doctor also may recommend hospitalization if your safety is at risk. Treatment can help you learn skills to manage and cope with your condition. With treatment, you can feel better about yourself and live a more stable, rewarding life. Psychotherapy Psychotherapy - also called talk therapy - is a fundamental treatment approach for borderline personality disorder. Your therapist may adapt the type of therapy to best meet your needs. The goals of psychotherapy are to help you: - Focus on you current ability to function - Learn to manage emotions that feel uncomfortable - Reduce your impulsiveness by helping you observe feelings rather than acting on them - Work on improving relationships by being aware of your feelings and those of others - Learn about borderline personality disorder Types of psychotherapy that have been found to be effective include: - Dialectical behavior therapy (DBT). DBT can include group or individual therapy designed specifically to treat borderline personality disorder. DBT uses a skills-based approach to teach you how to manage your emotions, tolerate distress and improve relationships. - Schema-focused therapy. Schema-focused therapy can be done individually or in a group. It can help you identify unmet needs that have led to negative life patterns, which at some time may have been helpful for survival, but as an adult are hurtful in many areas of your life. Therapy focuses on helping you get your needs met in a healthy manner to promote positive life patterns. - Mentalization-based therapy (MBT). MBT is a type of talk therapy that helps you identify your own thoughts and feelings at any given moment and create an alternate perspective on the situation. MBT emphasizes thinking before reacting. - Systems training for emotional predictability and problem-solving (STEPPS). STEPPS is a 20-week treatment which involves working in groups that incorporate your family members, caregivers, friends or significant others into treatment. STEPPS is used in addition to other types of psychotherapy. - Transference-focused psychotherapy (TFP). Also called psychodynamic psychotherapy, TFP aims to help you understand your emotions and interpersonal difficulties through the developing relationship between you and your therapist. You then apply these insights to ongoing situations. - General psychiatric management. This treatment approach relies on case management and focuses on making sense of emotionally difficult moments by considering the interpersonal context for feelings. It may integrate medications, groups, family education and individual therapy. Medications Although no drugs have been approved by the Food and Drug Administration specifically for the treatment of borderline personality disorder, certain medications may help with symptoms or co-occurring problems such as depression, impulsiveness, aggression or anxiety. Medications may include antidepressants, antipsychotics or mood-stabilizing drugs. Talk to your doctor about the benefits and side effects of medications. Hospitalization At times, you may need more-intense treatment in a psychiatric hospital or clinic. Hospitalization may also keep you safe from self-injury or address suicidal thoughts or behaviors. Recovery takes time Learning to manage your emotions, thoughts and behaviors takes time. You may need many months or years of treatment, and you may always struggle with some symptoms of borderline personality disorder. You may experience times when your symptoms are better or worse. But treatment can improve your ability to function and help you feel better about yourself. Because treatment can be intense and long term, you have the best chance for success when you consult mental health providers who have experience treating borderline personality disorder.",
+    "https://www.mayoclinic.org/diseases-conditions/borderline-personality-disorder/symptoms-causes/syc-20370237"
+  ],
+  [
+    "Hoarding disorder (Treatment): Treatment of hoarding disorder can be challenging because many people don't recognize the negative impact of hoarding on their lives or don't believe they need treatment. This is especially true if the possessions or animals offer comfort. If these possessions or animals are taken away, people will often react with frustration and anger and quickly collect more to help fulfill emotional needs. The main treatment for hoarding disorder is cognitive behavioral therapy. Medications may be added, particularly if you also have anxiety or depression. Psychotherapy Psychotherapy, also called talk therapy, is the primary treatment. Cognitive behavioral therapy is the most common form of psychotherapy used to treat hoarding disorder. Try to find a therapist or other mental health professional with experience in treating hoarding disorder. As part of cognitive behavioral therapy, you may: - Learn to identify and challenge thoughts and beliefs related to acquiring and saving items - Learn to resist the urge to acquire more items - Learn to organize and categorize possessions to help you decide which ones to discard - Improve your decision-making and coping skills - Declutter your home during in-home visits by a therapist or professional organizer - Learn to reduce isolation and increase social involvement with more meaningful activities - Learn ways to enhance motivation for change - Attend family or group therapy - Have periodic visits or ongoing treatment to help you keep up healthy habits Treatment often involves routine assistance from family, friends and agencies to help remove clutter. This is particularly the case for the elderly or those struggling with medical conditions that may make it difficult to maintain effort and motivation. Children with hoarding disorder For children with hoarding disorder, it's important to have the parents involved in treatment. Sometimes called \"family accommodation,\" over the years, some parents may think that allowing their child to get and save countless items may help lower their child's anxiety. Actually it may do the opposite, increasing anxiety. So, in addition to therapy for the child, parents need professional guidance to learn how to respond to and help manage their child's hoarding behavior. Medications There are currently no medications approved by the Food and Drug Administration (FDA) to treat hoarding disorder. Typically, medications are used to treat other disorders such as anxiety and depression that often occur along with hoarding disorder. The medications most commonly used are a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). Research continues on the most effective ways to use medications in the treatment of hoarding disorder.",
+    "https://www.mayoclinic.org/diseases-conditions/hoarding-disorder/symptoms-causes/syc-20356056"
+  ],
+  [
+    "Schizoid personality disorder (Treatment): People with this disorder will often not seek treatment. For this reason, little is known about which treatments work. Talk therapy may not be effective. This is because people with this disorder may have a hard time forming a good working relationship with a therapist. One approach that seems to help is to put fewer demands for emotional closeness or intimacy on the person. People with schizoid personality disorder often do well in relationships that don't focus on emotional closeness. They tend to be better at handling relationships that focus on: - Work - Intellectual activities - Expectations",
+    "https://medlineplus.gov/ency/article/000920.htm"
+  ],
+  [
+    "Alcohol use disorder (Treatment): Treatment for alcohol use disorder can vary, depending on your needs. Treatment may involve a brief intervention, individual or group counseling, an outpatient program, or a residential inpatient stay. Working to stop the use of alcohol to improve quality of life is the main treatment goal. Treatment for alcohol use disorder may include: - Detox and withdrawal. Treatment may begin with a program of detoxification or detox - withdrawal that's medically managed - which generally takes two to seven days. You may need to take sedating medications to prevent withdrawal symptoms. Detox is usually done at an inpatient treatment center or a hospital. - Learning skills and establishing a treatment plan. This usually involves alcohol treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center. - Psychological counseling. Counseling and therapy for groups and individuals help you better understand your problem with alcohol and support recovery from the psychological aspects of alcohol use. You may benefit from couples or family therapy - family support can be an important part of the recovery process. - Oral medications. Naltrexone (Revia), a drug that blocks the good feelings alcohol causes, may prevent heavy drinking and reduce the urge to drink. Acamprosate (Campral) may help combat alcohol cravings once you stop drinking. Disulfiram (Antabuse) may help to prevent you from drinking, though it won't cure alcohol use disorder or remove the compulsion to drink. If you drink alcohol, the drug produces a physical reaction that may include flushing, nausea, vomiting and headaches. Unlike disulfiram, naltrexone and acamprosate don't make you feel sick after taking a drink. - Injected medication. Vivitrol, a version of the drug naltrexone, is injected once a month by a health care professional. Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol use disorder to use consistently. - Continuing support. Aftercare programs and support groups help people recovering from alcohol use disorder to stop drinking, manage relapses and cope with necessary lifestyle changes. This may include medical or psychological care or attending a support group. - Treatment for psychological problems. Alcohol use disorder commonly occurs along with other mental health disorders. If you have depression, anxiety or another mental health condition, you may need talk therapy (psychotherapy), medications or other treatment. - Medical treatment for health conditions. Many alcohol-related health problems improve significantly once you stop drinking. But some health conditions may warrant continued treatment and follow-up. - Spiritual practice. People who are involved with some type of regular spiritual practice may find it easier to maintain recovery from alcohol use disorder or other addictions. For many people, gaining greater insight into their spiritual side is a key element in recovery. Residential treatment programs For a serious alcohol problem, you may need a stay at a residential treatment facility. Most residential treatment programs include individual and group therapy, support groups, educational lectures, family involvement and activity therapy. Residential treatment programs typically include licensed alcohol and drug counselors, social workers, nurses, doctors and others with expertise and experience in treating alcohol use disorder.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Social anxiety disorder (social phobia) (Treatment): Treatment depends on how much social anxiety disorder affects your ability to function in daily life. The two most common types of treatment for social anxiety disorder are psychotherapy (also called psychological counseling or talk therapy) or medications or both. Psychotherapy Psychotherapy improves symptoms in most people with social anxiety disorder. In therapy, you learn how to recognize and change negative thoughts about yourself and develop skills to help you gain confidence in social situations. Cognitive behavioral therapy is the most effective type of psychotherapy for anxiety, and it can be equally effective when conducted individually or in groups. In exposure-based cognitive behavioral therapy, you gradually work up to facing the situations you fear most. This can improve your coping skills and help you develop the confidence to deal with anxiety-inducing situations. You may also participate in skills training or role-playing to practice your social skills and gain comfort and confidence relating to others. Practicing exposures to social situations is particularly helpful to challenge your worries. First choices in medications Though several types of medications are available, selective serotonin reuptake inhibitors (SSRIs) are often the first type of drug tried for persistent symptoms of social anxiety. Your doctor may prescribe paroxetine (Paxil) or sertraline (Zoloft). The serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor XR) also may be an option for social anxiety disorder. To reduce the risk of side effects, your doctor may start you at a low dose of medication and gradually increase your prescription to a full dose. It may take several weeks to several months of treatment for your symptoms to noticeably improve. Other medications Your doctor may also prescribe other medications for symptoms of social anxiety, such as: - Other antidepressants. You may have to try several different antidepressants to find one that's the most effective for you with the fewest side effects. - Anti-anxiety medications. Benzodiazepines (ben-zoe-die-AZ-uh-peens) may reduce your level of anxiety. Although they often work quickly, they can be habit-forming and sedating, so they're typically prescribed for only short-term use. - Beta blockers. These medications work by blocking the stimulating effect of epinephrine (adrenaline). They may reduce heart rate, blood pressure, pounding of the heart, and shaking voice and limbs. Because of that, they may work best when used infrequently to control symptoms for a particular situation, such as giving a speech. They're not recommended for general treatment of social anxiety disorder. Stick with it Don't give up if treatment doesn't work quickly. You can continue to make strides in psychotherapy over several weeks or months. And finding the right medication for your situation can take some trial and error. For some people, the symptoms of social anxiety disorder may fade over time, and medication can be discontinued. Others may need to take medication for years to prevent a relapse. To make the most of treatment, keep your medical or therapy appointments, challenge yourself by setting goals to approach social situations that cause you anxiety, take medications as directed, and talk to your doctor about any changes in your condition. Alternative medicine Several herbal remedies have been studied as treatments for anxiety. Results tend to be mixed, and in several studies people report no benefits from their use. More research is needed to fully understand the risks and benefits. Some herbal supplements, such as kava and valerian, increase the risk of serious liver damage. Other supplements, such as passionflower or theanine, may have a calming effect, but they're often combined with other products so it's hard to tell whether they help with symptoms of anxiety. Before taking any herbal remedies or supplements, talk with your doctor to make sure they're safe and won't interact with any medications you take.",
+    "https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561"
+  ],
+  [
+    "Schizoaffective disorder (Treatment): Treatment can vary. In general, your provider will prescribe medicines to improve your mood and treat psychosis: - Antipsychotic medicines are used to treat psychotic symptoms. - Antidepressant medicines, or mood stabilizers, may be prescribed to improve mood. Talk therapy can help with creating plans, solving problems, and maintaining relationships. Group therapy can help with social isolation. Support and work training may be helpful for work skills, relationships, money management, and living situations.",
+    "https://medlineplus.gov/ency/article/000930.htm"
+  ],
+  [
+    "Methadone: [Posted 09/20/2017] AUDIENCE: Health Professional, Pain Management ISSUE: Based on additional review, FDA is advising that the opioid addiction medications buprenorphine and methadone should not be withheld from patients taking benzodiazepines or other drugs that depress the central nervous system (CNS). The combined use of these drugs increases the risk of serious side effects; however, the harm caused by untreated opioid addiction usually outweighs these risks. Careful medication management by health care professionals can reduce these risks. FDA is requiring this information to be added to the buprenorphine and methadone drug labels along with detailed recommendations for minimizing the use of medication-assisted treatment (MAT) drugs and benzodiazepines together. BACKGROUND: Many patients with opioid dependence may also use benzodiazepines or other CNS depressants, either under a health care professional's direction or illicitly. Although there are serious risks with combining these medicines, excluding patients from MAT or discharging patients from treatment because of use of benzodiazepines or CNS depressants is not likely to stop them from using these drugs together. Instead, the combined use may continue outside the treatment setting, which could result in more severe outcomes. RECOMMENDATIONS: Health care professionals should take several actions and precautions and develop a treatment plan when buprenorphine or methadone is used in combination with benzodiazepines or other CNS depressants. These include: - Educating patients about the serious risks of combined use, including overdose and death, that can occur with CNS depressants even when used as prescribed, as well as when used illicitly. - Developing strategies to manage the use of prescribed or illicit benzodiazepines or other CNS depressants when starting MAT. - Tapering the benzodiazepine or CNS depressant to discontinuation if possible. - Verifying the diagnosis if a patient is receiving prescribed benzodiazepines or other CNS depressants for anxiety or insomnia, and considering other treatment options for these conditions. - Recognizing that patients may require MAT medications indefinitely and their use should continue for as long as patients are benefiting and their use contributes to the intended treatment goals. - Coordinating care to ensure other prescribers are aware of the patient's buprenorphine or methadone treatment. - Monitoring for illicit drug use, including urine or blood screening. Patients taking MAT drugs should continue to take these medicines as prescribed. Do not stop taking other prescribed medicines without first talking to your health care professional. Before starting any new medicines, tell your health care professional that you are taking MAT. Do not take non-prescribed benzodiazepines or other sedatives (See Table 2 in the Drug Safety Communication, available at: http://bit.ly/2fdAzZI, List of Benzodiazepines and Other CNS Depressants) or use alcohol when taking MAT because the combined use increases the possibility of harm, including overdose and death. For more information visit the FDA website at: http://www.fda.gov/Safety/MedWatch/SafetyInformation and http://www.fda.gov/Drugs/DrugSafety. Methadone may cause serious or life-threatening breathing problems, especially during the first 24 to 72 hours of your treatment and any time your dose is increased. Your doctor will monitor you carefully during your treatment. Tell your doctor if you have or have ever had slowed breathing or asthma. Your doctor will probably tell you not to take methadone. Also tell your doctor if you have or have ever had lung disease such as chronic obstructive pulmonary disease (COPD; a group of lung diseases that includes chronic bronchitis and emphysema), a head injury, or any condition that increases the amount of pressure in your brain. The risk that you will develop breathing problems may be higher if you are an older adult or are weak or malnourished due to disease. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment: slowed breathing, long pauses between breaths, or shortness of breath. Taking certain other medications during your treatment with methadone may increase the risk that you will experience serious, life-threatening side effects such as breathing problems, sedation, or coma. Tell your doctor if you are taking or plan to take any of the following medications: benzodiazepines such as alprazolam (Xanax), diazepam (Diastat, Valium), estazolam, flurazepam, lorazepam (Ativan), and triazolam (Halcion); other narcotic pain medications; medications for nausea or mental illness; muscle relaxants; sedatives; sleeping pills; or tranquilizers. Your doctor may need to change the doses of your medications and will monitor you carefully. If you take methadone with any of these medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own. Drinking alcohol, taking prescription or nonprescription medications that contain alcohol, or using street drugs during your treatment with methadone increases the risk that you will experience serious, life-threatening side effects. Do not drink alcohol, take prescription or nonprescription medications that contain alcohol, or use street drugs during your treatment. Methadone may be habit-forming. Do not take a larger dose, take it more often, or take it for a longer period of time or in a different way than prescribed by your doctor. Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, or has overused prescription medications, or if you have or have ever had depression or another mental illness. There is a greater risk that you will overuse methadone if you have or have ever had any of these conditions. Do not allow anyone else to take your medication. Methadone may harm or cause death to other people who take your medication, especially children. Store methadone in a safe place so that no one else can take it accidentally or on purpose. Be especially careful to keep methadone out of the reach of children. Keep track of how many tablets or how much liquid is left so you will know if any medication is missing. Dispose of any unwanted methadone tablets or oral solution properly according to instructions. (See STORAGE and DISPOSAL.) Methadone may cause a prolonged QT interval (a rare heart problem that may cause irregular heartbeat, fainting, or sudden death). Tell your doctor if you or anyone in your family has or has ever had long QT syndrome; or if you have or ever had a slow or irregular heartbeat; low blood levels of potassium or magnesium, or heart disease. Tell your doctor and pharmacist if you are taking or plan to take any of the following medications: antidepressants such as amitriptyline, amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); certain antifungals such as fluconazole (Diflucan), itraconazole (Onmel, Sporanox), ketoconazole (Nizoral), and voriconazole (Vfend); diuretics ('water pills'); erythromycin (Eryc, Erythrocin, others); fludrocortisone; certain laxatives; medications for irregular heartbeat such as amiodarone (Cordarone, Nexterone, Pacerone), disopyramide (Norpace), dofetilide (Tikosyn), flecainide, ibutilide (Corvert), procainamide, and quinidine (in Nuedexta); nicardipine (Cardene); risperidone (Risperdal); and sertraline (Zoloft). If you experience any of the following symptoms, call your doctor immediately: pounding heartbeat, dizziness, lightheadedness, or fainting. Tell your doctor if you are pregnant or plan to become pregnant. If you take methadone regularly during your pregnancy, your baby may experience life-threatening withdrawal symptoms after birth. Tell your baby's doctor right away if your baby experiences any of the following symptoms: irritability, hyperactivity, abnormal sleep, high-pitched cry, uncontrollable shaking of a part of the body, vomiting, diarrhea, or failure to gain weight. Talk to your doctor about the risks of taking methadone for your condition. Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with methadone and each time you fill your prescription if a Medication Guide is available for the methadone product you are taking. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide. Use of methadone to treat opiate addiction: If you have been addicted to an opiate (narcotic drug such as heroin), and you are taking methadone to help you stop taking or continue not taking the drug, you must enroll in a treatment program. The treatment program must be approved by the state and federal governments and must treat patients according to specific federal laws. You may have to take your medication at the treatment program facility under the supervision of the program staff. Ask your doctor or the treatment program staff if you have any questions about enrolling in the program or taking or getting your medication. Methadone is used to relieve severe pain in people who are expected to need pain medication around the clock for a long time and who cannot be treated with other medications. It also is used to prevent withdrawal symptoms in patients who were addicted to opiate drugs and are enrolled in treatment programs in order to stop taking or continue not taking the drugs. Methadone is in a class of medications called opiate (narcotic) analgesics. Methadone works to treat pain by changing the way the brain and nervous system respond to pain. It works to treat people who were addicted to opiate drugs by producing similar effects and preventing withdrawal symptoms in people who have stopped using these drugs. Methadone comes as a tablet, a dispersible (can be dissolved in liquid) tablet , a solution (liquid), and a concentrated solution to take by mouth. When methadone is used to relieve pain, it may be taken every 8 to 12 hours. If you take methadone as part of a treatment program, your doctor will prescribe the dosing schedule that is best for you. Follow the directions on your prescription label carefully and ask your doctor or pharmacist to explain any part you do not understand. Take methadone exactly as directed. If you are using the dispersible tablets, do not chew or swallow before mixing the tablet in a liquid. If your doctor has told you to take only part of a tablet, break the tablet carefully along the lines that have been scored into it. Place the tablet or piece of the tablet in at least 120 mL (4 ounces) of water, orange juice, Tang\u00ae, citrus flavors of Kool-Aid\u00ae, or a citrus fruit drink to dissolve. Drink the entire mixture right away. If some tablet residue remains in the cup after you drink the mixture, add a small amount of liquid to the cup and drink it all. Your doctor may change your dose of methadone during your treatment. Your doctor may decrease your dose or tell you to take methadone less often as your treatment continues. If you experience pain during your treatment, your doctor may increase your dose or may prescribe an additional medication to control your pain. Talk to your doctor about how you are feeling during your treatment with methadone. Do not take extra doses of methadone or take doses of methadone earlier than they are scheduled even if you experience pain. Do not stop taking methadone without talking to your doctor. Your doctor will probably want to decrease your dose gradually. If you suddenly stop taking methadone, you may experience withdrawal symptoms such as restlessness, teary eyes, runny nose, yawning, sweating, chills, muscle pain, widened pupils (black circles in the middle of the eyes), irritability, anxiety, backache, joint pain, weakness, stomach cramps, difficulty falling asleep or staying asleep, nausea, decreased appetite, vomiting, or diarrhea. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before taking methadone, - tell your doctor and pharmacist if you are allergic to methadone, any other medications, or any of the ingredients in the methadone product you plan to take. Ask your doctor or pharmacist or check the Medication Guide for a list of the ingredients. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: antihistamines; buprenorphine (Suboxone, in Zubsolv); butorphanol; carbamazepine (Cabatrol, Equetro, Tegretol, others); cyclobenzaprine (Amrix); dextromethorphan (found in many cough medications; in Nuedexta); fluvoxamine (Luvox); medications for glaucoma, irritable bowel disease, Parkinson's disease, ulcers, and urinary problems; certain medications for HIV including abacavir (Ziagen, in Trizivir), darunavir (Prezista), didanosine (Videx), efavirenz (Sustiva, in Atripla), lopinavir (in Kaletra), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir, in Kaletra), saquinavir (Invirase), stavudine (Zerit), telaprevir (no longer available in the U.S.; Incivek), tipranavir (Aptivus), and zidovudine (Retrovir, in Combivir); lithium (Lithobid); medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Alsuma, Imitrex, in Treximet), and zolmitriptan (Zomig); mirtazapine (Remeron); nalbuphine; naloxone (Evzio, Narcan, in Zubsolv); naltrexone (ReVia, Vivitrol, in Embeda); pentazocine (Talwin); phenobarbital; phenytoin (Dilantin, Phenytek); rifampin (Rifadin, Rimactane, in Rifamate, in Rifater); 5HT3 serotonin blockers such as alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran, Zuplenz), or palonosetron (Aloxi); selective serotonin-reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Prozac, Pexeva), and sertraline (Zoloft); serotonin and norepinephrine reuptake inhibitors such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor); tramadol (Conzip, Ultram, in Ultracet), and trazodone (Oleptro). Also tell your doctor or pharmacist if you are taking or receiving the following medications or have stopped taking them in the past 14 days: monoamine oxidase (MAO) inhibitors including isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelpar), and tranylcypromine (Parnate). Many other medications may also interact with methadone, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor what herbal products you are taking, especially St. John's wort and tryptophan. - tell your doctor if you have any of the conditions mentioned in the IMPORTANT WARNING section or have or have ever had paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you that you should not take methadone. - tell your doctor if you have or have ever had a blockage in your intestine; difficulty urinating; an enlarged prostate (a male reproductive gland); Addison's disease (a condition in which the adrenal gland does not make enough of certain natural substances); seizures; or thyroid, pancreas, gallbladder, liver, or kidney disease. - tell your doctor if you are breastfeeding. If you breastfeed during your treatment with methadone, your baby may receive some methadone in breastmilk. Watch your baby closely for any changes in behavior or breathing, especially when you start taking methadone. If your baby develops any of these symptoms, call your baby's doctor immediately or get emergency medical help: unusual sleepiness, difficulty breastfeeding, difficulty breathing, or limpness. Talk to your baby's doctor when you are ready to wean your baby. You will need to wean your baby gradually so that your baby will not develop withdrawal symptoms when he or she stops receiving methadone in breastmilk. - you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of taking methadone. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking methadone. - you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. - you should know that methadone may cause dizziness when you get up too quickly from a lying position. This is more common when you first start taking methadone. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up. - you should know that methadone may cause constipation. Talk to your doctor about changing your diet or using other medications to prevent or treat constipation while you are taking methadone. Talk to your doctor about eating grapefruit and drinking grapefruit juice while taking this medicine. If your doctor has told you to take methadone for pain, take the missed dose as soon as you remember it and then continue your regular dosing schedule. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are taking methadone to treat opioid addiction, skip the missed dose and take the next dose the next day as scheduled. Do not take a double dose to make up for a missed one. Methadone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - headache - weight gain - stomach pain - dry mouth - sore tongue - flushing - difficulty urinating - mood changes - vision problems - difficulty falling asleep or staying asleep Some side effects can be serious. If you experience any of the following symptoms or those mentioned in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical help: - seizures - itching - hives - rash - swelling of the eyes, face, mouth, tongue, or throat - hoarseness - difficulty breathing or swallowing - extreme drowsiness - agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea - nausea, vomiting, loss of appetite, weakness, or dizziness - inability to get or keep an erection - irregular menstruation - decreased sexual desire Methadone may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication. Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Flush any methadone tablets or solution that is outdated or no longer needed down the toilet. Talk to your pharmacist about the proper disposal of your medication. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of overdose may include the following: - small, pinpoint pupils (black circles in the center of the eyes) - slow or shallow breathing - drowsiness - cool, clammy, or blue skin - loss of consciousness (coma) - limp muscles Keep all appointments with your doctor or clinic. Your doctor may order certain lab tests to check your response to methadone. Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are taking methadone. This prescription is not refillable. If you continue to experience pain after you finish taking the methadone, call your doctor. If you take this medication on a regular basis, be sure to schedule appointments with your doctor so that you do not run out of medication. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Diskets\u00ae\u00b6 - Dolophine\u00ae - Methadose\u00ae - Methadose\u00ae Oral Concentrate - Westadone\u00ae\u00b6",
+    "https://medlineplus.gov/druginfo/meds/a682134.html"
+  ],
+  [
+    "What are the side effects or risks of Methadone?: Methadone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - weakness - headache - nausea - vomiting - loss of appetite - weight gain - stomach pain - dry mouth - sore tongue - sweating - flushing - difficulty urinating - mood changes - vision problems - difficulty falling asleep or staying asleep - decreased sexual desire or ability - missed menstrual periods Some side effects can be serious. If you experience any of the following symptoms or those mentioned in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical help: - seizures - itching - hives - rash - swelling of the eyes, face, mouth, tongue, or throat - hoarseness - difficulty breathing or swallowing - extreme drowsiness - hallucinating (seeing things or hearing voices that do not exist) Methadone may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682134.html"
+  ],
+  [
+    "Methadone overdose: Methadone is a very strong painkiller. It is also used to treat heroin addiction. Methadone overdose occurs when someone accidentally or intentionally takes more than the normal or recommended amount of this medicine. This can be by accident or on purpose. Methadone overdose can also occur if a person takes methadone with certain painkillers. These painkillers include oxycontin, hydrocodone (Vicodin), or morphine. This is for information only and not for use in the treatment or management of an actual overdose. This article is for information only. DO NOT use it to treat or manage an actual overdose. If you or someone you are with overdoses, call your local emergency number (such as 911), or your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. Methadone can be poisonous in large amounts. Medicines with these brand names contain methadone: - Dolophine - Eptadone - Methadose - Physeptone Other medicines may also contain methadone. The ones above include methadone products that are swallowed or injected into a vein, muscle, or under the skin. Below are symptoms of a methadone overdose in different parts of the body. EYES, EARS, NOSE, AND THROAT - Tiny pupils STOMACH AND INTESTINES - Constipation - Nausea and vomiting - Spasms of the stomach or intestines HEART AND BLOOD - Low blood pressure - Weak pulse LUNGS - Breathing problems, including slow, labored, or shallow breathing - No breathing NERVOUS SYSTEM - Coma (decreased level of consciousness and lack of responsiveness) - Confusion - Disorientation - Dizziness - Drowsiness - Fatigue - Muscle twitches - Weakness SKIN - Blue fingernails and lips - Cold, clammy skin Seek medical help right away. DO NOT make the person throw up unless poison control or a health care provider tells you to. Have this information ready: - Person's age, weight, and condition - Name of the medicine (strength, if known) - Time it was swallowed - Amount swallowed Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. They will give you further instructions. This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week. Take the container with you to the hospital, if possible. The provider will measure and monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. You may receive: - Activated charcoal - Blood and urine tests - Breathing support, including tube through the mouth and breathing machine (ventilator) - Chest x-ray - EKG (electrocardiogram, or heart tracing) - Fluids through a vein (by IV) - Laxatives - Medicine to reverse the effects of the methadone (an antidote) and to treat other symptoms - Tube from the mouth into the stomach to empty the stomach (gastric lavage) How well someone does depends on the amount of poison swallowed and how quickly they receive treatment. The faster medical help is given, the better the chance for recovery. If an antidote can be given, recovery from an overdose begins right away. However, since methadone's effects can last for about a day, the person usually stays in the hospital overnight. They may receive several doses of the antidote. People who take a large overdose may stop breathing. They may have seizures if they do not get the antidote quickly. Complications such as pneumonia, muscle damage from lying on a hard surface for a long time, or brain damage from lack of oxygen may cause permanent disability. Death may occur in severe cases. Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002679.htm"
+  ],
+  [
+    "Methadone (IMPORTANT WARNING:): Methadone may cause serious or life-threatening breathing problems, especially during the first 24 to 72 hours of your treatment and any time your dose is increased. Your doctor will monitor you carefully during your treatment. Tell your doctor if you have or have ever had slowed breathing or asthma. Your doctor will probably tell you not to take methadone. Also tell your doctor if you have or have ever had lung disease such as chronic obstructive pulmonary disease (COPD; a group of lung diseases that includes chronic bronchitis and emphysema), a head injury, or any condition that increases the amount of pressure in your brain. The risk that you will develop breathing problems may be higher if you are an older adult or are weak or malnourished due to disease. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment: slowed breathing, long pauses between breaths, or shortness of breath. Taking certain other medications during your treatment with methadone may increase the risk that you will experience serious, life-threatening side effects such as breathing problems, sedation, or coma. Tell your doctor if you are taking or plan to take any of the following medications: benzodiazepines such as alprazolam (Xanax), diazepam (Diastat, Valium), estazolam, flurazepam, lorazepam (Ativan), and triazolam (Halcion); other narcotic pain medications; medications for nausea or mental illness; muscle relaxants; sedatives; sleeping pills; or tranquilizers. Your doctor may need to change the doses of your medications and will monitor you carefully. If you take methadone with any of these medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own. Drinking alcohol, taking prescription or nonprescription medications that contain alcohol, or using street drugs during your treatment with methadone increases the risk that you will experience serious, life-threatening side effects. Do not drink alcohol, take prescription or nonprescription medications that contain alcohol, or use street drugs during your treatment. Methadone may be habit-forming. Do not take a larger dose, take it more often, or take it for a longer period of time or in a different way than prescribed by your doctor. Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, or has overused prescription medications, or if you have or have ever had depression or another mental illness. There is a greater risk that you will overuse methadone if you have or have ever had any of these conditions. Do not allow anyone else to take your medication. Methadone may harm or cause death to other people who take your medication, especially children. Store methadone in a safe place so that no one else can take it accidentally or on purpose. Be especially careful to keep methadone out of the reach of children. Keep track of how many tablets or how much liquid is left so you will know if any medication is missing. Dispose of any unwanted methadone tablets or oral solution properly according to instructions. (See STORAGE and DISPOSAL.) Methadone may cause a prolonged QT interval (a rare heart problem that may cause irregular heartbeat, fainting, or sudden death). Tell your doctor if you or anyone in your family has or has ever had long QT syndrome; or if you have or ever had a slow or irregular heartbeat; low blood levels of potassium or magnesium, or heart disease. Tell your doctor and pharmacist if you are taking or plan to take any of the following medications: antidepressants such as amitriptyline, amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); certain antifungals such as fluconazole (Diflucan), itraconazole (Onmel, Sporanox), ketoconazole (Nizoral), and voriconazole (Vfend); diuretics ('water pills'); erythromycin (Eryc, Erythrocin, others); fludrocortisone; certain laxatives; medications for irregular heartbeat such as amiodarone (Cordarone, Nexterone, Pacerone), disopyramide (Norpace), dofetilide (Tikosyn), flecainide, ibutilide (Corvert), procainamide, and quinidine (in Nuedexta); nicardipine (Cardene); risperidone (Risperdal); and sertraline (Zoloft). If you experience any of the following symptoms, call your doctor immediately: pounding heartbeat, dizziness, lightheadedness, or fainting. Tell your doctor if you are pregnant or plan to become pregnant. If you take methadone regularly during your pregnancy, your baby may experience life-threatening withdrawal symptoms after birth. Tell your baby's doctor right away if your baby experiences any of the following symptoms: irritability, hyperactivity, abnormal sleep, high-pitched cry, uncontrollable shaking of a part of the body, vomiting, diarrhea, or failure to gain weight. Talk to your doctor about the risks of taking methadone for your condition. Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with methadone and each time you fill your prescription if a Medication Guide is available for the methadone product you are taking. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide. Use of methadone to treat opiate addiction: If you have been addicted to an opiate (narcotic drug such as heroin), and you are taking methadone to help you stop taking or continue not taking the drug, you must enroll in a treatment program. The treatment program must be approved by the state and federal governments and must treat patients according to specific federal laws. You may have to take your medication at the treatment program facility under the supervision of the program staff. Ask your doctor or the treatment program staff if you have any questions about enrolling in the program or taking or getting your medication.",
+    "https://medlineplus.gov/druginfo/meds/a682134.html"
+  ],
+  [
+    "Methadone (What special precautions should I follow?): Before taking methadone, - tell your doctor and pharmacist if you are allergic to methadone, any other medications, or any of the ingredients in the methadone product you plan to take. Ask your doctor or pharmacist or check the Medication Guide for a list of the ingredients. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: antihistamines; buprenorphine (Suboxone, in Zubsolv); butorphanol; carbamazepine (Cabatrol, Equetro, Tegretol, others); cyclobenzaprine (Amrix); dextromethorphan (found in many cough medications; in Nuedexta); fluvoxamine (Luvox); medications for glaucoma, irritable bowel disease, Parkinson's disease, ulcers, and urinary problems; certain medications for HIV including abacavir (Ziagen, in Trizivir), darunavir (Prezista), didanosine (Videx), efavirenz (Sustiva, in Atripla), lopinavir (in Kaletra), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir, in Kaletra), saquinavir (Invirase), stavudine (Zerit), telaprevir (no longer available in the U.S.; Incivek), tipranavir (Aptivus), and zidovudine (Retrovir, in Combivir); lithium (Lithobid); medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Alsuma, Imitrex, in Treximet), and zolmitriptan (Zomig); mirtazapine (Remeron); nalbuphine; naloxone (Evzio, Narcan, in Zubsolv); naltrexone (ReVia, Vivitrol, in Embeda); pentazocine (Talwin); phenobarbital; phenytoin (Dilantin, Phenytek); rifampin (Rifadin, Rimactane, in Rifamate, in Rifater); 5HT3 serotonin blockers such as alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran, Zuplenz), or palonosetron (Aloxi); selective serotonin-reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Prozac, Pexeva), and sertraline (Zoloft); serotonin and norepinephrine reuptake inhibitors such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor); tramadol (Conzip, Ultram, in Ultracet), and trazodone (Oleptro). Also tell your doctor or pharmacist if you are taking or receiving the following medications or have stopped taking them in the past 14 days: monoamine oxidase (MAO) inhibitors including isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelpar), and tranylcypromine (Parnate). Many other medications may also interact with methadone, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor what herbal products you are taking, especially St. John's wort and tryptophan. - tell your doctor if you have any of the conditions mentioned in the IMPORTANT WARNING section or have or have ever had paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you that you should not take methadone. - tell your doctor if you have or have ever had a blockage in your intestine; difficulty urinating; an enlarged prostate (a male reproductive gland); Addison's disease (a condition in which the adrenal gland does not make enough of certain natural substances); seizures; or thyroid, pancreas, gallbladder, liver, or kidney disease. - tell your doctor if you are breastfeeding. If you breastfeed during your treatment with methadone, your baby may receive some methadone in breastmilk. Watch your baby closely for any changes in behavior or breathing, especially when you start taking methadone. If your baby develops any of these symptoms, call your baby's doctor immediately or get emergency medical help: unusual sleepiness, difficulty breastfeeding, difficulty breathing, or limpness. Talk to your baby's doctor when you are ready to wean your baby. You will need to wean your baby gradually so that your baby will not develop withdrawal symptoms when he or she stops receiving methadone in breastmilk. - you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of taking methadone. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking methadone. - you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. - you should know that methadone may cause dizziness when you get up too quickly from a lying position. This is more common when you first start taking methadone. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up. - you should know that methadone may cause constipation. Talk to your doctor about changing your diet or using other medications to prevent or treat constipation while you are taking methadone.",
+    "https://medlineplus.gov/druginfo/meds/a682134.html"
+  ],
+  [
+    "Methadone (How should this medicine be used?): Methadone comes as a tablet, a dispersible (can be dissolved in liquid) tablet , a solution (liquid), and a concentrated solution to take by mouth. When methadone is used to relieve pain, it may be taken every 8 to 12 hours. If you take methadone as part of a treatment program, your doctor will prescribe the dosing schedule that is best for you. Follow the directions on your prescription label carefully and ask your doctor or pharmacist to explain any part you do not understand. Take methadone exactly as directed. If you are using the dispersible tablets, do not chew or swallow before mixing the tablet in a liquid. If your doctor has told you to take only part of a tablet, break the tablet carefully along the lines that have been scored into it. Place the tablet or piece of the tablet in at least 120 mL (4 ounces) of water, orange juice, Tang\u00ae, citrus flavors of Kool-Aid\u00ae, or a citrus fruit drink to dissolve. Drink the entire mixture right away. If some tablet residue remains in the cup after you drink the mixture, add a small amount of liquid to the cup and drink it all. Your doctor may change your dose of methadone during your treatment. Your doctor may decrease your dose or tell you to take methadone less often as your treatment continues. If you experience pain during your treatment, your doctor may increase your dose or may prescribe an additional medication to control your pain. Talk to your doctor about how you are feeling during your treatment with methadone. Do not take extra doses of methadone or take doses of methadone earlier than they are scheduled even if you experience pain. Do not stop taking methadone without talking to your doctor. Your doctor will probably want to decrease your dose gradually. If you suddenly stop taking methadone, you may experience withdrawal symptoms such as restlessness, teary eyes, runny nose, yawning, sweating, chills, muscle pain, widened pupils (black circles in the middle of the eyes), irritability, anxiety, backache, joint pain, weakness, stomach cramps, difficulty falling asleep or staying asleep, nausea, decreased appetite, vomiting, or diarrhea.",
+    "https://medlineplus.gov/druginfo/meds/a682134.html"
+  ],
+  [
+    "Methadone (What other information should I know?): Keep all appointments with your doctor or clinic. Your doctor may order certain lab tests to check your response to methadone. Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are taking methadone. This prescription is not refillable. If you continue to experience pain after you finish taking the methadone, call your doctor. If you take this medication on a regular basis, be sure to schedule appointments with your doctor so that you do not run out of medication. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.",
+    "https://medlineplus.gov/druginfo/meds/a682134.html"
+  ],
+  [
+    "Methadone (Why is this medication prescribed?): Methadone is used to relieve severe pain in people who are expected to need pain medication around the clock for a long time and who cannot be treated with other medications. It also is used to prevent withdrawal symptoms in patients who were addicted to opiate drugs and are enrolled in treatment programs in order to stop taking or continue not taking the drugs. Methadone is in a class of medications called opiate (narcotic) analgesics. Methadone works to treat pain by changing the way the brain and nervous system respond to pain. It works to treat people who were addicted to opiate drugs by producing similar effects and preventing withdrawal symptoms in people who have stopped using these drugs.",
+    "https://medlineplus.gov/druginfo/meds/a682134.html"
+  ],
+  [
+    "Methadone (What should I do if I forget a dose?): If your doctor has told you to take methadone for pain, take the missed dose as soon as you remember it and then continue your regular dosing schedule. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are taking methadone to treat opioid addiction, skip the missed dose and take the next dose the next day as scheduled. Do not take a double dose to make up for a missed one.",
+    "https://medlineplus.gov/druginfo/meds/a682134.html"
+  ],
+  [
+    "Methylprednisolone: Methylprednisolone, a corticosteroid, is similar to a natural hormone produced by your adrenal glands. It is often used to replace this chemical when your body does not make enough of it. It relieves inflammation (swelling, heat, redness, and pain) and is used to treat certain forms of arthritis; skin, blood, kidney, eye, thyroid, and intestinal disorders (e.g., colitis); severe allergies; and asthma. Methylprednisolone is also used to treat certain types of cancer. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information. Methylprednisolone comes as a tablet to take by mouth. Your doctor will prescribe a dosing schedule that is best for you. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take methylprednisolone exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not stop taking methylprednisolone without talking to your doctor. Stopping the drug abruptly can cause loss of appetite, upset stomach, vomiting, drowsiness, confusion, headache, fever, joint and muscle pain, peeling skin, and weight loss. If you take large doses for a long time, your doctor probably will decrease your dose gradually to allow your body to adjust before stopping the drug completely. Watch for these side effects if you are gradually decreasing your dose and after you stop taking the tablets. If these problems occur, call your doctor immediately. You may need to increase your dose of tablets temporarily or start taking them again. Before taking methylprednisolone, - tell your doctor and pharmacist if you are allergic to methylprednisolone, aspirin, tartrazine (a yellow dye in some processed foods and drugs), or any other drugs. - tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially anticoagulants ('blood thinners') such as warfarin (Coumadin), arthritis medications, aspirin, azithromycin (Zithromax), clarithromycin (Biaxin), cyclosporine (Neoral, Sandimmune), digoxin (Lanoxin), diuretics ('water pills'), erythromycin, estrogen (Premarin), ketoconazole (Nizoral), oral contraceptives, phenobarbital, phenytoin (Dilantin), rifampin (Rifadin), theophylline (Theo-Dur), and vitamins. - if you have a fungal infection (other than on your skin), do not take methylprednisolone without talking to your doctor. - tell your doctor if you have or have ever had liver, kidney, intestinal, or heart disease; diabetes; an underactive thyroid gland; high blood pressure; mental illness; myasthenia gravis; osteoporosis; herpes eye infection; seizures; tuberculosis (TB); or ulcers. - tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking methylprednisolone, call your doctor. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking methylprednisolone. - if you have a history of ulcers or take large doses of aspirin or other arthritis medication, limit your consumption of alcoholic beverages while taking this drug. Methylprednisolone makes your stomach and intestines more susceptible to the irritating effects of alcohol, aspirin, and certain arthritis medications. This effect increases your risk of ulcers. Your doctor may instruct you to follow a low-sodium, low-salt, potassium-rich, or high-protein diet. Follow these directions. Methylprednisolone may cause an upset stomach. Take methylprednisolone with food or milk. When you start to take methylprednisolone, ask your doctor what to do if you forget a dose. Write down these instructions so that you can refer to them later. If you take methylprednisolone once a day, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Methylprednisolone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - upset stomach - stomach irritation - vomiting - headache - dizziness - insomnia - restlessness - depression - anxiety - acne - increased hair growth - easy bruising - irregular or absent menstrual periods If you experience any of the following symptoms, call your doctor immediately: - skin rash - swollen face, lower legs, or ankles - vision problems - cold or infection that lasts a long time - muscle weakness - black or tarry stool If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to methylprednisolone. Checkups are especially important for children because methylprednisolone can slow bone growth. If your condition worsens, call your doctor. Your dose may need to be adjusted. Carry an identification card that indicates that you may need to take supplementary doses (write down the full dose you took before gradually decreasing it) of methylprednisolone during periods of stress (injuries, infections, and severe asthma attacks). Ask your pharmacist or doctor how to obtain this card. List your name, medical problems, drugs and dosages, and doctor's name and telephone number on the card. This drug makes you more susceptible to illnesses. If you are exposed to chicken pox, measles, or tuberculosis (TB) while taking methylprednisolone, call your doctor. Do not have a vaccination, other immunization, or any skin test while you are taking methylprednisolone unless your doctor tells you that you may. Report any injuries or signs of infection (fever, sore throat, pain during urination, and muscle aches) that occur during treatment. Your doctor may instruct you to weigh yourself every day. Report any unusual weight gain. If your sputum (the matter you cough up during an asthma attack) thickens or changes color from clear white to yellow, green, or gray, call your doctor; these changes may be signs of an infection. If you have diabetes, methylprednisolone may increase your blood sugar level. If you monitor your blood sugar (glucose) at home, test your blood or urine more frequently than usual. Call your doctor if your blood sugar is high or if sugar is present in your urine; your dose of diabetes medication and your diet may need to be changed. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Medrol\u00ae",
+    "https://medlineplus.gov/druginfo/meds/a682795.html"
+  ],
+  [
+    "Methylprednisolone Injection: Methylprednisolone injection is used to treat severe allergic reactions. Methylprednisolone injection is used in the management of multiple sclerosis (a disease in which the nerves do not function properly), lupus (a disease in which the body attacks many of its own organs), gastrointestinal disease, and certain types of arthritis. Methylprednisolone injection is also used to treat certain conditions that affect the blood, skin, eyes, nervous system, thyroid, kidneys, and lungs. It is sometimes used in combination with other medications to treat symptoms of low corticosteroid levels (lack of certain substances that are usually produced by the body and are needed for normal body functioning). Methylprednisolone injection is in a class of medications called corticosteroids. It works to treat people with low levels of corticosteroids by replacing steroids that are normally produced naturally by the body. It also works to treat other conditions by reducing swelling and redness and by changing the way the immune system works. Methylprednisolone injection comes as powder to be mixed with liquid to be injected intramuscularly (into a muscle) or intravenously (into a vein). It also comes as a suspension for injection to be injected intramuscularly, intra-articularly (into a joint), or intralesionally (into a lesion). Your personal dosing schedule will depend on your condition and on how you respond to treatment. You may receive methylprednisolone injection in a hospital or medical facility, or you may be given the medication to use at home. If you will be using methylprednisolone injection at home, your healthcare provider will show you how to inject the medication. Be sure that you understand these directions, and ask your healthcare provider if you have any questions. Ask your healthcare provider what to do if you have any problems using methylprednisolone injection. Your doctor may change your dose of methylprednisolone injection during your treatment to be sure that you are always using the lowest dose that works for you. Your doctor may also need to change your dose if you experience unusual stress on your body such as surgery, illness, or infection. Tell your doctor if your symptoms improve or get worse or if you get sick or have any changes in your health during your treatment. Methylprednisolone injection is also sometimes used to treat nausea and vomiting from certain types of chemotherapy for cancer and to prevent organ transplant rejection. Talk to your doctor about the risks of using this medication for your condition. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before receiving methylprednisolone injection, - tell your doctor and pharmacist if you are allergic to methylprednisolone, any other medications, benzyl alcohol, or any of the ingredients in methylprednisolone injection. Ask your pharmacist for a list of the ingredients. - tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: aminoglutethimide (Cytadren; no longer available in U.S.); amphotericin B (Abelcet, Ambisome, Amphotec); anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) and selective COX-2 inhibitors such as celecoxib (Celebrex); carbamazepine (Equetro, Tegretol, Teril); cholinesterase inhibitors such as donepezil (Aricept, in Namzaric), galantamine (Razadyne), neostigmine (Bloxiverz), pyridostigmine (Mestinon, Regonol), and rivastigmine (Exelon); cholestyramine (Prevalite); cyclosporine (Gengraf, Neoral, Sandimmune); medications for diabetes including insulin; digoxin (Lanoxin); diuretics ('water pills'); erythromycin (E.E.S., Ery-Tab, Erythrocin, others); estrogens including hormonal contraceptives (birth control pills, patches, rings, implants, and injections); isoniazid (Laniazid, Rifamate, in Rifater); ketoconazole (Nizoral, Xolegel); phenobarbital; phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin); and rifampin (Rifadin, Rimactane, in Rifamate, in Rifater). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor if you have a fungal infection (other than on your skin or nails). Your doctor will probably tell you not to use methylprednisolone injection. Also, tell your doctor if you have idiopathic thrombocytopenic purpura (ITP; an ongoing condition that may cause easy bruising or bleeding due to an abnormally low number of platelets in the blood). Your doctor probably will not give you methylprednisolone intramuscularly, if you have ITP. - tell your doctor if you have or have ever had tuberculosis (TB: a type of lung infection); cataracts (clouding of the lens of the eye); glaucoma (an eye disease); Cushing's syndrome (condition where the body produces too much of the hormone cortisol); diabetes; high blood pressure; heart failure; a recent heart attack; emotional problems, depression or other types of mental illness; myasthenia gravis (a condition in which the muscles become weak); osteoporosis (condition in which the bones become weak and fragile and can break easily); seizures; ulcers; or liver, kidney, heart, intestinal, or thyroid disease. Also tell your doctor if you have any type of untreated bacterial, parasitic, or viral infection anywhere in your body or a herpes eye infection (a type of infection that causes a sore on the eyelid or eye surface). - tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while receiving methylprednisolone injection, call your doctor. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are receiving methylprednisolone injection. - do not have any vaccinations (shots to prevent diseases) without talking to your doctor. - you should know that methylprednisolone injection may decrease your ability to fight infection and may prevent you from developing symptoms if you get an infection. Stay away from people who are sick and wash your hands often while you are using this medication. Be sure to avoid people who have chicken pox or measles. Call your doctor immediately if you think you may have been around someone who had chicken pox or measles. Your doctor may instruct you to follow a low-salt or a diet high in potassium or calcium. Your doctor may also prescribe or recommend a calcium or potassium supplement. Follow these directions carefully. Methylprednisolone injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - headache - dizziness - slowed healing of cuts and bruises - acne - thin, fragile, or dry skin - red or purple blotches or lines under the skin - skin depressions at the injection site - increased body fat or movement to different areas of your body - difficulty falling asleep or staying asleep - inappropriate happiness - extreme changes in mood changes in personality - extreme tiredness - depression - increased sweating - muscle weakness - joint pain - dizziness - irregular or absent menstrual periods - increased appetite - hiccups Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment: - sore throat, fever, chills, cough, or other signs of infection - seizures - vision problems - swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles, or lower legs - difficulty breathing or swallowing - shortness of breath - sudden weight gain - rash - hives - itching - confusion - abnormal skin patches in the mouth, nose, or throat - numbness, burning, or tingling in the face, arms, legs, feet, or hands Methylprednisolone injection may cause children to grow more slowly. Your child's doctor will watch your child's growth carefully while your child is using methylprednisolone injection. Talk to your child's doctor about the risks of giving this medication to your child. People who use methylprednisolone injection for a long time may develop glaucoma or cataracts. Talk to your doctor about the risks of using methylprednisolone injection and how often you should have your eyes examined during your treatment. Methylprednisolone injection may increase your risk of developing osteoporosis. Talk to your doctor about the risks of using this medication. Methylprednisolone injection may cause other side effects. Call your doctor if you have any unusual problems while using this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to methylprednisolone injection. Before having any laboratory test, tell your doctor and the laboratory personnel that you are using methylprednisolone injection. If you are having any skin tests such as allergy or tuberculosis tests, tell the doctor or technician that you are receiving methylprednisolone injection. Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription. Ask your pharmacist any questions you have about methylprednisolone injection. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - A-Methapred\u00ae - Depo-Medrol\u00ae - Solu-Medrol\u00ae",
+    "https://medlineplus.gov/druginfo/meds/a601157.html"
+  ],
+  [
+    "Methylprednisolone (What special precautions should I follow?): Before taking methylprednisolone, - tell your doctor and pharmacist if you are allergic to methylprednisolone, aspirin, tartrazine (a yellow dye in some processed foods and drugs), or any other drugs. - tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially anticoagulants ('blood thinners') such as warfarin (Coumadin), arthritis medications, aspirin, azithromycin (Zithromax), clarithromycin (Biaxin), cyclosporine (Neoral, Sandimmune), digoxin (Lanoxin), diuretics ('water pills'), erythromycin, estrogen (Premarin), ketoconazole (Nizoral), oral contraceptives, phenobarbital, phenytoin (Dilantin), rifampin (Rifadin), theophylline (Theo-Dur), and vitamins. - if you have a fungal infection (other than on your skin), do not take methylprednisolone without talking to your doctor. - tell your doctor if you have or have ever had liver, kidney, intestinal, or heart disease; diabetes; an underactive thyroid gland; high blood pressure; mental illness; myasthenia gravis; osteoporosis; herpes eye infection; seizures; tuberculosis (TB); or ulcers. - tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking methylprednisolone, call your doctor. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking methylprednisolone. - if you have a history of ulcers or take large doses of aspirin or other arthritis medication, limit your consumption of alcoholic beverages while taking this drug. Methylprednisolone makes your stomach and intestines more susceptible to the irritating effects of alcohol, aspirin, and certain arthritis medications. This effect increases your risk of ulcers.",
+    "https://medlineplus.gov/druginfo/meds/a682795.html"
+  ],
+  [
+    "Methylprednisolone (What special dietary instructions should I follow?): Your doctor may instruct you to follow a low-sodium, low-salt, potassium-rich, or high-protein diet. Follow these directions. Methylprednisolone may cause an upset stomach. Take methylprednisolone with food or milk.",
+    "https://medlineplus.gov/druginfo/meds/a682795.html"
+  ],
+  [
+    "Methylprednisolone (What should I do if I forget a dose?): When you start to take methylprednisolone, ask your doctor what to do if you forget a dose. Write down these instructions so that you can refer to them later. If you take methylprednisolone once a day, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.",
+    "https://medlineplus.gov/druginfo/meds/a682795.html"
+  ],
+  [
+    "Methylprednisolone (What other information should I know?): Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to methylprednisolone. Checkups are especially important for children because methylprednisolone can slow bone growth. If your condition worsens, call your doctor. Your dose may need to be adjusted. Carry an identification card that indicates that you may need to take supplementary doses (write down the full dose you took before gradually decreasing it) of methylprednisolone during periods of stress (injuries, infections, and severe asthma attacks). Ask your pharmacist or doctor how to obtain this card. List your name, medical problems, drugs and dosages, and doctor's name and telephone number on the card. This drug makes you more susceptible to illnesses. If you are exposed to chicken pox, measles, or tuberculosis (TB) while taking methylprednisolone, call your doctor. Do not have a vaccination, other immunization, or any skin test while you are taking methylprednisolone unless your doctor tells you that you may. Report any injuries or signs of infection (fever, sore throat, pain during urination, and muscle aches) that occur during treatment. Your doctor may instruct you to weigh yourself every day. Report any unusual weight gain. If your sputum (the matter you cough up during an asthma attack) thickens or changes color from clear white to yellow, green, or gray, call your doctor; these changes may be signs of an infection. If you have diabetes, methylprednisolone may increase your blood sugar level. If you monitor your blood sugar (glucose) at home, test your blood or urine more frequently than usual. Call your doctor if your blood sugar is high or if sugar is present in your urine; your dose of diabetes medication and your diet may need to be changed. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.",
+    "https://medlineplus.gov/druginfo/meds/a682795.html"
+  ],
+  [
+    "Methylprednisolone (How should this medicine be used?): Methylprednisolone comes as a tablet to take by mouth. Your doctor will prescribe a dosing schedule that is best for you. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take methylprednisolone exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not stop taking methylprednisolone without talking to your doctor. Stopping the drug abruptly can cause loss of appetite, upset stomach, vomiting, drowsiness, confusion, headache, fever, joint and muscle pain, peeling skin, and weight loss. If you take large doses for a long time, your doctor probably will decrease your dose gradually to allow your body to adjust before stopping the drug completely. Watch for these side effects if you are gradually decreasing your dose and after you stop taking the tablets. If these problems occur, call your doctor immediately. You may need to increase your dose of tablets temporarily or start taking them again.",
+    "https://medlineplus.gov/druginfo/meds/a682795.html"
+  ],
+  [
+    "Methylprednisolone Injection (How should this medicine be used?): Methylprednisolone injection comes as powder to be mixed with liquid to be injected intramuscularly (into a muscle) or intravenously (into a vein). It also comes as a suspension for injection to be injected intramuscularly, intra-articularly (into a joint), or intralesionally (into a lesion). Your personal dosing schedule will depend on your condition and on how you respond to treatment. You may receive methylprednisolone injection in a hospital or medical facility, or you may be given the medication to use at home. If you will be using methylprednisolone injection at home, your healthcare provider will show you how to inject the medication. Be sure that you understand these directions, and ask your healthcare provider if you have any questions. Ask your healthcare provider what to do if you have any problems using methylprednisolone injection. Your doctor may change your dose of methylprednisolone injection during your treatment to be sure that you are always using the lowest dose that works for you. Your doctor may also need to change your dose if you experience unusual stress on your body such as surgery, illness, or infection. Tell your doctor if your symptoms improve or get worse or if you get sick or have any changes in your health during your treatment.",
+    "https://medlineplus.gov/druginfo/meds/a601157.html"
+  ],
+  [
+    "Methylprednisolone Injection (What other information should I know?): Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to methylprednisolone injection. Before having any laboratory test, tell your doctor and the laboratory personnel that you are using methylprednisolone injection. If you are having any skin tests such as allergy or tuberculosis tests, tell the doctor or technician that you are receiving methylprednisolone injection. Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription. Ask your pharmacist any questions you have about methylprednisolone injection. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.",
+    "https://medlineplus.gov/druginfo/meds/a601157.html"
+  ],
+  [
+    "Simvastatin (How should this medicine be used?): Simvastatin comes as a tablet to take by mouth. It usually is taken once a day in the evening. Take simvastatin at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take simvastatin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor may start you on a low dose of simvastatin and gradually increase your dose, not more than once every 4 weeks. Continue to take simvastatin even if you feel well. Do not stop taking simvastatin without talking to your doctor.",
+    "https://medlineplus.gov/druginfo/meds/a692030.html"
+  ],
+  [
+    "Do you have information about Taking medicines - what to ask your doctor: Summary : Medications - taking Description : Many people take medicines every day. You might need to take medicine for an infection or to treat a chronic illness. Take charge of your health. Ask questions and learn about the medicine you take. Take charge of your health : - Know what medicines, vitamins, and herbal supplements you take. - Make a list of your medicines to keep in your wallet. - Take time to understand the purpose of your medicine. - Ask questions when you don't know the meaning of related words, or when instructions aren't clear. And write down the answers to your questions. - Bring a family member or friend to the pharmacy or to your doctor's visits to help you retain the information you are given. Get information about your new medicine : When your doctor prescribes a medicine, find out about it. Ask questions, such as: - What is the name of the medicine? - Why am I taking this medicine? - What is the name of the condition this medicine will treat? - How long will it take to work? - How should I store the medicine? Does it need to be refrigerated? - Can the pharmacist substitute a cheaper, generic form of the medicine? - Will the medicine create conflicts with other medicines I take? Find out how to take the medicine : Ask your doctor, pharmacist, or nurse about the right way to take your medicine. Ask questions, such as: - When and how often should I take the medicine? As needed, or on a schedule? - Do I take medicine before, with, or between meals? - How long will I have to take it? Know what to expect with the new medicine : Ask about how you will feel. - How will I feel once I start taking this medicine? - How will I know if this medicine is working? - What side effects might I expect? Should I report them? - Are there any lab tests to check the medicine's level or for any harmful side effects? Ask if this new medicine fits in with your other medicines. - Are there other medicines or activities I should avoid when taking this medicine? - Will this medicine change how my other medicines work? (Ask about both prescription and over-the-counter medicines.) - Will this medicine change how any of my herbal or dietary supplements work? Ask if your new medicine interferes with eating or drinking. - Are there any foods that I should not drink or eat? - Can I drink alcohol when taking this medicine? How much? - Is it OK to eat or drink food before or after I take the medicine? Ask other questions, such as: - If I forget to take it, what should I do? - What should I do if I feel I want to stop taking this medicine? Is it safe to just stop? When to call the doctor or pharmacist : Call your doctor or pharmacist if: - You have questions or you are confused or uncertain about the directions for your medicine. - You are having side effects from the medicine. Do not stop taking the medicine without telling your doctor. You might need a different dose or a different medicine. - Your medicine looks different than you expected. - Your refill medicine is different than what you usually get.",
+    "https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000535.htm"
+  ],
+  [
+    "Simvastatin (What special precautions should I follow?): Before taking simvastatin, - tell your doctor and pharmacist if you are allergic to simvastatin, any other medications, or any of the ingredients in simvastatin tablets. Ask your doctor or pharmacist for a list of the ingredients. - tell your doctor if you are taking antifungal medications such as itraconazole (Sporanox), ketoconazole (Nizoral), posaconazole (Noxafil) and voriconazole (Vfend); boceprevir (Victrelis); clarithromycin (Biaxin, in Prevpac); cobicistat-containing medications (Stribild); cyclosporine (Gengraf, Neoral, Sandimmune); danazol; erythromycin (E.E.S., E-Mycin, Erythrocin); gemfibrozil (Lopid); HIV protease inhibitors such as atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir (in Kaletra), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra), saquinavir (Invirase), and tipranavir (Aptivus); nefazodone; telaprevir (Incivek); and telithromycin (Ketek). Your doctor will probably tell you not to take simvastatin if you are taking these medications. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); amlodipine (Norvasc, in Caduet, in Lotrel); anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); colchicine (Colcrys); digoxin (Digitek, Lanoxicaps, Lanoxin); diltiazem (Cardizem, Dilacor, Tiazac); dronedarone (Multaq); other cholesterol-lowering medications such as fenofibrate (Tricor), lomitapide (Juxtapid), and niacin (nicotinic acid, Niacor, Niaspan); ranolazine (Ranexa); and verapamil (Calan, Covera, Isoptin, Verelan). . Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Other medications may also interact with simvastatin, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. - tell your doctor if you have liver disease. Your doctor will order blood tests to see how well your liver is working even if you do not think you have liver disease. Your doctor will probably tell you not to take simvastatin if you have liver disease or if the tests show that you may be developing liver disease. - tell your doctor if you drink more than two alcoholic beverages per day, if you are 65 years of age or older, or if you are Asian, especially if you are Chinese. Also tell your doctor if you have or have ever had an underactive thyroid gland, diabetes, seizures, muscle aches or weakness, low blood pressure, or kidney disease. - tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant during your treatment with simvastatin. Talk to your doctor about birth control methods that will work for you. If you become pregnant while taking simvastatin, stop taking simvastatin and call your doctor immediately. Simvastatin can harm the fetus. - tell your doctor if you are breastfeeding. You should not breastfeed while you are taking simvastatin. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking simvastatin. If you are hospitalized due to serious injury or infection, tell the doctor who treats you that you are taking simvastatin. - ask your doctor about the safe use of alcoholic beverages while you are taking simvastatin. Alcohol can increase the risk of serious side effects.",
+    "https://medlineplus.gov/druginfo/meds/a692030.html"
+  ],
+  [
+    "Simvastatin: Simvastatin is used together with diet, weight-loss, and exercise to reduce the risk of heart attack and stroke and to decrease the chance that heart surgery will be needed in people who have heart disease or who are at risk of developing heart disease. Simvastatin is also used to decrease the amount of fatty substances such as low-density lipoprotein (LDL) cholesterol (''bad cholesterol'') and triglycerides in the blood and to increase the amount of high-density lipoprotein (HDL) cholesterol (''good cholesterol'') in the blood. Simvastatin may also be used to decrease the amount of cholesterol and other fatty substances in the blood in children and teenagers 10 to 17 years of age who have familial heterozygous hypercholesterolemia (an inherited condition in which cholesterol cannot be removed from the body normally). Simvastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries and block blood flow to the heart, brain, and other parts of the body. Accumulation of cholesterol and fats along the walls of your arteries (a process known as atherosclerosis) decreases blood flow and, therefore, the oxygen supply to your heart, brain, and other parts of your body. Lowering your blood level of cholesterol and fats with simvastatin has been shown to prevent heart disease, angina (chest pain), strokes, and heart attacks. Simvastatin comes as a tablet to take by mouth. It usually is taken once a day in the evening. Take simvastatin at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take simvastatin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor may start you on a low dose of simvastatin and gradually increase your dose, not more than once every 4 weeks. Continue to take simvastatin even if you feel well. Do not stop taking simvastatin without talking to your doctor. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before taking simvastatin, - tell your doctor and pharmacist if you are allergic to simvastatin, any other medications, or any of the ingredients in simvastatin tablets. Ask your doctor or pharmacist for a list of the ingredients. - tell your doctor if you are taking antifungal medications such as itraconazole (Sporanox), ketoconazole (Nizoral), posaconazole (Noxafil) and voriconazole (Vfend); boceprevir (Victrelis); clarithromycin (Biaxin, in Prevpac); cobicistat-containing medications (Stribild); cyclosporine (Gengraf, Neoral, Sandimmune); danazol; erythromycin (E.E.S., E-Mycin, Erythrocin); gemfibrozil (Lopid); HIV protease inhibitors such as atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir (in Kaletra), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra), saquinavir (Invirase), and tipranavir (Aptivus); nefazodone; telaprevir (Incivek); and telithromycin (Ketek). Your doctor will probably tell you not to take simvastatin if you are taking these medications. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); amlodipine (Norvasc, in Caduet, in Lotrel); anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); colchicine (Colcrys); digoxin (Digitek, Lanoxicaps, Lanoxin); diltiazem (Cardizem, Dilacor, Tiazac); dronedarone (Multaq); other cholesterol-lowering medications such as fenofibrate (Tricor), lomitapide (Juxtapid), and niacin (nicotinic acid, Niacor, Niaspan); ranolazine (Ranexa); and verapamil (Calan, Covera, Isoptin, Verelan). . Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Other medications may also interact with simvastatin, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. - tell your doctor if you have liver disease. Your doctor will order blood tests to see how well your liver is working even if you do not think you have liver disease. Your doctor will probably tell you not to take simvastatin if you have liver disease or if the tests show that you may be developing liver disease. - tell your doctor if you drink more than two alcoholic beverages per day, if you are 65 years of age or older, or if you are Asian, especially if you are Chinese. Also tell your doctor if you have or have ever had an underactive thyroid gland, diabetes, seizures, muscle aches or weakness, low blood pressure, or kidney disease. - tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant during your treatment with simvastatin. Talk to your doctor about birth control methods that will work for you. If you become pregnant while taking simvastatin, stop taking simvastatin and call your doctor immediately. Simvastatin can harm the fetus. - tell your doctor if you are breastfeeding. You should not breastfeed while you are taking simvastatin. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking simvastatin. If you are hospitalized due to serious injury or infection, tell the doctor who treats you that you are taking simvastatin. - ask your doctor about the safe use of alcoholic beverages while you are taking simvastatin. Alcohol can increase the risk of serious side effects. Eat a low-fat, low-cholesterol diet. Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. You can also visit the National Cholesterol Education Program (NCEP) website for additional dietary information at http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf. Avoid drinking grapefruit juice while taking simvastatin. Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue the regular dosing schedule. Do not take a double dose to make up for a missed one. Simvastatin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - constipation - stomach pain - nausea - headache - memory loss or forgetfulness - confusion Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately or get emergency medical help. - muscle pain, tenderness, or weakness - dark red urine - decreased urination - lack of energy, tiredness, or weakness - loss of appetite - pain in the upper right part of the stomach - yellowing of the skin or eyes - dark colored urine - fever or chills - flushing - blisters - rash - hives - itching - swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs - difficulty breathing or swallowing - hoarseness - joint pain - sensitivity to light This medication may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests during your treatment, especially if you develop symptoms of liver damage. Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking simvastatin. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Zocor\u00ae - Juvisync\u00ae (containing Simvastatin, Sitagliptin) - Simcor\u00ae (containing Niacin, Simvastatin) - Vytorin\u00ae (containing Ezetimibe, Simvastatin)",
+    "https://medlineplus.gov/druginfo/meds/a692030.html"
+  ],
+  [
+    "Simvastatin (Brand names of combination products): - Juvisync\u00ae (containing Simvastatin, Sitagliptin) - Simcor\u00ae (containing Niacin, Simvastatin) - Vytorin\u00ae (containing Ezetimibe, Simvastatin)",
+    "https://medlineplus.gov/druginfo/meds/a692030.html"
+  ],
+  [
+    "Simvastatin (What other information should I know?): Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests during your treatment, especially if you develop symptoms of liver damage. Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking simvastatin. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.",
+    "https://medlineplus.gov/druginfo/meds/a692030.html"
+  ],
+  [
+    "Simvastatin (What special dietary instructions should I follow?): Eat a low-fat, low-cholesterol diet. Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. You can also visit the National Cholesterol Education Program (NCEP) website for additional dietary information at http://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf. Avoid drinking grapefruit juice while taking simvastatin.",
+    "https://medlineplus.gov/druginfo/meds/a692030.html"
+  ],
+  [
+    "Simvastatin (What side effects can this medication cause?): Simvastatin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - constipation - stomach pain - nausea - headache - memory loss or forgetfulness - confusion Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately or get emergency medical help. - muscle pain, tenderness, or weakness - dark red urine - decreased urination - lack of energy, tiredness, or weakness - loss of appetite - pain in the upper right part of the stomach - yellowing of the skin or eyes - dark colored urine - fever or chills - flushing - blisters - rash - hives - itching - swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs - difficulty breathing or swallowing - hoarseness - joint pain - sensitivity to light This medication may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).",
+    "https://medlineplus.gov/druginfo/meds/a692030.html"
+  ],
+  [
+    "Simvastatin (Other uses for this medicine): This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.",
+    "https://medlineplus.gov/druginfo/meds/a692030.html"
+  ],
+  [
+    "Simvastatin (What should I do if I forget a dose?): Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue the regular dosing schedule. Do not take a double dose to make up for a missed one.",
+    "https://medlineplus.gov/druginfo/meds/a692030.html"
+  ],
+  [
+    "Prednisone (What side effects can this medication cause?): Prednisone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - headache - dizziness - difficulty falling asleep or staying asleep - inappropriate happiness - extreme changes in mood - changes in personality - bulging eyes - acne - thin, fragile skin - red or purple blotches or lines under the skin - slowed healing of cuts and bruises - increased hair growth - changes in the way fat is spread around the body - extreme tiredness - weak muscles - irregular or absent menstrual periods - decreased sexual desire - heartburn - increased sweating Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately: - vision problems - eye pain, redness, or tearing - sore throat, fever, chills, cough, or other signs of infection - seizures - depression - loss of contact with reality - confusion - muscle twitching or tightening - shaking of the hands that you cannot control - numbness, burning, or tingling in the face, arms, legs, feet, or hands - upset stomach - vomiting - lightheadedness - irregular heartbeat - sudden weight gain - shortness of breath, especially during the night - dry, hacking cough - swelling or pain in the stomach - swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles, or lower legs - difficulty breathing or swallowing - rash - hives - itching Prednisone may slow growth and development in children. Your child's doctor will watch his or her growth carefully. Talk to your child's doctor about the risks of giving prednisone to your child. Prednisone may increase the risk that you will develop osteoporosis. Talk to your doctor about the risks of taking prednisone and about things that you can do to decrease the chance that you will develop osteoporosis. Some patients who took prednisone or similar medications developed a type of cancer called Kaposi's sarcoma. Talk to your doctor about the risks of taking prednisone. Prednisone may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).",
+    "https://medlineplus.gov/druginfo/meds/a601102.html"
+  ],
+  [
+    "How to prevent Cancer treatment: preventing infection?: There are many things you can do to help prevent infection. Here are some tips: - Wash your hands often. Hand washing is especially important after using the bathroom, before eating or cooking, after touching animals, and after blowing your nose or coughing. Carry hand sanitizer for times when you cannot wash. - Take care of your mouth. Brush your teeth often with a soft toothbrush and use a mouth rinse that does not contain alcohol. - Stay away from sick people. It is easy to catch a cold, the flu, chicken pox, or other infection from someone who has it. You should also avoid anyone who has had a live vaccine. - Clean yourself carefully after bowel movements. Use baby wipes or water instead of toilet paper and let your doctor know if you have any bleeding or hemorrhoids. - Make sure your food and drinks are safe. DO NOT eat fish, eggs, or meat that is raw or undercooked. And DO NOT eat anything that is spoiled or past the freshness date. - Ask someone else to clean up after pets. DO NOT pick up pet waste or clean fish tanks or birdcages. - Carry sanitizing wipes. Use them before touching public surfaces such as doorknobs, ATM machines, and railings. - Guard against cuts. Use an electric razor to avoid nicking yourself while shaving and do not tear at nail cuticles. Also be careful when using knives, needles, and scissors. If you do get a cut, clean it right away with soap, warm water, and an antiseptic. Clean your cut this way every day until it forms a scab. - Use gloves when gardening. There are often bacteria in soil. - Stay away from crowds. Plan your outings and errands for times that are less crowded. Wear a mask when you have to be around lots of people. - Be gentle with your skin. Use a towel to gently pat dry your skin after a shower or bath, and use lotion to keep it soft. DO NOT pick at pimples or other spots on your skin. - Ask about getting a flu shot. DO NOT get any vaccines without first talking to your provider. You should NOT receive any vaccines that contain a live virus. - Skip the nail salon and care for your nails at home. Make sure you use tools that have been cleaned well.",
+    "https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000913.htm"
+  ],
+  [
+    "Prednisone: Prednisone is used alone or with other medications to treat the symptoms of low corticosteroid levels (lack of certain substances that are usually produced by the body and are needed for normal body functioning). Prednisone is also used to treat other conditions in patients with normal corticosteroid levels. These conditions include certain types of arthritis; severe allergic reactions; multiple sclerosis (a disease in which the nerves do not function properly); lupus (a disease in which the body attacks many of its own organs); and certain conditions that affect the lungs, skin, eyes, kidneys blood, thyroid, stomach, and intestines. Prednisone is also sometimes used to treat the symptoms of certain types of cancer. Prednisone is in a class of medications called corticosteroids. It works to treat patients with low levels of corticosteroids by replacing steroids that are normally produced naturally by the body. It works to treat other conditions by reducing swelling and redness and by changing the way the immune system works. Prednisone comes as a tablet, a solution (liquid), and a concentrated solution to take by mouth. Prednisone is usually taken with food one to four times a day or once every other day. Your doctor will probably tell you to take your dose(s) of prednisone at certain time(s) of day every day. Your personal dosing schedule will depend on your condition and on how you respond to treatment. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take prednisone exactly as directed. Do not take more or less of it or take it more often or for a longer period of time than prescribed by your doctor. If you are taking the concentrated solution, use the specially marked dropper that comes with the medication to measure your dose. You may mix the concentrated solution with juice, other flavored liquids, or soft foods such as applesauce. Your doctor may change your dose of prednisone often during your treatment to be sure that you are always taking the lowest dose that works for you. Your doctor may also need to change your dose if you experience unusual stress on your body such as surgery, illness, infection, or a severe asthma attack. Tell your doctor if your symptoms improve or get worse or if you get sick or have any changes in your health during your treatment. If you are taking prednisone to treat a long-lasting disease, the medication may help control your condition but will not cure it. Continue to take prednisone even if you feel well. Do not stop taking prednisone without talking to your doctor. If you suddenly stop taking prednisone, your body may not have enough natural steroids to function normally. This may cause symptoms such as extreme tiredness, weakness, slowed movements, upset stomach, weight loss, changes in skin color, sores in the mouth, and craving for salt. Call your doctor if you experience these or other unusual symptoms while you are taking decreasing doses of prednisone or after you stop taking the medication. Prednisone is also sometimes used with antibiotics to treat a certain type of pneumonia in patients with acquired immunodeficiency syndrome (AIDS). Talk to your doctor about the risks of using this drug for your condition. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before taking prednisone, - tell your doctor and pharmacist if you are allergic to prednisone, any other medications, or any of the inactive ingredients in prednisone tablets or solutions. Ask your doctor or pharmacist for a list of the inactive ingredients. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); anticoagulants ('blood thinners') such as warfarin (Coumadin); certain antifungals such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral) and voriconazole (Vfend);aprepitant (Emend); aspirin; carbamazepine (Carbatrol, Epitol, Tegretol); cimetidine (Tagamet); clarithromycin (Biaxin, in Prevpak); cyclosporine (Neoral, Sandimmune); delavirdine (Rescriptor); diltiazem (Cardizem, Dilacor, Tiazac, others); dexamethasone (Decadron, Dexpak); diuretics ('water pills'); efavirenz (Sustiva); fluoxetine (Prozac, Sarafem); fluvoxamine (Luvox); griseofulvin (Fulvicin, Grifulvin, Gris-PEG); HIV protease inhibitors including atazanavir (Reyataz), indinavir (Crixivan), lopinavir (in Kaletra), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra), and saquinavir (Fortovase, Invirase); hormonal contraceptives (birth control pills, patches, rings, implants, and injections); lovastatin (Altocor, Mevacor); medications for diabetes; nefazodone; nevirapine (Viramune); phenobarbital; phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin), rifampin (Rifadin, Rimactane, in Rifamate); sertraline (Zoloft); troleandomycin (TAO); verapamil (Calan, Covera, Isoptin, Verelan); and zafirlukast (Accolate).Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor what herbal products you are taking or plan to take, especially St. John's wort. - tell your doctor if you have an eye infection now or have ever had eye infections that come and go and if you have or have ever had threadworms (a type of worm that can live inside the body); diabetes; high blood pressure; emotional problems; mental illness; myasthenia gravis (a condition in which the muscles become weak); osteoporosis (condition in which the bones become weak and fragile and can break easily); seizures; tuberculosis (TB); ulcers; or liver, kidney, intestinal, heart, or thyroid disease. - tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking prednisone, call your doctor. - if you are having surgery, including dental surgery, or need emergency medical treatment, tell the doctor, dentist, or medical staff that you are taking or have recently stopped taking prednisone. You should carry a card or wear a bracelet with this information in case you are unable to speak in a medical emergency. - do not have any vaccinations (shots to prevent diseases) without talking to your doctor. - you should know that prednisone may decrease your ability to fight infection and may prevent you from developing symptoms if you get an infection. Stay away from people who are sick and wash your hands often while you are taking this medication. Be sure to avoid people who have chicken pox or measles. Call your doctor immediately if you think you may have been around someone who had chicken pox or measles. Your doctor may instruct you to follow a low-salt, high potassium, or high calcium diet. Your doctor may also prescribe or recommend a calcium or potassium supplement. Follow these directions carefully. Talk to your doctor about eating grapefruit and drinking grapefruit juice while you are taking this medication. When you start to take prednisone, ask your doctor what to do if you forget to take a dose. Write down these instructions so that you can refer to them later. Call your doctor or pharmacist if you miss a dose and do not know what to do. Do not take a double dose to make up for a missed dose. Prednisone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - headache - dizziness - difficulty falling asleep or staying asleep - inappropriate happiness - extreme changes in mood - changes in personality - bulging eyes - acne - thin, fragile skin - red or purple blotches or lines under the skin - slowed healing of cuts and bruises - increased hair growth - changes in the way fat is spread around the body - extreme tiredness - weak muscles - irregular or absent menstrual periods - decreased sexual desire - heartburn - increased sweating Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately: - vision problems - eye pain, redness, or tearing - sore throat, fever, chills, cough, or other signs of infection - seizures - depression - loss of contact with reality - confusion - muscle twitching or tightening - shaking of the hands that you cannot control - numbness, burning, or tingling in the face, arms, legs, feet, or hands - upset stomach - vomiting - lightheadedness - irregular heartbeat - sudden weight gain - shortness of breath, especially during the night - dry, hacking cough - swelling or pain in the stomach - swelling of the eyes, face, lips, tongue, throat, arms, hands, feet, ankles, or lower legs - difficulty breathing or swallowing - rash - hives - itching Prednisone may slow growth and development in children. Your child's doctor will watch his or her growth carefully. Talk to your child's doctor about the risks of giving prednisone to your child. Prednisone may increase the risk that you will develop osteoporosis. Talk to your doctor about the risks of taking prednisone and about things that you can do to decrease the chance that you will develop osteoporosis. Some patients who took prednisone or similar medications developed a type of cancer called Kaposi's sarcoma. Talk to your doctor about the risks of taking prednisone. Prednisone may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to prednisone. If you are having any skin tests such as allergy tests or tuberculosis tests, tell the doctor or technician that you are taking prednisone. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Cortan\u00ae\u00b6 - Deltasone\u00ae\u00b6 - Orasone\u00ae\u00b6 - Prednisone Intensol - Sterapred\u00ae - Sterapred\u00ae DS",
+    "https://medlineplus.gov/druginfo/meds/a601102.html"
+  ],
+  [
+    "Prednisone (How should this medicine be used?): Prednisone comes as a tablet, a solution (liquid), and a concentrated solution to take by mouth. Prednisone is usually taken with food one to four times a day or once every other day. Your doctor will probably tell you to take your dose(s) of prednisone at certain time(s) of day every day. Your personal dosing schedule will depend on your condition and on how you respond to treatment. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take prednisone exactly as directed. Do not take more or less of it or take it more often or for a longer period of time than prescribed by your doctor. If you are taking the concentrated solution, use the specially marked dropper that comes with the medication to measure your dose. You may mix the concentrated solution with juice, other flavored liquids, or soft foods such as applesauce. Your doctor may change your dose of prednisone often during your treatment to be sure that you are always taking the lowest dose that works for you. Your doctor may also need to change your dose if you experience unusual stress on your body such as surgery, illness, infection, or a severe asthma attack. Tell your doctor if your symptoms improve or get worse or if you get sick or have any changes in your health during your treatment. If you are taking prednisone to treat a long-lasting disease, the medication may help control your condition but will not cure it. Continue to take prednisone even if you feel well. Do not stop taking prednisone without talking to your doctor. If you suddenly stop taking prednisone, your body may not have enough natural steroids to function normally. This may cause symptoms such as extreme tiredness, weakness, slowed movements, upset stomach, weight loss, changes in skin color, sores in the mouth, and craving for salt. Call your doctor if you experience these or other unusual symptoms while you are taking decreasing doses of prednisone or after you stop taking the medication.",
+    "https://medlineplus.gov/druginfo/meds/a601102.html"
+  ],
+  [
+    "Prednisone (Other uses for this medicine): Prednisone is also sometimes used with antibiotics to treat a certain type of pneumonia in patients with acquired immunodeficiency syndrome (AIDS). Talk to your doctor about the risks of using this drug for your condition. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.",
+    "https://medlineplus.gov/druginfo/meds/a601102.html"
+  ],
+  [
+    "Prednisone (What special precautions should I follow?): Before taking prednisone, - tell your doctor and pharmacist if you are allergic to prednisone, any other medications, or any of the inactive ingredients in prednisone tablets or solutions. Ask your doctor or pharmacist for a list of the inactive ingredients. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); anticoagulants ('blood thinners') such as warfarin (Coumadin); certain antifungals such as fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral) and voriconazole (Vfend);aprepitant (Emend); aspirin; carbamazepine (Carbatrol, Epitol, Tegretol); cimetidine (Tagamet); clarithromycin (Biaxin, in Prevpak); cyclosporine (Neoral, Sandimmune); delavirdine (Rescriptor); diltiazem (Cardizem, Dilacor, Tiazac, others); dexamethasone (Decadron, Dexpak); diuretics ('water pills'); efavirenz (Sustiva); fluoxetine (Prozac, Sarafem); fluvoxamine (Luvox); griseofulvin (Fulvicin, Grifulvin, Gris-PEG); HIV protease inhibitors including atazanavir (Reyataz), indinavir (Crixivan), lopinavir (in Kaletra), nelfinavir (Viracept), ritonavir (Norvir, in Kaletra), and saquinavir (Fortovase, Invirase); hormonal contraceptives (birth control pills, patches, rings, implants, and injections); lovastatin (Altocor, Mevacor); medications for diabetes; nefazodone; nevirapine (Viramune); phenobarbital; phenytoin (Dilantin, Phenytek); rifabutin (Mycobutin), rifampin (Rifadin, Rimactane, in Rifamate); sertraline (Zoloft); troleandomycin (TAO); verapamil (Calan, Covera, Isoptin, Verelan); and zafirlukast (Accolate).Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor what herbal products you are taking or plan to take, especially St. John's wort. - tell your doctor if you have an eye infection now or have ever had eye infections that come and go and if you have or have ever had threadworms (a type of worm that can live inside the body); diabetes; high blood pressure; emotional problems; mental illness; myasthenia gravis (a condition in which the muscles become weak); osteoporosis (condition in which the bones become weak and fragile and can break easily); seizures; tuberculosis (TB); ulcers; or liver, kidney, intestinal, heart, or thyroid disease. - tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking prednisone, call your doctor. - if you are having surgery, including dental surgery, or need emergency medical treatment, tell the doctor, dentist, or medical staff that you are taking or have recently stopped taking prednisone. You should carry a card or wear a bracelet with this information in case you are unable to speak in a medical emergency. - do not have any vaccinations (shots to prevent diseases) without talking to your doctor. - you should know that prednisone may decrease your ability to fight infection and may prevent you from developing symptoms if you get an infection. Stay away from people who are sick and wash your hands often while you are taking this medication. Be sure to avoid people who have chicken pox or measles. Call your doctor immediately if you think you may have been around someone who had chicken pox or measles.",
+    "https://medlineplus.gov/druginfo/meds/a601102.html"
+  ],
+  [
+    "Prednisone (What other information should I know?): Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to prednisone. If you are having any skin tests such as allergy tests or tuberculosis tests, tell the doctor or technician that you are taking prednisone. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.",
+    "https://medlineplus.gov/druginfo/meds/a601102.html"
+  ],
+  [
+    "Prednisone (What should I do if I forget a dose?): When you start to take prednisone, ask your doctor what to do if you forget to take a dose. Write down these instructions so that you can refer to them later. Call your doctor or pharmacist if you miss a dose and do not know what to do. Do not take a double dose to make up for a missed dose.",
+    "https://medlineplus.gov/druginfo/meds/a601102.html"
+  ],
+  [
+    "Prednisone (What special dietary instructions should I follow?): Your doctor may instruct you to follow a low-salt, high potassium, or high calcium diet. Your doctor may also prescribe or recommend a calcium or potassium supplement. Follow these directions carefully. Talk to your doctor about eating grapefruit and drinking grapefruit juice while you are taking this medication.",
+    "https://medlineplus.gov/druginfo/meds/a601102.html"
+  ],
+  [
+    "Swallowing problems: Difficulty with swallowing is the feeling that food or liquid is stuck in the throat or at any point before the food enters the stomach. This problem is also called dysphagia. This may be caused by a brain or nerve disorder, stress or anxiety, or problems that involve the tube leading from your throat to your stomach-the esophagus. Symptoms of swallowing problems include: - Coughing or choking, either during or after eating - Gurgling sounds from the throat, during or after eating - Throat clearing after drinking or swallowing - Slow chewing or eating - Coughing food back up after eating - Hiccups after swallowing - Chest discomfort during or after swallowing - Unexplained weight loss Symptoms may be mild or severe. Most people with dysphagia should be checked by a health care provider. But these general tips may help. - Keep mealtime relaxed. - Sit up as straight as possible when you eat. - Take small bites, less than 1 teaspoon (5 ml) of food per bite. - Chew well and swallow your food before taking another bite. - If one side of your face or mouth is weaker, chew food on the stronger side of your mouth. - DO NOT mix solid foods with liquids in the same bite. - DO NOT try to wash down solids with sips of liquids, unless your speech or swallowing therapist says this is OK. - DO NOT talk and swallow at the same time. - Sit upright for 30 to 45 minutes after eating. - DO NOT drink thin liquids without checking with your doctor or therapist first. You may need someone to remind you to finish swallowing. It may also help to ask caregivers and family members not to talk to you when you are eating or drinking. Call your provider if: - You cough or have fever or shortness of breath - You are losing weight - Your swallowing problems are getting worse Updated by: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000065.htm"
+  ],
+  [
+    "What to do for Swallowing problems?: Most people with dysphagia should be checked by a health care provider. But these general tips may help. - Keep mealtime relaxed. - Sit up as straight as possible when you eat. - Take small bites, less than 1 teaspoon of food per bite. - Chew well and swallow your food before taking another bite. - If one side of your face or mouth is weaker, chew food on the stronger side of your mouth. - Do not mix solid foods with liquids in the same bite. - Do not try to wash down solids with sips of liquids, unless your speech or swallowing therapist says this is OK. - Do not talk and swallow at the same time. - Sit upright for 30 to 45 minutes after eating. - Do not drink thin liquids without checking with your doctor or therapist first. You may need someone to remind you to finish swallowing. It may also help to ask caregivers and family members not to talk to you when you are eating or drinking.",
+    "https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000065.htm"
+  ],
+  [
+    "Swallowing problems (When to Call the Doctor): Call your provider if: - You cough or have fever or shortness of breath - You are losing weight - Your swallowing problems are getting worse",
+    "https://medlineplus.gov/ency/patientinstructions/000065.htm"
+  ],
+  [
+    "Swallowing problems (Summary): Difficulty with swallowing is the feeling that food or liquid is stuck in the throat or at any point before the food enters the stomach. This problem is also called dysphagia. This may be caused by a brain or nerve disorder, stress or anxiety, or problems that involve the tube leading from your throat to your stomach-the esophagus.",
+    "https://medlineplus.gov/ency/patientinstructions/000065.htm"
+  ],
+  [
+    "Swallowing problems (Review Date 5/11/2016): Updated by: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000065.htm"
+  ],
+  [
+    "Lower esophageal ring (When to Contact a Medical Professional): Call your health care provider if you have swallowing problems.",
+    "https://medlineplus.gov/ency/article/000208.htm"
+  ],
+  [
+    "Achalasia: The tube that carries food from the mouth to the stomach is the esophagus. Achalasia makes it harder for the esophagus to move food into the stomach. There is a muscular ring at the point where the esophagus and stomach meet. It is called the lower esophageal sphincter (LES). Normally, this muscle relaxes when you swallow to allow food to pass into the stomach. In people with achalasia, it does not relax as well. In addition, the normal muscle activity of the esophagus (peristalsis) is reduced. This problem is caused by damage to the nerves of the esophagus. Other problems can cause similar symptoms, such as cancer of the esophagus or upper stomach, and a parasite infection that causes Chagas disease. Achalasia is rare. It may occur at any age, but is most common in middle-aged or older adults. In some people, the problem may be inherited. Symptoms include: - Backflow (regurgitation) of food - Chest pain, which may increase after eating, or may be felt as pain in the back, neck, and arms - Cough - Difficulty swallowing liquids and solids - Heartburn - Unintentional weight loss Physical exam may show signs of anemia or malnutrition. Tests include: - Manometry, a test to measure how well the esophagus is working. - EGD or upper endoscopy, a test to examine the lining of the stomach and esophagus. It uses a flexible tube and camera. - Upper GI x-ray. The goal of treatment is to reduce the pressure at the sphincter muscle and allow food and liquids to pass easily into the stomach. Therapy may involve: - Injection with botulinum toxin (Botox). This may help relax the sphincter muscles. However, the benefit wears off within a few weeks or months. - Medicines, such as long-acting nitrates or calcium channel blockers. These drugs can be used to relax the lower esophagus sphincter. - Surgery (called a myotomy). In this procedure, the lower sphincter muscle is cut. - Widening (dilation) of the esophagus at the location of the narrowing. This is done during EGD. Your health care provider can help you decide which treatment is best for you. The outcomes of surgery and non-surgical treatments are similar. More than one treatment is sometimes necessary. Complications may include: - Backflow (regurgitation) of acid or food from the stomach into the esophagus (reflux) - Breathing food contents into the lungs (aspiration), which can cause pneumonia - Tearing (perforation) of the esophagus Call your provider if: - You have trouble swallowing or painful swallowing - Your symptoms continue, even with treatment for achalasia Many of the causes of achalasia cannot be prevented. However, treatment may help to prevent complications. Updated by: Subodh K. Lal, MD, gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000267.htm"
+  ],
+  [
+    "Achalasia (When to Contact a Medical Professional): Call your provider if: - You have trouble swallowing or painful swallowing - Your symptoms continue, even with treatment for achalasia",
+    "https://medlineplus.gov/ency/article/000267.htm"
+  ],
+  [
+    "Lower esophageal ring: A lower esophageal ring is an abnormal ring of tissue that forms where the esophagus (the tube from the mouth to the stomach) and stomach meet. A lower esophageal ring is a birth defect of the esophagus that occurs in a small number of people. It causes narrowing of the lower esophagus. Narrowing of the esophagus may also be caused by: - Injury - Tumors - Esophageal stricture For most people, lower esophageal ring does not cause symptoms. The most common symptom is the feeling that food (especially solid food) is stuck in the lower neck or under the breastbone (sternum). Tests that show the lower esophageal ring include: - EGD (esophagogastroduodenoscopy) - Upper GI (x-ray with barium) A device called a dilator is passed through the narrowed area\u00a0to stretch the ring. Sometimes, a balloon is placed in the area and inflated, to help widen the ring. Swallowing problems may return. You may need repeat treatment. Call your health care provider if you have swallowing problems. Updated by: Raymond S. Koff, MD, Clinical Professor of Medicine, University of Connecticut School of Medicine, Farmington, CT. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000208.htm"
+  ],
+  [
+    "Calcitonin Salmon Nasal Spray: Calcitonin salmon is used to treat osteoporosis in women who are at least 5 years past menopause and cannot or do not want to take estrogen products. Osteoporosis is a disease that causes bones to weaken and break more easily. Calcitonin is a human hormone that is also found in salmon. It works by preventing bone breakdown and increasing bone density (thickness). Calcitonin salmon comes as a spray to be used in the nose. It is usually used once a day, alternating nostrils every day. To help you remember to use calcitonin salmon, use it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use calcitonin salmon exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor. Calcitonin salmon helps treat osteoporosis but does not cure it. Continue to use calcitonin salmon even if you feel well. Do not stop using calcitonin salmon without talking to your doctor. Before using calcitonin salmon nasal spray the first time, read the written instructions that come with it. Ask your doctor or pharmacist to show you how to use it. Practice using the nasal spray while he or she watches. To put the pump and bottle together, remove the rubber stopper from the bottle, and then remove the plastic protective cap from the bottom of the spray unit. Put the spray pump into the bottle and turn to tighten. Then take the plastic cover off of the top of the spray unit. Before the first time you use a new bottle, you need to prime (activate) the pump. To prime the pump, follow these steps: - Allow the bottle to reach room temperature. - Hold the bottle upright, and press down on the two white side arms of the pump at least 5 times, until a full spray is produced. The pump is now primed. To use the nasal spray, follow these steps: - Keep your head up and place the nozzle in one nostril. - Press down on the pump to release the calcitonin salmon. - Use the opposite nostril each day. - Each bottle has enough medication for 30 doses. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before using calcitonin salmon, - tell your doctor and pharmacist if you are allergic to calcitonin salmon or any other medications. Your doctor may do a skin test before you start calcitonin salmon to make sure you do not have an allergic reaction to it. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. - tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using calcitonin salmon, call your doctor. It is important that you get enough calcium and vitamin D while you are using calcitonin salmon. Your doctor may prescribe supplements if your dietary intake is not enough. Apply the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one. Calcitonin salmon may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - runny nose - nosebleed - sinus pain - nose symptoms such as crusts, dryness, redness, or swelling - back pain - joint pain - upset stomach - flushing (feeling of warmth) Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately: - hives - skin rash - itching - difficulty breathing or swallowing - swelling of the tongue or throat Calcitonin salmon may cause other side effects. Call your doctor if you have any unusual problems while using this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store unopened calcitonin salmon nasal spray in the refrigerator; do not freeze. Store opened bottles at room temperature in an upright position. Replace the plastic cover to keep the nozzle clean. Opened calcitonin salmon stored at room temperature should be disposed of after 35 days. Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to calcitonin salmon. You will also need occasional examinations of the nose to make sure calcitonin salmon nasal spray is not causing injury to the nose. Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Fortical\u00ae - Miacalcin\u00ae Nasal Spray",
+    "https://medlineplus.gov/druginfo/meds/a601031.html"
+  ],
+  [
+    "Calcitonin blood test: The calcitonin blood test measures the level of the hormone calcitonin in the blood. A blood sample is needed. There is usually no special preparation needed. When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or slight bruising. This soon goes away. Calcitonin is a hormone produced in C cells of the thyroid gland. The thyroid gland is located inside the front of your lower neck. Calcitonin helps control the breakdown and rebuilding of bone. Your health care provider may order a calcitonin test when you have symptoms of medullary cancer of the thyroid or multiple endocrine neoplasia (MEN) syndrome, or a family history of these conditions. Calcitonin may also be higher in other tumors, such as: - Insulinoma (tumor in the pancreas that produces too much insulin) - Lung cancer - VIPoma (cancer that usually grows from islet cells in the pancreas) A normal value is less than 10 pg/mL. Women and men can have different normal values, with men having higher values. Sometimes, calcitonin in the blood is checked several times after you are given a shot (injection) of a special medicine that stimulates calcitonin production. You will need this extra test if your baseline calcitonin is normal, but your doctor suspects you have medullary cancer of the thyroid. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or may test different specimens. Talk to your doctor about the meaning of your specific test results. A higher-than-normal level may indicate: - Insulinoma - Lung cancer - Medullary cancer of thyroid (most common) - VIPoma Higher-than-normal levels can also occur in people with kidney disease, smokers, higher body weight, and when taking certain medicines to stop stomach acid production. Veins and arteries vary in size from one person to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others. Other risks associated with having blood drawn are slight, but may include: - Excessive bleeding - Fainting or feeling lightheaded - Hematoma (blood accumulating under the skin) - Infection (a slight risk any time the skin is broken) Updated by: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology and Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003699.htm"
+  ],
+  [
+    "Calcitonin Salmon Nasal Spray (What other information should I know?): Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to calcitonin salmon. You will also need occasional examinations of the nose to make sure calcitonin salmon nasal spray is not causing injury to the nose. Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.",
+    "https://medlineplus.gov/druginfo/meds/a601031.html"
+  ],
+  [
+    "Calcitonin Salmon Injection (How should this medicine be used?): Calcitonin salmon comes as a solution to be injected under the skin (subcutaneously) or into the muscle (intramuscularly). It is usually used once a day or once every other day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use calcitonin salmon injection exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor. Your doctor, nurse, or pharmacist will show you how to administer the medication. Follow all directions carefully. Dispose of all empty syringes and vials as directed by your healthcare provider. Before preparing a dose, look at the vial. If the solution is discolored or contains particles, do not use it, and call your pharmacist. Calcitonin salmon helps treat osteoporosis and Paget's disease of bone but does not cure them. Continue to use calcitonin salmon even if you feel well. Do not stop using calcitonin salmon without talking to your doctor.",
+    "https://medlineplus.gov/druginfo/meds/a682788.html"
+  ],
+  [
+    "Swollen lymph nodes: Swollen lymph nodes usually occur as a result of exposure to bacteria or viruses. When swollen lymph nodes are caused by an infection, this is known as lymphadenitis (lim-fad-uh-NIE-tis). Rarely, swollen lymph nodes are caused by cancer. Your lymph nodes, also called lymph glands, play a vital role in your body's ability to fight off infections. They function as filters, trapping viruses, bacteria and other causes of illnesses before they can infect other parts of your body. Common areas where you might notice swollen lymph nodes include your neck, under your chin, in your armpits and in your groin. In some cases, the passage of time and warm compresses may be all you need to treat swollen lymph nodes. Treatment of lymphadenitis depends on the cause. Your lymphatic system is a network of organs, vessels and lymph nodes situated throughout your body. Many lymph nodes are located in your head and neck region. Lymph nodes that frequently swell are in this area, as well as in your armpits and groin area. Swollen lymph nodes are a sign that something is wrong somewhere in your body. When your lymph nodes first swell, you might notice: - Tenderness and pain in the lymph nodes - Swelling that may be the size of a pea or kidney bean, or even larger in the lymph nodes Depending on the cause of your swollen lymph nodes, other signs and symptoms you might have include: - Runny nose, sore throat, fever and other indications of an upper respiratory infection - General swelling of lymph nodes throughout your body - which may indicate an infection, such as HIV or mononucleosis, or an immune disorder, such as lupus or rheumatoid arthritis - Hard, fixed, rapidly growing nodes, indicating a possible tumor - Fever - Night sweats Some swollen lymph nodes return to normal when the underlying condition, such as a minor infection, gets better. See your doctor if you're concerned or if your swollen lymph nodes: - Have appeared for no apparent reason - Continue to enlarge or have been present for two to four weeks - Feel hard or rubbery, or don't move when you push on them - Are accompanied by persistent fever, night sweats or unexplained weight loss Seek immediate medical care if you're having difficulty swallowing or breathing. A lymph node is a small, round or bean-shaped cluster of cells covered by a capsule of connective tissue. The cells are a combination of lymphocytes - which produce protein particles that capture invaders, such as viruses - and macrophages, which break down the captured material. Lymphocytes and macrophages filter your lymphatic fluid as it travels through your body and protect you by destroying invaders. Lymph nodes are located in groups, and each group drains a specific area of your body. You may be more likely to notice swelling in certain areas, such as in the lymph nodes in your neck, under your chin, in your armpits and in your groin. The site of the swollen lymph nodes may help identify the underlying cause. The most common cause of swollen lymph nodes is an infection, particularly a viral infection, such as the common cold. Other possible causes of swollen lymph nodes include: - Strep throat - Measles - Ear infections - Infected (abscessed) tooth - Mononucleosis - Skin or wound infections, such as cellulitis - Human immunodeficiency virus (HIV) - the virus that causes AIDS - Tuberculosis - Certain sexually transmitted infections, such as syphilis - Toxoplasmosis - a parasitic infection resulting from contact with the feces of an infected cat or eating undercooked meat - Cat scratch fever - a bacterial infection from a cat scratch or bite - Lupus - a chronic inflammatory disease that can target your joints, skin, kidneys, blood cells, heart and lungs - Rheumatoid arthritis - a chronic inflammatory disease that targets the tissue that lines your joints (synovium) - Lymphoma - cancer that originates in your lymphatic system - Leukemia - cancer of your body's blood-forming tissue, including your bone marrow and lymphatic system - Other cancers that have spread (metastasized ) to lymph nodes Other possible but rare causes include certain medications, such as the anti-seizure medication phenytoin (Dilantin) and preventive medications for malaria. To diagnose what might be causing your swollen lymph nodes, your doctor may need: - Your medical history. In addition, your doctor will want to know when and how your swollen lymph nodes developed and if you have any other signs or symptoms. - A physical exam. Your doctor will also want to check lymph nodes near the surface of your skin for size, tenderness, warmth and texture. The site of your swollen lymph nodes and your other signs and symptoms will offer clues to the underlying cause. - Blood tests. Depending on what your doctor suspects is causing your swollen lymph nodes, certain blood tests may be done to confirm or exclude the suspected underlying condition. The specific tests will depend on the suspected cause, but most likely will include a complete blood count (CBC). This helps evaluate your overall health and detect a range of disorders, including infections and leukemia. - Imaging studies. A chest X-ray or computerized tomography (CT) scan of the affected area may help determine potential sources of infection or find tumors. - Lymph node biopsy. Your doctor may have you undergo a biopsy. He or she will remove a sample from a lymph node or even an entire lymph node for microscopic examination. Swollen lymph nodes caused by a virus may return to normal after the viral infection resolves. Antibiotics are not useful to treat viral infections. Treatment for swollen lymph nodes from other causes depends on the cause: - Infection. The most common treatment for swollen lymph nodes caused by a bacterial infection is antibiotics. If your swollen lymph nodes are due to an HIV infection, you'll receive specific treatment for that condition. - Immune disorder. If your swollen lymph nodes are a result of certain conditions, such as lupus or rheumatoid arthritis, treatment is directed at the underlying condition. - Cancer. Swollen nodes caused by cancer require treatment for the cancer. Depending on the type of cancer, treatment may involve surgery, radiation or chemotherapy. If your swollen lymph nodes are tender or painful, you might get some relief by doing the following: - Apply a warm compress. Apply a warm, wet compress, such as a washcloth dipped in hot water and wrung out, to the affected area. - Take an over-the-counter pain reliever. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns. - Get adequate rest. You often need rest to aid your recovery from the underlying condition.",
+    "https://www.mayoclinic.org/diseases-conditions/swollen-lymph-nodes/symptoms-causes/syc-20353902"
+  ],
+  [
+    "Do you have information about D and C: Summary : D and C is a procedure to scrape and collect the tissue (endometrium) from inside the uterus. - Dilation (\"D\") is a widening of the cervix to allow instruments into the uterus. - Curettage (\"C\") is the scraping of the walls of the uterus. Description : D and C, also called uterine scraping, may be performed in the hospital or in a clinic while you are under general or local anesthesia. The health care provider will insert an instrument called a speculum into the vagina. This holds open the vaginal canal. Numbing medicine may be applied to the opening to the uterus (cervix). The cervical canal is widened, and a curette (a metal loop on the end of a long, thin handle) is passed through the opening into the uterus cavity. The health care provider gently scrapes the inner layer of tissue, called the endometrium. The tissue is collected for examination. Why the Procedure is Performed : This procedure may be done to: - Diagnose or rule out conditions such as uterine cancer - Remove tissue after a miscarriage - Treat heavy menstrual bleeding, irregular periods, or bleeding between periods - Perform a therapeutic or elective abortion Your health care provider may also recommend a D and C if you have: - Abnormal bleeding while you are on hormone replacement therapy - An embedded intrauterine device (IUD) - Bleeding after menopause - Endometrial polyps (small lumps of tissue on the endometrium) - Thickening of the uterus This list may not include all possible reasons for a D and C. Risks : Risks related to D and C include: - Puncture of the uterus - Scarring of the uterine lining (Asherman syndrome, may lead to infertility later) - Tear of the cervix Risks due to anesthesia include: - Reactions to medications - Problems breathing Risks of any surgery include: - Bleeding - Infection After the Procedure : A D and C has few risks. It can provide relief from bleeding, and can help diagnose infection, cancer, and other diseases. You may return to your normal activities as soon as you feel better, possibly even the same day. You may have vaginal bleeding, pelvic cramps, and back pain for a few days after the procedure. You can usually manage pain well with medications. Avoid using tampons and having sexual intercourse for 1 - 2 weeks after the procedure.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/002914.htm"
+  ],
+  [
+    "Cancer and lymph nodes (How Cancer Gets in the Lymph Nodes): Cancer can start in the lymph nodes. This is called lymphoma. There are several types of lymphomas, such as non-Hodgkin lymphoma. Cancer cells can also spread to the lymph nodes from a cancer in any part of the body. This is called metastatic cancer. Cancer cells break off from a tumor in the body and travel to an area of lymph nodes. The cancer cells often travel to nodes near the tumor first.",
+    "https://medlineplus.gov/ency/patientinstructions/000824.htm"
+  ],
+  [
+    "Cancer and lymph nodes (Removing Lymph Nodes): Surgical removal of lymph nodes is called lymphadenectomy. Surgery can help to get rid of the cancer before spreading further. After nodes are removed, fluid has fewer places to go. Sometimes back up of lymph fluid, or lymphedema, can occur.",
+    "https://medlineplus.gov/ency/patientinstructions/000824.htm"
+  ],
+  [
+    "Cancer and lymph nodes (How Cancer in Lymph Nodes is Found): Nodes swell as they work hard to fight cancer cells. You or your health care provider may feel or see swollen lymph nodes if they are close to the surface of the skin, such as in the neck, groin, or underarms. Keep in mind that many other things also can cause lymph nodes to swell. So having swollen lymph nodes does not mean you definitely have cancer. When a provider suspects that cancer cells may be present in lymph nodes, certain tests may be performed to detect cancer, such as: - Lymph node biopsy - B-cell leukemia/lymphoma panel - Other imaging tests",
+    "https://medlineplus.gov/ency/patientinstructions/000824.htm"
+  ],
+  [
+    "Cancer and lymph nodes: Lymph nodes are part of the lymph system, a network of organs, nodes, ducts, and vessels that support the body's immune system. Nodes are little filters throughout the body. The cells in lymph nodes help to destroy infection, such as from a virus, or harmful cells, such as cancer cells. Cancer can spread or start in lymph nodes. Cancer can start in the lymph nodes. This is called lymphoma. There are several types of lymphomas, such as non-Hodgkin lymphoma. Cancer cells can also spread to the lymph nodes from a cancer in any part of the body. This is called metastatic cancer. Cancer cells break off from a tumor in the body and travel to an area of lymph nodes. The cancer cells often travel to nodes near the tumor first. Nodes swell as they work hard to fight cancer cells. You or your health care provider may feel or see swollen lymph nodes if they are close to the surface of the skin, such as in the neck, groin, or underarms. Keep in mind that many other things also can cause lymph nodes to swell. So having swollen lymph nodes does not mean you definitely have cancer. When a provider suspects that cancer cells may be present in lymph nodes, certain tests may be performed to detect cancer, such as: - Lymph node biopsy - B-cell leukemia/lymphoma panel - Other imaging tests A node can have a small or large amount of cancer cells in it. There are hundreds of nodes throughout the body. Several clusters or only a few nodes may be affected. Nodes near or far from the primary tumor may be affected. The location, amount of swelling, number of cancer cells, and number of nodes affected will help determine the treatment plan. When cancer has spread to lymph nodes, it is in a more advanced stage. The cancer in lymph nodes can be treated with: - Surgery - Chemotherapy - Radiation Surgical removal of lymph nodes is called lymphadenectomy. Surgery can help to get rid of the cancer before spreading further. After nodes are removed, fluid has fewer places to go. Sometimes back up of lymph fluid, or lymphedema, can occur. Call your provider if you have questions or concerns about swollen lymph nodes or your cancer treatment. Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists and Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000824.htm"
+  ],
+  [
+    "Swollen lymph nodes (Treatment): Swollen lymph nodes caused by a virus may return to normal after the viral infection resolves. Antibiotics are not useful to treat viral infections. Treatment for swollen lymph nodes from other causes depends on the cause: - Infection. The most common treatment for swollen lymph nodes caused by a bacterial infection is antibiotics. If your swollen lymph nodes are due to an HIV infection, you'll receive specific treatment for that condition. - Immune disorder. If your swollen lymph nodes are a result of certain conditions, such as lupus or rheumatoid arthritis, treatment is directed at the underlying condition. - Cancer. Swollen nodes caused by cancer require treatment for the cancer. Depending on the type of cancer, treatment may involve surgery, radiation or chemotherapy.",
+    "https://www.mayoclinic.org/diseases-conditions/swollen-lymph-nodes/symptoms-causes/syc-20353902"
+  ],
+  [
+    "Swollen lymph nodes (Diagnosis): To diagnose what might be causing your swollen lymph nodes, your doctor may need: - Your medical history. In addition, your doctor will want to know when and how your swollen lymph nodes developed and if you have any other signs or symptoms. - A physical exam. Your doctor will also want to check lymph nodes near the surface of your skin for size, tenderness, warmth and texture. The site of your swollen lymph nodes and your other signs and symptoms will offer clues to the underlying cause. - Blood tests. Depending on what your doctor suspects is causing your swollen lymph nodes, certain blood tests may be done to confirm or exclude the suspected underlying condition. The specific tests will depend on the suspected cause, but most likely will include a complete blood count (CBC). This helps evaluate your overall health and detect a range of disorders, including infections and leukemia. - Imaging studies. A chest X-ray or computerized tomography (CT) scan of the affected area may help determine potential sources of infection or find tumors. - Lymph node biopsy. Your doctor may have you undergo a biopsy. He or she will remove a sample from a lymph node or even an entire lymph node for microscopic examination.",
+    "https://www.mayoclinic.org/diseases-conditions/swollen-lymph-nodes/symptoms-causes/syc-20353902"
+  ],
+  [
+    "Isolated sleep paralysis: Isolated sleep paralysis is a type of paralysis that occurs when a person just goes to sleep or upon waking from sleep. It is not associated with another sleep disorder. Episodes of isolated sleep paralysis last from a few seconds to 1 or 2 minutes. During these episodes the person is unable to move or speak. Breathing is not affected. These spells end on their own or when the person is touched or moved. In rare cases, the person may have dream-like sensations or hallucinations, which may be scary to them. Sleep paralysis can be a symptom of narcolepsy. But if you do not have other symptoms of narcolepsy, there is usually no need to have sleep studies done. In most cases, isolated sleep paralysis occurs so rarely that treatment is not needed. If the cause is known, for example due to lack of sleep, correcting the cause, such as getting enough sleep, often resolves the condition. In persons with mental health conditions, medicine and behavioral therapy (talk therapy) to help treat the mental condition may resolve sleep paralysis. Updated by: Allen J. Blaivas, DO, Division of Pulmonary, Critical Care, and Sleep Medicine, VA New Jersey Health Care System, Clinical Assistant Professor, Rutger's New Jersey Medical School, East Orange, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000801.htm"
+  ],
+  [
+    "What is Paralysis?: Paralysis is the loss of muscle function in part of your body. It happens when something goes wrong with the way messages pass between your brain and muscles. Paralysis can be complete or partial. It can occur on one or both sides of your body. It can also occur in just one area, or it can be widespread. Paralysis of the lower half of your body, including both legs, is called paraplegia. Paralysis of the arms and legs is quadriplegia. Most paralysis is due to strokes or injuries such as spinal cord injury or a broken neck. Other causes of paralysis include - Nerve diseases such as amyotrophic lateral sclerosis - Autoimmune diseases such as Guillain-Barre syndrome - Bell's palsy, which affects muscles in the face Polio used to be a cause of paralysis, but polio no longer occurs in the U.S.",
+    "https://www.nlm.nih.gov/medlineplus/paralysis.html"
+  ],
+  [
+    "Isolated sleep paralysis (Treatment): In most cases, isolated sleep paralysis occurs so rarely that treatment is not needed. If the cause is known, for example due to lack of sleep, correcting the cause, such as getting enough sleep, often resolves the condition. In persons with mental health conditions, medicine and behavioral therapy (talk therapy) to help treat the mental condition may resolve sleep paralysis.",
+    "https://medlineplus.gov/ency/article/000801.htm"
+  ],
+  [
+    "Isolated sleep paralysis (Exams and Tests): Sleep paralysis can be a symptom of narcolepsy. But if you do not have other symptoms of narcolepsy, there is usually no need to have sleep studies done.",
+    "https://medlineplus.gov/ency/article/000801.htm"
+  ],
+  [
+    "Isolated sleep paralysis (Symptoms): Episodes of isolated sleep paralysis last from a few seconds to 1 or 2 minutes. During these episodes the person is unable to move or speak. Breathing is not affected. These spells end on their own or when the person is touched or moved. In rare cases, the person may have dream-like sensations or hallucinations, which may be scary to them.",
+    "https://medlineplus.gov/ency/article/000801.htm"
+  ],
+  [
+    "Isolated sleep paralysis (Review Date 4/13/2015): Updated by: Allen J. Blaivas, DO, Division of Pulmonary, Critical Care, and Sleep Medicine, VA New Jersey Health Care System, Clinical Assistant Professor, Rutger's New Jersey Medical School, East Orange, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000801.htm"
+  ],
+  [
+    "Sleep (What is REM sleep?): The brain cycles through five distinct phases during sleep: stages 1, 2, 3, 4, and rapid eye movement (REM) sleep. REM sleep makes up about 25% of your sleep cycle and first occurs about 70 to 90 minutes after you fall asleep. Because your sleep cycle repeats, you enter REM sleep several times during the night. During REM sleep, your brain and body are energized and dreaming occurs. REM is thought to be involved in the process of storing memories, learning, and balancing your mood, although the exact mechanisms are not well understood. REM sleep begins in response to signals sent to and from different regions of the brain. Signals are sent to the brain's cerebral cortex, which is responsible for learning, thinking, and organizing information. Signals are also sent to the spinal cord to shut off movement, creating a temporary inability to move the muscles (\"paralysis\") in the arms and legs. Abnormal disruption of this temporary paralysis can cause people to move while they are dreaming. For example, this type of movement while dreaming can lead to injuries that could happen when a person runs into furniture while dreaming of catching a ball. REM sleep stimulates regions of the brain that are used for learning. Studies have shown that when people are deprived of REM sleep, they are not able to remember what they were taught before going to sleep. Lack of REM sleep has also been linked to certain health conditions, including migraines. The reason for dreaming during REM sleep is not understood. While some of the signals sent to the cortex during sleep are important for learning and memory, some signals seem to be random. It is these random signals that may form the basis for a \"story\" that the brain's cortex tries to interpret or find meaning in, resulting in dreaming. \u00ab What are circadian rhythms? What is the effect of sleep deprivation? \u00bb \u200b",
+    "https://www.nichd.nih.gov/health/topics/sleep"
+  ],
+  [
+    "Facial paralysis: Facial paralysis occurs when a person is no longer able to move some or all of the muscles on one side of the face. Facial paralysis is almost always caused by: - Damage or swelling of the facial nerve, which carries signals from the brain to the muscles of the face - Damage to the area of the brain that sends signals to the muscles of the face In people who are otherwise healthy, facial paralysis is often due to Bell palsy. This is a condition in which the facial nerve becomes inflamed. Stroke may cause facial paralysis. With a stroke, other muscles on one side of the body may also be involved. Facial paralysis that is due to a brain tumor usually develops slowly. Symptoms can include headaches, seizures, or hearing loss. In newborns, facial paralysis may be caused by trauma during birth. Other causes include: - Infection of the brain or surrounding tissues - Lyme disease - Sarcoidosis - Tumor that presses on the facial nerve Follow your health care provider's instructions on how to take care of yourself at home. Take any medicines as directed. If the eye cannot fully close, the cornea must be protected from drying out with prescription eye drops or gel. Call your provider if you have weakness or numbness in your face. Seek emergency medical help right away if you have these symptoms along with a severe headache, seizure, or blindness. The provider will perform a physical exam and ask questions about your medical history and symptoms, including: - Are both sides of your face affected? - Have you recently been sick or injured? - What other symptoms do you have? For example, drooling, excessive tears from one eye, headaches, seizures, vision problems, weakness, or paralysis. Tests that may be ordered include: - Blood tests, including blood sugar, CBC, (ESR), Lyme test - CT scan of the head - Electromyography - MRI of the head Treatment depends on the cause. Follow your provider's treatment recommendations. The provider may refer you to a physical, speech, or occupational therapist. If facial paralysis from Bell palsy lasts for more than 6 to 12 months, plastic surgery may be recommended to help the eye close and improve the appearance of the face. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003028.htm"
+  ],
+  [
+    "Sleep: Alzheimer's disease often affects a person's sleeping habits. It may be hard to get the person to go to bed and stay there. Someone with Alzheimer's may sleep a lot or not enough, and may wake up many times during the night.Here are some tips that may help caregivers manage sleep problems in people with Alzheimer's disease:- Help the person get exercise each day, limit naps, and make sure the person gets enough rest at night. Being overly tired can increase late-afternoon and nighttime restlessness. - Plan activities that use more energy early in the day. For example, try bathing in the morning or having the largest family meal in the middle of the day. - Set a quiet, peaceful mood in the evening to help the person relax. Keep the lights low, try to reduce the noise levels, and play soothing music if he or she enjoys it. - Try to have the person go to bed at the same time each night. A bedtime routine, such as reading out loud, also may help. - Limit caffeine. - Use nightlights in the bedroom, hall, and bathroom.Read about this topic in Spanish. Lea sobre este tema en espanol. Alzheimer's disease often affects a person's sleeping habits. It may be hard to get the person to go to bed and stay there. Someone with Alzheimer's may sleep a lot or not enough, and may wake up many times during the night.Here are some tips that may help caregivers manage sleep problems in people with Alzheimer's disease:- Help the person get exercise each day, limit naps, and make sure the person gets enough rest at night. Being overly tired can increase late-afternoon and nighttime restlessness. - Plan activities that use more energy early in the day. For example, try bathing in the morning or having the largest family meal in the middle of the day. - Set a quiet, peaceful mood in the evening to help the person relax. Keep the lights low, try to reduce the noise levels, and play soothing music if he or she enjoys it. - Try to have the person go to bed at the same time each night. A bedtime routine, such as reading out loud, also may help. - Limit caffeine. - Use nightlights in the bedroom, hall, and bathroom.Read about this topic in Spanish. Lea sobre este tema en espanol. Alzheimer's disease often affects a person's sleeping habits. It may be hard to get the person to go to bed and stay there. Someone with Alzheimer's may sleep a lot or not enough, and may wake up many times during the night.Here are some tips that may help caregivers manage sleep problems in people with Alzheimer's disease:- Help the person get exercise each day, limit naps, and make sure the person gets enough rest at night. Being overly tired can increase late-afternoon and nighttime restlessness. - Plan activities that use more energy early in the day. For example, try bathing in the morning or having the largest family meal in the middle of the day. - Set a quiet, peaceful mood in the evening to help the person relax. Keep the lights low, try to reduce the noise levels, and play soothing music if he or she enjoys it. - Try to have the person go to bed at the same time each night. A bedtime routine, such as reading out loud, also may help. - Limit caffeine. - Use nightlights in the bedroom, hall, and bathroom.Read about this topic in Spanish. Lea sobre este tema en espanol. The years of the menopausal transition are often a time when there are other changes in a woman's life. You may be caring for aging parents, supporting children as they move into adulthood, and reflecting on your own life journey. Add hot flashes on top of all this, and you may find yourself having trouble sleeping at night.Not getting enough sleep can affect all areas of life. Lack of sleep can make you feel irritable or depressed, might cause you to be more forgetful than normal, and could lead to more falls or accidents.Some women who have trouble sleeping may use over-the-counter sleep aids like melatonin. Others use prescription medicines to help them sleep, which may help when used for a short time. But, medicines are not a cure for insomnia. Developing healthy habits at bedtime can help you get a good night's sleep. The years of the menopausal transition are often a time when there are other changes in a woman's life. You may be caring for aging parents, supporting children as they move into adulthood, and reflecting on your own life journey. Add hot flashes on top of all this, and you may find yourself having trouble sleeping at night.Not getting enough sleep can affect all areas of life. Lack of sleep can make you feel irritable or depressed, might cause you to be more forgetful than normal, and could lead to more falls or accidents.Some women who have trouble sleeping may use over-the-counter sleep aids like melatonin. Others use prescription medicines to help them sleep, which may help when used for a short time. But, medicines are not a cure for insomnia. Developing healthy habits at bedtime can help you get a good night's sleep. To improve your sleep through the menopausal transition and beyond:- Follow a regular sleep schedule. Go to sleep and get up at the same time each day. - Avoid napping in the late afternoon or evening if you can. It may keep you awake at night. - Develop a bedtime routine. Some people read a book, listen to soothing music, or soak in a warm bath. - Try not to watch television or use your computer or mobile device in the bedroom. The light from these devices may make it difficult for you to fall asleep. - Keep your bedroom at a comfortable temperature, not too hot or too cold, and as quiet as possible. - Exercise at regular times each day but not close to bedtime. - Avoid eating large meals close to bedtime. - Stay away from caffeine (found in some coffees, teas, or chocolate) late in the day. - Remember, alcohol won't help you sleep. Even small amounts make it harder to stay asleep.If these changes to your bedtime routine don't help as much as you'd like, you may want to consider cognitive behavioral therapy. This problem-solving approach to therapy has recently been shown to help sleep disturbances in women with menopausal symptoms. Cognitive behavioral therapy can be found through a class or in one-on-one sessions. Be sure that your therapy is guided by a trained professional with experience working with women during their menopausal transition. Your doctor may be able to recommend a therapist in your area.Learn more about getting a good night's sleep as you age. Just like Edward, you want a good night's rest. Getting enough sleep helps you stay healthy and alert. But, many older people don't sleep well. If you're always sleepy or you find it hard to get enough sleep at night, it may be time to see a doctor. Waking up every day feeling tired is a sign that you are not getting the rest you need. Just like Edward, you want a good night's rest. Getting enough sleep helps you stay healthy and alert. But, many older people don't sleep well. If you're always sleepy or you find it hard to get enough sleep at night, it may be time to see a doctor. Waking up every day feeling tired is a sign that you are not getting the rest you need. Older adults need about the same amount of sleep as all adults-7 to 9 hours each night. But, older people tend to go to sleep earlier and get up earlier than they did when they were younger.There are many reasons why older people may not get enough sleep at night. Feeling sick or being in pain can make it hard to sleep. Some medicines can keep you awake. No matter the reason, if you don't get a good night's sleep, the next day you may:- Be irritable - Have memory problems or be forgetful - Feel depressed - Have more falls or accidents Being older doesn't mean you have to be tired all the time. You can do many things to help you get a good night's sleep. Here are some ideas:- Follow a regular sleep schedule. Go to sleep and get up at the same time each day, even on weekends or when you are traveling. - Avoid napping in the late afternoon or evening, if you can. Naps may keep you awake at night. - Develop a bedtime routine. Take time to relax before bedtime each night. Some people read a book, listen to soothing music, or soak in a warm bath. - Try not to watch television or use your computer, cell phone, or tablet in the bedroom. The light from these devices may make it difficult for you to fall asleep. And alarming or unsettling shows or movies, like horror movies, may keep you awake. - Keep your bedroom at a comfortable temperature, not too hot or too cold, and as quiet as possible. - Use low lighting in the evenings and as you prepare for bed. - Exercise at regular times each day but not within 3 hours of your bedtime. - Avoid eating large meals close to bedtime-they can keep you awake. - Stay away from caffeine late in the day. Caffeine (found in coffee, tea, soda, and chocolate) can keep you awake. - Remember-alcohol won't help you sleep. Even small amounts make it harder to stay asleep. Insomnia is the most common sleep problem in adults age 60 and older. People with this condition have trouble falling asleep and staying asleep. Insomnia can last for days, months, and even years. Having trouble sleeping can mean you:- Take a long time to fall asleep - Wake up many times in the night - Wake up early and are unable to get back to sleep - Wake up tired - Feel very sleepy during the dayOften, being unable to sleep becomes a habit. Some people worry about not sleeping even before they get into bed. This may make it harder to fall asleep and stay asleep.Some older adults who have trouble sleeping may use over-the-counter sleep aids. Others may use prescription medicines to help them sleep. These medicines may help when used for a short time. But remember, medicines aren't a cure for insomnia.Developing healthy habits at bedtime may help you get a good night's sleep. People with sleep apnea have short pauses in breathing while they are asleep. These pauses may happen many times during the night. If not treated, sleep apnea can lead to other problems, such as high blood pressure, stroke, or memory loss.You can have sleep apnea and not even know it. Feeling sleepy during the day and being told you are snoring loudly at night could be signs that you have sleep apnea.If you think you have sleep apnea, see a doctor who can treat this sleep problem. You may need to learn to sleep in a position that keeps your airways open. Treatment using a continuous positive airway pressure (CPAP) device almost always helps people with sleep apnea. A dental device or surgery may also help. Restless legs syndrome, periodic limb movement disorder, and rapid eye movement sleep behavior disorder are common in older adults. These movement disorders can rob you of needed sleep.People with restless legs syndrome, or RLS, feel like there is tingling, crawling, or pins and needles in one or both legs. This feeling is worse at night. See your doctor for more information about medicines to treat RLS.Periodic limb movement disorder, or PLMD, causes people to jerk and kick their legs every 20 to 40 seconds during sleep. Medication, warm baths, exercise, and relaxation exercises can help.Rapid eye movement, or REM, sleep behavior disorder is another condition that may make it harder to get a good night's sleep. During normal REM sleep, your muscles cannot move, so your body stays still. But, if you have REM sleep behavior disorder, your muscles can move and your sleep is disrupted. Alzheimer's disease often changes a person's sleeping habits. Some people with Alzheimer's disease sleep too much; others don't sleep enough. Some people wake up many times during the night; others wander or yell at night.The person with Alzheimer's disease isn't the only one who loses sleep. Caregivers may have sleepless nights, leaving them tired for the challenges they face.If you're caring for someone with Alzheimer's disease, take these steps to make him or her safer and help you sleep better at night:- Make sure the floor is clear of objects. - Lock up any medicines. - Attach grab bars in the bathroom. - Place a gate across the stairs. Try to set up a safe and restful place to sleep. Make sure you have smoke alarms on each floor of your home. Before going to bed, lock all windows and doors that lead outside. Other ideas for a safe night's sleep are:- Keep a telephone with emergency phone numbers by your bed. - Have a lamp within reach that is easy to turn on. - Put a glass of water next to the bed in case you wake up thirsty. - Don't smoke, especially in bed. - Remove area rugs so you won't trip if you get out of bed during the night. You may have heard about some tricks to help you fall asleep. You don't really have to count sheep-you could try counting slowly to 100. Some people find that playing mental games makes them sleepy. For example, tell yourself it is 5 minutes before you have to get up, and you're just trying to get a little bit more sleep.Some people find that relaxing their bodies puts them to sleep. One way to do this is to imagine your toes are completely relaxed, then your feet, and then your ankles are completely relaxed. Work your way up the rest of your body, section by section. You may drift off to sleep before getting to the top of your head.Use your bedroom only for sleeping. After turning off the light, give yourself about 20 minutes to fall asleep. If you're still awake and not drowsy, get out of bed. When you feel sleepy, go back to bed.If you feel tired and unable to do your activities for more than 2 or 3 weeks, you may have a sleep problem. Talk with your doctor about changes you can make to get a better night's sleep.Read about this topic in Spanish. Lea sobre este tema en espanol.",
+    "https://www.nia.nih.gov/health/topics/sleep"
+  ],
+  [
+    "Asthma - children (Treatment): You and your child's providers should work together as a team to create and carry out an asthma action plan. This plan will tell you how to: - Avoid asthma triggers - Monitor symptoms - Measure peak flow - Take medicines The plan should also tell you when to call the provider. It is important to know what questions to ask your child's provider. Children with asthma need a lot of support at school. - Give the school staff your asthma action plan so they know how to take care of your child's asthma. - Find out how to let your child take medicine during school hours. (You may need to sign a consent form.) - Having asthma does not mean your child cannot exercise. Coaches, gym teachers, and your child should know what to do if your child has asthma symptoms caused by exercise. ASTHMA MEDICINES There are two basic kinds of medicine used to treat asthma. Long-term control drugs are taken every day to prevent asthma symptoms. Your child should take these medicines even if no symptoms are present. Some children may need more than one long-term control medicine. Types of long-term control medicines include: - Inhaled steroids (these are usually the first choice of treatment) - Long-acting bronchodilators (these are almost always used with inhaled steroids) - Leukotriene inhibitors - Cromolyn sodium Quick relief or rescue asthma drugs work fast to control asthma symptoms. Children take them when they are coughing, wheezing, having trouble breathing, or having an asthma attack. Some of your child's asthma medicines can be taken using an inhaler. - Children who use an inhaler should use a spacer device. This helps them get the medicine into the lungs properly. - If your child uses the inhaler the wrong way, less medicine gets into the lungs. Have your provider show your child how to correctly use an inhaler. - Younger children can use a nebulizer instead of an inhaler to take their medicine. A nebulizer turns asthma medicine into a mist. GETTING RID OF TRIGGERS It is important to know your child's asthma triggers. Avoiding them is the first step toward helping your child feel better. Keep pets outdoors, or at least away from the child's bedroom. No one should smoke in a house or around a child with asthma. - Getting rid of tobacco smoke in the home is the single most important thing a family can do to help a child with asthma. - Smoking outside the house is not enough. Family members and visitors who smoke carry the smoke inside on their clothes and hair. This can trigger asthma symptoms. - DO NOT use indoor fireplaces. Keep the house clean. Keep food in containers and out of bedrooms. This helps reduce the possibility of cockroaches, which can trigger asthma attacks. Cleaning products in the home should be unscented. MONITOR YOUR CHILD'S ASTHMA Checking peak flow is one of the best ways to control asthma. It can help you keep your child's asthma from getting worse. Asthma attacks usually DO NOT happen without warning. Children under age 5 may not be able to use a peak flow meter well enough for it to be helpful. However, a child should start using the peak flow meter at a young age to get used to it. An adult should always watch for a child's asthma symptoms.",
+    "https://medlineplus.gov/ency/article/000990.htm"
+  ],
+  [
+    "Exercising and asthma at school: Sometimes exercise triggers asthma symptoms. This is called exercise-induced asthma (EIA). The symptoms of EIA are coughing, wheezing, a feeling of tightness in your chest, or shortness of breath. Most times, these symptoms start soon after you stop exercising. Some people may have symptoms after they start exercising. Having asthma symptoms when exercising does not mean a student cannot or should not exercise. Taking part in recess, physical education (PE), and after-school sports is important for all children. And children with asthma should not have to sit on the side lines. School staff and coaches should know your child's asthma triggers, such as: - Cold or dry air. Breathing through the nose or wearing a scarf or mask over the mouth may help. - Polluted air. - Freshly mowed fields or lawns. A student with asthma should warm up before exercising and cool down afterward. Read the student's asthma action plan. Make sure staff members know where it is kept. Discuss the action plan with the parent or guardian. Find out what type of activities the student can do and for how long. Teachers, coaches, and other school staff should know the symptoms of asthma and what to do if a student has an asthma attack. Help the student take the medicines listed in his or her asthma action plan. Encourage the student to participate in PE. To help prevent an asthma attack, modify PE activities. For example, a running program might be set up this way: - Walk the whole distance - Run part of the distance - Alternate running and walking Some exercises may be less likely to trigger asthma symptoms. - Swimming is often a good choice. The warm, moist air may keep symptoms away. - Football, baseball, and other sports that have periods of inactivity are less likely to trigger asthma symptoms. Activities that are more intense and sustained, such as long periods of running, basketball, and soccer, are more likely to trigger asthma symptoms. If an asthma action plan instructs the student to take medicines before exercising, remind the student to do so. These may include short-acting and long-acting medicines. Short-acting, or quick-relief, medicines: - Are taken 10 to 15 minutes before exercise - Can help for up to 4 hours Long-acting inhaled medicines: - Are used at least 30 minutes before exercise - Last up to 12 hours Children can take long-acting medicines before school and they will help for the whole day. Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000037.htm"
+  ],
+  [
+    "Asthma (Treatment): Prevention and long-term control are key in stopping asthma attacks before they start. Treatment usually involves learning to recognize your triggers, taking steps to avoid them and tracking your breathing to make sure your daily asthma medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler, such as albuterol. Medications The right medications for you depend on a number of things - your age, symptoms, asthma triggers and what works best to keep your asthma under control. Preventive, long-term control medications reduce the inflammation in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. In some cases, allergy medications are necessary. Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you'll have an asthma attack. Types of long-term control medications include: - Inhaled corticosteroids. These anti-inflammatory drugs include fluticasone (Flonase, Flovent HFA), budesonide (Pulmicort Flexhaler, Rhinocort), flunisolide (Aerospan HFA), ciclesonide (Alvesco, Omnaris, Zetonna), beclomethasone (Qnasl, Qvar), mometasone (Asmanex) and fluticasone furoate (Arnuity Ellipta). You may need to use these medications for several days to weeks before they reach their maximum benefit. Unlike oral corticosteroids, these corticosteroid medications have a relatively low risk of side effects and are generally safe for long-term use. - Leukotriene modifiers. These oral medications - including montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo) - help relieve asthma symptoms for up to 24 hours. In rare cases, these medications have been linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away for any unusual reaction. - Long-acting beta agonists. These inhaled medications, which include salmeterol (Serevent) and formoterol (Foradil, Perforomist), open the airways. Some research shows that they may increase the risk of a severe asthma attack, so take them only in combination with an inhaled corticosteroid. And because these drugs can mask asthma deterioration, don't use them for an acute asthma attack. - Combination inhalers. These medications - such as fluticasone-salmeterol (Advair Diskus), budesonide-formoterol (Symbicort) and formoterol-mometasone (Dulera) - contain a long-acting beta agonist along with a corticosteroid. Because these combination inhalers contain long-acting beta agonists, they may increase your risk of having a severe asthma attack. - Theophylline. Theophylline (Theo-24, Elixophyllin, others) is a daily pill that helps keep the airways open (bronchodilator) by relaxing the muscles around the airways. It's not used as often now as in past years. Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an asthma attack - or before exercise if your doctor recommends it. Types of quick-relief medications include: - Short-acting beta agonists. These inhaled, quick-relief bronchodilators act within minutes to rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others) and levalbuterol (Xopenex). Short-acting beta agonists can be taken using a portable, hand-held inhaler or a nebulizer - a machine that converts asthma medications to a fine mist - so that they can be inhaled through a face mask or a mouthpiece. - Ipratropium (Atrovent). Like other bronchodilators, ipratropium acts quickly to immediately relax your airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis, but it's sometimes used to treat asthma attacks. - Oral and intravenous corticosteroids. These medications - which include prednisone and methylprednisolone - relieve airway inflammation caused by severe asthma. They can cause serious side effects when used long term, so they're used only on a short-term basis to treat severe asthma symptoms. If you have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But if your long-term control medications are working properly, you shouldn't need to use your quick-relief inhaler very often. Keep a record of how many puffs you use each week. If you need to use your quick-relief inhaler more often than your doctor recommends, see your doctor. You probably need to adjust your long-term control medication. Allergy medications may help if your asthma is triggered or worsened by allergies. These include: - Allergy shots (immunotherapy). Over time, allergy shots gradually reduce your immune system reaction to specific allergens. You generally receive shots once a week for a few months, then once a month for a period of three to five years. - Omalizumab (Xolair). This medication, given as an injection every two to four weeks, is specifically for people who have allergies and severe asthma. It acts by altering the immune system. Bronchial thermoplasty This treatment - which isn't widely available nor right for everyone - is used for severe asthma that doesn't improve with inhaled corticosteroids or other long-term asthma medications. Generally, over the span of three outpatient visits, bronchial thermoplasty heats the insides of the airways in the lungs with an electrode, reducing the smooth muscle inside the airways. This limits the ability of the airways to tighten, making breathing easier and possibly reducing asthma attacks. Treat by severity for better control: A stepwise approach Your treatment should be flexible and based on changes in your symptoms, which should be assessed thoroughly each time you see your doctor. Then your doctor can adjust your treatment accordingly. For example, if your asthma is well-controlled, your doctor may prescribe less medicine. If your asthma isn't well-controlled or is getting worse, your doctor may increase your medication and recommend more-frequent visits. Asthma action plan Work with your doctor to create an asthma action plan that outlines in writing when to take certain medications or when to increase or decrease the dose of your medications based on your symptoms. Also include a list of your triggers and the steps you need to take to avoid them. Your doctor may also recommend tracking your asthma symptoms or using a peak flow meter on a regular basis to monitor how well your treatment is controlling your asthma.",
+    "https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653"
+  ],
+  [
+    "Asthma attack (Treatment): If you and your doctor have worked out an asthma plan, follow its directions at the first sign of an asthma attack. This generally means taking two to six puffs of a quick-acting (rescue) inhaler to get airway-expanding medication, such as albuterol (ProAir HFA, Proventil HFA, Ventolin HFA, others), deep into your lungs. Small children and those who have trouble with inhalers can use a nebulizer. After 20 minutes, you can repeat the treatment one time if necessary. For an asthma attack with severe symptoms, such as difficulty speaking because you're so short of breath, start with the same initial step of using quick-acting medication - but instead of waiting for the drug to work, get to a doctor's office or urgent care immediately. Same-day medical care is also warranted if you continue to wheeze and feel at all breathless after initial treatment. Your doctor may recommend that you continue to use quick-acting medication every three to four hours for a day or two after the attack. You might also need to take oral corticosteroid medication for a short time. Emergency treatment If you go to the emergency room for an asthma attack in progress, you'll need medications to get your asthma under immediate control. These can include: - Short-acting beta agonists, such as albuterol (ProAir HFA, Proventil HFA, Ventolin HFA, others). These are the same medications as those in your quick-acting (rescue) inhaler. You may need to use a machine called a nebulizer, which turns the medication into a mist that can be inhaled deep into your lungs. - Oral corticosteroids. Taken in pill form, these medications help reduce lung inflammation and get your asthma symptoms under control. Corticosteroids can also be given intravenously, typically to patients who are vomiting or under respiratory failure. - Ipratropium (Atrovent). Ipratropium is sometimes used as a bronchodilator to treat a severe asthma attack, especially if albuterol is not fully effective. - Intubation, mechanical ventilation and oxygen. If your asthma attack is life-threatening, your doctor may put a breathing tube down your throat into your upper airway. Using a machine that pumps oxygen into your lungs will help you breathe while your doctor gives you medications to bring your asthma under control. After your asthma symptoms improve, your doctor may want you to stay in the emergency room for a few hours or longer to make sure you don't have another asthma attack. When your doctor feels your asthma is sufficiently under control, you'll be able to go home. Your doctor will give you instructions on what to do if you have another asthma attack. If your asthma symptoms don't improve after emergency treatment, your doctor may admit you to the hospital and give you medications every hour or every few hours. If you're having severe asthma symptoms, you may need to breathe oxygen through a mask. In some cases, a severe, persistent asthma attack requires a stay in the intensive care unit (ICU).",
+    "https://www.mayoclinic.org/diseases-conditions/asthma-attack/symptoms-causes/syc-20354268"
+  ],
+  [
+    "Asthma: Asthma is a disease that causes the airways of the lungs to swell and narrow. It leads to wheezing, shortness of breath, chest tightness, and coughing. Asthma is caused by swelling (inflammation) in the airways. When an asthma attack occurs, the lining of the air passages swells and the muscles surrounding the airways become tight. This reduces the amount of air that can pass through the airway. In people who have sensitive airways, asthma symptoms can be triggered by breathing in substances called allergens or triggers. Common asthma triggers include: - Animals (pet hair or dander) - Dust mites - Certain medicines (aspirin and other NSAIDS) - Changes in weather (most often cold weather) - Chemicals in the air or in food - Exercise - Mold - Pollen - Respiratory infections, such as the common cold - Strong emotions (stress) - Tobacco smoke Substances in some workplaces can also trigger asthma symptoms, leading to occupational asthma. The most common triggers are wood dust, grain dust, animal dander, fungi, or chemicals. Many people with asthma have a personal or family history of allergies, such as hay fever (allergic rhinitis) or eczema. Others have no history of allergies. Most people with asthma have attacks separated by symptom-free periods. Some people have long-term shortness of breath with episodes of increased shortness of breath. Either wheezing or a cough may be the main symptom. Asthma attacks can last for minutes to days. Attacks can become dangerous if airflow is severely blocked. Symptoms of asthma include: - Cough with or without sputum (phlegm) production - Pulling in of the skin between the ribs when breathing (intercostal retractions) - Shortness of breath that gets worse with exercise or activity - Wheezing Emergency symptoms that need prompt medical help include: - Bluish color to the lips and face - Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack - Extreme difficulty breathing - Rapid pulse - Severe anxiety due to shortness of breath - Sweating Other symptoms that may occur: - Abnormal breathing pattern -- breathing out takes more than twice as long as breathing in - Breathing temporarily stops - Chest pain - Tightness in the chest The health care provider will use a stethoscope to listen to your lungs. Wheezing or other asthma-related sounds may be heard. Tests that may be ordered include: - Allergy testing -- skin or a blood test to see if a person with asthma is allergic to certain substances - Arterial blood gas (usually only done with people who are having a severe asthma attack) - Chest x-ray - Lung function tests, including peak flow measurements The goals of treatment are: - Control airway swelling - Stay away from substances that trigger your symptoms - Help you to be able to do normal activities without asthma symptoms You and your doctor should work as a team to manage your asthma. Follow your doctor's instructions on taking medicines, eliminating asthma triggers, and monitoring symptoms. MEDICINES FOR ASTHMA There are two kinds of medicines for treating asthma: - Control medicines to help prevent attacks - Quick-relief (rescue) medicines for use during attacks LONG-TERM MEDICINES These are also called maintenance or control medicines. They are used to prevent symptoms in people with moderate to severe asthma. You must take them every day for them to work. Take them even when you feel OK. Some long-term medicines are breathed in (inhaled), such as steroids and long-acting beta-agonists. Others are taken by mouth (orally). Your doctor will prescribe the right medicine for you. QUICK-RELIEF MEDICINES These are also called rescue medicines. They are taken: - For coughing, wheezing, trouble breathing, or an asthma attack - Just before exercising to help prevent asthma symptoms caused by exercise Tell your doctor if you are using quick-relief medicines twice a week or more. If so, your asthma may not be under control and your doctor may need to change your dose of daily control drugs. Quick-relief medicines include: - Short-acting inhaled bronchodilators - Oral corticosteroids for when you have an asthma attack that is not going away A severe asthma attack requires a checkup by a doctor. You may also need a hospital stay. There, you will likely be given oxygen, breathing assistance, and medicines given through a vein (IV). ASTHMA CARE AT HOME - Know the asthma symptoms to watch for. - Know how to take your peak flow reading and what it means. - Know which triggers make your asthma worse and what to do when this happens. - Know how to care for your asthma when you exercise. Asthma action plans are written documents for managing asthma. An asthma action plan should include: - Instructions for taking asthma medicines when your condition is stable - A list of asthma triggers and how to avoid them - How to recognize when your asthma is getting worse, and when to call your provider A peak flow meter is a simple device to measure how quickly you can move air out of your lungs. - It can help you see if an attack is coming, sometimes even before symptoms appear. Peak flow measurements help let you know when you need to take medicine or other action. - Peak flow values of 50% to 80% of your best results are a sign of a moderate asthma attack. Numbers below 50% are a sign of a severe attack. There is no cure for asthma, although symptoms sometimes improve over time. With proper self-management and medical treatment, most people with asthma can lead a normal life. The complications of asthma can be severe, and may include: - Death - Decreased ability to exercise and take part in other activities - Lack of sleep due to nighttime symptoms - Permanent changes in the function of the lungs - Persistent cough - Trouble breathing that requires breathing assistance (ventilator) Call for an appointment with your provider if asthma symptoms develop. Call your provider or go to the emergency room if: - An asthma attack requires more medicine than recommended - Symptoms get worse or do not improve with treatment - You have shortness of breath while talking - Your peak flow measurement is 50% to 80% of your personal best Go to the emergency room if these symptoms occur: - Drowsiness or confusion - Severe shortness of breath at rest - A peak flow measurement of less than 50% of your personal best - Severe chest pain - Bluish color to the lips and face - Extreme difficulty breathing - Rapid pulse - Severe anxiety due to shortness of breath You can reduce asthma symptoms by avoiding triggers and substances that irritate the airways. - Cover bedding with allergy-proof casings to reduce exposure to dust mites. - Remove carpets from bedrooms and vacuum regularly. - Use only unscented detergents and cleaning materials in the home. - Keep humidity levels low and fix leaks to reduce the growth of organisms such as mold. - Keep the house clean and keep food in containers and out of bedrooms. This helps reduce the possibility of cockroaches. Body parts and droppings from cockroaches can trigger asthma attacks in some people. - If someone is allergic to an animal that cannot be removed from the home, the animal should be kept out of the bedroom. Place filtering material over the heating outlets to trap animal dander. Change the filter in furnaces and air conditioners often. - Eliminate tobacco smoke from the home. This is the single most important thing a family can do to help someone with asthma. Smoking outside the house is not enough. Family members and visitors who smoke outside carry smoke residue inside on their clothes and hair. This can trigger asthma symptoms. If you smoke, now is a good time to quit. - Avoid air pollution, industrial dust, and irritating fumes as much as possible. Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Internal review and update on 07/24/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000141.htm"
+  ],
+  [
+    "Asthma (Symptoms): Most people with asthma have attacks separated by symptom-free periods. Some people have long-term shortness of breath with episodes of increased shortness of breath. Either wheezing or a cough may be the main symptom. Asthma attacks can last for minutes to days. Attacks can become dangerous if airflow is severely blocked. Symptoms of asthma include: - Cough with or without sputum (phlegm) production - Pulling in of the skin between the ribs when breathing (intercostal retractions) - Shortness of breath that gets worse with exercise or activity - Wheezing Emergency symptoms that need prompt medical help include: - Bluish color to the lips and face - Decreased level of alertness, such as severe drowsiness or confusion, during an asthma attack - Extreme difficulty breathing - Rapid pulse - Severe anxiety due to shortness of breath - Sweating Other symptoms that may occur: - Abnormal breathing pattern -- breathing out takes more than twice as long as breathing in - Breathing temporarily stops - Chest pain - Tightness in the chest",
+    "https://medlineplus.gov/ency/article/000141.htm"
+  ],
+  [
+    "Sleep terrors (night terrors): Sleep terrors are episodes of screaming, intense fear and flailing while still asleep. Also known as night terrors, sleep terrors often are paired with sleepwalking. Like sleepwalking, sleep terrors are considered a parasomnia - an undesired occurrence during sleep. A sleep terror episode usually lasts from seconds to a few minutes, but episodes may last longer. Sleep terrors affect almost 40 percent of children and a much smaller percentage of adults. However frightening, sleep terrors aren't usually a cause for concern. Most children outgrow sleep terrors by their teenage years. Sleep terrors may require treatment if they cause problems getting enough sleep or they pose a safety risk. Sleep terrors differ from nightmares. The dreamer of a nightmare wakes up from the dream and may remember details, but a person who has a sleep terror episode remains asleep. Children usually don't remember anything about their sleep terrors in the morning. Adults may recall a dream fragment they had during the sleep terrors. Sleep terrors generally occur in the first third to first half of the night, and rarely during naps. A sleep terror may lead to sleepwalking. During a sleep terror episode, a person may: - Begin with a frightening scream or shout - Sit up in bed and appear frightened - Stare wide-eyed - Sweat, breathe heavily, and have a racing pulse, flushed face and dilated pupils - Kick and thrash - Be hard to awaken, and be confused if awakened - Be inconsolable - Have no or little memory of the event the next morning - Possibly, get out of bed and run around the house or have aggressive behavior if blocked or restrained Occasional sleep terrors aren't usually a cause for concern. If your child has sleep terrors, you can simply mention them at a routine well-child exam. However, consult your doctor if sleep terrors: - Become more frequent - Routinely disrupt the sleep of the person with sleep terrors or other family members - Lead to safety concerns or injury - Result in daytime symptoms of excessive sleepiness or problems functioning - Continue beyond the teen years or start in adulthood Sleep terrors are classified as a parasomnia - an undesirable behavior or experience during sleep. Sleep terrors are a disorder of arousal, meaning they occur during N3 sleep, the deepest stage of non-rapid eye movement (NREM) sleep. Another NREM disorder is sleepwalking, which can occur together with sleep terrors. Various factors can contribute to sleep terrors, such as: - Sleep deprivation and extreme tiredness - Stress - Sleep schedule disruptions, travel or sleep interruptions - Fever Sleep terrors sometimes can be triggered by underlying conditions that interfere with sleep, such as: - Sleep-disordered breathing - a group of disorders that include abnormal breathing patterns during sleep, the most common of which is obstructive sleep apnea - Restless legs syndrome - Some medications - Mood disorders, such as depression and anxiety - In adults, alcohol use Sleep terrors are more common if family members have a history of sleep terrors or sleepwalking. In children, sleep terrors are more common in females. To diagnose sleep terrors, your doctor reviews your medical history and your symptoms. Your evaluation may include: - Physical exam. Your doctor may do a physical exam to identify any conditions that may be contributing to the sleep terrors. - Discussing your symptoms. Sleep terrors are usually diagnosed by your doctor based on your description of the events. Your doctor may ask about your family history of sleep problems. Your doctor may also ask you or your partner to fill out a questionnaire about your sleep behaviors. - Nocturnal sleep study (polysomnography). In some cases, your doctor may recommend an overnight study in a sleep lab. Sensors placed on your body record and monitor brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements while you sleep. You may be videotaped to document your behavior during sleep cycles. Treatment for infrequent sleep terrors isn't usually necessary. If the sleep terrors lead to the potential for injury, are disruptive to family members, or result in embarrassment or sleep disruption for the person who has sleep terrors, treatment may be needed. Treatment generally focuses on promoting safety and eliminating causes or triggers. Treatment options may include: - Treating any underlying condition. If the sleep terrors are associated with an underlying medical or mental health condition or another sleep disorder, such as obstructive sleep apnea, treatment is aimed at the underlying problem. - Addressing stress. If stress or anxiety seems to be contributing to the sleep terrors, your doctor may suggest meeting with a therapist or counselor. Cognitive behavioral therapy, hypnosis, biofeedback or relaxation therapy may help. - Anticipatory awakening. This involves waking the person who has sleep terrors about 15 minutes before he or she usually experiences the event. Then the person stays awake for a few minutes before falling asleep again. - Medication. Medication is rarely used to treat sleep terrors, particularly for children. If necessary, however, use of benzodiazepines or certain antidepressants may be effective. Lifestyle and home remedies If sleep terrors are a problem for you or your child, here are some strategies to try: - Get adequate sleep. Fatigue can contribute to sleep terrors. If you're sleep deprived, try an earlier bedtime and a more regular sleep schedule. Sometimes a short nap may help. If possible, avoid sleep-time noises or other stimuli that could interrupt sleep. - Establish a regular, relaxing routine before bedtime. Do quiet, calming activities - such as reading books, doing puzzles or soaking in a warm bath - before bed. Meditation or relaxation exercises may help, too. Make the bedroom comfortable and quiet for sleep. - Make the environment safe. To help prevent injury, close and lock all windows and exterior doors at night. You might even lock interior doors or put alarms or bells on them. Block doorways or stairways with a gate, and move electrical cords or other objects that pose a tripping hazard. Avoid using bunk beds. Place any sharp or fragile objects out of reach, and lock up all weapons. - Put stress in its place. Identify the things that stress you out, and brainstorm possible ways to handle the stress. If your child seems anxious or stressed, talk about what's bothering him or her. A mental health professional can help. - Offer comfort. If your child has a sleep terror episode, consider simply waiting it out. It may be distressing to watch, but it won't harm your child. You might cuddle and gently soothe your child and try to get him or her back into bed. Speak softly and calmly. Shaking your child or shouting may make things worse. Usually the episode will shortly stop on its own. - Look for a pattern. If your child has sleep terrors, keep a sleep diary. For several nights, note how many minutes after bedtime a sleep terror episode occurs. If the timing is fairly consistent, anticipatory awakenings may help.",
+    "https://www.mayoclinic.org/diseases-conditions/sleep-terrors/symptoms-causes/syc-20353524"
+  ],
+  [
+    "Timing of breastfeeding (Nursing at Night): You may find that keeping your baby in the same room with you, or in a room close by, helps you rest better. You can use a baby monitor so you can hear your baby cry. - Some mothers like their babies to sleep next to them in a bassinet. They can nurse in bed and return the baby to the bassinet. - Other mothers prefer their baby to sleep in a separate bedroom. They nurse in a chair and return the baby to the crib. The American Academy of Pediatrics recommends that you not sleep with your baby. - Return the baby to the crib or bassinet when breastfeeding is done. - DO NOT bring your baby into bed if you are very tired or taking medicine that makes you really sleepy. Expect your baby to nurse a lot at night when you go back to work. Breastfeeding at night is ok for your baby's teeth. - If your baby is drinking sugary drinks and breastfeeding, your baby may have problems with tooth decay. DO NOT give your baby sugary drinks, especially close to sleep time. - Formula feeding at night can cause tooth decay.",
+    "https://medlineplus.gov/ency/patientinstructions/000636.htm"
+  ],
+  [
+    "Sleep: Alzheimer's disease often affects a person's sleeping habits. It may be hard to get the person to go to bed and stay there. Someone with Alzheimer's may sleep a lot or not enough, and may wake up many times during the night.Here are some tips that may help caregivers manage sleep problems in people with Alzheimer's disease:- Help the person get exercise each day, limit naps, and make sure the person gets enough rest at night. Being overly tired can increase late-afternoon and nighttime restlessness. - Plan activities that use more energy early in the day. For example, try bathing in the morning or having the largest family meal in the middle of the day. - Set a quiet, peaceful mood in the evening to help the person relax. Keep the lights low, try to reduce the noise levels, and play soothing music if he or she enjoys it. - Try to have the person go to bed at the same time each night. A bedtime routine, such as reading out loud, also may help. - Limit caffeine. - Use nightlights in the bedroom, hall, and bathroom.Read about this topic in Spanish. Lea sobre este tema en espanol. Alzheimer's disease often affects a person's sleeping habits. It may be hard to get the person to go to bed and stay there. Someone with Alzheimer's may sleep a lot or not enough, and may wake up many times during the night.Here are some tips that may help caregivers manage sleep problems in people with Alzheimer's disease:- Help the person get exercise each day, limit naps, and make sure the person gets enough rest at night. Being overly tired can increase late-afternoon and nighttime restlessness. - Plan activities that use more energy early in the day. For example, try bathing in the morning or having the largest family meal in the middle of the day. - Set a quiet, peaceful mood in the evening to help the person relax. Keep the lights low, try to reduce the noise levels, and play soothing music if he or she enjoys it. - Try to have the person go to bed at the same time each night. A bedtime routine, such as reading out loud, also may help. - Limit caffeine. - Use nightlights in the bedroom, hall, and bathroom.Read about this topic in Spanish. Lea sobre este tema en espanol. Alzheimer's disease often affects a person's sleeping habits. It may be hard to get the person to go to bed and stay there. Someone with Alzheimer's may sleep a lot or not enough, and may wake up many times during the night.Here are some tips that may help caregivers manage sleep problems in people with Alzheimer's disease:- Help the person get exercise each day, limit naps, and make sure the person gets enough rest at night. Being overly tired can increase late-afternoon and nighttime restlessness. - Plan activities that use more energy early in the day. For example, try bathing in the morning or having the largest family meal in the middle of the day. - Set a quiet, peaceful mood in the evening to help the person relax. Keep the lights low, try to reduce the noise levels, and play soothing music if he or she enjoys it. - Try to have the person go to bed at the same time each night. A bedtime routine, such as reading out loud, also may help. - Limit caffeine. - Use nightlights in the bedroom, hall, and bathroom.Read about this topic in Spanish. Lea sobre este tema en espanol. The years of the menopausal transition are often a time when there are other changes in a woman's life. You may be caring for aging parents, supporting children as they move into adulthood, and reflecting on your own life journey. Add hot flashes on top of all this, and you may find yourself having trouble sleeping at night.Not getting enough sleep can affect all areas of life. Lack of sleep can make you feel irritable or depressed, might cause you to be more forgetful than normal, and could lead to more falls or accidents.Some women who have trouble sleeping may use over-the-counter sleep aids like melatonin. Others use prescription medicines to help them sleep, which may help when used for a short time. But, medicines are not a cure for insomnia. Developing healthy habits at bedtime can help you get a good night's sleep. The years of the menopausal transition are often a time when there are other changes in a woman's life. You may be caring for aging parents, supporting children as they move into adulthood, and reflecting on your own life journey. Add hot flashes on top of all this, and you may find yourself having trouble sleeping at night.Not getting enough sleep can affect all areas of life. Lack of sleep can make you feel irritable or depressed, might cause you to be more forgetful than normal, and could lead to more falls or accidents.Some women who have trouble sleeping may use over-the-counter sleep aids like melatonin. Others use prescription medicines to help them sleep, which may help when used for a short time. But, medicines are not a cure for insomnia. Developing healthy habits at bedtime can help you get a good night's sleep. To improve your sleep through the menopausal transition and beyond:- Follow a regular sleep schedule. Go to sleep and get up at the same time each day. - Avoid napping in the late afternoon or evening if you can. It may keep you awake at night. - Develop a bedtime routine. Some people read a book, listen to soothing music, or soak in a warm bath. - Try not to watch television or use your computer or mobile device in the bedroom. The light from these devices may make it difficult for you to fall asleep. - Keep your bedroom at a comfortable temperature, not too hot or too cold, and as quiet as possible. - Exercise at regular times each day but not close to bedtime. - Avoid eating large meals close to bedtime. - Stay away from caffeine (found in some coffees, teas, or chocolate) late in the day. - Remember, alcohol won't help you sleep. Even small amounts make it harder to stay asleep.If these changes to your bedtime routine don't help as much as you'd like, you may want to consider cognitive behavioral therapy. This problem-solving approach to therapy has recently been shown to help sleep disturbances in women with menopausal symptoms. Cognitive behavioral therapy can be found through a class or in one-on-one sessions. Be sure that your therapy is guided by a trained professional with experience working with women during their menopausal transition. Your doctor may be able to recommend a therapist in your area.Learn more about getting a good night's sleep as you age. Just like Edward, you want a good night's rest. Getting enough sleep helps you stay healthy and alert. But, many older people don't sleep well. If you're always sleepy or you find it hard to get enough sleep at night, it may be time to see a doctor. Waking up every day feeling tired is a sign that you are not getting the rest you need. Just like Edward, you want a good night's rest. Getting enough sleep helps you stay healthy and alert. But, many older people don't sleep well. If you're always sleepy or you find it hard to get enough sleep at night, it may be time to see a doctor. Waking up every day feeling tired is a sign that you are not getting the rest you need. Older adults need about the same amount of sleep as all adults-7 to 9 hours each night. But, older people tend to go to sleep earlier and get up earlier than they did when they were younger.There are many reasons why older people may not get enough sleep at night. Feeling sick or being in pain can make it hard to sleep. Some medicines can keep you awake. No matter the reason, if you don't get a good night's sleep, the next day you may:- Be irritable - Have memory problems or be forgetful - Feel depressed - Have more falls or accidents Being older doesn't mean you have to be tired all the time. You can do many things to help you get a good night's sleep. Here are some ideas:- Follow a regular sleep schedule. Go to sleep and get up at the same time each day, even on weekends or when you are traveling. - Avoid napping in the late afternoon or evening, if you can. Naps may keep you awake at night. - Develop a bedtime routine. Take time to relax before bedtime each night. Some people read a book, listen to soothing music, or soak in a warm bath. - Try not to watch television or use your computer, cell phone, or tablet in the bedroom. The light from these devices may make it difficult for you to fall asleep. And alarming or unsettling shows or movies, like horror movies, may keep you awake. - Keep your bedroom at a comfortable temperature, not too hot or too cold, and as quiet as possible. - Use low lighting in the evenings and as you prepare for bed. - Exercise at regular times each day but not within 3 hours of your bedtime. - Avoid eating large meals close to bedtime-they can keep you awake. - Stay away from caffeine late in the day. Caffeine (found in coffee, tea, soda, and chocolate) can keep you awake. - Remember-alcohol won't help you sleep. Even small amounts make it harder to stay asleep. Insomnia is the most common sleep problem in adults age 60 and older. People with this condition have trouble falling asleep and staying asleep. Insomnia can last for days, months, and even years. Having trouble sleeping can mean you:- Take a long time to fall asleep - Wake up many times in the night - Wake up early and are unable to get back to sleep - Wake up tired - Feel very sleepy during the dayOften, being unable to sleep becomes a habit. Some people worry about not sleeping even before they get into bed. This may make it harder to fall asleep and stay asleep.Some older adults who have trouble sleeping may use over-the-counter sleep aids. Others may use prescription medicines to help them sleep. These medicines may help when used for a short time. But remember, medicines aren't a cure for insomnia.Developing healthy habits at bedtime may help you get a good night's sleep. People with sleep apnea have short pauses in breathing while they are asleep. These pauses may happen many times during the night. If not treated, sleep apnea can lead to other problems, such as high blood pressure, stroke, or memory loss.You can have sleep apnea and not even know it. Feeling sleepy during the day and being told you are snoring loudly at night could be signs that you have sleep apnea.If you think you have sleep apnea, see a doctor who can treat this sleep problem. You may need to learn to sleep in a position that keeps your airways open. Treatment using a continuous positive airway pressure (CPAP) device almost always helps people with sleep apnea. A dental device or surgery may also help. Restless legs syndrome, periodic limb movement disorder, and rapid eye movement sleep behavior disorder are common in older adults. These movement disorders can rob you of needed sleep.People with restless legs syndrome, or RLS, feel like there is tingling, crawling, or pins and needles in one or both legs. This feeling is worse at night. See your doctor for more information about medicines to treat RLS.Periodic limb movement disorder, or PLMD, causes people to jerk and kick their legs every 20 to 40 seconds during sleep. Medication, warm baths, exercise, and relaxation exercises can help.Rapid eye movement, or REM, sleep behavior disorder is another condition that may make it harder to get a good night's sleep. During normal REM sleep, your muscles cannot move, so your body stays still. But, if you have REM sleep behavior disorder, your muscles can move and your sleep is disrupted. Alzheimer's disease often changes a person's sleeping habits. Some people with Alzheimer's disease sleep too much; others don't sleep enough. Some people wake up many times during the night; others wander or yell at night.The person with Alzheimer's disease isn't the only one who loses sleep. Caregivers may have sleepless nights, leaving them tired for the challenges they face.If you're caring for someone with Alzheimer's disease, take these steps to make him or her safer and help you sleep better at night:- Make sure the floor is clear of objects. - Lock up any medicines. - Attach grab bars in the bathroom. - Place a gate across the stairs. Try to set up a safe and restful place to sleep. Make sure you have smoke alarms on each floor of your home. Before going to bed, lock all windows and doors that lead outside. Other ideas for a safe night's sleep are:- Keep a telephone with emergency phone numbers by your bed. - Have a lamp within reach that is easy to turn on. - Put a glass of water next to the bed in case you wake up thirsty. - Don't smoke, especially in bed. - Remove area rugs so you won't trip if you get out of bed during the night. You may have heard about some tricks to help you fall asleep. You don't really have to count sheep-you could try counting slowly to 100. Some people find that playing mental games makes them sleepy. For example, tell yourself it is 5 minutes before you have to get up, and you're just trying to get a little bit more sleep.Some people find that relaxing their bodies puts them to sleep. One way to do this is to imagine your toes are completely relaxed, then your feet, and then your ankles are completely relaxed. Work your way up the rest of your body, section by section. You may drift off to sleep before getting to the top of your head.Use your bedroom only for sleeping. After turning off the light, give yourself about 20 minutes to fall asleep. If you're still awake and not drowsy, get out of bed. When you feel sleepy, go back to bed.If you feel tired and unable to do your activities for more than 2 or 3 weeks, you may have a sleep problem. Talk with your doctor about changes you can make to get a better night's sleep.Read about this topic in Spanish. Lea sobre este tema en espanol.",
+    "https://www.nia.nih.gov/health/topics/sleep"
+  ],
+  [
+    "Sleep Deprivation and Deficiency (How Much Sleep Is Enough): The amount of sleep you need each day will change over the course of your life. Although sleep needs vary from person to person, the chart below shows general recommendations for different age groups.\u00a0This table reflects recent American Academy of Sleep Medicine (AASM) recommendations that the American Academy of Pediatrics (AAP) has endorsed. \u00a0 If you routinely lose sleep or choose to sleep less than needed, the sleep loss adds up. The total sleep lost is called your sleep debt. For example, if you lose 2 hours of sleep each night, you'll have a sleep debt of 14 hours after a week. Some people nap as a way to deal with sleepiness. Naps may provide a short-term boost in alertness and performance. However, napping doesn't provide all of the other benefits of night-time sleep. Thus, you can't really make up for lost sleep. Some people sleep more on their days off than on work days. They also may go to bed later and get up later on days off. Sleeping more on days off might be a sign that you aren't getting enough sleep. Although extra sleep on days off might help you feel better, it can upset your body's sleep\u2013wake rhythm. Bad sleep habits and long-term sleep loss will affect your health. If you're worried about whether you're getting enough sleep, try using a sleep diary for a couple of weeks. \u00a0 Write down how much you sleep each night, how alert and rested you feel in the morning, and how sleepy you feel during the day. Show the results to your doctor and talk about how you can improve your sleep. You can find a sample sleep diary in the National Heart, Lung, and Blood Institute's \"Your Guide to Healthy Sleep.\" Sleeping when your body is ready to sleep also is very important. Sleep deficiency can affect people even when they sleep the total number of hours recommended for their age group. For example, people whose sleep is out of sync with their body clocks (such as shift workers) or routinely interrupted (such as caregivers or emergency responders) might need to pay special attention to their sleep needs. \u00a0 If your job or daily routine limits your ability to get enough sleep or sleep at the right times, talk with your doctor. You also should talk with your doctor if you sleep more than 8 hours a night, but don't feel well rested. You may have a sleep disorder or other health problem.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/sdd"
+  ],
+  [
+    "Bed-wetting: Bed-wetting - also called nighttime incontinence or nocturnal enuresis - is involuntary urination while asleep after the age at which staying dry at night can be reasonably expected. Soggy sheets and pajamas - and an embarrassed child - are a familiar scene in many homes. But don't despair. Bed-wetting isn't a sign of toilet training gone bad. It's often just a normal part of a child's development. Generally, bed-wetting before age 7 isn't a concern. At this age, your child may still be developing nighttime bladder control. If bed-wetting continues, treat the problem with patience and understanding. Lifestyle changes, bladder training, moisture alarms and sometimes medication may help reduce bed-wetting. Most kids are fully toilet trained by age 5, but there's really no target date for developing complete bladder control. Between the ages of 5 and 7, bed-wetting remains a problem for some children. After 7 years of age, a small number of children still wet the bed. When to see a doctor Most children outgrow bed-wetting on their own - but some need a little help. In other cases, bed-wetting may be a sign of an underlying condition that needs medical attention. Consult your child's doctor if: - Your child still wets the bed after age 7 - Your child starts to wet the bed after a few months of being dry at night - Bed-wetting is accompanied by painful urination, unusual thirst, pink or red urine, hard stools, or snoring No one knows for sure what causes bed-wetting, but various factors may play a role: - A small bladder. Your child's bladder may not be developed enough to hold urine produced during the night. - Inability to recognize a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not wake your child - especially if your child is a deep sleeper. - A hormone imbalance. During childhood, some kids don't produce enough anti-diuretic hormone (ADH) to slow nighttime urine production. - Urinary tract infection. This infection can make it difficult for your child to control urination. Signs and symptoms may include bed-wetting, daytime accidents, frequent urination, red or pink urine, and pain during urination. - Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child's breathing is interrupted during sleep - often due to inflamed or enlarged tonsils or adenoids. Other signs and symptoms may include snoring and daytime drowsiness. - Diabetes. For a child who's usually dry at night, bed-wetting may be the first sign of diabetes. Other signs and symptoms may include passing large amounts of urine at once, increased thirst, fatigue and weight loss in spite of a good appetite. - Chronic constipation. The same muscles are used to control urine and stool elimination. When constipation is long term, these muscles can become dysfunctional and contribute to bed-wetting at night. - A structural problem in the urinary tract or nervous system. Rarely, bed-wetting is related to a defect in the child's neurological system or urinary system. Bed-wetting can affect anyone, but it's twice as common in boys as in girls. Several factors have been associated with an increased risk of bed-wetting, including: - Stress and anxiety. Stressful events - such as becoming a big brother or sister, starting a new school, or sleeping away from home - may trigger bed-wetting. - Family history. If one or both of a child's parents wet the bed as children, their child has a significant chance of wetting the bed, too. - Attention-deficit/hyperactivity disorder (ADHD). Bed-wetting is more common in children who have ADHD. Depending on the circumstances, your doctor may recommend the following to identify any underlying cause of bed-wetting and help determine treatment: - Physical exam - Discussion of symptoms, fluid intake, family history, bowel and bladder habits, and problems associated with bed-wetting - Urine tests to check for signs of an infection or diabetes - X-rays or other imaging tests of the kidneys or bladder to look at the structure of the urinary tract - Other types of urinary tract tests or assessments, as needed Most children outgrow bed-wetting on their own. If treatment is needed, it can be based on a discussion of options with your doctor and identifying what will work best for your situation. If your child isn't especially bothered or embarrassed by an occasional wet night, lifestyle changes - such as avoiding caffeine entirely and limiting fluid intake in the evening - may work well. However, if lifestyle changes aren't successful or if your grade schooler is terrified about wetting the bed, he or she may be helped by additional treatments. If found, underlying causes of bed-wetting, such as constipation or sleep apnea, should be addressed before other treatment. Options for treating bed-wetting may include moisture alarms and medication. Moisture alarms These small, battery-operated devices - available without a prescription at most pharmacies - connect to a moisture-sensitive pad on your child's pajamas or bedding. When the pad senses wetness, the alarm goes off. Ideally, the moisture alarm sounds just as your child begins to urinate - in time to help your child wake, stop the urine stream and get to the toilet. If your child is a heavy sleeper, another person may need to listen for the alarm and wake the child. If you try a moisture alarm, give it plenty of time. It often takes one to three months to see any type of response and up to 16 weeks to achieve dry nights. Moisture alarms are effective for many children, carry a low risk of relapse or side effects, and may provide a better long-term solution than medication does. These devices are not typically covered by insurance. Medication As a last resort, your child's doctor may prescribe medication for a short period of time to stop bed-wetting. Certain types of medication can: - Slow nighttime urine production. The drug desmopressin (DDAVP) reduces urine production at night. But drinking too much liquid with the medication can cause problems, and desmopressin should be avoided if your child has symptoms such as a fever, diarrhea or nausea. Be sure to carefully follow instructions for using this drug. Desmopressin is given orally as a tablet and is only for children over 5 years old. According to the Food and Drug Administration, nasal spray formulations of desmopressin (Noctiva, others) are no longer recommended for treatment of bed-wetting due to the risk of serious side effects. - Calm the bladder. If your child has a small bladder, an anticholinergic drug such as oxybutynin (Ditropan XL) may help reduce bladder contractions and increase bladder capacity, especially if daytime wetting also occurs. This drug is usually used along with other medications and is generally recommended when other treatments have failed. Sometimes a combination of medications is most effective. There are no guarantees, however, and medication doesn't cure the problem. Bed-wetting typically resumes when medication is stopped, until it resolves on its own at an age that varies from child to child. Here are changes you can make at home that may help: - Limit fluids in the evening. It's important to get enough fluids, so there's no need to limit how much your child drinks in a day. However, encourage drinking liquids in the morning and early afternoon, which may reduce thirst in the evening. But don't limit evening fluids if your child participates in sports practice or games in the evenings. - Avoid beverages and foods with caffeine. Beverages with caffeine are discouraged for children at any time of day. Because caffeine may stimulate the bladder, it's especially discouraged in the evening. - Encourage double voiding before bed. Double voiding is urinating at the beginning of the bedtime routine and then again just before falling asleep. Remind your child that it's OK to use the toilet during the night if needed. Use small night lights, so your child can easily find the way between the bedroom and bathroom. - Encourage regular toilet use throughout the day. During the day and evening, suggest that your child urinate every two hours or so, or at least often enough to avoid a feeling of urgency. - Prevent rashes. To prevent a rash caused by wet underwear, help your child rinse his or her bottom and genital area every morning. It also may help to cover the affected area with a protective moisture barrier ointment or cream at bedtime. Ask your pediatrician for product recommendations. Some people may choose to try complementary or alternative medicine approaches to treat bed-wetting. For approaches such as hypnosis, acupuncture, chiropractic therapy and herbal therapy, evidence of effectiveness for bed-wetting is weak and inconclusive or such efforts have proved to be ineffective. In some cases, the studies were too small or not rigorous enough, or both. Be sure to talk to your child's doctor before starting any complementary or alternative therapy. If you choose a nonconventional approach, ask the doctor if it's safe for your child and make sure it won't interact with any medications your child may take.",
+    "https://www.mayoclinic.org/diseases-conditions/bed-wetting/symptoms-causes/syc-20366685"
+  ],
+  [
+    "Day to day with COPD (Sleep): A good night's sleep can make you feel better and keep you healthier. But when you have COPD, certain things make it harder to get enough rest: - You might wake up short of breath or coughing. - Some COPD medicines make it hard to sleep. - You might have to take a dose of medicine in the middle of the night. Here are some safe ways to sleep better: - Let your provider know you are having trouble sleeping. A change in your treatment might help you sleep. - Go to bed at the same time every night. - Do something to relax before you go to bed. You might take a bath or read a book. - Use window shades to block outside light. - Ask your family to help keep the house quiet when it is time for you to sleep. - DO NOT use over-the-counter sleep aids. They can make it harder to breathe.",
+    "https://medlineplus.gov/ency/patientinstructions/000697.htm"
+  ],
+  [
+    "Sleep Deprivation and Deficiency (How To Discuss Sleep): Doctors might not detect sleep problems during routine office visits because patients are awake. Thus, you should let your doctor know if you think you might have a sleep problem. For example, talk with your doctor if you often feel sleepy during the day, don't wake up feeling refreshed and alert, or are having trouble adapting to shift work. To get a better sense of your sleep problem, your doctor will ask you about your sleep habits. Before you see the doctor, think about how to describe your problems, including: How often you have trouble sleeping and how long you've had the problem When you go to bed and get up on workdays and days off How long it takes you to fall asleep, how often you wake up at night, and how long it takes you to fall back asleep Whether you snore loudly and often or wake up gasping or feeling out of breath How refreshed you feel when you wake up, and how tired you feel during the day How often you doze off or have trouble staying awake during routine tasks, especially driving Your doctor also may ask questions about your personal routine and habits. For example, he or she may ask about your work and exercise routines. Your doctor also may ask whether you use caffeine, tobacco, alcohol, or any medicines (including over-the-counter medicines). To help your doctor, consider keeping a sleep diary for a couple of weeks. Write down when you go to sleep, wake up, and take naps. (For example, you might note: Went to bed at 10 a.m.; woke up at 3 a.m. and couldn't fall back asleep; napped after work for 2\u00a0hours.) Also write down how much you sleep each night, how alert and rested you feel in the morning, as well as how sleepy you feel at various times during the day. Share the information in your sleep diary with your doctor. You can find a sample sleep diary in the National Heart, Lung, and Blood Institute's \"Your Guide to Healthy Sleep.\" Doctors can diagnose some sleep disorders by asking questions about sleep schedules and habits and by getting information from sleep partners or parents. To diagnose other sleep disorders, doctors also use the results from sleep studies and other medical tests. Sleep studies allow your doctor to measure how much and how well you sleep. They also help show whether you have sleep problems and how severe they are. For more information, go to the Health Topics Sleep Studies article. Your doctor will do a physical exam to rule out other medical problems that might interfere with sleep. You may need blood tests to check for thyroid problems or other conditions that can cause sleep problems.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/sdd"
+  ],
+  [
+    "Can't sleep? Try these tips: Everyone has trouble sleeping some of the time. But if it happens often, lack of sleep can affect your health and make it hard to get through the day. Learn lifestyle tips that can help you get the rest you need. Some people have trouble falling asleep. Others wake up in the middle of the night and cannot get back to sleep. You can change your habits and your home to make sleep less fleeting. Stick to a sleep schedule: - Go to bed and get up at the same time. Going to sleep at the same time every night trains your body and brain to wind down and get ready for slumber. - Get up if you cannot sleep. If you lay awake for 15 minutes, get out of bed and go to another part of the house. This way your bed is less likely to become a place of stress. - Do something quiet and relaxing like read a book. This can also help take your mind of the fact that you are not sleeping. When you feel drowsy, return to bed. Make your bedroom comfortable: - Get a comfortable mattress. If your mattress is lumpy, too soft, or too hard, it will be hard to get comfortable enough for sleep. - Keep it cool. Your body temperature goes down when you sleep. Make sure your bedroom is cool enough but not so cool that you wake up cold. Experiment with the thermostat and blankets to find what temperature works for you. - Control the light. Light from the street, a TV, or the next room can make it hard to stay asleep. Use curtains and doors to make your room dark so you can sleep. You can also try using a sleep mask. - Control sounds. Make your room as quiet as you can. You might use a fan, soft music, or sound machine to create white noise you can sleep to. - Hide the clock. Watching the hours tick by can stress you out. Turn the clock so you cannot see it from your pillow. - Put away electronics. Silence any device that reminds you of emails you need to send or things you need to do. You will be better off doing those things after a good night's sleep. Practice Relaxation Try different ways to relax. Find what works for you. Such as: - Drink something warm and non-caffeinated like warm milk or herbal tea. - Take a warm shower or bath. - Read a book or magazine. - Listen to soft music or an audiobook. - Count backward from 300 by 3. - Meditate. - Starting at your feet and working your way up to your head, tense each group of muscles for a second or two and then relax them. - Do belly breathing. Put your hand on your belly. Take a breath in, letting it push your hand out as your belly rises. Your chest should not move. Hold it for a count of 5, release for a count of 5. Repeat. Live for Good Sleep Things you do during the day can affect how well you sleep at night. You should: - Limit evening activities. When you are on the run, your day may not end until late evening. Try to limit evening plans to a few nights a week. Give yourself time for a soothing bedtime ritual to help prepare you for sleep, such as a warm bath or reading in bed. - Exercise. Regular exercise will help you sleep better. Just be sure you plan your workout right. Overtraining or exercising less than 3 hours before bedtime can make you toss and turn. - Limit naps. If you are having trouble sleeping, cut out the catnaps. You will sleep better at night. - Limit caffeine. It might be a helpful pick-up in the morning, but you may go to bed wired if you drink coffee, tea, or caffeinated sodas in the afternoon or evening. - Limit alcohol. It may help you get to sleep at first, but alcohol keeps you from deep, restoring sleep later at night. - Kick the habit. Need another reason to quit smoking? The nicotine in cigarettes can disrupt sleep. - Eat smart. Avoid heavy meals before bedtime. Try to eat 2 or 3 hours before bedtime. If you feel hungry right before you go to bed, have a small, healthy snack like a small bowl of yogurt or low sugar cereal. Call your health care provider if lack of sleep is interfering with your daily activities. Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000853.htm"
+  ],
+  [
+    "Sleep and your health (Why You Might Not Get Enough Sleep): There are many reasons why sleep is in such short supply. - Busy schedules. Evening activities, whether it is work or social, are one of the top reasons people do not get enough sleep. - Poor sleep environment. It is a lot harder to get a good night's sleep in a bedroom with too much noise or light, or that is either too cold or too warm. - Electronics. Tablets and cell phones that ring and beep throughout the night disrupt sleep. They can also make it impossible to disconnect from the waking world. - Medical conditions. Some health conditions can prevent deep sleep. These include arthritis, back pain, heart disease, and conditions such as asthma that make it hard to breathe. Depression, anxiety, and substance abuse also make sleep hard to come by. Some medicines disrupt sleep. - Stress about sleeping. After several nights of tossing and turning, just being in bed can make you anxious and awake, even when you are very tired. Sleep disorders Sleep problems are a big reason why many people can't get enough sleep. Treatment can help in many cases. - Insomnia, occurs when you have trouble falling asleep or sleeping through the night. It is the most common sleep disorder. Insomnia can last for a night, a couple of weeks, or for months on end. - Sleep apnea is a condition in which your breathing pauses throughout the night. Even if you do not wake up all the way, sleep apnea repeatedly interrupts deep sleep. - Restless legs syndrome can keep you awake with the desire to move your legs anytime you are resting. Often restless legs syndrome comes with uncomfortable feelings such as burning, tingling, itching, or creeping in your legs.",
+    "https://medlineplus.gov/ency/patientinstructions/000871.htm"
+  ],
+  [
+    "Bundle branch block: Bundle branch block is a condition in which there's a delay or obstruction along the pathway that electrical impulses travel to make your heart beat. The delay or blockage may occur on the pathway that sends electrical impulses to the left or the right side of the bottom chambers (ventricles) of your heart. Bundle branch block sometimes makes it harder for your heart to pump blood efficiently through your circulatory system. There's no specific treatment for bundle branch block itself. However, any underlying health condition that caused bundle branch block, such as heart disease, will need to be treated. In most people, bundle branch block doesn't cause any symptoms. Sometimes, people with the condition don't even know they have a bundle branch block. For those people who do have signs and symptoms, they may include: - Fainting (syncope) - Feeling as if you're going to faint (presyncope) When to see a doctor If you've fainted, see your doctor to rule out any serious, underlying causes. If you have heart disease, or if your doctor has already diagnosed you as having bundle branch block, ask your doctor how often you should have follow-up visits. You might want to carry a medical alert card that identifies you as having bundle branch block in case you're seen in an emergency by a doctor who isn't familiar with your medical history. Normally, electrical impulses within your heart's muscle signal it to beat (contract). These impulses travel along a pathway, including the right and the left bundles. If one or both of these branch bundles become damaged - due to a heart attack, for example - this change can block the electrical impulses and cause your heart to beat abnormally. The underlying cause for bundle branch blocks may differ depending on whether the left or right bundle branch is affected. It's also possible that this condition can occur without any known underlying cause. Specific causes may include: Left bundle branch block - Heart disease - Thickened, stiffened or weakened heart muscle (cardiomyopathy) - A viral or bacterial infection of the heart muscle (myocarditis) - High blood pressure (hypertension) Right bundle branch block - A heart abnormality that's present at birth (congenital) - such as atrial septal defect, a hole in the wall separating the upper chambers of the heart - A heart attack (myocardial infarction) - A viral or bacterial infection of the heart muscle (myocarditis) - High blood pressure (hypertension) - A blood clot in the lungs (pulmonary embolism) Risk factors for bundle branch block include: - Increasing age. Bundle branch block is more common in older adults than in people who are middle-aged. - Underlying health problems. People who have high blood pressure or heart disease are more likely to have bundle branch block than people without those conditions. Tests that may be used to diagnose a bundle branch block or the underlying problem causing it include: - Electrocardiogram. An electrocardiogram records the electrical impulses in your heart through wires attached to the skin on your chest and other locations on your body. Abnormalities may indicate the presence of bundle branch block, as well as which side is being affected. - Echocardiogram. An echocardiogram can be used to pinpoint an underlying condition that caused the bundle branch block. This test uses sound waves to produce images of the heart, allowing your doctor to see your heart in motion. An echocardiogram provides detailed images of the heart's structure and shows the thickness of your heart muscle and whether your heart valves are moving normally. Most people with bundle branch block are symptom-free and don't need treatment. However, if you have an underlying heart condition causing bundle branch block, treatment of the underlying condition is recommended. Treatment of underlying conditions may involve using medications to reduce high blood pressure or lessen the effects of heart failure, or the use of a coronary angioplasty to open up the artery leading to your heart. Additionally, depending on your symptoms and whether you have other heart problems, your doctor might also recommend: - A pacemaker. For some people with bundle branch block and a history of fainting, doctors may recommend implanting a pacemaker. A pacemaker is a compact device implanted under the skin of your upper chest (internal pacemaker) with two wires that connect to the right side of your heart. The pacemaker provides electrical impulses when needed to keep your heart beating regularly. - Cardiac resynchronization. Also known as biventricular pacing, this procedure is similar to having a pacemaker implanted. However, in cardiac resynchronization, there's a third wire that's connected to the left side of the heart so the device can keep both sides in proper rhythm.",
+    "https://www.mayoclinic.org/diseases-conditions/bundle-branch-block/symptoms-causes/syc-20370514"
+  ],
+  [
+    "What are the symptoms of Heart Block?: Signs and symptoms depend on the type of heart block you have. First-degree heart block may not cause any symptoms. Signs and symptoms of second- and third-degree heart block include: Fainting Dizziness or light-headedness Fatigue (tiredness) Shortness of breath Chest pain These symptoms may suggest other health problems as well. If these symptoms are new or severe, call 911 or have someone drive you to the hospital emergency room. If you have milder symptoms, talk with your doctor right away to find out whether you need prompt treatment.",
+    "http://www.nhlbi.nih.gov/health/health-topics/topics/hb"
+  ],
+  [
+    "His bundle electrography: His bundle electrography is a test that measures electrical activity in a part of the heart that carries the signals that control the time between heartbeats (contractions). The bundle of His is a group of fibers that carry electrical impulses through the center of the heart. If these signals are blocked, you will have problems with your heartbeat. Watch this video about: Cardiac conduction system The His bundle electrography is part of an electrophysiology (EP) study. An intravenous catheter (IV line) is inserted into your arm so that you can be given medicines during the test. Electrocardiogram (ECG) leads are placed on your arms and legs. Your arm, neck, or groin will be cleaned and numbed with a local anesthetic. After the area is numb, the cardiologist makes a small cut in a vein and inserts a thin tube called a catheter inside. The catheter is carefully moved through the vein up into the heart. An x-ray method called fluoroscopy helps guide the doctor to the right place. During the test, you are watched for any abnormal heartbeats (arrhythmias). The catheter has a sensor on the end, which is used to measure the electrical activity of the bundle of His. You will be told not to eat or drink anything for 6 to 8 hours before the test. The test will be done in a hospital. Some people may need to check into the hospital the night before the test. Otherwise, you will check in the morning of the test. Although the test may take some time, most people DO NOT need to stay in the hospital overnight. Your health care provider will explain the procedure and its risks. You must sign a consent form before the test starts. About half an hour before the procedure, you will be given a mild sedative to help you relax. You will wear a hospital gown. The procedure may last from 1 to several hours. You are awake during the test. You may feel some discomfort when the IV is placed into your arm, and some pressure at the site when the catheter is inserted. This test may be done to: - Determine if you need a pacemaker or other treatment - Diagnose arrhythmias - Find the specific location where electrical signals through the heart are blocked The time between electrical signals from the bundle of His are evenly spaced. A pacemaker will be needed if the test results are abnormal. Abnormal results may mean you have or had: - Chronic conduction system disease - Carotid sinus pressure - Recent heart attack - Atrial disease Risks of the procedure include: - Arrhythmias - Cardiac tamponade - Embolism from blood clots at the tip of the catheter - Heart attack - Hemorrhage - Infection - Injury to the vein or artery - Low blood pressure - Stroke Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003391.htm"
+  ],
+  [
+    "Bundle branch block (Symptoms): In most people, bundle branch block doesn't cause any symptoms. Sometimes, people with the condition don't even know they have a bundle branch block. For those people who do have signs and symptoms, they may include: - Fainting (syncope) - Feeling as if you're going to faint (presyncope) When to see a doctor If you've fainted, see your doctor to rule out any serious, underlying causes. If you have heart disease, or if your doctor has already diagnosed you as having bundle branch block, ask your doctor how often you should have follow-up visits. You might want to carry a medical alert card that identifies you as having bundle branch block in case you're seen in an emergency by a doctor who isn't familiar with your medical history.",
+    "https://www.mayoclinic.org/diseases-conditions/bundle-branch-block/symptoms-causes/syc-20370514"
+  ],
+  [
+    "Bundle branch block (Risk factors): Risk factors for bundle branch block include: - Increasing age. Bundle branch block is more common in older adults than in people who are middle-aged. - Underlying health problems. People who have high blood pressure or heart disease are more likely to have bundle branch block than people without those conditions.",
+    "https://www.mayoclinic.org/diseases-conditions/bundle-branch-block/symptoms-causes/syc-20370514"
+  ],
+  [
+    "Heart Block: Heart block is a problem that occurs with the heart's electrical system. This system controls the rate and rhythm of heartbeats. (\"Rate\" refers to the number of times your heart beats per minute. \"Rhythm\" refers to the pattern of regular or irregular pulses produced as the heart beats.) With each heartbeat, an electrical signal spreads across the heart from the upper to the lower chambers. As it travels, the signal causes the heart to contract and pump blood. Heart block occurs if the electrical signal is slowed or disrupted as it moves through the heart. Overview Heart block is a type of arrhythmia (ah-RITH-me-ah). An arrhythmia is any problem with the rate or rhythm of the heartbeat. Some people are born with heart block, while others develop it during their lifetimes. If you're born with the condition, it's called congenital (kon-JEN-ih-tal) heart block. If the condition develops after birth, it's called acquired heart block. Doctors might detect congenital heart block before or after a baby is born. Certain diseases that may occur during pregnancy can cause heart block in a baby. Some congenital heart defects also can cause heart block. Congenital heart defects are problems with the heart's structure that are present at birth. Often, doctors don't know what causes these defects. Acquired heart block is more common than congenital heart block. Damage to the heart muscle or its electrical system causes acquired heart block. Diseases, surgery, or medicines can cause this damage. The three types of heart block are first degree, second degree, and third degree. First degree is the least severe, and third degree is the most severe. This is true for both congenital and acquired heart block. Doctors use a test called an EKG (electrocardiogram) to help diagnose heart block. This test detects and records the heart's electrical activity. It maps the data on a graph for the doctor to review. Outlook The symptoms and severity of heart block depend on which type you have. First-degree heart block may not cause any severe symptoms. Second-degree heart block may result in the heart skipping a beat or beats. This type of heart block also can make you feel dizzy or faint. Third-degree heart block limits the heart's ability to pump blood to the rest of the body. This type of heart block may cause fatigue (tiredness), dizziness, and fainting. Third-degree heart block requires prompt treatment because it can be fatal. A medical device called a pacemaker is used to treat third-degree heart block and some cases of second-degree heart block. This device uses electrical pulses to prompt the heart to beat at a normal rate. Pacemakers typically are not used to treat first-degree heart block. All types of heart block may increase your risk for other arrhythmias, such as atrial fibrillation (A-tre-al fih-brih-LA-shun). Talk with your doctor to learn more about the signs and symptoms of arrhythmias. Doctors use a test called an EKG (electrocardiogram) to help diagnose heart block. This test detects and records the heart's electrical activity. An EKG records the strength and timing of electrical signals as they pass through the heart. The data are recorded on a graph so your doctor can study your heart's electrical activity. Different parts of the graph show each step of an electrical signal's journey through the heart. EKG Each electrical signal begins in a group of cells called the sinus node or sinoatrial (SA) node. The SA node is located in the right atrium (AY-tree-um), which is the upper right chamber of the heart. (Your heart has two upper chambers and two lower chambers.) In a healthy adult heart at rest, the SA node sends an electrical signal to begin a new heartbeat 60 to 100 times a minute. From the SA node, the signal travels through the right and left atria. This causes the atria to contract, which helps move blood into the heart's lower chambers, the ventricles (VEN-trih-kuls). The electrical signal moving through the atria is recorded as the P wave on the EKG. The electrical signal passes between the atria and ventricles through a group of cells called the atrioventricular (AV) node. The signal slows down as it passes through the AV node. This slowing allows the ventricles enough time to finish filling with blood. On the EKG, this part of the process is the flat line between the end of the P wave and the beginning of the Q wave. The electrical signal then leaves the AV node and travels along a pathway called the bundle of His. From there, the signal travels into the right and left bundle branches. The signal spreads quickly across your heart's ventricles, causing them to contract and pump blood to your lungs and the rest of your body. This process is recorded as the QRS waves on the EKG. The ventricles then recover their normal electrical state (shown as the T wave on the EKG). The muscle stops contracting to allow the heart to refill with blood. This entire process continues over and over with each new heartbeat. The animation below shows how your heart's electrical system works and how an EKG records your heart's electrical activity. Click the \"start\" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames. The animation shows how an electrical signal moves through your heart and how an EKG records your heart's electrical activity. For more information about the heart's electrical system, go to the Health Topics How the Heart Works article. Some people are born with heart block (congenital), while others develop it during their lifetimes (acquired). Acquired heart block is more common than congenital heart block. The three types of heart block are first degree, second degree, and third degree. First degree is the least severe, and third degree is the most severe. This is true for both congenital and acquired heart block. First-Degree Heart Block In first-degree heart block, the heart's electrical signals are slowed as they move from the atria to the ventricles (the heart's upper and lower chambers, respectively). This results in a longer, flatter line between the P and the R waves on the EKG (electrocardiogram). First-degree heart block may not cause any symptoms or require treatment. Second-Degree Heart Block In this type of heart block, electrical signals between the atria and ventricles are slowed to a large degree. Some signals don't reach the ventricles. On an EKG, the pattern of QRS waves doesn't follow each P wave as it normally would. If an electrical signal is blocked before it reaches the ventricles, they won't contract and pump blood to the lungs and the rest of the body. Second-degree heart block is divided into two types: Mobitz type I and Mobitz type II. Mobitz Type I In this type (also known as Wenckebach's block), the electrical signals are delayed more and more with each heartbeat, until the heart skips a beat. On the EKG, the delay is shown as a line (called the PR interval) between the P and QRS waves. The line gets longer and longer until the QRS waves don't follow the next P wave. Sometimes people who have Mobitz type I feel dizzy or have other symptoms. This type of second-degree heart block is less serious than Mobitz type II. The animation below shows how your heart's electrical system works. It also shows what happens during second-degree Mobitz type I heart block. Click the \"start\" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames. The first part of this animation is the same as the animation in the section on understanding the heart's electrical system and EKG results. If you want to skip directly to the frames on Mobitz type I heart block, click the \"skip intro\" link above the start, pause, and replay buttons. The first part of the animation shows how an electrical signal moves through your heart and how an EKG records your heart's electrical activity. The second part of the animation shows how a pause in the heart's electrical signal can delay or block the contraction of the ventricles. Mobitz Type II In second-degree Mobitz type II heart block, some of the electrical signals don't reach the ventricles. However, the pattern is less regular than it is in Mobitz type I. Some signals move between the atria and ventricles normally, while others are blocked. On an EKG, the QRS wave follows the P wave at a normal speed. Sometimes, though, the QRS wave is missing (when a signal is blocked). Mobitz type II is less common than type I, but it's usually more severe. Some people who have type II need medical devices called pacemakers to maintain their heart rates. Third-Degree Heart Block In this type of heart block, none of the electrical signals reach the ventricles. This type also is called complete heart block or complete AV block. When complete heart block occurs, special areas in the ventricles may create electrical signals to cause the ventricles to contract. This natural backup system is slower than the normal heart rate and isn't coordinated with the contraction of the atria. On an EKG, the normal pattern is disrupted. The P\u00a0waves occur at a faster rate, and it isn't coordinated with the QRS waves. Complete heart block can result in sudden cardiac arrest and death. This type of heart block often requires emergency treatment. A temporary pacemaker might be used to keep the heart beating until you get a long-term pacemaker. \u00a0 Heart block has many causes. Some people are born with the disorder (congenital), while others develop it during their lifetimes (acquired). Congenital Heart Block One form of congenital heart block occurs in babies whose mothers have autoimmune diseases, such as lupus. People who have these diseases make proteins called antibodies that attack and damage the body's tissues or cells. In pregnant women, antibodies can cross the placenta. (The placenta is the organ that attaches the umbilical cord to the mother's womb.) These proteins can damage the baby's heart and lead to congenital heart block. Congenital heart defects also may cause congenital heart block. These defects are problems with the heart's structure that are present at birth. Often, doctors don't know what causes these defects. Acquired Heart Block Many factors can cause acquired heart block. Examples include: Damage to the heart from a heart attack. This is the most common cause of acquired heart block. Coronary heart disease, also called coronary artery disease. Myocarditis (MI-o-kar-DI-tis), or inflammation of the heart muscle. Heart failure. Rheumatic (roo-MAT-ik) fever. Cardiomyopathy (KAR-de-o-mi-OP-a-the), or heart muscle diseases. Other diseases may increase the risk of heart block. Examples include sarcoidosis (sar-koy-DOE-sis) and the degenerative muscle disorders Lev's disease and Lenegre's disease. Certain types of surgery also may damage the heart's electrical system and lead to heart block. Exposure to toxic substances and taking certain medicines\u2014including digitalis, beta blockers, and calcium channel blockers\u2014also may cause heart block. Doctors closely watch people who are taking these medicines for signs of problems. Some types of heart block have been linked to genetic mutations (changes in the genes). An overly active vagus nerve also can cause heart block. You have one vagus nerve on each side of your body. These nerves run from your brain stem all the way to your abdomen. Activity in the vagus nerve slows the heart rate. In some cases, acquired heart block may go away if the factor causing it is treated or resolved. For example, heart block that occurs after a heart attack or surgery may go away during recovery. Also, if a medicine is causing heart block, the disorder may go away if the medicine is stopped or the dosage is lowered. Always talk with your doctor before you change the way you take your medicines. The risk factors for congenital and acquired heart block are different. Congenital Heart Block If a pregnant woman has an autoimmune disease, such as lupus, her fetus is at risk for heart block. Autoimmune diseases can cause the body to make proteins called antibodies that can cross the placenta. (The placenta is the organ that attaches the umbilical cord to the mother's womb.) These antibodies may damage the baby's heart and lead to congenital heart block. Congenital heart defects also can cause heart block. These defects are problems with the heart's structure that are present at birth. Most of the time, doctors don't know what causes congenital heart defects. Heredity may play a role in certain heart defects. For example, a parent who has a congenital heart defect might be more likely than other people to have a child with the condition. Acquired Heart Block Acquired heart block can occur in people of any age. However, most types of the condition are more common in older people. This is because many of the risk factors are more common in older people. People who have a history of heart disease or heart attacks are at increased risk for heart block. Examples of heart disease that can lead to heart block include heart failure, coronary heart disease, and cardiomyopathy (heart muscle diseases). Other diseases also may raise the risk of heart block, such as sarcoidosis and the degenerative muscle disorders Lev's disease and Lenegre's disease. Exposure to toxic substances or taking certain medicines, such as digitalis, also can raise your risk for heart block. Well-trained athletes and young people are at higher risk for first-degree heart block caused by an overly active vagus nerve. You have one vagus nerve on each side of your body. These nerves run from your brain stem all the way to your abdomen. Activity in the vagus nerve slows the heart rate. Signs and symptoms depend on the type of heart block you have. First-degree heart block may not cause any symptoms. Signs and symptoms of second- and third-degree heart block include: Fainting Dizziness or light-headedness Fatigue (tiredness) Shortness of breath Chest pain These symptoms may suggest other health problems as well. If these symptoms are new or severe, call 9\u20131\u20131 or have someone drive you to the hospital emergency room. If you have milder symptoms, talk with your doctor right away to find out whether you need prompt treatment. Heart block might be diagnosed as part of a routine doctor's visit or during an emergency situation. (Third-degree heart block often is an emergency.) Your doctor will diagnose heart block based on your family and medical histories, a physical exam, and test results. Specialists Involved Your primary care doctor might be involved in diagnosing heart block. However, if you have the condition, you might need to see a heart specialist. Heart specialists include: Cardiologists (doctors who diagnose and treat adults who have heart problems) Pediatric cardiologists (doctors who diagnose and treat babies and children who have heart problems) Electrophysiologists (cardiologists or pediatric cardiologists who specialize in the heart's electrical system) Family and Medical Histories Your doctor may ask whether: You have any signs or symptoms of heart block You have any health problems, such as heart disease Any of your family members have been diagnosed with heart block or other health problems You're taking any medicines, including herbal products and prescription and over-the-counter medicines You smoke or use alcohol or drugs Your doctor also may ask about other health habits, such as how physically active you are. Physical Exam During the physical exam, your doctor will listen to your heart. He or she will listen carefully for abnormal rhythms or heart murmurs (extra or unusual sounds heard during heartbeats). Your doctor also may: Check your pulse to find out how fast your heart is beating Check for swelling in your legs or feet, which could be a sign of an enlarged heart or heart failure Look for signs of other diseases that could be causing heart rate or rhythm problems (such as coronary heart disease) Diagnostic Tests and Procedures EKG (Electrocardiogram) Doctors usually use an EKG (electrocardiogram) to help diagnose heart block. This simple test detects and records the heart's electrical activity. An EKG shows how fast the heart is beating and its rhythm (steady or irregular). The test also records the strength and timing of electrical signals as they pass through the heart. The data are recorded on a graph. Different types of heart block have different patterns on the graph. (For more information, go to \"Types of Heart Block.\") A standard EKG only records the heart's activity for a few seconds. To diagnose heart rhythm problems that come and go, your doctor may have you wear a portable EKG monitor. The most common types of portable EKGs are Holter and event monitors. Your doctor may have you use one of these monitors to diagnose first- or second-degree heart block. Holter and Event Monitors A Holter monitor records the heart's electrical signals for a full 24- or 48-hour period. You wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG. An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it. You may wear an event monitor for 1 to 2 months, or as long as it takes to get a recording of your heart during symptoms. Electrophysiology Study For some cases of heart block, doctors may do electrophysiology studies (EPS). During this test, a thin, flexible wire is passed through a vein in your groin (upper thigh) or arm to your heart. The wire records your heart's electrical signals. Other Tests To diagnose heart block, your doctor may recommend tests to rule out other types of arrhythmias (irregular heartbeats). For more information, go to \"How Are Arrhythmias Diagnosed?\" Treatment depends on the type of heart block you have. If you have first-degree heart block, you may not need treatment. If you have second-degree heart block, you may need a pacemaker. A pacemaker is a small device that's placed under the skin of your chest or abdomen. This device uses electrical pulses to prompt the heart to beat at a normal rate. If you have third-degree heart block, you will need a pacemaker. In an emergency, a temporary pacemaker might be used until you can get a long-term device. Most people who have third-degree heart block need pacemakers for the rest of their lives. Some people who have third-degree congenital heart block don't need pacemakers for many years. Others may need pacemakers at a young age or during infancy. If a pregnant woman has an autoimmune disease, such as lupus, her fetus is at risk for heart block. If heart block is detected in a fetus, the mother might be given medicine to reduce the fetus' risk of developing serious heart block. Sometimes acquired heart block goes away if the factor causing it is treated or resolved. For example, heart block that occurs after a heart attack or surgery may go away during recovery. Also, if a medicine is causing heart block, the condition may go away if the medicine is stopped or the dosage is lowered. (Always talk with your doctor before you change the way you take your medicines.) First-degree heart block may not cause any symptoms or require treatment. However, some research has shown that people who have first-degree heart block might be at higher risk for atrial fibrillation (AF) in the future. AF is a type of arrhythmia. It occurs if rapid, disorganized electrical signals cause the heart's upper chambers to contract very fast and irregularly. If you've been diagnosed with first-degree heart block, ask your doctor whether you need to take any special steps to control it. Your doctor can tell you whether you need ongoing care or whether you need to change the way you take certain medicines. If you have second-degree heart block that doesn't require a pacemaker, talk with your doctor about keeping your heart healthy. Your doctor will tell you whether you need ongoing care for your condition. Living With a Pacemaker People who have third-degree heart block and some people who have second-degree heart block need pacemakers. These devices use electrical pulses to prompt the heart to beat at a normal rate. If you have a pacemaker, you should take special care to avoid things that may interfere with it. Avoid close or prolonged contact with electrical devices and devices that have strong magnetic fields. These objects can keep your pacemaker from working properly. Let all of your doctors, dentists, and medical technicians know that you have a pacemaker. You also should notify airport screeners. Your doctor can give you a card that states what kind of pacemaker you have. Carry this card in your wallet. You may want to wear a medical ID bracelet or necklace that states that you have a pacemaker. Certain medical procedures can disrupt pacemakers. Examples include MRI (magnetic resonance imaging), electrocauterization during surgery, and shock-wave lithotripsy to get rid of kidney stones. Your doctor may need to check your pacemaker several times a year to make sure it's working well. Some pacemakers must be checked in the doctor's office, but others can be checked over the phone. Ask your doctor about what types of physical activity are safe for you. A pacemaker usually won't limit you from doing sports and physical activity. But you may need to avoid full-contact sports, such as football, that can damage the pacemaker. For more information about living with a pacemaker, go to the Health Topics Pacemaker article.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/hb"
+  ],
+  [
+    "Heart block: Heart block is a problem in the electrical signals in the heart. Normally, the heart beat starts in an area in the top chambers of the heart (atria). This area is the heart's pacemaker. The electrical signals travel to the lower chambers of the heart (ventricles). This keeps the heart beat steady and regular.\u00a0 Heart block occurs when the electrical signal is slowed down or does not reach the bottom chambers of the heart. Your heart may beat slowly, or it may skip beats. Heart block may resolve on its own, or it may be permanent and require treatment. There are three degrees of heart block. First-degree heart block is the mildest type and third-degree is the most severe. First-degree heart block: - Rarely has symptoms Second-degree heart block: - The electrical impulse may not reach the lower chambers of the heart. - The heart may miss a beat or beats and may be slow and irregular. - You may feel dizzy, faint, or have other symptoms. Third-degree heart block: - The electrical signal does not move to the lower chambers of the heart. In this case, the lower chambers beat at a much slower rhythm, and the upper and lower chambers do not beat at the same rate. - The heart fails to pump enough blood to the body. This can lead to fainting and shortness of breath. - This is an emergency that needs medical help right away. Heart block may be caused by: - Medicine side effects.\u00a0Heart block can be a side effect of digitalis, beta-blockers, calcium channel blockers, and other medicines. - A heart attack that damages the electrical system in the heart. - Heart diseases, such as heart valve disease and cardiac sarcoidosis. - Some infections,\u00a0such as Lyme disease. - Heart surgery. You may have heart block because you were born with it. You are more at risk for this if: - You have a heart defect. - Your mother has an autoimmune disease, such as\u00a0lupus. Talk to your health care provider about your symptoms. The symptoms are different for first, second, and third-degree heart block. You may not have any symptoms for first-degree heart block. You may not know you have heart block until it shows up on a test called an electrocardiogram (ECG). If you have second-degree or third-degree heart block, symptoms may include: - Chest pain - Dizziness - Feeling faint - Tiredness - Heart palpitations. Palpitations are when your heart feels like it is pounding or racing. Your health care provider will most likely send you to a heart doctor (cardiologist) to check for heart block. The cardiologist will talk to you about your medical history and the medicines you are taking. The cardiologist will also: - Do a complete physical exam. The doctor will check you for signs of heart failure, such as\u00a0swollen ankles and feet. - Do an ECG test to check the electrical signals in your heart. - You may need to wear a heart monitor for 24 to 48 hours or longer to check the electrical signals in your heart. The treatment for heart block depends the type of heart block you have and the cause. If you do not have serious symptoms and have a milder type of heart block, you will most likely need to: - Have regular checkups with your health care provider. - Check your pulse every day. - Be aware of your symptoms and know when to call your provider if symptoms change. If you have second- or third-degree heart block, you may need a pacemaker to help your heart beat regularly. - A pacemaker is smaller than a deck of cards. It is put inside the skin on your chest. It gives off electrical signals to make your heart beat at a regular rate and rhythm. - How long you need the pacemaker depends on the type of heart block you have. - Heart block caused by a heart attack or heart surgery may go away as you recover. - If medicine is causing heart block, changing medications can fix the problem. Do NOT stop taking any medicine unless your doctor tells you to do so. With regular monitoring and treatment, you should be able to keep up most of all of your usual activities. Heart block may increase the risk for: - Other kinds of heart rhythm problems (arrhythmias), such as\u00a0atrial fibrillation. Talk to your health care provider about symptoms of other arrhythmias. - Heart attack. If you have a pacemaker, you cannot be near magnetic fields. You need to let people know that you have a pacemaker. - Do NOT go through the usual security\u00a0station at\u00a0an airport, courthouse, or\u00a0other place that requires people to walk through a security screening. Tell the security personnel you have a pacemaker and ask for an alternate type of security screening. - Do NOT get an MRI without telling the MRI technician about your pacemaker. Call your health care provider if you feel: - Dizzy - Weak - Faint - Racing heart beat - Skipped heart beat - Chest pain Call your provider if you have signs of heart failure: - Weakness - Swollen legs, ankles, or feet - Feel short of breath Updated by: Larry A. Weinrauch MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007658.htm"
+  ],
+  [
+    "progressive familial heart block: Progressive familial heart block is a genetic condition that alters the normal beating of the heart. A normal heartbeat is controlled by electrical signals that move through the heart in a highly coordinated way. These signals begin in a specialized cluster of cells called the sinoatrial node (the heart's natural pacemaker) located in the heart's upper chambers (the atria). From there, a group of cells called the atrioventricular node carries the electrical signals to another cluster of cells called the bundle of His. This bundle separates into multiple thin spindles called bundle branches, which carry electrical signals into the heart's lower chambers (the ventricles). Electrical impulses move from the sinoatrial node down to the bundle branches, stimulating a normal heartbeat in which the ventricles contract slightly later than the atria. Heart block occurs when the electrical signaling is obstructed anywhere from the atria to the ventricles. In people with progressive familial heart block, the condition worsens over time: early in the disorder, the electrical signals are partially blocked, but the block eventually becomes complete, preventing any signals from passing through the heart. Partial heart block causes a slow or irregular heartbeat (bradycardia or arrhythmia, respectively), and can lead to the buildup of scar tissue (fibrosis) in the cells that carry electrical impulses. Fibrosis contributes to the development of complete heart block, resulting in uncoordinated electrical signaling between the atria and the ventricles and inefficient pumping of blood in the heart. Complete heart block can cause a sensation of fluttering or pounding in the chest (palpitations), shortness of breath, fainting (syncope), or sudden cardiac arrest and death. Progressive familial heart block can be divided into type I and type II, with type I being further divided into types IA and IB. These types differ in where in the heart signaling is interrupted and the genetic cause. In types IA and IB, the heart block originates in the bundle branch, and in type II, the heart block originates in the atrioventricular node. The different types of progressive familial heart block have similar signs and symptoms. Most cases of heart block are not genetic and are not considered progressive familial heart block. The most common cause of heart block is fibrosis of the heart, which occurs as a normal process of aging. Other causes of heart block can include the use of certain medications or an infection of the heart tissue. The prevalence of progressive familial heart block is unknown. In the United States, about 1 in 5,000 individuals have complete heart block from any cause; worldwide, about 1 in 2,500 individuals have complete heart block. Mutations in the SCN5A and TRPM4 genes cause most cases of progressive familial heart block types IA and IB, respectively. The proteins produced from these genes are channels that allow positively charged atoms (cations) into and out of cells. Both channels are abundant in heart (cardiac) cells and play key roles in these cells' ability to generate and transmit electrical signals. These channels play a major role in signaling the start of each heartbeat, coordinating the contractions of the atria and ventricles, and maintaining a normal heart rhythm. The SCN5A and TRPM4 gene mutations that cause progressive familial heart block alter the normal function of the channels. As a result of these channel alterations, cardiac cells have difficulty producing and transmitting the electrical signals that are necessary to coordinate normal heartbeats, leading to heart block. Death of these impaired cardiac cells over time can lead to fibrosis, worsening the heart block. Mutations in other genes, some of which are unknown, account for the remaining cases of progressive familial heart block. Progressive familial heart block types I and II are inherited in an autosomal dominant pattern, which means one copy of an altered gene in each cell is sufficient to cause the disorder. Some people with TRPM4 gene mutations never develop the condition, a situation known as reduced penetrance. In most cases, an affected person has one parent with progressive familial heart block. Barra SN, Provid\u00eancia R, Paiva L, Nascimento J, Marques AL. A review on advanced atrioventricular block in young or middle-aged adults. Pacing Clin Electrophysiol. 2012 Nov;35(11):1395-405. doi: 10.1111/j.1540-8159.2012.03489.x. Epub 2012 Aug 16. Review.",
+    "https://ghr.nlm.nih.gov/condition/progressive-familial-heart-block"
+  ],
+  [
+    "Congenital heart block: Congenital heart block is a rare condition that affects the heart's electrical system, which controls and coordinates its pumping function. In infants affected by this condition, the electrical signal that spreads across the heart and causes it to contract and pump blood, is slowed or completely interrupted. This can interfere with the heart's normal rate and rhythm and may significantly limit the ability of the heart to pump blood to the rest of the body. Congenital heart block generally develops between 18 and 33 weeks of pregnancy. The underlying cause of the condition is poorly understood. However, mothers with lupus or another autoimmune diseases and parents with congenital heart disorders have an increased risk of having a\u00a0child with\u00a0a congenital heart block. The condition is generally treated with a pacemaker. Some cases may benefit from prenatal administration of steroids. [1] [2] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Absent atrioventricular node - Cardiomyopathy - Mitral regurgitation - Myocardial calcification - Myocardial fibrosis - Primary atrial arrhythmia -",
+    "https://rarediseases.info.nih.gov/diseases/6164/congenital-heart-block"
+  ],
+  [
+    "Hookworm infection (Treatment): The goals of treatment are to: - Cure the infection - Treat complications of anemia - Improve nutrition Parasite-killing drugs such as albendazole, mebendazole, or pyrantel pamoate are often prescribed. Symptoms and complications of anemia are treated, if needed. The health care provider will likely recommend increasing the amount of protein in your diet.",
+    "https://medlineplus.gov/ency/article/000629.htm"
+  ],
+  [
+    "Who should get Cephalexin and why is it prescribed?: Cephalexin is a cephalosporin antibiotic used to treat certain infections caused by bacteria such as pneumonia and bone, ear, skin, and urinary tract infections. Antibiotics will not work for colds, flu, or other viral infections. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682733.html"
+  ],
+  [
+    "Hookworm infection: Hookworm infection is caused by roundworms. The disease affects the small intestine and lungs. The infection is caused by infestation with any of the following roundworms: - Necator americanus - Ancylostoma duodenale - Ancylostoma ceylanicum - Ancylostoma braziliense The first 2 roundworms affect humans only. The last 2 types also occur in animals. Hookworm disease is common in the moist tropics and subtropics. In developing nations, the disease leads to the death of many children by increasing their risk for infections that their bodies would normally fight off. There is very little risk of getting the disease in the United States because of advances in sanitation and waste control. The important factor in getting the disease is walking barefoot on ground where there are feces of people who have hookworm. The larvae (immature form of the worm) enter the skin. The larvae move to the lungs via the bloodstream and enter the airways. The worms are about one half inch (1 centimeter) long. After traveling up the windpipe, the larvae are swallowed. After the larvae are swallowed, they infect the small intestine. They develop into adult worms and live there for 1 or more years. The worms attach to the intestinal wall and suck blood, which results in iron deficiency anemia and protein loss. Adult worms and larvae are released in the feces. Symptoms may include: - Abdominal discomfort - Cough - Diarrhea - Fatigue - Fever - Gas - Itchy rash - Loss of appetite - Nausea, vomiting - Pale skin Most people have no symptoms once the worms enter the intestines. Tests that can help diagnose the infection include: - Complete blood count (CBC) with differential - Stool ova and parasites exam The goals of treatment are to: - Cure the infection - Treat complications of anemia - Improve nutrition Parasite-killing drugs such as albendazole, mebendazole, or pyrantel pamoate are often prescribed. Symptoms and complications of anemia are treated, if needed. The health care provider will likely recommend increasing the amount of protein in your diet. You will have a complete recovery if you get treated before serious complications develop. Treatment gets rid of the infection. Health problems that may result from hookworm infection include: - Iron deficiency anemia, caused by loss of blood - Nutritional deficiencies - Severe protein loss with fluid buildup in the abdomen (ascites) Call for an appointment with your provider if symptoms of hookworm infection develop. Handwashing and wearing shoes will reduce the likelihood of infection. Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000629.htm"
+  ],
+  [
+    "Shigella infection (Treatment): Shigella infection usually runs its course in five to seven days. Replacing lost fluids from diarrhea may be all the treatment you need, particularly if your general health is good and your shigella infection is mild. Avoid drugs intended to treat diarrhea, such as loperamide (Imodium) or atropine (Lomotil), because they can make your condition worse. Antibiotics For severe shigella infection, antibiotics may shorten the duration of the illness. However, some shigella bacteria have become drug resistant. So it's better not to take antibiotics unless your shigella infection is severe. Antibiotics may also be necessary for infants, older adults and people who have HIV infection, as well as in situations where there's a high risk of spreading the disease. Fluid and salt replacement For generally healthy adults, drinking water may be enough to counteract the dehydrating effects of diarrhea. Children may benefit from an oral rehydration solution, such as Pedialyte, available in drugstores. Many pharmacies carry their own brands. Children and adults who are severely dehydrated need treatment in a hospital emergency room, where they can receive salts and fluids through a vein (intravenously), rather than by mouth. Intravenous hydration provides the body with water and essential nutrients much more quickly than oral solutions do.",
+    "https://www.mayoclinic.org/diseases-conditions/shigella/symptoms-causes/syc-20377529"
+  ],
+  [
+    "Salmonella infection (Risk factors): Factors that may increase your risk of salmonella infection include activities that may bring you into closer contact with salmonella bacteria and health problems that may weaken your resistance to infection in general. - International travel. Salmonella infection, including varieties that cause typhoid fever, is more common in developing countries with poor sanitation. - Owning a pet bird or reptile. Some pets, particularly birds and reptiles, can carry salmonella bacteria. Your body has many natural defenses against salmonella infection. For example, strong stomach acid can kill many types of salmonella bacteria. But some medical problems or medications can short-circuit these natural defenses. Examples include: - Antacids. Lowering your stomach's acidity allows more salmonella bacteria to survive. - Inflammatory bowel disease. This disorder damages the lining of your intestines, which makes it easier for salmonella bacteria to take hold. - Recent use of antibiotics. This can reduce the number of \"good\" bacteria in your intestines, which may impair your ability to fight off a salmonella infection. The following medical problems or medications appear to increase your risk of contracting salmonella by impairing your immune system. - AIDS - Sickle cell disease - Malaria - Anti-rejection drugs taken after organ transplants - Corticosteroids",
+    "https://www.mayoclinic.org/diseases-conditions/salmonella/symptoms-causes/syc-20355329"
+  ],
+  [
+    "Ancylostomiasis (Summary): The following summary is from Orphanet, a European reference portal for information on rare diseases and orphan drugs. Orpha Number: 78 Disease definition Ankylostomiasis is a hookworm infection caused primarily by the species Ancylostoma duodenale or Necator americanus, usually acquired through penetration of the skin, (often asymptomatic but that can also manifest with an allergic reaction at the site of skin penetration), followed by the migration of larva through the bloodstream to the lungs (causing asymptomatic pneumonitis, eosinophilia) and finally reaching and colonizing the small intestines where they cause blood extravasation leading to diarrhea, abdominal pain, and when untreated, melena, iron-deficiency anemia and protein malnutrition. Visit the Orphanet disease page for more resources.",
+    "https://rarediseases.info.nih.gov/diseases/9742/ancylostomiasis"
+  ],
+  [
+    "Aspergillosis: Aspergillosis is an infection or allergic response due to the Aspergillus fungus. Aspergillosis is caused by a fungus called Aspergillus. The fungus is often found growing on dead leaves, stored grain, compost piles, or in other decaying vegetation. It can also be found on marijuana leaves. Although most people are often exposed to Aspergillus, infections caused by the fungus rarely occur in people who have a healthy immune system. There are several forms of aspergillosis: - Allergic pulmonary aspergillosis is an allergic reaction to the fungus. This infection usually develops in people who already have lung problems such as asthma or cystic fibrosis. - Aspergilloma is a growth (fungus ball) that develops in an area of past lung disease or lung scarring such as tuberculosis or lung abscess. - Invasive pulmonary aspergillosis is a serious infection with pneumonia. It can spread to other parts of the body. This infection occurs most often in people with a weakened immune system. This can be from cancer, AIDS, leukemia, an organ transplant, chemotherapy, or other conditions or drugs that lower the number or function of white blood cells or weaken the immune system. Symptoms depend on the type of infection. Symptoms of allergic pulmonary aspergillosis may include: - Cough - Coughing up blood or brownish mucus plugs - Fever - General ill feeling (malaise) - Wheezing - Weight loss Other symptoms depend on the part of the body affected, and may include: - Bone pain - Chest pain - Chills - Decreased urine output - Headaches - Increased phlegm production, which may be bloody - Shortness of breath - Skin sores (lesions) - Vision problems Tests to diagnose Aspergillus infection include: - Aspergillus antibody test - Chest x-ray - Complete blood count - CT scan - Galactomannan (a molecule from the fungus that is sometimes found in the blood) - Immunoglobulin E (IgE) blood level - Lung function tests - Sputum stain and culture for Aspergillus - Tissue biopsy A fungus ball is usually not treated with antifungal medicines unless there is bleeding into the lung tissue. In such a case, surgery and medicines are needed. Invasive aspergillosis is treated with several weeks of an antifungal medicine. It can be given by mouth or IV (into a vein). Endocarditis caused by Aspergillus is treated by surgically removing the infected heart valves. Long-term antifungal drugs are also needed. Allergic aspergillosis is treated with drugs that suppress the immune system (immunosuppressive drugs), such as prednisone. With treatment, people with allergic aspergillosis usually get better over time. It is common for the disease to come back (relapse) and need repeat treatment. If invasive aspergillosis does not get better with drug treatment, it eventually leads to death. The outlook for invasive aspergillosis also depends on the person's underlying disease and immune system health. Health problems from the disease or treatment include: - Amphotericin B can cause kidney damage and unpleasant side effects such as fever and chills - Bronchiectasis (permanent scarring and enlargement of the small sacs in the lungs) - Invasive lung disease can cause massive bleeding from the lung - Mucus plugs in the airways - Permanent airway blockage - Respiratory failure Call your health care provider if you develop symptoms of aspergillosis or if you have a weakened immune system and develop a fever. Precautions should be taken when using medicines that suppress the immune system. Preventing HIV/AIDS also prevents certain diseases, including aspergillosis, that are associated with a damaged or weakened immune system. Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/001326.htm"
+  ],
+  [
+    "Urinary tract infection (UTI) (Treatment): Antibiotics usually are the first line treatment for urinary tract infections. Which drugs are prescribed and for how long depend on your health condition and the type of bacteria found in your urine. Simple infection Drugs commonly recommended for simple UTIs include: - Trimethoprim/sulfamethoxazole (Bactrim, Septra, others) - Fosfomycin (Monurol) - Nitrofurantoin (Macrodantin, Macrobid) - Cephalexin (Keflex) - Ceftriaxone The group of antibiotic medicines known as fluoroquinolones - such as ciprofloxacin (Cipro), levofloxacin (Levaquin) and others - isn't commonly recommended for simple UTIs, as the risks of these medicines generally outweigh the benefits for treating uncomplicated UTIs. In some cases, such as a complicated UTI or kidney infection, your doctor might prescribe a fluoroquinolone medicine if no other treatment options exist. Often, symptoms clear up within a few days of treatment. But you may need to continue antibiotics for a week or more. Take the entire course of antibiotics as prescribed. For an uncomplicated UTI that occurs when you're otherwise healthy, your doctor may recommend a shorter course of treatment, such as taking an antibiotic for one to three days. But whether this short course of treatment is enough to treat your infection depends on your particular symptoms and medical history. Your doctor may also prescribe a pain medication (analgesic) that numbs your bladder and urethra to relieve burning while urinating, but pain usually is relieved soon after starting an antibiotic. Frequent infections If you have frequent UTIs, your doctor may make certain treatment recommendations, such as: - Low-dose antibiotics, initially for six months but sometimes longer - Self-diagnosis and treatment, if you stay in touch with your doctor - A single dose of antibiotic after sexual intercourse if your infections are related to sexual activity - Vaginal estrogen therapy if you're postmenopausal Severe infection For a severe UTI, you may need treatment with intravenous antibiotics in a hospital.",
+    "https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/symptoms-causes/syc-20353447"
+  ],
+  [
+    "Esophagitis - infectious: Esophagitis is a general term for any inflammation, irritation, or swelling of the esophagus. This is the tube that carries food and liquids from the mouth to the stomach. Infectious esophagitis is rare. It often occurs in people whose immune systems are weakened. People who have strong immune systems don't usually develop the infection. Common causes of a weakened immune system include: - HIV/AIDS - Chemotherapy - Diabetes - Leukemia or lymphoma - Medicines that suppress the immune system, such as ones given after organ or bone marrow transplant - Other conditions that suppress or weaken your immune system Organisms (germs) that cause esophagitis include fungi, yeast, and viruses. Common organisms include: - Candida albicans - Cytomegalovirus (CMV) - Herpes simplex virus (HSV) - Human papillomavirus (HPV) - Tuberculosis bacteria Symptoms of esophagitis include: - Difficulty swallowing and painful swallowing - Fever and chills - Yeast infection of the tongue and lining of the mouth (oral thrush) - Sores in the mouth or back of the throat (with herpes or CMV) The health care provider will ask about your symptoms and examine your mouth and throat. Tests may include: - Blood and urine tests for CMV - Culture of cells from the esophagus for herpes or CMV - Mouth or throat swab culture for candida You may need to have an upper endoscopy exam. This is a test to examine the lining of the esophagus. In most people with esophagitis, medicines can control the infection. These include: - Antiviral medicines such as acyclovir, famciclovir, or valacyclovir can treat a herpes infection. - Antifungal medicines such as fluconazole (taken by mouth), caspofungin (given by injection), or amphotericin (given by injection) can treat candida infection. - Antiviral medicines that are given through a vein (intravenously), such as ganciclovir or foscarnet can treat CMV infection. In some cases, a medicine called valganciclovir, which is taken by mouth, can be used for CMV infection. Some people may also need pain medicine. Ask your provider for special diet recommendations. For example, there may be foods you need to avoid eating as your esophagitis heals. Many people who are treated for an episode of infectious esophagitis need other, long-term medicines to suppress the virus or fungus, and to prevent the infection from coming back. Esophagitis can usually be treated effectively and usually heals in 3 to 5 days. People with a weakened immune system may take longer to get better. Health problems that may result from infectious esophagitis include: - Holes in your esophagus (perforations) - Infection at other sites - Recurrent infection Call your provider if you have any condition that can cause reduced immune response and you develop symptoms of infectious esophagitis. If you have a weakened immune system, try to avoid contact with people who have an infection with any of the organisms mentioned above. Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000646.htm"
+  ],
+  [
+    "Candida infection of the skin: Candida infection of the skin is a yeast infection of the skin. The medical name of the condition is cutaneous candidiasis. The body normally hosts a variety of germs, including bacteria and fungi. Some of these are useful to the body, some produce no harm or benefit, and some can cause harmful infections. Some fungal infections are caused by fungi that often live on the hair, nails, and outer skin layers. They include yeast-like fungi such as candida.\u00a0Sometimes, these yeast penetrate beneath the surface of the skin and cause infection. In cutaneous candidiasis, the skin is infected with candida fungi. This type of infection is fairly common. It can involve almost any skin on the body, but most often it occurs in warm, moist, creased areas such as the armpits and groin. The fungus that most often causes cutaneous candidiasis is Candida albicans. Candida is the most common cause of diaper rash in infants. The fungi take advantage of the warm, moist conditions inside the diaper. Candida infection is also particularly common in people with diabetes and in those who are obese. Antibiotics, steroid therapy, and chemotherapy increase the risk of cutaneous candidiasis. Candida can also cause infections of the nails, edges of the nails, and corners of the mouth. Oral thrush, a form of candida infection of the moist lining of the mouth, usually occurs when people take antibiotics. It may also be a sign of an HIV infection or other weakened immune system disorders when it occurs in adults. Individuals with candida infections are not usually contagious, though in some settings people with weakened immune systems may catch the infection. Candida is also the most frequent cause of vaginal yeast infections. These infections are common and often occur with antibiotic use. People with seriously weakened immune systems and cutaneous candidiasis may go on to develop more serious candida infections inside their body. A candida infection of the skin can cause intense itching. Symptoms also include: - Red, growing skin rash - Rash on the skin folds, genitals, middle of the body, buttocks, under the breasts, and other areas of skin - Infection of the hair follicles that may look like pimples Your health care provider can usually diagnose this condition by looking at your skin. Your provider may gently scrape off a sample of skin for testing. Older children and adults with a yeast skin infection should be tested for diabetes. High sugar levels, seen in people with diabetes, act as food for the yeast fungus, and help it grow. Good general health and hygiene are very important for treating candida infections of the skin. Keeping the skin dry and exposed to air is helpful. Drying (absorbent) powders may help prevent fungal infections. Losing weight may help eliminate the problem if you are overweight. Proper blood sugar control may also be helpful to those with diabetes. Antifungal skin creams or ointments may be used to treat a yeast infection of the skin, mouth, or vagina. You may need to take antifungal medicine by mouth for severe candida infections in the mouth, throat, or vagina. Cutaneous candidiasis often goes away with treatment, especially if the underlying cause is corrected. Repeat infections are common. These complications may occur: - Infection of the nails may cause the nails to become oddly shaped and may cause an infection around the nail. - Candida skin infections may return. - Widespread candidiasis may occur in people with weakened immune systems. Call your provider if you develop symptoms of cutaneous candidiasis. Updated by: Arnold Lentnek, MD, Infectious Diseases Medical Practice of NY and Clinical Research Centers of CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000880.htm"
+  ],
+  [
+    "Heart arrhythmia (Diagnosis): To diagnose a heart arrhythmia, your doctor will review your symptoms and your medical history and conduct a physical examination. Your doctor may ask about - or test for - conditions that may trigger your arrhythmia, such as heart disease or a problem with your thyroid gland. Your doctor may also perform heart-monitoring tests specific to arrhythmias. These may include: - Electrocardiogram (ECG). During an ECG, sensors (electrodes) that can detect the electrical activity of your heart are attached to your chest and sometimes to your limbs. An ECG measures the timing and duration of each electrical phase in your heartbeat. - Holter monitor. This portable ECG device can be worn for a day or more to record your heart's activity as you go about your routine. - Event monitor. For sporadic arrhythmias, you keep this portable ECG device available, attaching it to your body and pressing a button when you have symptoms. This lets your doctor check your heart rhythm at the time of your symptoms. - Echocardiogram. In this noninvasive test, a hand-held device (transducer) placed on your chest uses sound waves to produce images of your heart's size, structure and motion. - Implantable loop recorder. This device detects abnormal heart rhythms and is implanted under the skin in the chest area. If your doctor doesn't find an arrhythmia during those tests, he or she may try to trigger your arrhythmia with other tests, which may include: - Stress test. Some arrhythmias are triggered or worsened by exercise. During a stress test, you'll be asked to exercise on a treadmill or stationary bicycle while your heart activity is monitored. If doctors are evaluating you to determine if coronary artery disease may be causing the arrhythmia, and you have difficulty exercising, then your doctor may use a drug to stimulate your heart in a way that's similar to exercise. - Tilt table test. Your doctor may recommend this test if you've had fainting spells. Your heart rate and blood pressure are monitored as you lie flat on a table. The table is then tilted as if you were standing up. Your doctor observes how your heart and the nervous system that controls it respond to the change in angle. - Electrophysiological testing and mapping. In this test, doctors thread thin, flexible tubes (catheters) tipped with electrodes through your blood vessels to a variety of spots within your heart. Once in place, the electrodes can map the spread of electrical impulses through your heart. In addition, your cardiologist can use the electrodes to stimulate your heart to beat at rates that may trigger - or halt - an arrhythmia. This allows your doctor to see the location of the arrhythmia and what may be causing it.",
+    "https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668"
+  ],
+  [
+    "How to diagnose Arrhythmia?: Arrhythmias can be hard to diagnose, especially the types that only cause symptoms every once in a while. Doctors diagnose arrhythmias based on medical and family histories, a physical exam, and the results from tests and procedures. Specialists Involved Doctors who specialize in the diagnosis and treatment of heart diseases include: Cardiologists. These doctors diagnose and treat adults who have heart problems. Pediatric cardiologists. These doctors diagnose and treat babies, children, and youth who have heart problems. Electrophysiologists. These doctors are cardiologists or pediatric cardiologists who specialize in arrhythmias. Medical and Family Histories To diagnose an arrhythmia, your doctor may ask you to describe your symptoms. He or she may ask whether you feel fluttering in your chest and whether you feel dizzy or light-headed. Your doctor also may ask whether you have other health problems, such as a history of heart disease, high blood pressure, diabetes, or thyroid problems. He or she may ask about your family's medical history, including whether anyone in your family: Has a history of arrhythmias Has ever had heart disease or high blood pressure Has died suddenly Has other illnesses or health problems Your doctor will likely want to know what medicines you're taking, including over-the-counter medicines and supplements. Your doctor may ask about your health habits, such as physical activity, smoking, or using alcohol or drugs (for example, cocaine). He or she also may want to know whether you've had emotional stress or anger. Physical Exam During a physical exam, your doctor may: Listen to the rate and rhythm of your heartbeat Listen to your heart for a heart murmur (an extra or unusual sound heard during your heartbeat) Check your pulse to find out how fast your heart is beating Check for swelling in your legs or feet, which could be a sign of an enlarged heart or heart failure Look for signs of other diseases, such as thyroid disease, that could be causing the problem Diagnostic Tests and Procedures EKG (Electrocardiogram) An EKG is a simple, painless test that detects and records the heart's electrical activity. It's the most common test used to diagnose arrhythmias. An EKG shows how fast the heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through the heart. A standard EKG only records the heartbeat for a few seconds. It won't detect arrhythmias that don't happen during the test. To diagnose arrhythmias that come and go, your doctor may have you wear a portable EKG monitor. The two most common types of portable EKGs are Holter and event monitors. Holter and Event Monitors A Holter monitor records the heart's electrical signals for a full 24- or 48-hour period. You wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG. An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it. For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms. Some event monitors are able to send data about your heart's electrical activity to a central monitoring station. Technicians at the station review the information and send it to your doctor. You also can use the device to report any symptoms you're having. You can wear an event monitor for weeks or until symptoms occur. Other Tests Other tests also are used to help diagnose arrhythmias. Blood tests. Blood tests check the level of substances in the blood, such as potassium and thyroid hormone. Abnormal levels of these substances can increase your chances of having an arrhythmia. Chest x ray. A chest x ray is a painless test that creates pictures of the structures in your chest, such as your heart and lungs. This test can show whether your heart is enlarged. Echocardiography. This test uses sound waves to create a moving picture of your heart. Echocardiography (echo) provides information about the size and shape of your heart and how well your heart chambers and valves are working. The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow. There are several types of echo, including stress echo. This test is done both before and after a stress test (see below). A stress echo usually is done to find out whether you have decreased blood flow to your heart, a sign of coronary heart disease (CHD). A transesophageal (tranz-ih-sof-uh-JEE-ul) echo, or TEE, is a special type of echo that takes pictures of the heart through the esophagus. The esophagus is the passage leading from your mouth to your stomach. Stress test. Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicine to make your heart work hard and beat fast. The heart tests done during stress testing may include nuclear heart scanning, echo, and positron emission tomography (PET) scanning of the heart. Electrophysiology study (EPS). This test is used to assess serious arrhythmias. During an EPS, a thin, flexible wire is passed through a vein in your groin (upper thigh) or arm to your heart. The wire records your heart's electrical signals. Your doctor can use the wire to electrically stimulate your heart and trigger an arrhythmia. This allows your doctor to see whether an antiarrhythmia medicine can stop the problem. Catheter ablation, a procedure used to treat some arrhythmias, may be done during an EPS. Tilt table testing. This test sometimes is used to help find the cause of fainting spells. You lie on a table that moves from a lying down to an upright position. The change in position may cause you to faint. Your doctor watches your symptoms, heart rate, EKG reading, and blood pressure throughout the test. He or she may give you medicine and then check your response to the medicine. Coronary angiography. Coronary angiography uses dye and special x rays to show the inside of your coronary arteries. To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-e-ter-ih-ZA-shun). A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels. This helps your doctor find blockages that can cause a heart attack. Implantable loop recorder. This device detects abnormal heart rhythms. Minor surgery is used to place this device under the skin in the chest area. An implantable loop recorder helps doctors figure out why a person may be having palpitations or fainting spells, especially if these symptoms don't happen very often. The device can be used for as long as 12 to 24 months.",
+    "http://www.nhlbi.nih.gov/health/health-topics/topics/arr"
+  ],
+  [
+    "Arrhythmia: Espa\u00f1ol An arrhythmia (ah-RITH-me-ah) is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. A heartbeat that is too fast is called tachycardia (TAK-ih-KAR-de-ah). A heartbeat that is too slow is called bradycardia (bray-de-KAR-de-ah). Most arrhythmias are harmless, but some can be serious or even life threatening. During an arrhythmia, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs. Understanding the Heart's Electrical System To understand arrhythmias, it helps to understand the heart's internal electrical system. The heart's electrical system controls the rate and rhythm of the heartbeat. With each heartbeat, an electrical signal spreads from the top of the heart to the bottom. As the signal travels, it causes the heart to contract and pump blood. Each electrical signal begins in a group of cells called the sinus node or sinoatrial (SA) node. The SA node is located in the heart's upper right chamber, the right atrium (AY-tree-um). In a healthy adult heart at rest, the SA node fires off an electrical signal to begin a new heartbeat 60 to 100 times a minute. From the SA node, the electrical signal travels through special pathways in the right and left atria. This causes the atria to contract and pump blood into the heart's two lower chambers, the ventricles (VEN-trih-kuls). The electrical signal then moves down to a group of cells called the atrioventricular (AV) node, located between the atria and the ventricles. Here, the signal slows down just a little, allowing the ventricles time to finish filling with blood. The electrical signal then leaves the AV node and travels along a pathway called the bundle of His. This pathway divides into a right bundle branch and a left bundle branch. The signal goes down these branches to the ventricles, causing them to contract and pump blood to the lungs and the rest of the body. The ventricles then relax, and the heartbeat process starts all over again in the SA node. (For more information about the heart's electrical system, including detailed animations, go to the Health Topics How the Heart Works article.) A problem with any part of this process can cause an arrhythmia. For example, in atrial fibrillation (A-tre-al fi-bri-LA-shun), a common type of arrhythmia, electrical signals travel through the atria in a fast and disorganized way. This causes the atria to quiver instead of contract. Outlook There are many types of arrhythmia. Most arrhythmias are harmless, but some are not. The outlook for a person who has an arrhythmia depends on the type and severity of the arrhythmia. Even serious arrhythmias often can be successfully treated. Most people who have arrhythmias are able to live normal, healthy lives. The four main types of arrhythmia are premature (extra) beats, supraventricular (SU-prah-ven-TRIK-yu-lar) arrhythmias, ventricular arrhythmias, and bradyarrhythmias (bray-de-ah-RITH-me-ahs). Premature (Extra) Beats Premature beats are the most common type of arrhythmia. They're harmless most of the time and often don't cause any symptoms. When symptoms do occur, they usually feel like fluttering in the chest or a feeling of a skipped heartbeat. Most of the time, premature beats need no treatment, especially in healthy people. Premature beats that occur in the atria (the heart's upper chambers) are called premature atrial contractions, or PACs. Premature beats that occur in the ventricles (the heart's lower chambers) are called premature ventricular contractions, or PVCs. In most cases, premature beats happen naturally. However, some heart diseases can cause premature beats. They also can happen because of stress, too much exercise, or too much caffeine or nicotine. Supraventricular Arrhythmias Supraventricular arrhythmias are tachycardias (fast heart rates) that start in the atria or atrioventricular (AV) node. The AV node is a group of cells located between the atria and the ventricles. Types of supraventricular arrhythmias include atrial fibrillation (AF), atrial flutter, paroxysmal supraventricular tachycardia (PSVT), and Wolff-Parkinson-White (WPW) syndrome. Atrial Fibrillation AF is the most common type of serious arrhythmia. It involves a very fast and irregular contraction of the atria. In AF, the heart's electrical signals don't begin in the SA node. Instead, they begin in another part of the atria or in the nearby pulmonary veins. The signals don't travel normally. They may spread throughout the atria in a rapid, disorganized way. This causes the walls of the atria to quiver very fast (fibrillate) instead of beating normally. As a result, the atria aren't able to pump blood into the ventricles the way they should. The animation below shows what happens during AF. Click the \"start\" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames. The animation shows how the heart's electrical signal can start outside of the sinoatrial node. This can cause the atria to beat very fast and irregularly. In AF, electrical signals can travel through the atria at a rate of more than 300 per minute. Some of these abnormal signals can travel to the ventricles, causing them to beat too fast and with an irregular rhythm. AF usually isn't life threatening, but it can be dangerous if it causes the ventricles to beat very fast. AF has two major complications\u2014stroke and heart failure. In AF, blood can pool in the atria, causing blood clots to form. If a clot breaks off and travels to the brain, it can cause a stroke. Blood-thinning medicines that reduce the risk of stroke are an important part of treatment for people who have AF. Heart failure occurs if the heart can't pump enough blood to meet the body's needs. AF can lead to heart failure because the ventricles are beating very fast and can't completely fill with blood. Thus, they may not be able to pump enough blood to the lungs and body. Damage to the heart's electrical system causes AF. The damage most often is the result of other conditions that affect the health of the heart, such as high blood pressure, coronary heart disease, and rheumatic heart disease. Inflammation also is thought to play a role in the development of AF. Other conditions also can lead to AF, including an overactive thyroid gland (too much thyroid hormone produced) and heavy alcohol use. The risk of AF increases with age. Sometimes AF and other supraventricular arrhythmias can occur for no obvious reason. Atrial Flutter Atrial flutter is similar to AF. However, the heart's electrical signals spread through the atria in a fast and regular\u2014instead of irregular\u2014rhythm. Atrial flutter is much less common than AF, but it has similar symptoms and complications. Paroxysmal Supraventricular Tachycardia PSVT is a very fast heart rate that begins and ends suddenly. PSVT occurs because of problems with the electrical connection between the atria and the ventricles. In PSVT, electrical signals that begin in the atria and travel to the ventricles can reenter the atria, causing extra heartbeats. This type of arrhythmia usually isn't dangerous and tends to occur in young people. It can happen during vigorous physical activity. A special type of PSVT is called Wolff-Parkinson-White syndrome. WPW syndrome is a condition in which the heart's electrical signals travel along an extra pathway from the atria to the ventricles. This extra pathway disrupts the timing of the heart's electrical signals and can cause the ventricles to beat very fast. This type of arrhythmia can be life threatening. The animation below shows what happens during Wolff-Parkinson-White syndrome. Click the \"start\" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames. The animation shows how an extra, abnormal electrical pathway in the heart disrupts the normal timing of the heart's electrical signal, causing the atria and ventricles to beat too fast. Ventricular Arrhythmias These arrhythmias start in the heart's lower chambers, the ventricles. They can be very dangerous and usually require medical care right away. Ventricular arrhythmias include ventricular tachycardia and ventricular fibrillation (v-fib). Coronary heart disease, heart attack, a weakened heart muscle, and other problems can cause ventricular arrhythmias. Ventricular Tachycardia Ventricular tachycardia is a fast, regular beating of the ventricles that may last for only a few seconds or for much longer. A few beats of ventricular tachycardia often don't cause problems. However, episodes that last for more than a few seconds can be dangerous. Ventricular tachycardia can turn into other, more serious arrhythmias, such as v-fib. Ventricular Fibrillation V-fib occurs if disorganized electrical signals make the ventricles quiver instead of pump normally. Without the ventricles pumping blood to the body, sudden cardiac arrest and death can occur within a few minutes. To prevent death, the condition must be treated right away with an electric shock to the heart called defibrillation (de-fib-rih-LA-shun). V-fib may occur during or after a heart attack or in someone whose heart is already weak because of another condition. The animation below shows ventricular fibrillation. Click the \"start\" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames. The animation shows how disorganized electrical signals in the heart's ventricles make them pump abnormally and quiver. Torsades de pointes (torsades) is a type of v-fib that causes a unique pattern on an EKG (electrocardiogram) test. Certain medicines or imbalanced amounts of potassium, calcium, or magnesium in the bloodstream can cause this condition. People who have long QT syndrome are at increased risk for torsades. People who have this condition need to be careful about taking certain antibiotics, heart medicines, and over-the-counter products. Bradyarrhythmias Bradyarrhythmias occur if the heart rate is slower than normal. If the heart rate is too slow, not enough blood reaches the brain. This can cause you to pass out. In adults, a heart rate slower than 60 beats per minute is considered a bradyarrhythmia. Some people normally have slow heart rates, especially people who are very physically fit. For them, a heartbeat slower than 60 beats per minute isn't dangerous and doesn't cause symptoms. But in other people, serious diseases or other conditions may cause bradyarrhythmias. Bradyarrhythmias can be caused by: Heart attacks Conditions that harm or change the heart's electrical activity, such as an underactive thyroid gland or aging An imbalance of chemicals or other substances in the blood, such as potassium Medicines such as beta blockers, calcium channel blockers, some antiarrhythmia medicines, and digoxin Arrhythmias in Children Children's heart rates normally decrease as they get older. A newborn's heart beats between 95 to 160 times a minute. A 1-year-old's heart beats between 90 to 150 times a minute, and a 6- to 8-year-old's heart beats between 60 to 110 times a minute. A baby or child's heart can beat fast or slow for many reasons. Like adults, when children are active, their hearts will beat faster. When they're sleeping, their hearts will beat slower. Their heart rates can speed up and slow down as they breathe in and out. All of these changes are normal. Some children are born with heart defects that cause arrhythmias. In other children, arrhythmias can develop later in childhood. Doctors use the same tests to diagnose arrhythmias in children and adults. Treatments for children who have arrhythmias include medicines, defibrillation (electric shock), surgically implanted devices that control the heartbeat, and other procedures that fix abnormal electrical signals in the heart. Dysrhythmia An arrhythmia can occur if the electrical signals that control the heartbeat are delayed or blocked. This can happen if the special nerve cells that produce electrical signals don't work properly. It also can happen if the electrical signals don't travel normally through the heart. An arrhythmia also can occur if another part of the heart starts to produce electrical signals. This adds to the signals from the special nerve cells and disrupts the normal heartbeat. Smoking, heavy alcohol use, use of some drugs (such as cocaine or amphetamines), use of some prescription or over-the-counter medicines, or too much caffeine or nicotine can lead to arrhythmias in some people. Strong emotional stress or anger can make the heart work harder, raise blood pressure, and release stress hormones. Sometimes these reactions can lead to arrhythmias. A heart attack or other condition that damages the heart's electrical system also can cause arrhythmias. Examples of such conditions include high blood pressure, coronary heart disease, heart failure, an overactive or underactive thyroid gland (too much or too little thyroid hormone produced), and rheumatic heart disease. Congenital (kon-JEN-ih-tal) heart defects can cause some arrhythmias, such as Wolff-Parkinson-White syndrome. The term \"congenital\u201d means the defect is present at birth. Sometimes the cause of arrhythmias is unknown. Arrhythmias are very common in older adults. Atrial fibrillation (a common type of arrhythmia that can cause problems) affects millions of people, and the number is rising. Most serious arrhythmias affect people older than 60. This is because older adults are more likely to have heart disease and other health problems that can lead to arrhythmias. Older adults also tend to be more sensitive to the side effects of medicines, some of which can cause arrhythmias. Some medicines used to treat arrhythmias can even cause arrhythmias as a side effect. Some types of arrhythmia happen more often in children and young adults. Paroxysmal supraventricular tachycardia (PSVT), including Wolff-Parkinson-White syndrome, is more common in young people. PSVT is a fast heart rate that begins and ends suddenly. Major Risk Factors Arrhythmias are more common in people who have diseases or conditions that weaken the heart, such as: Heart attack Heart failure or cardiomyopathy, which weakens the heart and changes the way electrical signals move through the heart Heart tissue that's too thick or stiff or that hasn't formed normally Leaking or narrowed heart valves, which make the heart work too hard and can lead to heart failure Congenital heart defects (defects present at birth) that affect the heart's structure or function Other conditions also can raise the risk for arrhythmias, such as: High blood pressure Infections that damage the heart muscle or the sac around the heart Diabetes, which increases the risk of high blood pressure and coronary heart disease Sleep apnea, which can stress the heart because the heart doesn't get enough oxygen An overactive or underactive thyroid gland (too much or too little thyroid hormone in the body) Several other risk factors also can raise your risk for arrhythmias. Examples include heart surgery, certain drugs (such as cocaine or amphetamines), or an imbalance of chemicals or other substances (such as potassium) in the bloodstream. Many arrhythmias cause no signs or symptoms. When signs or symptoms are present, the most common ones are: Palpitations (feelings that your heart is skipping a beat, fluttering, or beating too hard or fast) A slow heartbeat An irregular heartbeat Feeling pauses between heartbeats More serious signs and symptoms include: Anxiety Weakness, dizziness, and light-headedness Fainting or nearly fainting Sweating Shortness of breath Chest pain Arrhythmias can be hard to diagnose, especially the types that only cause symptoms every once in a while. Doctors diagnose arrhythmias based on medical and family histories, a physical exam, and the results from tests and procedures. Specialists Involved Doctors who specialize in the diagnosis and treatment of heart diseases include: Cardiologists. These doctors diagnose and treat adults who have heart problems. Pediatric cardiologists. These doctors diagnose and treat babies, children, and youth who have heart problems. Electrophysiologists. These doctors are cardiologists or pediatric cardiologists who specialize in arrhythmias. Medical and Family Histories To diagnose an arrhythmia, your doctor may ask you to describe your symptoms. He or she may ask whether you feel fluttering in your chest and whether you feel dizzy or light-headed. Your doctor also may ask whether you have other health problems, such as a history of heart disease, high blood pressure, diabetes, or thyroid problems. He or she may ask about your family's medical history, including whether anyone in your family: Has a history of arrhythmias Has ever had heart disease or high blood pressure Has died suddenly Has other illnesses or health problems Your doctor will likely want to know what medicines you're taking, including over-the-counter medicines and supplements. Your doctor may ask about your health habits, such as physical activity, smoking, or using alcohol or drugs (for example, cocaine). He or she also may want to know whether you've had emotional stress or anger. Physical Exam During a physical exam, your doctor may: Listen to the rate and rhythm of your heartbeat Listen to your heart for a heart murmur (an extra or unusual sound heard during your heartbeat) Check your pulse to find out how fast your heart is beating Check for swelling in your legs or feet, which could be a sign of an enlarged heart or heart failure Look for signs of other diseases, such as thyroid disease, that could be causing the problem Diagnostic Tests and Procedures EKG (Electrocardiogram) An EKG is a simple, painless test that detects and records the heart's electrical activity. It's the most common test used to diagnose arrhythmias. An EKG shows how fast the heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through the heart. A standard EKG only records the heartbeat for a few seconds. It won't detect arrhythmias that don't happen during the test. To diagnose arrhythmias that come and go, your doctor may have you wear a portable EKG monitor. The two most common types of portable EKGs are Holter and event monitors. Holter and Event Monitors A Holter monitor records the heart's electrical signals for a full 24- or 48-hour period. You wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard EKG. An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart's electrical activity at certain times while you're wearing it. For many event monitors, you push a button to start the monitor when you feel symptoms. Other event monitors start automatically when they sense abnormal heart rhythms. Some event monitors are able to send data about your heart's electrical activity to a central monitoring station. Technicians at the station review the information and send it to your doctor. You also can use the device to report any symptoms you're having. You can wear an event monitor for weeks or until symptoms occur. Other Tests Other tests also are used to help diagnose arrhythmias. Blood tests. Blood tests check the level of substances in the blood, such as potassium and thyroid hormone. Abnormal levels of these substances can increase your chances of having an arrhythmia. Chest x ray. A chest x ray is a painless test that creates pictures of the structures in your chest, such as your heart and lungs. This test can show whether your heart is enlarged. Echocardiography. This test uses sound waves to create a moving picture of your heart. Echocardiography (echo) provides information about the size and shape of your heart and how well your heart chambers and valves are working. The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow. There are several types of echo, including stress echo. This test is done both before and after a stress test (see below). A stress echo usually is done to find out whether you have decreased blood flow to your heart, a sign of coronary heart disease (CHD). A transesophageal (tranz-ih-sof-uh-JEE-ul) echo, or TEE, is a special type of echo that takes pictures of the heart through the esophagus. The esophagus is the passage leading from your mouth to your stomach. Stress test. Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicine to make your heart work hard and beat fast. The heart tests done during stress testing may include nuclear heart scanning, echo, and positron emission tomography (PET) scanning of the heart. Electrophysiology study (EPS). This test is used to assess serious arrhythmias. During an EPS, a thin, flexible wire is passed through a vein in your groin (upper thigh) or arm to your heart. The wire records your heart's electrical signals. Your doctor can use the wire to electrically stimulate your heart and trigger an arrhythmia. This allows your doctor to see whether an antiarrhythmia medicine can stop the problem. Catheter ablation, a procedure used to treat some arrhythmias, may be done during an EPS. Tilt table testing. This test sometimes is used to help find the cause of fainting spells. You lie on a table that moves from a lying down to an upright position. The change in position may cause you to faint. Your doctor watches your symptoms, heart rate, EKG reading, and blood pressure throughout the test. He or she may give you medicine and then check your response to the medicine. Coronary angiography. Coronary angiography uses dye and special x rays to show the inside of your coronary arteries. To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-e-ter-ih-ZA-shun). A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels. This helps your doctor find blockages that can cause a heart attack. Implantable loop recorder. This device detects abnormal heart rhythms. Minor surgery is used to place this device under the skin in the chest area. An implantable loop recorder helps doctors figure out why a person may be having palpitations or fainting spells, especially if these symptoms don't happen very often. The device can be used for as long as 12 to 24 months. Common arrhythmia treatments include medicines, medical procedures, and surgery. Your doctor may recommend treatment if your arrhythmia causes serious symptoms, such as dizziness, chest pain, or fainting. Your doctor also may recommend treatment if the arrhythmia increases your risk for problems such as heart failure, stroke, or sudden cardiac arrest. Medicines Medicines can slow down a heart that's beating too fast. They also can change an abnormal heart rhythm to a normal, steady rhythm. Medicines that do this are called antiarrhythmics. Some of the medicines used to slow a fast heart rate are beta blockers (such as metoprolol and atenolol), calcium channel blockers (such as diltiazem and verapamil), and digoxin (digitalis). These medicines often are used to treat atrial fibrillation (AF). Some of the medicines used to restore a normal heart rhythm are amiodarone, sotalol, flecainide, propafenone, dofetilide, ibutilide, quinidine, procainamide, and disopyramide. These medicines often have side effects. Some side effects can make an arrhythmia worse or even cause a different kind of arrhythmia. Currently, no medicine can reliably speed up a slow heart rate. Abnormally slow heart rates are treated with pacemakers. People who have AF and some other arrhythmias may be treated with blood-thinning medicines. These medicines reduce the risk of blood clots forming. Warfarin (Coumadin\u00ae), dabigatran, heparin, and aspirin are examples of blood-thinning medicines. Medicines also can control an underlying medical condition that might be causing an arrhythmia, such as heart disease or a thyroid condition. Medical Procedures Some arrhythmias are treated with pacemakers. A pacemaker is a small device that's placed under the skin of your chest or abdomen to help control abnormal heart rhythms. Pacemakers have sensors that detect the heart's electrical activity. When the device senses an abnormal heart rhythm, it sends electrical pulses to prompt the heart to beat at a normal rate. Some arrhythmias are treated with a jolt of electricity to the heart. This type of treatment is called cardioversion or defibrillation, depending on which type of arrhythmia is being treated. Some people who are at risk for ventricular fibrillation are treated with a device called an implantable cardioverter defibrillator (ICD). Like a pacemaker, an ICD is a small device that's placed under the skin in the chest. This device uses electrical pulses or shocks to help control life-threatening arrhythmias. An ICD continuously monitors the heartbeat. If it senses a dangerous ventricular arrhythmia, it sends an electric shock to the heart to restore a normal heartbeat. A procedure called catheter ablation is used to treat some arrhythmias if medicines don't work. During this procedure, a thin, flexible tube is put into a blood vessel in your arm, groin (upper thigh), or neck. Then, the tube is guided to your heart. A special machine sends energy through the tube to your heart. The energy finds and destroys small areas of heart tissue where abnormal heart rhythms may start. Catheter ablation usually is done in a hospital as part of an electrophysiology study. Your doctor may recommend transesophageal echocardiography before catheter ablation to make sure no blood clots are present in the atria (the heart's upper chambers). Surgery Doctors treat some arrhythmias with surgery. This may occur if surgery is already being done for another reason, such as repair of a heart valve. One type of surgery for AF is called maze surgery. During this surgery, a surgeon makes small cuts or burns in the atria. These cuts or burns prevent the spread of disorganized electrical signals. If coronary heart disease is the cause of your arrhythmia, your doctor may recommend coronary artery bypass grafting. This surgery improves blood flow to the heart muscle. Other Treatments Vagal maneuvers are another type of treatment for arrhythmia. These simple exercises sometimes can stop or slow down certain types of supraventricular arrhythmias. They do this by affecting the vagus nerve, which helps control the heart rate. Some vagal maneuvers include: Gagging Holding your breath and bearing down (Valsalva maneuver) Immersing your face in ice-cold water Coughing Putting your fingers on your eyelids and pressing down gently Vagal maneuvers aren't an appropriate treatment for everyone. Discuss with your doctor whether vagal maneuvers are an option for you. Many arrhythmias are harmless. It's common to have an occasional extra heartbeat or mild palpitations. People who have harmless arrhythmias can live healthy lives. They usually don't need treatment for their arrhythmias. Even people who have serious arrhythmias often can be successfully treated and lead normal lives. Ongoing Care If you have an arrhythmia that requires treatment, you should: Keep all of your medical appointments. Bring a list of all the medicines you're taking to every doctor and emergency room visit. This will help your doctors know exactly what medicines you're taking, which can help prevent medication errors. Take your medicines as prescribed. Check with your doctor before taking over-the-counter medicines, nutritional supplements, or cold and allergy medicines. Some of these products can trigger rapid heart rhythms or interact poorly with heart rhythm medicines. Tell your doctor if you're having side effects from your medicines. Side effects might include depression and palpitations. These side effects often can be treated. Tell your doctor if arrhythmia symptoms are getting worse or if you have new symptoms. See your doctor for regular checkups if you're taking blood-thinning medicines. You may need routine blood tests to check how the medicines are working. If you have an arrhythmia, taking care of yourself is important. If you feel dizzy or faint, you should lie down. Don't try to walk or drive. Let your doctor know about these symptoms. Ask your doctor whether vagal maneuvers are an option for you. These exercises can help stop a rapid heartbeat, but they're not appropriate for everyone. Learn how to take your pulse. Discuss with your doctor what pulse rate is normal for you. Keep a record of changes in your pulse rate and share this information with your doctor. Lifestyle Changes Many arrhythmias are caused by underlying heart disease. Keep your heart healthy by following a healthy diet. A healthy diet includes a variety of fruits and vegetables. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, and beans and peas. A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber). For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's \"Your Guide to Lowering Your Blood Pressure With DASH\" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating. A healthy lifestyle also includes being physically active, quitting smoking, maintaining a healthy weight, and keeping your blood cholesterol and blood pressure at healthy levels. Strong emotional stress or anger can lead to arrhythmias. Try to manage stress and anger through activities such as yoga, quiet time, meditation, and relaxation techniques. Getting support from friends and family also can help you manage stress. Your doctor may want you to avoid certain substances if they make your heart beat too fast. These substances may include alcohol and cold and cough medicines.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/arr"
+  ],
+  [
+    "Heart arrhythmia (Treatment): If you have an arrhythmia, treatment may or may not be necessary. Usually, it's required only if the arrhythmia is causing significant symptoms or if it's putting you at risk of a more serious arrhythmia or arrhythmia complication. Treating slow heartbeats If slow heartbeats (bradycardias) don't have a cause that can be corrected, doctors often treat them with a pacemaker because there aren't any medications that can reliably speed up your heart. A pacemaker is a small device that's usually implanted near your collarbone. One or more electrode-tipped wires run from the pacemaker through your blood vessels to your inner heart. If your heart rate is too slow or if it stops, the pacemaker sends out electrical impulses that stimulate your heart to beat at a steady rate. Treating fast heartbeats For fast heartbeats (tachycardias), treatments may include one or more of the following: - Vagal maneuvers. You may be able to stop an arrhythmia that begins above the lower half of your heart (supraventricular tachycardia) by using particular maneuvers that include holding your breath and straining, dunking your face in ice water, or coughing. These maneuvers affect the nervous system that controls your heartbeat (vagus nerves), often causing your heart rate to slow. However, vagal maneuvers don't work for all types of arrhythmias. - Medications. For many types of tachycardia, you may be prescribed medication to control your heart rate or restore a normal heart rhythm. It's very important to take any anti-arrhythmic medication exactly as directed by your doctor in order to minimize complications. If you have atrial fibrillation, your doctor may prescribe blood-thinning medications to help keep dangerous blood clots from forming. - Cardioversion. If you have a certain type of arrhythmia, such as atrial fibrillation, your doctor may use cardioversion, which can be conducted as a procedure or by using medications. In the procedure, a shock is delivered to your heart through paddles or patches on your chest. The current affects the electrical impulses in your heart and can restore a normal rhythm. - Catheter ablation. In this procedure, your doctor threads one or more catheters through your blood vessels to your heart. Electrodes at the catheter tips can use heat, extreme cold or radiofrequency energy to damage (ablate) a small spot of heart tissue and create an electrical block along the pathway that's causing your arrhythmia. Implantable devices Treatment for heart arrhythmias also may involve use of an implantable device: - Pacemaker. A pacemaker is an implantable device that helps control abnormal heart rhythms. A small device is placed under the skin near the collarbone in a minor surgical procedure. An insulated wire extends from the device to the heart, where it's permanently anchored. If a pacemaker detects a heart rate that's abnormal, it emits electrical impulses that stimulate your heart to beat at a normal rate. - Implantable cardioverter-defibrillator (ICD). Your doctor may recommend this device if you're at high risk of developing a dangerously fast or irregular heartbeat in the lower half of your heart (ventricular tachycardia or ventricular fibrillation). If you have had sudden cardiac arrest or have certain heart conditions that increase your risk of sudden cardiac arrest, your doctor may also recommend an ICD. An ICD is a battery-powered unit that's implanted under the skin near the collarbone - similar to a pacemaker. One or more electrode-tipped wires from the ICD run through veins to the heart. The ICD continuously monitors your heart rhythm. If it detects an abnormal heart rhythm, it sends out low- or high-energy shocks to reset the heart to a normal rhythm. An ICD doesn't prevent an abnormal heart rhythm from occurring, but it treats it if it occurs. Surgical treatments In some cases, surgery may be the recommended treatment for heart arrhythmias: - Maze procedure. In the maze procedure, a surgeon makes a series of surgical incisions in the heart tissue in the upper half of your heart (atria) to create a pattern or maze of scar tissue. Because scar tissue doesn't conduct electricity, it interferes with stray electrical impulses that cause some types of arrhythmia. The procedure is effective, but because it requires surgery, it's usually reserved for people who don't respond to other treatments or for those who are having heart surgery for other reasons. - Coronary bypass surgery. If you have severe coronary artery disease in addition to arrhythmias, your doctor may perform coronary bypass surgery. This procedure may improve the blood flow to your heart.",
+    "https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668"
+  ],
+  [
+    "Heart arrhythmia (Complications): Certain arrhythmias may increase your risk of developing conditions such as: - Stroke. When your heart quivers, it's unable to pump blood effectively, which can cause blood to pool. This can cause blood clots to form. If a clot breaks loose, it can travel from your heart to your brain. There it might block blood flow, causing a stroke. Certain medications, such as blood thinners, can greatly lower your risk of stroke or damage to other organs caused by blood clots. Your doctor will determine if a blood-thinning medication is appropriate for you, depending on your type of arrhythmia and your risk of blood clots. - Heart failure. Heart failure can result if your heart is pumping ineffectively for a prolonged period due to a bradycardia or tachycardia, such as atrial fibrillation. Sometimes controlling the rate of an arrhythmia that's causing heart failure can improve your heart's function.",
+    "https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668"
+  ],
+  [
+    "Arrhythmia (Who Is at Risk): Arrhythmias are very common in older adults. Atrial fibrillation (a common type of arrhythmia that can cause problems) affects millions of people, and the number is rising. Most serious arrhythmias affect people older than 60. This is because older adults are more likely to have heart disease and other health problems that can lead to arrhythmias. Older adults also tend to be more sensitive to the side effects of medicines, some of which can cause arrhythmias. Some medicines used to treat arrhythmias can even cause arrhythmias as a side effect. Some types of arrhythmia happen more often in children and young adults. Paroxysmal supraventricular tachycardia (PSVT), including Wolff-Parkinson-White syndrome, is more common in young people. PSVT is a fast heart rate that begins and ends suddenly. Major Risk Factors Arrhythmias are more common in people who have diseases or conditions that weaken the heart, such as: Heart attack Heart failure or cardiomyopathy, which weakens the heart and changes the way electrical signals move through the heart Heart tissue that's too thick or stiff or that hasn't formed normally Leaking or narrowed heart valves, which make the heart work too hard and can lead to heart failure Congenital heart defects (defects present at birth) that affect the heart's structure or function Other conditions also can raise the risk for arrhythmias, such as: High blood pressure Infections that damage the heart muscle or the sac around the heart Diabetes, which increases the risk of high blood pressure and coronary heart disease Sleep apnea, which can stress the heart because the heart doesn't get enough oxygen An overactive or underactive thyroid gland (too much or too little thyroid hormone in the body) Several other risk factors also can raise your risk for arrhythmias. Examples include heart surgery, certain drugs (such as cocaine or amphetamines), or an imbalance of chemicals or other substances (such as potassium) in the bloodstream.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/arr"
+  ],
+  [
+    "Arrhythmia (Living With): Many arrhythmias are harmless. It's common to have an occasional extra heartbeat or mild palpitations. People who have harmless arrhythmias can live healthy lives. They usually don't need treatment for their arrhythmias. Even people who have serious arrhythmias often can be successfully treated and lead normal lives. Ongoing Care If you have an arrhythmia that requires treatment, you should: Keep all of your medical appointments. Bring a list of all the medicines you're taking to every doctor and emergency room visit. This will help your doctors know exactly what medicines you're taking, which can help prevent medication errors. Take your medicines as prescribed. Check with your doctor before taking over-the-counter medicines, nutritional supplements, or cold and allergy medicines. Some of these products can trigger rapid heart rhythms or interact poorly with heart rhythm medicines. Tell your doctor if you're having side effects from your medicines. Side effects might include depression and palpitations. These side effects often can be treated. Tell your doctor if arrhythmia symptoms are getting worse or if you have new symptoms. See your doctor for regular checkups if you're taking blood-thinning medicines. You may need routine blood tests to check how the medicines are working. If you have an arrhythmia, taking care of yourself is important. If you feel dizzy or faint, you should lie down. Don't try to walk or drive. Let your doctor know about these symptoms. Ask your doctor whether vagal maneuvers are an option for you. These exercises can help stop a rapid heartbeat, but they're not appropriate for everyone. Learn how to take your pulse. Discuss with your doctor what pulse rate is normal for you. Keep a record of changes in your pulse rate and share this information with your doctor. Lifestyle Changes Many arrhythmias are caused by underlying heart disease. Keep your heart healthy by following a healthy diet. A healthy diet includes a variety of fruits and vegetables. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, and beans and peas. A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber). For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute's \"Your Guide to Lowering Your Blood Pressure With DASH\" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating. A healthy lifestyle also includes being physically active, quitting smoking, maintaining a healthy weight, and keeping your blood cholesterol and blood pressure at healthy levels. Strong emotional stress or anger can lead to arrhythmias. Try to manage stress and anger through activities such as yoga, quiet time, meditation, and relaxation techniques. Getting support from friends and family also can help you manage stress. Your doctor may want you to avoid certain substances if they make your heart beat too fast. These substances may include alcohol and cold and cough medicines.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/arr"
+  ],
+  [
+    "Piroxicam overdose: Piroxicam is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain and swelling. Piroxicam overdose occurs when someone takes too much of this drug. This is for information only and not for use in the treatment or management of an actual overdose. DO NOT use it to treat or manage an actual overdose. If you or someone you are with overdoses, call your local emergency number (such as 911), or your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. Piroxicam Piroxicam is also sold under the brand name Feldene. Airways and lungs: - Rapid breathing - Slow, labored breathing - Wheezing Eyes, ears, nose, and throat: - Ringing in the ears - Blurred vision Nervous system: - Agitation, confusion, incoherence (not understandable) - Coma - Convulsions (seizures) - Drowsiness - Headache (severe) - Unsteadiness, movement problems Skin: - Rash Stomach and intestines: - Diarrhea - Heartburn - Nausea, vomiting - Stomach pain (possible bleeding in the stomach and intestines) The following information is helpful for emergency assistance: - The person's age, weight, and condition - Name of product (as well as the ingredients and strength if known) - The time it was swallowed - The amount swallowed - If the medicine was prescribed for the patient However, DO NOT delay calling for help if this information is not immediately available. Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This hotline number will let you talk to experts in poisoning. They will give you further instructions. This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. You can call 24 hours a day, 7 days a week. Take the container with you to the hospital, if possible. The health care provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The person may receive: - Activated charcoal - Airway support, including oxygen, breathing tube through the mouth (intubation), and ventilator (breathing machine) - Blood and urine tests - Chest x-ray - EKG (electrocardiogram, or heart tracing) - Fluids through the vein (intravenous or IV) - Laxative - Medicines to treat symptoms Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002534.htm"
+  ],
+  [
+    "Do you have information about Cancer Alternative Therapies: Summary : You have many choices to make about your cancer treatment. One choice you might be thinking about is complementary and alternative medicine (CAM). CAM is the term for medical products and practices that are not part of standard care. Examples of CAM therapies are acupuncture, chiropractic, and herbal medicines. People with cancer may use CAM to - Help cope with the side effects of cancer treatments - Ease worries of cancer treatment and related stress - Feel that they are doing something more to help their own care CAM treatments do not work for everyone. Some methods, such as acupuncture, might help with nausea, pain and other side effects of cancer treatment. Talk to your doctor to make sure that all aspects of your cancer care work together. NIH: National Cancer Institute",
+    "https://www.nlm.nih.gov/medlineplus/canceralternativetherapies.html"
+  ],
+  [
+    "Piroxicam overdose (Where Found): Piroxicam is also sold under the brand name Feldene.",
+    "https://medlineplus.gov/ency/article/002534.htm"
+  ],
+  [
+    "Piroxicam overdose (Before Calling Emergency): The following information is helpful for emergency assistance: - The person's age, weight, and condition - Name of product (as well as the ingredients and strength if known) - The time it was swallowed - The amount swallowed - If the medicine was prescribed for the patient However, DO NOT delay calling for help if this information is not immediately available.",
+    "https://medlineplus.gov/ency/article/002534.htm"
+  ],
+  [
+    "Piroxicam overdose (Poisonous Ingredient): Piroxicam",
+    "https://medlineplus.gov/ency/article/002534.htm"
+  ],
+  [
+    "Piroxicam overdose (Symptoms): Airways and lungs: - Rapid breathing - Slow, labored breathing - Wheezing Eyes, ears, nose, and throat: - Ringing in the ears - Blurred vision Nervous system: - Agitation, confusion, incoherence (not understandable) - Coma - Convulsions (seizures) - Drowsiness - Headache (severe) - Unsteadiness, movement problems Skin: - Rash Stomach and intestines: - Diarrhea - Heartburn - Nausea, vomiting - Stomach pain (possible bleeding in the stomach and intestines)",
+    "https://medlineplus.gov/ency/article/002534.htm"
+  ],
+  [
+    "Piroxicam overdose (Poison Control): Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This hotline number will let you talk to experts in poisoning. They will give you further instructions. This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. You can call 24 hours a day, 7 days a week. Take the container with you to the hospital, if possible.",
+    "https://medlineplus.gov/ency/article/002534.htm"
+  ],
+  [
+    "Piroxicam overdose (Review Date 1/31/2017): Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002534.htm"
+  ],
+  [
+    "Piroxicam (Brand names): - Feldene\u00ae",
+    "https://medlineplus.gov/druginfo/meds/a684045.html"
+  ],
+  [
+    "Normal pressure hydrocephalus (Treatment): Treatment for NPH is usually surgery to place a tube called a shunt that routes the excess CSF out of the brain ventricles. This is called a ventricoperitoneal shunt.",
+    "https://medlineplus.gov/ency/article/000752.htm"
+  ],
+  [
+    "Where to find support for people with Intersex?: Support groups are very important for families dealing with intersex. Different support groups may differ in their thoughts regarding this very sensitive topic. Look for one that supports your thoughts and feelings on the topic. The following organizations provide further information: - Association for X and Y chromosome variations: www.axysgenetic.org - CARES Foundation: www.caresfoundation.org - Congenital Adrenal Hyperplasia Education and Support Network: www.congenitaladrenalhyperplasia.org - Hypospadias and Epispadias Association: www.heainfo.org - Intersex Society of North America: www.isna.org - Turner Syndrome Society of the United States: www.turnersyndrome.org - XXYY Project: xxyysyndrome.org/main",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/001669.htm"
+  ],
+  [
+    "Normal pressure hydrocephalus: Hydrocephalus is a buildup of spinal fluid inside the fluid chambers of the brain. Hydrocephalus means \"water on the brain.\" Normal pressure hydrocephalus (NPH) is a rise in cerebrospinal fluid (CSF) in the brain that affects brain function. However, the pressure of the fluid is usually normal. There is no known cause for NPH. But the chance of developing NPH is high in someone who has had any of the following: - Bleeding from a blood vessel or aneurysm in the brain (subarachnoid hemorrhage) - Certain head injuries - Meningitis or similar infections - Surgery on the brain (craniotomy) As CSF builds up in the brain, the fluid-filled chambers (ventricles) of the brain swell. This causes pressure on brain tissue. This can damage or destroy parts of the brain. Symptoms of NPH often begin slowly. There are 3 main symptoms of NPH: - Changes in the way a person walks: difficulty when beginning to walk (gait apraxia), feel as if they are stuck to the ground (magnetic gait) - Slowing of mental function: forgetfulness, difficulty paying attention, apathy or no mood - Problems controlling urine (urinary incontinence), and sometimes controlling stools (bowel incontinence) Diagnosis of NPH can be made if any of the above symptoms occur and NPH is suspected and testing is done. The doctor will perform a physical examination and ask about the symptoms. If you have NPH, the doctor will likely find that your walking (gait) is not normal. You may also have memory problems. Tests that may be done include: - Lumbar puncture (spinal tap) with careful testing of walking before and right after the spinal tap - Head CT scan or MRI of the head Treatment for NPH is usually surgery to place a tube called a shunt that routes the excess CSF out of the brain ventricles. This is called a ventricoperitoneal shunt. Without treatment, symptoms often get worse and could lead to death. Surgery improves symptoms in some people. Those with mild symptoms have the best outcome. Walking is the symptom most likely to improve. Problems that may result from NPH or its treatment include: - Complications of surgery (infection, bleeding, shunt that does not work well) - Loss of brain function (dementia) that becomes worse over time - Injury from falls - Shortened life span Call your health care provider if: - You or a loved one is having increasing problems with memory, walking, or urine incontinence. - A person with NPH worsens to the point where you are unable to care for the person yourself. Go to the emergency room or call the local emergency number (such as 911) if a sudden change in mental status occurs. This may mean that another disorder has developed. Updated by: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000752.htm"
+  ],
+  [
+    "Normal pressure hydrocephalus (Symptoms): Symptoms of NPH often begin slowly. There are 3 main symptoms of NPH: - Changes in the way a person walks: difficulty when beginning to walk (gait apraxia), feel as if they are stuck to the ground (magnetic gait) - Slowing of mental function: forgetfulness, difficulty paying attention, apathy or no mood - Problems controlling urine (urinary incontinence), and sometimes controlling stools (bowel incontinence) Diagnosis of NPH can be made if any of the above symptoms occur and NPH is suspected and testing is done.",
+    "https://medlineplus.gov/ency/article/000752.htm"
+  ],
+  [
+    "Normal pressure hydrocephalus (Causes): There is no known cause for NPH. But the chance of developing NPH is high in someone who has had any of the following: - Bleeding from a blood vessel or aneurysm in the brain (subarachnoid hemorrhage) - Certain head injuries - Meningitis or similar infections - Surgery on the brain (craniotomy) As CSF builds up in the brain, the fluid-filled chambers (ventricles) of the brain swell. This causes pressure on brain tissue. This can damage or destroy parts of the brain.",
+    "https://medlineplus.gov/ency/article/000752.htm"
+  ],
+  [
+    "Normal pressure hydrocephalus (Possible Complications): Problems that may result from NPH or its treatment include: - Complications of surgery (infection, bleeding, shunt that does not work well) - Loss of brain function (dementia) that becomes worse over time - Injury from falls - Shortened life span",
+    "https://medlineplus.gov/ency/article/000752.htm"
+  ],
+  [
+    "Normal pressure hydrocephalus (Exams and Tests): The doctor will perform a physical examination and ask about the symptoms. If you have NPH, the doctor will likely find that your walking (gait) is not normal. You may also have memory problems. Tests that may be done include: - Lumbar puncture (spinal tap) with careful testing of walking before and right after the spinal tap - Head CT scan or MRI of the head",
+    "https://medlineplus.gov/ency/article/000752.htm"
+  ],
+  [
+    "Normal pressure hydrocephalus (When to Contact a Medical Professional): Call your health care provider if: - You or a loved one is having increasing problems with memory, walking, or urine incontinence. - A person with NPH worsens to the point where you are unable to care for the person yourself. Go to the emergency room or call the local emergency number (such as 911) if a sudden change in mental status occurs. This may mean that another disorder has developed.",
+    "https://medlineplus.gov/ency/article/000752.htm"
+  ],
+  [
+    "nephronophthisis (Description): Nephronophthisis is a disorder that affects the kidneys. It is characterized by inflammation and scarring (fibrosis) that impairs kidney function. These abnormalities lead to increased urine production (polyuria), excessive thirst (polydipsia), general weakness, and extreme tiredness (fatigue). In addition, affected individuals develop fluid-filled cysts in the kidneys, usually in an area known as the corticomedullary region. Another feature of nephronophthisis is a shortage of red blood cells, a condition known as anemia. Nephronophthisis eventually leads to end-stage renal disease (ESRD), a life-threatening failure of kidney function that occurs when the kidneys are no longer able to filter fluids and waste products from the body effectively. Nephronophthisis can be classified by the approximate age at which ESRD begins: around age 1 (infantile), around age 13 (juvenile), and around age 19 (adolescent). About 85 percent of all cases of nephronophthisis are isolated, which means they occur without other signs and symptoms. Some people with nephronophthisis have additional features, which can include liver fibrosis, heart abnormalities, or mirror image reversal of the position of one or more organs inside the body (situs inversus). Nephronophthisis can occur as part of separate syndromes that affect other areas of the body; these are often referred to as nephronophthisis-associated ciliopathies. For example, Senior-L\u00f8ken syndrome is characterized by the combination of nephronophthisis and a breakdown of the light-sensitive tissue at the back of the eye (retinal degeneration); Joubert syndrome affects many parts of the body, causing neurological problems and other features, which can include nephronophthisis.",
+    "https://ghr.nlm.nih.gov/condition/nephronophthisis"
+  ],
+  [
+    "nephronophthisis (Frequency): Nephronophthisis is found in populations worldwide. It occurs in an estimated 1 in 50,000 newborns in Canada, 1 in 100,000 in Finland, and 1 in 922,000 in the United States. Its incidence in other populations is unknown. Nephronophthisis is the most common genetic cause of ESRD in children and young adults.",
+    "https://ghr.nlm.nih.gov/condition/nephronophthisis"
+  ],
+  [
+    "Gastric bypass surgery - discharge (Drugs): You may need to take some medicines when you go home. - You may need to give yourself shots underneath the skin of a blood-thinning drug for 2 or more weeks. Your provider will show you how. - You may need to take medicine to prevent gallstones. - You will need to take certain vitamins that your body may not absorb well from your food. Two of these are vitamin B-12 and vitamin D. - You may need to take calcium and iron supplements as well. Aspirin, ibuprofen (Advil, Motrin), and some other drugs may harm the lining of your stomach or even cause ulcers. Talk with your provider before you take these drugs.",
+    "https://medlineplus.gov/ency/patientinstructions/000172.htm"
+  ],
+  [
+    "What are the treatments for Depression?: Medications called antidepressants work to normalize brain chemicals called neurotransmitters, notably serotonin, norepinephrine, and dopamine. Scientists studying depression have found that these chemicals, and possibly others, are involved in regulating mood, but they are unsure of exactly how they work. Newer Antidepressants. The newest and most popular types of antidepressant medications are called selective serotonin reuptake inhibitors (SSRIs). They include fluoxetine (Prozac), citalopram (Celexa) and several others. Similar to SSRIs are serotonin and norepinephrine reuptake inhibitors (SNRIs) and include venlafaxine (Effexor) and duloxetine (Cymbalta). Another newer antidepressant bupropion (Wellbutrin) is neither an SSRI nor an SNRI but is popular as well. Older Antidepressants. Older antidepressants, called tricyclics and monoamine oxidase inhibitors (MAOIs), are still used sometimes, too. However, these older antidepressants are not as popular as the newer ones because they tend to have more side effects. However, medications affect everyone differently so talk with your doctor to decide which type is best for you. Practical Considerations. People taking MAOIs must follow strict food and medicine restrictions to avoid potentially serious interactions. If you take an MAOI, your doctor should give you a complete list of foods, medicines, and substances to avoid. MAOIs can also react with SSRIs to produce a serious condition called \"serotonin syndrome,\" which can cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, changes in blood pressure or heart rhythm, and other potentially life threatening conditions. MAOIs should not be taken with SSRIs. Caution is required when combining any serotonergic medication (not just MAOIs) with SSRIs. For example, in 2006 the FDA issued specific warnings against using triptans that are commonly-prescribed to treat migraine headaches together with SSRIs or SNRIs. Using these medications together can cause serotonin syndrome.",
+    "http://nihseniorhealth.gov/depression/toc.html"
+  ],
+  [
+    "Helping your teen with depression (Treatment Options for Your Teenager): You, your teen, and your health care provider should discuss what might help your teen the most. The most effective treatments for depression are: - Talk therapy - Antidepressant medicines If your teen might have a problem with drugs or alcohol, discuss this with the provider. If your teen has severe depression or is at risk for suicide, your teen may need to stay in the hospital for treatment.",
+    "https://medlineplus.gov/ency/patientinstructions/000646.htm"
+  ],
+  [
+    "What are the treatments for Depression?: A bushy, wild-growing plant with yellow flowers, St John's wort has been used for centuries in many folk and herbal remedies. It is commonly used in Europe to treat mild depression, and it is a top-seller in the United States as well. In a study funded by the National Institutes of Health, the herb was found to be no more effective than a placebo (sugar pill) in treating adults suffering from major depression. Other research has shown that St. John's wort can interact unfavorably with other drugs. The herb interferes with certain drugs used to treat heart disease, depression, seizures, certain cancers, and organ transplant rejection. Because of these potential interactions, older adults should always consult with their doctors before taking any herbal supplement. Another product sold as a dietary supplement, S-adenosyl methionine (SAMe), has shown promise in controlled trials as helpful when added to an SSRI antidepressant that is only partially effective.",
+    "http://nihseniorhealth.gov/depression/toc.html"
+  ],
+  [
+    "Protecting yourself from cancer scams (Investigational Drugs): There is a difference between an unproven treatment and investigational drugs. These are drugs that are being studied to see if they work well to treat cancer. Cancer patients may take investigational drugs as part of a clinical trial. This is a study to test how well the drug works, and to check its side effects and safety. Clinical trials are the last step before a drug can get approval from the FDA.",
+    "https://medlineplus.gov/ency/patientinstructions/000847.htm"
+  ],
+  [
+    "What are the treatments for Depression?: Several studies are looking at ways to help older adults get better access to depression treatment. One is developing and testing an education and intervention program to help primary care clinics and providers identify and treat late-life depression. Another study found that depressed older adults who had a \"care manager\" monitor their symptoms, side effects, and progress got better more quickly -- and stayed better longer -- than those who did not have case-managed care. Still other projects are investigating ways of improving older adults engagement in and ability to follow treatment plans for depression. Researchers are also looking at ways to - better understand the relationship between other medical illnesses and depression - integrate treatment for depression with treatments for other medical conditions a person may have - produce a quicker response to treatment - develop new methods for delivering treatment to those who are homebound, unable to move around without assistance, or who live in rural areas. (e.g., via use of telephonic or internet-assisted therapies) - help prevent depression by keeping it from developing or recurring in those at risk or by preventing those with milder symptoms from progressing to more severe episodes of depression. better understand the relationship between other medical illnesses and depression integrate treatment for depression with treatments for other medical conditions a person may have produce a quicker response to treatment develop new methods for delivering treatment to those who are homebound, unable to move around without assistance, or who live in rural areas. (e.g., via use of telephonic or internet-assisted therapies) help prevent depression by keeping it from developing or recurring in those at risk or by preventing those with milder symptoms from progressing to more severe episodes of depression.",
+    "http://nihseniorhealth.gov/depression/toc.html"
+  ],
+  [
+    "Antiplatelet drugs - P2Y12 inhibitors (Who Should Take Antiplatelet Drugs): Antiplatelet drugs may be used to: - Prevent heart attack or stroke for those with PAD. - Clopidogrel (Plavix, generic) may be used in place of aspirin for patients who have narrowing of the coronary arteries or who have had a stent inserted. - Sometimes two anti-platelet drugs (one of which is almost always aspirin) are prescribed for patients with unstable angina, acute coronary syndrome (unstable angina or early signs of heart attack), or those who have received a stent during PCI. - For heart disease primary and secondary prevention, daily aspirin is generally the first choice for antiplatelet therapy. Clopidogrel is prescribed instead of aspirin for patients who are aspirin allergic or who cannot tolerate aspirin. - Clopidogrel and aspirin is recommended for patients who are undergoing angioplasty with or without stenting. - Prevent or treat heart attacks. - Prevent stroke or transient ischemic attacks (TIAs are early warning signs of stroke. The are also called \"mini-strokes.\") - Prevent clots from forming inside stents put inside your arteries to open them. - Acute coronary syndrome. - After bypass graft surgery that uses a man-made or prosthetic graft performed on arteries below the knee. Your health care provider will choose which one of these drugs are best for your problem. At times, you may be asked to take low dose aspirin along with one of these drugs.",
+    "https://medlineplus.gov/ency/patientinstructions/000100.htm"
+  ],
+  [
+    "Depression (Overview): Depression affects both men and women, but more women than men are likely to be diagnosed with depression in any given year. That being said, depression is not a \"normal part of being a woman\" nor is it a \"female weakness.\" Many women with depression never seek treatment. But most women, even those with the most severe depression, can get better with treatment.",
+    "https://www.womenshealth.gov/a-z-topics/depression"
+  ],
+  [
+    "Postpartum depression (Summary): Postpartum depression is moderate to severe depression in a woman after she has given birth. It may occur soon after delivery or up to a year later. Most of the time, it occurs within the first 3 months after delivery.",
+    "https://medlineplus.gov/ency/article/007215.htm"
+  ],
+  [
+    "Major depression: Depression is feeling sad, blue, unhappy, or down in the dumps. Most people feel this way once in a while. Major depression is a mood disorder. It occurs when feelings of sadness, loss, anger, or frustration get in the way of your life over a long period of time. It also changes how your body works. Health care providers do not know the exact causes of depression. It is believed that chemical changes in the brain are responsible. This may be due to a problem with your genes. Or it may be triggered by certain stressful events. More likely, it is a combination of both. Some types of depression run in families. Other types occur even if you have no family history of the illness. Anyone can develop depression, including children and teens. Depression may be brought on by: - Alcohol or drug use - Certain medical problems, such as underactive thyroid, cancer, or long-term pain - Some kinds of medicines, such as steroids - Sleeping problems - Stressful life events, such as death or illness of someone close to you, divorce, childhood abuse or neglect, loneliness (common in older people), relationship breakup Depression can change or distort the way you see yourself, your life, and those around you. With depression, you often see everything in a negative way. It is hard for you to imagine that a problem or situation can be solved in a positive way. Symptoms of depression can include: - Agitation, restlessness, and irritability, and anger - Becoming withdrawn or isolated - Fatigue and lack of energy - Feeling hopeless, helpless, worthless, guilty and self-hate - Loss of interest or pleasure in activities that were once enjoyed - Sudden change in appetite, often with weight gain or loss - Thoughts of death or suicide - Trouble concentrating - Trouble sleeping or sleeping too much Depression in teens may be harder to recognize. Problems with school, behavior, or alcohol or drug use can all be signs. If depression is very severe, you may have hallucinations and delusions (false beliefs). This condition is called depression with psychotic features. Your provider will ask about your medical history and symptoms. Your answers can help your provider diagnose depression and determine how severe it may be. Blood and urine tests may be done to rule out other medical conditions that have symptoms similar to depression. Depression can be treated. Treatment typically includes medicines, with or without talk therapy. If you are thinking about suicide or are very depressed and cannot function, you may need to be treated in a hospital. After you have been on treatment, if you feel your symptoms are getting worse, talk with your provider. Your treatment plan may need to be changed. MEDICINES Antidepressants are medicines used to treat depression. They work by bringing back the chemicals in your brain to the right levels. This helps relieve your symptoms. If you have delusions or hallucinations, your provider may prescribe additional medicines. Tell your provider about any other medicines you take. Some medicines can change the way antidepressants work in your body. Allow your medicine time to work. It may take a few weeks before you feel better. Keep taking your medicine as instructed. DO NOT stop taking it or change the amount (dosage) you are taking without talking to your provider. Ask your provider about possible side effects, and what to do if you have any. If you feel your medicine is not working, tell your provider. The medicine or its dosage may need to be changed. DO NOT stop taking medicines on your own. WARNING Children, teens, and young adults should be watched closely for suicidal behavior. This is especially true during the first few months after starting medicines for depression. Women being treated for depression who are pregnant or thinking about becoming pregnant should not stop taking antidepressants without first talking to their provider. Beware of natural remedies such as St. John's wort. This is an herb sold without a prescription. It may help some people with mild depression. But it can change the way other medicines work in your body, including antidepressants. Talk to your provider before trying this herb. TALK THERAPY Talk therapy is counseling to talk about your feelings and thoughts, and help you learn how to deal with them. Types of talk therapy include: - Cognitive behavioral therapy teaches you how to fight off negative thoughts. You learn how to become more aware of your symptoms and how to spot things that make your depression worse. You are also taught problem-solving skills. - Psychotherapy can help you understand the issues that may be behind your thoughts and feelings. - At group therapy, you share with others who have problems like yours. Your therapist or provider can tell you more about group therapy. OTHER TREATMENTS FOR DEPRESSION - Electroconvulsive therapy (ECT) may improve mood in people with severe depression or suicidal thoughts who do not get better with other treatments. ECT is generally safe. - Light therapy may relieve depression symptoms in the winter time. This type of depression is called seasonal affective disorder. You may start feeling better a few weeks after starting treatment. If you take medicine, you will need to stay on the medicine for several months to feel good and prevent depression from returning. If your depression keeps coming back, you may need to stay on your medicine for a long period. Chronic depression may make it harder for you to manage other illnesses such as diabetes or heart disease. Ask your provider for help in managing these health problems. Alcohol or drug use can make depression worse. Talk to your provider about getting help. If you are thinking about hurting yourself or others, call your local emergency number (such as 911) right away. Or, go to the hospital emergency room. DO NOT delay. You can also call the National Suicide Prevention Lifeline at 1-800-273-8255 (1-800-273-TALK), where you can receive free and confidential support anytime day or night. Call your provider right away if: - You hear voices not coming from people around you. - You have frequent crying spells with little or no reason. - Your depression is disrupting work, school, or family life. - You think that your current medicine is not working or is causing side effects. DO NOT stop or change your medicine without talking to your provider. DO NOT drink alcohol or use illegal drugs. These substances make depression worse and may lead to thoughts of suicide. Take your medicine exactly as your provider instructed. Learn to recognize the early signs that your depression is getting worse. Keep going to your talk therapy sessions. The following tips may help you feel better: - Get more exercise. - Maintain good sleep habits. - Do activities that bring you pleasure. - Volunteer or get involved in group activities. - Talk to someone you trust about how you are feeling. - Try to be around people who are caring and positive. Learn more about depression by contacting a local mental health clinic. Your workplace employee assistance program (EAP) is also a good resource. Online resources can also provide good information. Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Editorial update 06/28/2017.",
+    "https://medlineplus.gov/ency/article/000945.htm"
+  ],
+  [
+    "Hepatitis A: Hepatitis A is inflammation (irritation and swelling) of the liver from the hepatitis A virus. The hepatitis A virus is found mostly in the stool and blood of an infected person. The virus is present about 15 to 45 days before symptoms occur and during the first week of illness. You can catch hepatitis A if: - You eat or drink food or water that has been contaminated by stools (feces) containing the hepatitis A virus. Unpeeled and uncooked fruits and vegetables, shellfish, ice, and water are common sources of the disease. - You come in contact with the stool or blood of a person who currently has the disease. - A person with hepatitis A passes the virus to an object or food due to poor hand-washing after using the toilet. - You take part in sexual practices that involve oral-anal contact. Not everyone has symptoms with hepatitis A infection. Therefore, many more people are infected than are diagnosed or reported. Risk factors include: - Overseas travel, especially to Asia, South or Central America, Africa and the Middle East\u00a0 - IV drug use - Living in a nursing home center - Working in a health care, food, or sewage industry Other common hepatitis virus infections include hepatitis B and hepatitis C. Hepatitis A is the least serious and mildest of these diseases. Symptoms most often show up 2 to 6 weeks after being exposed to the hepatitis A virus. They are most often mild, but may last for up to several months, especially in adults. Symptoms include: - Dark urine - Fatigue - Itching - Loss of appetite - Low-grade fever - Nausea and vomiting - Pale or clay-colored stools - Yellow skin (jaundice) The health care provider will perform a physical exam, which may show that your liver is enlarged and tender. Blood tests may show: - Raised IgM and IgG antibodies to hepatitis A (IgM is usually positive before IgG) - Elevated liver enzymes (liver function tests), especially transaminase enzyme levels There is no specific treatment for hepatitis A. - You should rest and stay well hydrated when the symptoms are the worst. - People with acute hepatitis should avoid alcohol and drugs that are toxic to the liver, including acetaminophen (Tylenol) during the acute illness and for several months after recovery. - Fatty foods may cause vomiting and are best avoided during the acute phase of the illness. The virus does not remain in the body after the infection is gone. Most people with hepatitis A recover within 3 months. Nearly all people get better within 6 months. There is no lasting damage once you've recovered. Also, you can't get the disease again. There is a low risk of death. The risk is higher among older adults and people with long-term liver disease.\u00a0 Call your provider if you have symptoms of hepatitis. The following tips can help reduce your risk of spreading or catching the virus: - Always wash your hands well after using the restroom, and when you come in contact with an infected person's blood, stools, or other bodily fluid. - Avoid unclean food and water. The virus may spread more rapidly through day care centers and other places where people are in close contact. Thorough hand washing before and after each diaper change, before serving food, and after using the\u00a0toilet may help prevent such outbreaks. Ask your provider about getting either immune globulin or the hepatitis A vaccine if you are exposed to the disease and have not had hepatitis A or the hepatitis A vaccine. Common reasons for getting one or both of these treatments include: - You have hepatitis B or C or any form of long-term liver disease. - You live with someone who has hepatitis A. - You recently had sexual contact with someone who has hepatitis A. - You recently shared illegal drugs, either injected or noninjected, with someone who has hepatitis A. - You have had close personal contact over a period of time with someone who has hepatitis A. - You have eaten in a restaurant where food or food handlers were found to be infected or contaminated with hepatitis. - You are planning travel to where hepatitis A is common. Vaccines that protect against hepatitis A infection are available. The vaccine begins to protect 4 weeks after you get the first dose. You will need to get a booster shot 6 to 12 months later for long-term protection. Travelers should take the following steps to protect against getting the disease: - Avoid dairy products. - Avoid raw or undercooked meat and fish. - Beware of sliced fruit that may have been washed in unclean water. Travelers should peel all fresh fruits and vegetables themselves. - DO NOT buy food from street vendors. - Get vaccinated against hepatitis A (and possibly hepatitis B) if traveling to countries where outbreaks of the disease occur. - Use only carbonated bottled water for brushing teeth and drinking. (Remember that ice cubes can carry infection.) - If bottled water is not available, boiling water is the best way to get rid of hepatitis A. Bring the water to a full boil for at least 1 minute to make it safe to drink. - Heated food should be hot to the touch and eaten right away. Updated by: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000278.htm"
+  ],
+  [
+    "What is Hepatitis B?: Hepatitis B is irritation and swelling (inflammation) of the liver due to infection with the hepatitis B virus (HBV). Other types of viral hepatitis include hepatitis A, hepatitis C, and hepatitis D.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000279.htm"
+  ],
+  [
+    "Hepatitis C: Hepatitis C is a viral disease that leads to swelling (inflammation) of the liver. Other types of viral hepatitis include: - Hepatitis A - Hepatitis B - Hepatitis D Hepatitis C infection is caused by the hepatitis C virus (HCV). You can catch hepatitis C if the blood of someone who has hepatitis C enters your body. Exposure may occur: - After a needle stick or sharps injury - If blood from someone who has hepatitis C\u00a0contacts a cut on your skin or contacts your eyes or mouth People at risk of hepatitis C are those who: - Inject street drugs or share a needle with someone who has hepatitis C - Have been on long-term kidney dialysis - Have regular contact with blood at work (such as a health care worker) - Have unprotected sexual contact with a person who has hepatitis C - Were born to a mother who had hepatitis C - Received a tattoo or acupuncture with needles that were not disinfected properly after being used on another person (risk is very low with practitioners who have a tattoo license or permit or an acupuncture license) - Received an organ transplant\u00a0from a donor who has hepatitis C - Share personal items, such as toothbrushes and razors, with someone who has hepatitis C (less common) - Received a blood transfusion (rare in the United States since blood screening became available in 1992) Most people who\u00a0are recently infected with hepatitis C do not have symptoms in most cases. Some people have yellowing of the skin (jaundice) that goes away. Chronic infection often causes no symptoms. But tiredness, skin disorders and other problems can occur. Persons who have long-term (chronic) infection often have no symptoms until their liver becomes scarred (cirrhosis). Most people with this condition are ill and have many health problems. The following symptoms\u00a0may occur with hepatitis C infection: - Pain in the right upper abdomen - Abdominal swelling due to fluid (ascites) - Clay-colored or pale stools - Dark urine - Fatigue - Fever - Itching - Jaundice - Loss of appetite - Nausea and vomiting Blood tests are done to check for hepatitis C: - Enzyme immunoassay (EIA) to detect hepatitis C antibody - Hepatitis C RNA assays to measure virus levels (viral load) Everyone born from 1945 to 1965 (the baby boomer generation) should get a one-time test for hepatitis C. Genetic testing is done to check for the type of hepatitis C (genotype). There are six types of the virus (genotypes 1 through 6). Test results can help your health care provider choose treatment that is best for you. The following tests are done to identify and monitor liver damage from hepatitis C: - Albumin level - Liver function tests - Prothrombin time - Liver biopsy You should talk to your provider about your treatment options and when treatment should begin. - The goal of treatment is to rid the body of the virus. This can prevent liver damage that may lead to liver failure or liver cancer. - Your provider will monitor you by checking liver blood tests, viral load (the amount of HCV in your blood), imaging tests, and biopsy results. - Treatment is especially important for people who are showing signs liver fibrosis or scarring. Medicines used to treat hepatitis C are called antiviral drugs because they fight the HCV. Newer antiviral drugs: - Provide a much improved cure rate - Have fewer side effects and are easier to take - Are taken by mouth for 8 to 24 weeks The choice of which drug depends on the genotype of the virus you have. A liver transplant may be recommended for people who develop cirrhosis and liver cancer. Your provider can tell you more about liver transplant. If you have hepatitis C: - Do not take over-the-counter medicines that you have not taken before without asking your provider. Also ask about vitamins and other supplements. - Do not use alcohol or street drugs. Alcohol can speed up the damage to your liver. It can also reduce how well medicines work. - Ask your provider whether you need the hepatitis A and hepatitis B vaccines. Joining a support group\u00a0can help ease the stress of having hepatitis C. Ask your provider about liver disease resources\u00a0and support groups in your area. Most people (75% to 85%) who are infected with the virus develop chronic hepatitis C. This condition poses a risk for cirrhosis, liver cancer, or both. The outlook for hepatitis C depends in part on the genotype. A good response to treatment occurs when the virus can no longer be detected in the blood 12 weeks or more after treatment. This is called \"sustained virologic response\" (SVR). Up to 90% of those treated for some genotypes have this type of response. Some people do not respond to initial treatment. They may need to be re-treated with a different drug regimen. Also, some people can become re-infected or infected with a different genotype strain. Call your provider if: - You develop symptoms of hepatitis - You believe you have been exposed to the HCV Steps that can be\u00a0taken to help\u00a0prevent the spread of hepatitis C from one person to another include: - Health care workers should follow precautions when handling blood. - Do not share needles with anyone. - Do not get tattoos or body piercings or receive acupuncture from someone who does not have a permit or license. - Do not share personal items, such as razors and toothbrushes. - Practice safer sex. If you or your partner is infected with hepatitis C and you have been in a stable and monogamous (no other partners) relationship, the risk of giving the virus to, or getting the virus from, the other person is low. HCV cannot be spread by casual contact, such as holding hands, kissing, coughing or sneezing, breastfeeding, sharing eating utensils or drinking glasses. Currently there is no vaccine for hepatitis C. Updated by: Subodh K. Lal, MD, gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000284.htm"
+  ],
+  [
+    "Autoimmune hepatitis: Autoimmune hepatitis is inflammation of the liver. It occurs when immune cells mistake the liver's normal cells for harmful invaders and attack them. This form of hepatitis is an autoimmune disease. The body's immune system cannot tell the difference between healthy body tissue and harmful, outside substances. The result is an immune response that destroys normal body tissues. Liver inflammation, or hepatitis, may occur along with other autoimmune diseases. These include: - Graves disease - Inflammatory bowel disease - Rheumatoid arthritis - Scleroderma - Sj\u00f6gren syndrome - Systemic lupus erythematosus - Thyroiditis - Type 1 diabetes - Ulcerative colitis Autoimmune hepatitis may occur in family members of people with autoimmune diseases. There may be a genetic cause. This disease is most common in young girls and women. Symptoms may include: - Fatigue - General discomfort, uneasiness, or ill feeling (malaise) - Itching - Loss of appetite - Nausea or vomiting - Joint pain - Pale or clay-colored stools - Dark urine - Abdominal distention Absence of menstruation (amenorrhea) may also be a symptom. Tests for autoimmune hepatitis include the following blood tests: - Liver function tests - Anti-liver kidney microsome type 1 antibody (anti LKM-1) - Anti-nuclear antibody (ANA) - Anti-smooth muscle antibody (SMA) - Serum IgG - Liver biopsy to look for long-term\u00a0hepatitis You may need prednisone or other corticosteroid medicines to help reduce the inflammation. Azathioprine and 6-mercaptopurine are drugs used to treat other autoimmune disorders. They have been shown to help people with autoimmune hepatitis, as well. Some people may need a liver transplant. The outcome varies. Corticosteroid medicines may slow the progress of the disease. However, autoimmune hepatitis may advance to cirrhosis. This would require a liver transplant. Complications may include: - Cirrhosis - Side effects from steroids and other medicines - Hepatocellular carcinoma - Liver failure Call your health care provider if you notice symptoms of autoimmune hepatitis. Autoimmune hepatitis cannot be prevented in most cases. Knowing the risk factors may help you detect and treat the disease early. Updated by: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000245.htm"
+  ],
+  [
+    "Hepatitis A: Hepatitis A is a viral infection that causes liver inflammation and damage. Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can damage organs.Viruses invade normal cells in your body. Many viruses cause infections that can be spread from person to person. The hepatitis A virus typically spreads through contact with food or water that has been contaminated by an infected person\u2019s stool.Hepatitis A is an acute or short-term infection, which means people usually get better without treatment after a few weeks. Hepatitis A does not lead to long-term complications, such as cirrhosis, because the infection only lasts a short time.You can take steps to protect yourself from hepatitis A, including getting the hepatitis A vaccine. If you have hepatitis A, you can take steps to prevent spreading hepatitis A to others. In the United States, hepatitis A has become relatively uncommon. Since the hepatitis A vaccine became available in 1995, the rate of hepatitis A infections has declined by 95 percent in the United States. Researchers estimate that about 2,500 cases of hepatitis A occurred in the United States in 2014.1Hepatitis A is more common in developing countries where sanitation is poor and access to clean water is limited. Hepatitis A is more common in parts of Africa, Asia, Central and South America, and Eastern Europe than it is in the United States. People more likely to get hepatitis A are those whotravel to developing countries have sex with an infected person are men who have sex with men use illegal drugs, including drugs that are not injected live with or care for someone who has hepatitis APeople who travel to developing countries are more likely to get hepatitis A. People typically recover from hepatitis A without complications. In rare cases, hepatitis A may lead to liver failure. Liver failure due to hepatitis A is more common in adults older than age 50 and in people who have another liver disease.2 Some people have symptoms 2 to 6 weeks after they come in contact with the virus.2 People with hepatitis A typically get better without treatment after a few weeks. In some cases, symptoms can last up to 6 months. These symptoms may includedark yellow urine feeling tired fever gray- or clay-colored stools joint pain loss of appetite nausea pain in the abdomen vomiting yellowish eyes and skin, called jaundiceSome people infected with hepatitis A have no symptoms, including many children younger than age 6.1 Older children and adults are more likely to have symptoms. The hepatitis A virus causes this type of hepatitis and spreads through contact with an infected person\u2019s stool. Contact can occur byeating food made by an infected person who did not wash his or her hands after using the bathroom drinking untreated water or eating food washed in untreated water placing a finger or an object in your mouth that came into contact with an infected person\u2019s stool having close personal contact with an infected person, such as through sex or caring for someone who is illYou cannot get hepatitis A frombeing coughed on or sneezed on by an infected person sitting next to an infected person hugging an infected personA baby cannot get hepatitis A from breast milk.3 Doctors diagnose hepatitis A based on symptoms and a blood test. A health care professional will take a blood sample from you and send the sample to a lab. A blood test will detect antibodies to the hepatitis A virus and show whether you have hepatitis A. Treatment includes resting, drinking plenty of liquids, and eating healthy foods to help relieve symptoms. Your doctor may also suggest medicines to help relieve symptoms.Talk with your doctor before taking any prescription or over-the-counter medicines, vitamins or other dietary supplements, or complementary or alternative medicines\u2014any of these could damage your liver. You should avoid alcohol until your doctor tells you that you have completely recovered from hepatitis A.See your doctor regularly to make sure your body has fully recovered. If you have symptoms for longer than 6 months, see your doctor again. You can protect yourself from hepatitis A by getting the hepatitis A vaccine. If you have not had the vaccine, you can take steps to reduce your chance of infection.If you have had hepatitis A in the past, you cannot get hepatitis A again. You can still get other types of viral hepatitis though.You can protect yourself from hepatitis A by getting the hepatitis A vaccine.Hepatitis A vaccineAll children should receive the hepatitis A vaccine between 12 and 23 months of age. People who are more likely to be infected and people with chronic liver disease should also receive the vaccine.Doctors give the hepatitis A vaccine in two shots. You should get the second shot 6 to 12 months after the first shot. You need to get both shots to be fully protected against the virus.If you are traveling to a developing country where hepatitis A is common and you haven\u2019t received the hepatitis A vaccine, try to get both shots before you go. If you don\u2019t have time to get both shots, get the first shot as soon as you can. Most people gain some protection within 2 weeks of the first shot.Reduce your chance of infectionYou can reduce your chance of hepatitis A by washing your hands thoroughly with soap and warm water for 15 to 30 secondsafter using the toilet after changing diapers before and after handling or preparing foodWhen traveling in a developing country, drink bottled water. Use bottled water to brush your teeth, make ice cubes, and wash fruits and vegetables.When traveling in a developing country, drink bottled water.Prevent infection after contact with the virusIf you think you have come in contact with the hepatitis A virus, see your doctor right away. A dose of the hepatitis A vaccine or a medicine called hepatitis A immune globulin may protect you from getting the infection. Your doctor may recommend a vaccine dose or medicine ifyou live with, have had sex with, or have had close contact with someone who has hepatitis\u00a0A you shared illegal drugs with someone who had hepatitis A you ate food or drank water possibly containing the hepatitis A virusYou must get the vaccine dose or medicine shortly after coming into contact with the virus to prevent infection. If you have hepatitis A, you can reduce your chance of spreading the infection by washing your hands with warm, soapy water after using the toilet and before fixing or eating food. While you are sick, avoid close contact with others, and don\u2019t prepare food or serve food to others. Also, tell your doctor, dentist, and other health care professionals that you have hepatitis A.Talk with a blood donation center before you donate blood. If you had hepatitis A when you were younger than 11, you may be able to donate blood. If you had hepatitis A when you were age 11 or older, you should not donate blood.You are most contagious\u2014able to spread the virus to others\u2014during the 2 weeks before you have symptoms. You may be contagious for up to 3 weeks after you develop symptoms. Children are often contagious longer than adults.4 If you have hepatitis A, you should eat a balanced, healthy diet. Talk with your doctor about healthy eating. You should also avoid alcohol because it can cause more liver damage. [1] Hepatitis A Questions and Answers for Health Professionals. Centers for Disease Control and Prevention, Division of Viral Hepatitis website. www.cdc.gov/hepatitis/hav/havfaq.htm. Updated July 13, 2016. Accessed July 25, 2016. [2] Hepatitis A Questions and Answers for the Public. Centers for Disease Control and Prevention, Division of Viral Hepatitis website. www.cdc.gov/hepatitis/hav/afaq.htm. Updated May 23, 2016. Accessed July 25, 2016. [3] Rac MW, Sheffield JS. Prevention and management of viral hepatitis in pregnancy. Obstetrics and Gynecology Clinics of North America. 2014;41(4):573\u2013592. [4] Centers for Disease Control and Prevention. Chapter 9: Hepatitis A. In Hamborsky J, Kroger A, Wolfe S, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. 13th ed. Washington, DC: Public Health Foundation; 2015:135\u2013148.",
+    "https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-a"
+  ],
+  [
+    "Hepatitis C: Hepatitis C is a viral infection that causes liver inflammation and damage. Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can damage organs.Viruses invade normal cells in your body. Many viruses cause infections that can be spread from person to person. The hepatitis C virus spreads through contact with an infected person\u2019s blood.Hepatitis C can cause an acute or chronic infection.Although no vaccine for hepatitis C is available, you can take steps to protect yourself from hepatitis C. If you have hepatitis C, talk with your doctor about treatment. Medicines can cure most cases of hepatitis C.Acute hepatitis CAcute hepatitis C is a short-term infection. Symptoms can last up to 6 months. Sometimes your body is able to fight off the infection and the virus goes away.Chronic hepatitis CChronic hepatitis C is a long-lasting infection. Chronic hepatitis C occurs when your body isn\u2019t able to fight off the virus. About 75 to 85 percent of people with acute hepatitis C will develop chronic hepatitis C.13Early diagnosis and treatment of chronic hepatitis C can prevent liver damage. Without treatment, chronic hepatitis C can cause chronic liver disease, cirrhosis, liver failure, or liver cancer. In the United States, hepatitis C is the most common chronic viral infection found in blood and spread through contact with blood.14Researchers estimate that about 2.7 million to 3.9 million people in the United States have chronic hepatitis C.13 Many people who have hepatitis C don\u2019t have symptoms and don\u2019t know they have this infection. About 75 percent of U.S. adults who have hepatitis C are baby boomers, born between 1945 and 1965.14Since 2006, the number of new hepatitis C infections has been rising, especially among people younger than age 30 who inject heroin or misuse prescription opioids and inject them.15,16New screening efforts and more effective hepatitis C treatments are helping doctors identify and cure more people with the disease. With more screening and treatment, hepatitis C may become less common in the future. Researchers estimate that hepatitis C could be a rare disease in the United States by 2036.17 People more likely to get hepatitis C are those whohave injected drugs had a blood transfusion or organ transplant before July 1992 have hemophilia and received clotting factor before 1987 have been on kidney dialysis have been in contact with blood or infected needles at work have had tattoos or body piercings have worked or lived in a prison were born to a mother with hepatitis C are infected with HIV have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease are men who have or had sex with menIn the United States, injecting drugs is the most common way that people get hepatitis C.13 Your doctor may recommend screening for hepatitis C if youhave a high chance of being infected were born between 1945 and 1965Screening is testing for a disease in people who have no symptoms. Doctors use blood tests to screen for hepatitis C. Many people who have hepatitis C don\u2019t have symptoms and don\u2019t know they have hepatitis C. Screening tests can help doctors diagnose and treat hepatitis C before it causes serious health problems.Your doctor may recommend screening you for hepatitis C if you were born between 1945 and 1965. Without treatment, hepatitis C may lead to cirrhosis, liver failure, and liver cancer. Early diagnosis and treatment of hepatitis C can prevent these complications.CirrhosisCirrhosis is a condition in which the liver slowly breaks down and is unable to function normally. Scar tissue replaces healthy liver tissue and partially blocks the flow of blood through the liver. In the early stages of cirrhosis, the liver continues to function. However, as cirrhosis gets worse, the liver begins to fail.Liver failureAlso called end-stage liver disease, liver failure progresses over months, years, or even decades. With end-stage liver disease, the liver can no longer perform important functions or replace damaged cells.Liver cancerHaving chronic hepatitis C increases your chance of developing liver cancer. If chronic hepatitis C causes severe liver damage or cirrhosis before you receive hepatitis C treatment, you will continue to have an increased chance of liver cancer even after treatment. Your doctor may order an ultrasound test to check for liver cancer every 6 months. Finding cancer at an early stage improves the chance of curing the cancer. Most people infected with hepatitis C have no symptoms. Some people with an acute hepatitis C infection may have symptoms within 1 to 3 months after they are exposed to the virus. These symptoms may includedark yellow urine feeling tired fever gray- or clay-colored stools joint pain loss of appetite nausea pain in your abdomen vomiting yellowish eyes and skin, called jaundiceIf you have chronic hepatitis C, you most likely will have no symptoms until complications develop, which could be decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms. The hepatitis C virus causes hepatitis C. The hepatitis C virus spreads through contact with an infected person\u2019s blood. Contact can occur bysharing drug needles or other drug materials with an infected person getting an accidental stick with a needle that was used on an infected person being tattooed or pierced with tools that were used on an infected person and were not properly sterilized, or cleaned in a way that destroys all viruses and other microorganisms having contact with the blood or open sores of an infected person using an infected person\u2019s razor, toothbrush, or nail clippers being born to a mother with hepatitis C having unprotected sex with an infected personYou can\u2019t get hepatitis C frombeing coughed or sneezed on by an infected person drinking water or eating food hugging an infected person shaking hands or holding hands with an infected person sharing spoons, forks, and other eating utensils sitting next to an infected personA baby can\u2019t get hepatitis C from breast milk.18 Doctors diagnose hepatitis C based on your medical history, a physical exam, and blood tests. If you have hepatitis C, your doctor may perform additional tests to check your liver.Medical historyYour doctor will ask about your symptoms and whether you have any history of blood transfusions or injected drug use.Physical examDuring a physical exam, your doctor will typically examine your body to check for signs of liver damage such aschanges in skin color swelling in your lower legs, feet, or ankles tenderness or swelling in your abdomen Doctors use blood tests to diagnose hepatitis C. Your doctor may order additional tests to check for liver damage, find out how much liver damage you have, or rule out other causes of liver disease.Blood testsYour doctor may order one or more blood tests to diagnose hepatitis C. A health care professional will take a blood sample from you and send the sample to a lab.Blood tests for hepatitis C include the following:Screening test for antibodies to the hepatitis C virus. A screening blood test will show whether you have developed antibodies to the hepatitis C virus. A positive antibody test means you were exposed to the hepatitis C virus at some point. However, the virus may no longer be present in your blood if your body fought off the infection on its own or if you received treatment that cured the infection. Hepatitis C RNA test. If your antibody test is positive, your doctor will use a hepatitis C RNA test to detect RNA\u2014a type of genetic material\u2014from the hepatitis C virus. The hepatitis C RNA test can show whether you still have the hepatitis C virus and how much virus is in your blood. This information can help your doctor treat the infection. To see if you are responding to treatment, your doctor may order this test while you are undergoing treatment to find out if the amount of virus in your blood is changing. Genotype test. Your doctor can use this test to find out what strain, or form, of hepatitis C virus you have. At least six specific strains\u2014called genotypes\u2014of hepatitis C exist. Genotype 1 is the most common hepatitis C genotype in the United States.1 Your doctor will recommend treatment based on which hepatitis C genotype you have.Your doctor may order one or more blood tests to diagnose hepatitis C.Additional testsIf you\u2019ve had chronic hepatitis C for a long time, you could have liver damage. Your doctor may recommend additional tests to find out whether you have liver damage, how much liver damage you have, or to rule out other causes of liver disease. These tests may includeblood tests transient elastography, a special ultrasound of your liver liver biopsy, in which a doctor uses a needle to take a small piece of tissue from your liverDoctors typically use liver biopsy only if other tests don\u2019t provide enough information about a person\u2019s liver damage or disease. Talk with your doctor about which tests are best for you. Doctors treat hepatitis C with antiviral medicines that attack the virus and can cure the disease in most cases.Several newer medicines, called direct-acting antiviral medicines, have been approved to treat hepatitis C since 2013. Studies show that these medicines can cure chronic hepatitis C in most people with this disease. These medicines can also cure acute hepatitis C. In some cases, doctors recommend waiting to see if an acute infection becomes chronic before starting treatment.Your doctor may prescribe one or more of these newer, direct-acting antiviral medicines to treat hepatitis C:daclatasvir (Daklinza) elbasvir/grazoprevir (Zepatier) ledipasvir/sofosbuvir (Harvoni) ombitasvir/paritaprevir/ritonavir (Technivie) ombitasvir/paritaprevir/ritonavir/dasabuvir (Viekira Pak, Viekira XR) simeprevir (Olysio) sofosbuvir (Sovaldi) sofosbuvir/velpatasvir (Epclusa) sofosbuvir/velpatasvir/voxilaprevir (Vosevi)Newer medicines are sometimes used along with these older hepatitis C medicines:ribavirin peginterferon alfa-2a (Pegasys) or peginterferon alfa-2b (PEG-Intron)Doctors treat hepatitis C with antiviral medicines that attack the virus.You may need to take medicines for 12 to 24 weeks to cure hepatitis C. Your doctor will prescribe medicines and recommend a length of treatment based onwhich hepatitis C genotype you have how much liver damage you have whether you have been treated for hepatitis C in the pastYour doctor may order blood tests during and after your treatment. Blood tests can show whether the treatment is working. Hepatitis C medicines cure the infection in most people who complete treatment.Hepatitis C medicines may cause side effects. Talk with your doctor about the side effects of treatment. Check with your doctor before taking any other prescription or over-the-counter medicines.For safety reasons, talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices.Cost of hepatitis C medicinesThe newer direct-acting antiviral medicines for hepatitis C can be costly. Most government and private health insurance prescription drug plans provide some coverage for these medicines. Talk with your doctor about your health insurance coverage for hepatitis C medicines.Drug companies, nonprofit organizations, and some states offer programs that can help pay for hepatitis C medicines. If you need help paying for medicines, talk with your doctor. Learn more about financial help for hepatitis C medicines. If hepatitis C leads to cirrhosis, you should see a doctor who specializes in liver diseases. Doctors can treat the health problems related to cirrhosis with medicines, surgery, and other medical procedures. If you have cirrhosis, you have an increased chance of liver cancer. Your doctor may order an ultrasound test to check for liver cancer every 6 months.If hepatitis C leads to liver failure or liver cancer, you may need a liver transplant. If you don\u2019t have hepatitis C, you can help protect yourself from hepatitis C infection bynot sharing drug needles or other drug materials wearing gloves if you have to touch another person\u2019s blood or open sores making sure your tattoo artist or body piercer uses sterile tools not sharing personal items such toothbrushes, razors, or nail clippers using a latex or polyurethane condom during sexDo not share drug needles or other drug materials.If you think you may have been exposed to the hepatitis C virus, see your doctor as soon as possible. Early diagnosis and treatment can help prevent liver damage. If you have hepatitis C, follow the steps above to avoid spreading the infection. In addition, you can protect others from infection by telling your doctor, dentist, and other health care providers that you have hepatitis C. Don\u2019t donate blood or blood products, semen, organs, or tissue.If you have hepatitis C, tell your sex partner and talk with your doctor about safe sex practices. Although hepatitis C can spread from person to person during sex, the chances are low. People who have multiple sex partners, have HIV or other sexually transmitted diseases, or who engage in rough or anal sex have a higher chance of spreading hepatitis C. Using a condom can help prevent the spread of hepatitis C. Researchers are still working on a vaccine for hepatitis C. If you have hepatitis C, talk with your doctor about vaccines for hepatitis A and hepatitis B. These vaccines can protect you from hepatitis A and hepatitis B infections, which could further damage your liver. If you have hepatitis C, you should eat a balanced, healthy diet. Talk with your doctor about healthy eating. You should also avoid alcohol because it can cause more liver damage. [13] Hepatitis C FAQs for health professionals. Centers for Disease Control and Prevention, Division of Viral Hepatitis website. www.cdc.gov/hepatitis/HCV/HCVfaq.htm. Updated July 21, 2016. Accessed October 19, 2016. [14] U.S. Preventive Services Task Force. Final recommendation statement: hepatitis C: screening. www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/hepatitis-c-screening. Current as of June 2013. Accessed October 19, 2016. [15] Suryaprasad AG, White JZ, Xu F, et al. Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006\u20132012. Clinical Infectious Diseases. 2014;59(10):1411\u20131419. [16] Viral hepatitis and young persons who inject prescription opioids and heroin. Centers for Disease Control and Prevention website. www.cdc.gov/hepatitis/featuredtopics/youngpwid.htm. Updated March 30, 2016. Accessed October 19, 2016. [17] Kabiri M, Jazwinski AB, Roberts MS, Schaefer AJ, Chhatwal J. The changing burden of hepatitis C virus infection in the United States: model-based predictions. Annals of Internal Medicine. 2014;161(3):170\u2013180. [18] Hepatitis B and C infections. Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity website. www.cdc.gov/breastfeeding/disease/hepatitis.htm. Updated June 17, 2015. Accessed October 19, 2016.",
+    "https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-c"
+  ],
+  [
+    "Jock itch (Symptoms): Jock itch usually begins with a reddened area of skin that spreads out from the crease in the groin in a half-moon shape onto the upper thigh. The border of the rash may consist of a line of small, raised blisters. The rash often itches or burns, and the skin may be flaky or scaly. See your doctor if you have a rash on your skin that doesn't improve within two weeks or if you treat it with over-the-counter medications and it returns within a few weeks. You may need prescription medication.",
+    "https://www.mayoclinic.org/diseases-conditions/jock-itch/symptoms-causes/syc-20353807"
+  ],
+  [
+    "What are the symptoms of Skin Cancer?: Early Detection is Important When skin cancer is found early, it is more likely to be treated successfully. Therefore, it is important to know how to recognize the signs of skin cancer in order to improve the chances of early diagnosis. Most non-melanoma skin cancers (basal cell carcinoma and squamous cell carcinoma) can be cured if found and treated early. Skin Changes A change on the skin is the most common sign of skin cancer. This may be a new growth, a sore that doesn't heal, or a change in an old growth. Not all skin cancers look the same. Sometimes skin cancer is painful, but usually it is not. Checking your skin for new growths or other changes is a good idea. Keep in mind that changes are not a sure sign of skin cancer. Still, you should report any changes to your health care provider right away. You may need to see a dermatologist, a doctor who has special training in the diagnosis and treatment of skin problems. A Mole That is Bleeding Also see a doctor if a mole is bleeding or if more moles appear around the first one. Most of the time, these signs are not cancer. Sometimes, it is not even a mole. Still, it is important to check with a doctor so that any problems can be diagnosed and treated as early as possible. Don't ignore your symptoms because you think they are not important or because you believe they are normal for your age. Signs of Melanoma Melanoma skin cancer is more difficult to treat, so it is important to check for signs and seek treatment as soon as possible. Use the following ABCDE rule to remember the symptoms of melanoma. See a doctor if you have a mole, birthmark, or other pigmented area of skin with A = Asymmetry. One half of the mole looks different than the other half. (top left image) B = Border. The edges are often ragged, notched, or blurred in outline. The pigment may spread into the surrounding skin. (top right image) C = Color. The mole is more than one color. Shades of black, brown, and tan may be present. Areas of white, gray, red, pink, or blue may also be seen.(bottom left image) D = Diameter.There is a change in size, usually an increase. Melanomas can be tiny, but most are larger than the size of a pea (larger than 6 millimeters or about 1/4 inch). (bottom right image) E = Evolving. The mole has changed over the past few weeks or months.",
+    "http://nihseniorhealth.gov/skincancer/toc.html"
+  ],
+  [
+    "Jock itch: Jock itch (tinea cruris) is a fungal infection that affects the skin of your genitals, inner thighs and buttocks. Jock itch causes an itchy, red, often ring-shaped rash in these warm, moist areas of your body. Jock itch gets its name because it is common in people who sweat a lot, as do athletes. It also is more likely to occur in people who are overweight. Although often uncomfortable and bothersome, jock itch usually isn't serious. Keeping your groin area clean and dry and applying topical antifungal medications usually are sufficient to treat jock itch. Jock itch usually begins with a reddened area of skin that spreads out from the crease in the groin in a half-moon shape onto the upper thigh. The border of the rash may consist of a line of small, raised blisters. The rash often itches or burns, and the skin may be flaky or scaly. See your doctor if you have a rash on your skin that doesn't improve within two weeks or if you treat it with over-the-counter medications and it returns within a few weeks. You may need prescription medication. Jock itch is caused by a type of fungus that can be spread from person to person or from shared use of contaminated towels or clothing. Jock itch is often caused by the same fungus that results in athlete's foot. It's common for the infection to spread from the feet to the groin, as the fungus can travel on your hands or on a towel. The organisms that cause jock itch thrive in damp, close environments. You're at greater risk of jock itch if you: - Are a man - Are a teen or young adult - Wear tight underwear - Are overweight - Sweat heavily - Have a weakened immune system - Have diabetes In many cases, your doctor can diagnose jock itch simply by looking at the rash. If the diagnosis isn't clear cut, your doctor may take skin scrapings or samples from the infected area and view them under a microscope. To rule out other conditions, your doctor might send a sample of the rash to a lab. This test is known as a culture. For a mild case of jock itch, your doctor may suggest first using an over-the-counter antifungal ointment, lotion, powder or spray. The rash may clear up quickly with these treatments, but continue applying the medication as directed for one to two weeks. If you also have athlete's foot, treat it at the same time you are treating your jock itch. This will reduce the risk of recurrence. If jock itch is severe or doesn't respond to over-the-counter medicine, you may need prescription-strength creams or ointments - or even antifungal pills.",
+    "https://www.mayoclinic.org/diseases-conditions/jock-itch/symptoms-causes/syc-20353807"
+  ],
+  [
+    "Jock itch (Treatment): For a mild case of jock itch, your doctor may suggest first using an over-the-counter antifungal ointment, lotion, powder or spray. The rash may clear up quickly with these treatments, but continue applying the medication as directed for one to two weeks. If you also have athlete's foot, treat it at the same time you are treating your jock itch. This will reduce the risk of recurrence. If jock itch is severe or doesn't respond to over-the-counter medicine, you may need prescription-strength creams or ointments - or even antifungal pills.",
+    "https://www.mayoclinic.org/diseases-conditions/jock-itch/symptoms-causes/syc-20353807"
+  ],
+  [
+    "Jock itch (Risk factors): The organisms that cause jock itch thrive in damp, close environments. You're at greater risk of jock itch if you: - Are a man - Are a teen or young adult - Wear tight underwear - Are overweight - Sweat heavily - Have a weakened immune system - Have diabetes",
+    "https://www.mayoclinic.org/diseases-conditions/jock-itch/symptoms-causes/syc-20353807"
+  ],
+  [
+    "Jock itch (Causes): Jock itch is caused by a type of fungus that can be spread from person to person or from shared use of contaminated towels or clothing. Jock itch is often caused by the same fungus that results in athlete's foot. It's common for the infection to spread from the feet to the groin, as the fungus can travel on your hands or on a towel.",
+    "https://www.mayoclinic.org/diseases-conditions/jock-itch/symptoms-causes/syc-20353807"
+  ],
+  [
+    "Jock itch (Diagnosis): In many cases, your doctor can diagnose jock itch simply by looking at the rash. If the diagnosis isn't clear cut, your doctor may take skin scrapings or samples from the infected area and view them under a microscope. To rule out other conditions, your doctor might send a sample of the rash to a lab. This test is known as a culture.",
+    "https://www.mayoclinic.org/diseases-conditions/jock-itch/symptoms-causes/syc-20353807"
+  ],
+  [
+    "Jock itch (Symptoms): Jock itch usually stays around the creases of the upper thigh and does not involve the scrotum or penis. Jock itch may spread to near the anus, causing anal itching and discomfort. Symptoms include: - Red, raised, scaly patches that may blister and ooze. The\u00a0patches often have sharply-defined edges with scale at the edges.\u00a0 - Abnormally dark or light skin. Sometimes, these changes are permanent.",
+    "https://medlineplus.gov/ency/article/000876.htm"
+  ],
+  [
+    "Jock itch: Jock itch is an infection of the groin area caused by a fungus. The medical term is tinea cruris, or ringworm of the groin. Jock itch occurs when a type of fungus grows\u00a0and spreads in the groin area. Jock itch occurs mostly in adult men and\u00a0teenage boys.\u00a0Some persons who have this infection also have athlete's foot\u00a0or another kind of\u00a0ringworm. The fungus that causes jock itch thrives in warm, moist areas. Jock itch can be triggered by friction from clothes and prolonged\u00a0moistness in the groin area, such as from sweating. A fungal infection of the feet can spread to the groin area by pulling up pants if the waistband gets contaminated with fungus from the feet. Jock itch can be passed from one person to\u00a0another by direct skin-to-skin contact or contact with unwashed clothing. Jock itch usually stays around the creases of the upper thigh and does not involve the scrotum or penis. Jock itch may spread to near the anus, causing anal itching and discomfort. Symptoms include: - Red, raised, scaly patches that may blister and ooze. The\u00a0patches often have sharply-defined edges with scale at the edges.\u00a0 - Abnormally dark or light skin. Sometimes, these changes are permanent. Your health care provider can usually diagnose jock itch based on how your skin looks. Tests are usually not necessary. If tests are needed, they may include: - A simple office test called a\u00a0KOH exam to check for fungus - Skin culture - A skin biopsy may also be performed with a special stain called PAS to identify fungus and yeast Jock itch usually responds to self-care within a couple of weeks: - Keep the skin clean and dry in the groin area. - Do not wear clothing that rubs and irritates the area. Wear loose-fitting underwear. - Wash athletic supporters frequently. - Over-the-counter antifungal or drying powders can help control the infection. These contain medicine, such as miconazole, clotrimazole, terbinafine, or tolnaftate. You may need treatment by a provider if your infection lasts longer than 2 weeks, is severe, or frequently returns.\u00a0The provider may prescribe: - Stronger topical (applied to the skin) antifungal medicines or oral antifungal\u00a0medicines - Antibiotics may be needed to treat bacterial infections that occur from scratching the area If you tend to get jock itch, continue to apply antifungal or drying powders after bathing, even when you do not have jock itch. Jock itch usually responds promptly to treatment. It is often less severe than other tinea infections, such as athlete's foot, but may last a long time. Call your\u00a0provider if jock itch does not respond to home care after 2 weeks or you have other symptoms. Updated by: David L. Swanson, MD, Vice Chair of Medical Dermatology, Associate Professor of Dermatology, Mayo Medical School, Scottsdale, AZ. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000876.htm"
+  ],
+  [
+    "General paresis (Treatment): The goals of treatment are to cure the infection and slow the disorder from getting worse. The doctor will prescribe penicillin or other antibiotics to treat the infection. Treatment will likely continue until the infection has completely cleared. Treating the infection will reduce new nerve damage. But it will not cure damage that has already occurred. Treatment of symptoms is needed for existing nervous system damage.",
+    "https://medlineplus.gov/ency/article/000748.htm"
+  ],
+  [
+    "What causes Ribcage pain?: Ribcage pain may be caused by any of the following: - Bruised, cracked, or fractured rib - Inflammation of cartilage near the breastbone (costochondritis) - Osteoporosis - Pleurisy (the pain is worse when breathing deeply)",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/003109.htm"
+  ],
+  [
+    "General anesthesia: General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery. After you receive these medicines, you will not be aware of what is happening around you. Most times, a doctor called an anesthesiologist will give you the anesthesia. Sometimes, a certified and registered nurse anesthetist will take care of you. The medicine is given into your vein. You may be asked to breathe in (inhale) a special gas through a mask. Once you are asleep, the doctor may insert a tube into your windpipe (trachea) to help you breathe and protect your lungs. You will be watched very closely while you are asleep. Your blood pressure, pulse, and breathing will be monitored. The health care provider taking care of you can change how deeply asleep you are during the surgery. You will not move, feel any pain, or have any memory of the procedure because of this medicine. General anesthesia is a safe way to stay asleep and pain-free during procedures that would: - Be too painful - Take a long time - Affect your ability to breathe - Make you uncomfortable - Cause too much anxiety You may also be able to have conscious sedation for your procedure. Sometimes, though, it is not enough to make you comfortable. Children may need general anesthesia for a medical or dental procedure to handle any pain or anxiety they may feel. General anesthesia is usually safe for healthy people. You may have a higher risk of problems with general anesthesia if you: - Abuse alcohol or medicines - Have allergies or a family history of being allergic to medicines - Have heart, lung, or kidney problems - Smoke Ask your doctor about these complications: - Death (rare) - Harm to your vocal cords - Heart attack - Lung infection - Mental confusion (temporary) - Stroke - Trauma to the teeth or tongue - Waking during anesthesia (rare) - Allergy to the drugs - Malignant hyperthermia (fast rise in body temperature and severe muscle contractions) Tell your provider: - If you could be pregnant - What medicines you are taking, even drugs or herbs you bought without a prescription During the days before the surgery: - An anesthesiologist will take a complete medical history to determine the type and amount of the anesthesia you need. This includes asking you about any allergies, health conditions, medicines, and history of anesthesia. - Several days to a week before surgery, you may be asked to stop taking blood thinning drugs, such as aspirin, ibuprofen (Advil, Motrin), and warfarin (Coumadin, Jantoven). - Ask your provider which drugs you should still take on the day of your surgery. - Always try to stop smoking. Your doctor can help. On the day of your surgery: - You will likely be asked not to drink or eat anything after midnight the night before the surgery. This is to prevent you from vomiting while you are under the effect of the anesthesia. Vomiting can cause food in the stomach to be inhaled into the lungs. This can lead to breathing problems. - Take the drugs that your provider told you to take with a small sip of water. - Arrive at the hospital on time. You will wake up tired and groggy in the recovery or operating room. You may also feel sick to your stomach, and have a dry mouth, sore throat, or feel cold or restless until the effect of the anesthesia wears off. Your nurse will monitor these side effects, which will wear off, but it may take a few hours. Sometimes, nausea and vomiting can be treated with other medicines. Follow your surgeon's instructions while you recover and care for your surgical wound. General anesthesia is generally safe because of modern equipment, medicines, and safety standards. Most people recover completely and do not have any complications. Updated by: Mary C. Mancini, MD, PhD, Department of Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007410.htm"
+  ],
+  [
+    "General paresis: General paresis is a problem with mental function due to damage to the brain from untreated syphilis. General paresis is one form of neurosyphilis. It usually occurs in people who have had untreated syphilis for many years. Syphilis is bacterial infection that is most often spread through sexual or nonsexual contact. Today, neurosyphilis is very rare. With neurosyphilis, the syphilis bacteria attack the brain and nervous system. General paresis often begins about 10 to 30 years after the syphilis infection. Syphilis infection can damage many different nerves of the brain. With general paresis, symptoms are usually those of dementia and may include: - Memory problems - Language problems, such as saying or writing words incorrectly - Decreased mental function, such as problems thinking and with judgment - Mood changes - Personality changes, such as delusions, hallucinations, irritability, inappropriate behavior The doctor will perform a physical exam and ask about your medical history. During the exam, the doctor may check your nervous system function. Mental function tests will also be done. Tests that may be ordered to detect syphilis in the body include: - CSF-VDRL - FTA-ABS Tests of the nervous system may include: - Head CT scan and MRI - Nerve conduction tests The goals of treatment are to cure the infection and slow the disorder from getting worse. The doctor will prescribe penicillin or other antibiotics to treat the infection. Treatment will likely continue until the infection has completely cleared. Treating the infection will reduce new nerve damage. But it will not cure damage that has already occurred. Treatment of symptoms is needed for existing nervous system damage. Without treatment, a person can become disabled. People with late syphilis infections are more likely to get other infections and diseases. Complications of this condition include: - Inability to communicate or interact with others - Injury due to seizures or falls - Inability to care for yourself Call your health care provider if you know you have been exposed to syphilis or another sexually transmitted infection in the past, and have not been treated. Call your provider if you have nervous system problems (such as trouble thinking), especially if you know you have been infected with syphilis. Go to the emergency room or call the local emergency number (such as 911) if you have seizures. Treating primary syphilis and secondary syphilis infections will prevent general paresis. Practicing safer sex, such as limiting partners and using protection, may reduce the risk of getting infected with syphilis. Avoid direct skin contact with people who have secondary syphilis. Updated by: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000748.htm"
+  ],
+  [
+    "General anesthesia (Why the Procedure is Performed): General anesthesia is a safe way to stay asleep and pain-free during procedures that would: - Be too painful - Take a long time - Affect your ability to breathe - Make you uncomfortable - Cause too much anxiety You may also be able to have conscious sedation for your procedure. Sometimes, though, it is not enough to make you comfortable. Children may need general anesthesia for a medical or dental procedure to handle any pain or anxiety they may feel.",
+    "https://medlineplus.gov/ency/article/007410.htm"
+  ],
+  [
+    "General anesthesia (Risks): General anesthesia is usually safe for healthy people. You may have a higher risk of problems with general anesthesia if you: - Abuse alcohol or medicines - Have allergies or a family history of being allergic to medicines - Have heart, lung, or kidney problems - Smoke Ask your doctor about these complications: - Death (rare) - Harm to your vocal cords - Heart attack - Lung infection - Mental confusion (temporary) - Stroke - Trauma to the teeth or tongue - Waking during anesthesia (rare) - Allergy to the drugs - Malignant hyperthermia (fast rise in body temperature and severe muscle contractions)",
+    "https://medlineplus.gov/ency/article/007410.htm"
+  ],
+  [
+    "General anesthesia (Outlook (Prognosis)): General anesthesia is generally safe because of modern equipment, medicines, and safety standards. Most people recover completely and do not have any complications.",
+    "https://medlineplus.gov/ency/article/007410.htm"
+  ],
+  [
+    "General paresis (Summary): General paresis is a problem with mental function due to damage to the brain from untreated syphilis.",
+    "https://medlineplus.gov/ency/article/000748.htm"
+  ],
+  [
+    "General paresis (Prevention): Treating primary syphilis and secondary syphilis infections will prevent general paresis. Practicing safer sex, such as limiting partners and using protection, may reduce the risk of getting infected with syphilis. Avoid direct skin contact with people who have secondary syphilis.",
+    "https://medlineplus.gov/ency/article/000748.htm"
+  ],
+  [
+    "Etiology: Etiology describes the cause or causes of a disease. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002356.htm"
+  ],
+  [
+    "What is Hantavirus?: Hantavirus is a life-threatening viral infection spread to humans by rodents. It has symptoms similar to influenza.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/001382.htm"
+  ],
+  [
+    "General anesthesia: General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery. After you receive these medicines, you will not be aware of what is happening around you. Most times, a doctor called an anesthesiologist will give you the anesthesia. Sometimes, a certified and registered nurse anesthetist will take care of you. The medicine is given into your vein. You may be asked to breathe in (inhale) a special gas through a mask. Once you are asleep, the doctor may insert a tube into your windpipe (trachea) to help you breathe and protect your lungs. You will be watched very closely while you are asleep. Your blood pressure, pulse, and breathing will be monitored. The health care provider taking care of you can change how deeply asleep you are during the surgery. You will not move, feel any pain, or have any memory of the procedure because of this medicine. General anesthesia is a safe way to stay asleep and pain-free during procedures that would: - Be too painful - Take a long time - Affect your ability to breathe - Make you uncomfortable - Cause too much anxiety You may also be able to have conscious sedation for your procedure. Sometimes, though, it is not enough to make you comfortable. Children may need general anesthesia for a medical or dental procedure to handle any pain or anxiety they may feel. General anesthesia is usually safe for healthy people. You may have a higher risk of problems with general anesthesia if you: - Abuse alcohol or medicines - Have allergies or a family history of being allergic to medicines - Have heart, lung, or kidney problems - Smoke Ask your doctor about these complications: - Death (rare) - Harm to your vocal cords - Heart attack - Lung infection - Mental confusion (temporary) - Stroke - Trauma to the teeth or tongue - Waking during anesthesia (rare) - Allergy to the drugs - Malignant hyperthermia (fast rise in body temperature and severe muscle contractions) Tell your provider: - If you could be pregnant - What medicines you are taking, even drugs or herbs you bought without a prescription During the days before the surgery: - An anesthesiologist will take a complete medical history to determine the type and amount of the anesthesia you need. This includes asking you about any allergies, health conditions, medicines, and history of anesthesia. - Several days to a week before surgery, you may be asked to stop taking blood thinning drugs, such as aspirin, ibuprofen (Advil, Motrin), and warfarin (Coumadin, Jantoven). - Ask your provider which drugs you should still take on the day of your surgery. - Always try to stop smoking. Your doctor can help. On the day of your surgery: - You will likely be asked not to drink or eat anything after midnight the night before the surgery. This is to prevent you from vomiting while you are under the effect of the anesthesia. Vomiting can cause food in the stomach to be inhaled into the lungs. This can lead to breathing problems. - Take the drugs that your provider told you to take with a small sip of water. - Arrive at the hospital on time. You will wake up tired and groggy in the recovery or operating room. You may also feel sick to your stomach, and have a dry mouth, sore throat, or feel cold or restless until the effect of the anesthesia wears off. Your nurse will monitor these side effects, which will wear off, but it may take a few hours. Sometimes, nausea and vomiting can be treated with other medicines. Follow your surgeon's instructions while you recover and care for your surgical wound. General anesthesia is generally safe because of modern equipment, medicines, and safety standards. Most people recover completely and do not have any complications. Updated by: Mary C. Mancini, MD, PhD, Department of Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007410.htm"
+  ],
+  [
+    "General anesthesia (Risks): General anesthesia is usually safe for healthy people. You may have a higher risk of problems with general anesthesia if you: - Abuse alcohol or medicines - Have allergies or a family history of being allergic to medicines - Have heart, lung, or kidney problems - Smoke Ask your doctor about these complications: - Death (rare) - Harm to your vocal cords - Heart attack - Lung infection - Mental confusion (temporary) - Stroke - Trauma to the teeth or tongue - Waking during anesthesia (rare) - Allergy to the drugs - Malignant hyperthermia (fast rise in body temperature and severe muscle contractions)",
+    "https://medlineplus.gov/ency/article/007410.htm"
+  ],
+  [
+    "General anesthesia (Why the Procedure is Performed): General anesthesia is a safe way to stay asleep and pain-free during procedures that would: - Be too painful - Take a long time - Affect your ability to breathe - Make you uncomfortable - Cause too much anxiety You may also be able to have conscious sedation for your procedure. Sometimes, though, it is not enough to make you comfortable. Children may need general anesthesia for a medical or dental procedure to handle any pain or anxiety they may feel.",
+    "https://medlineplus.gov/ency/article/007410.htm"
+  ],
+  [
+    "General paresis: General paresis is a problem with mental function due to damage to the brain from untreated syphilis. General paresis is one form of neurosyphilis. It usually occurs in people who have had untreated syphilis for many years. Syphilis is bacterial infection that is most often spread through sexual or nonsexual contact. Today, neurosyphilis is very rare. With neurosyphilis, the syphilis bacteria attack the brain and nervous system. General paresis often begins about 10 to 30 years after the syphilis infection. Syphilis infection can damage many different nerves of the brain. With general paresis, symptoms are usually those of dementia and may include: - Memory problems - Language problems, such as saying or writing words incorrectly - Decreased mental function, such as problems thinking and with judgment - Mood changes - Personality changes, such as delusions, hallucinations, irritability, inappropriate behavior The doctor will perform a physical exam and ask about your medical history. During the exam, the doctor may check your nervous system function. Mental function tests will also be done. Tests that may be ordered to detect syphilis in the body include: - CSF-VDRL - FTA-ABS Tests of the nervous system may include: - Head CT scan and MRI - Nerve conduction tests The goals of treatment are to cure the infection and slow the disorder from getting worse. The doctor will prescribe penicillin or other antibiotics to treat the infection. Treatment will likely continue until the infection has completely cleared. Treating the infection will reduce new nerve damage. But it will not cure damage that has already occurred. Treatment of symptoms is needed for existing nervous system damage. Without treatment, a person can become disabled. People with late syphilis infections are more likely to get other infections and diseases. Complications of this condition include: - Inability to communicate or interact with others - Injury due to seizures or falls - Inability to care for yourself Call your health care provider if you know you have been exposed to syphilis or another sexually transmitted infection in the past, and have not been treated. Call your provider if you have nervous system problems (such as trouble thinking), especially if you know you have been infected with syphilis. Go to the emergency room or call the local emergency number (such as 911) if you have seizures. Treating primary syphilis and secondary syphilis infections will prevent general paresis. Practicing safer sex, such as limiting partners and using protection, may reduce the risk of getting infected with syphilis. Avoid direct skin contact with people who have secondary syphilis. Updated by: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000748.htm"
+  ],
+  [
+    "General anesthesia (Outlook (Prognosis)): General anesthesia is generally safe because of modern equipment, medicines, and safety standards. Most people recover completely and do not have any complications.",
+    "https://medlineplus.gov/ency/article/007410.htm"
+  ],
+  [
+    "General paresis (Summary): General paresis is a problem with mental function due to damage to the brain from untreated syphilis.",
+    "https://medlineplus.gov/ency/article/000748.htm"
+  ],
+  [
+    "General paresis (Prevention): Treating primary syphilis and secondary syphilis infections will prevent general paresis. Practicing safer sex, such as limiting partners and using protection, may reduce the risk of getting infected with syphilis. Avoid direct skin contact with people who have secondary syphilis.",
+    "https://medlineplus.gov/ency/article/000748.htm"
+  ],
+  [
+    "General anesthesia: General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery. After you receive these medicines, you will not be aware of what is happening around you. Most times, a doctor called an anesthesiologist will give you the anesthesia. Sometimes, a certified and registered nurse anesthetist will take care of you. The medicine is given into your vein. You may be asked to breathe in (inhale) a special gas through a mask. Once you are asleep, the doctor may insert a tube into your windpipe (trachea) to help you breathe and protect your lungs. You will be watched very closely while you are asleep. Your blood pressure, pulse, and breathing will be monitored. The health care provider taking care of you can change how deeply asleep you are during the surgery. You will not move, feel any pain, or have any memory of the procedure because of this medicine. General anesthesia is a safe way to stay asleep and pain-free during procedures that would: - Be too painful - Take a long time - Affect your ability to breathe - Make you uncomfortable - Cause too much anxiety You may also be able to have conscious sedation for your procedure. Sometimes, though, it is not enough to make you comfortable. Children may need general anesthesia for a medical or dental procedure to handle any pain or anxiety they may feel. General anesthesia is usually safe for healthy people. You may have a higher risk of problems with general anesthesia if you: - Abuse alcohol or medicines - Have allergies or a family history of being allergic to medicines - Have heart, lung, or kidney problems - Smoke Ask your doctor about these complications: - Death (rare) - Harm to your vocal cords - Heart attack - Lung infection - Mental confusion (temporary) - Stroke - Trauma to the teeth or tongue - Waking during anesthesia (rare) - Allergy to the drugs - Malignant hyperthermia (fast rise in body temperature and severe muscle contractions) Tell your provider: - If you could be pregnant - What medicines you are taking, even drugs or herbs you bought without a prescription During the days before the surgery: - An anesthesiologist will take a complete medical history to determine the type and amount of the anesthesia you need. This includes asking you about any allergies, health conditions, medicines, and history of anesthesia. - Several days to a week before surgery, you may be asked to stop taking blood thinning drugs, such as aspirin, ibuprofen (Advil, Motrin), and warfarin (Coumadin, Jantoven). - Ask your provider which drugs you should still take on the day of your surgery. - Always try to stop smoking. Your doctor can help. On the day of your surgery: - You will likely be asked not to drink or eat anything after midnight the night before the surgery. This is to prevent you from vomiting while you are under the effect of the anesthesia. Vomiting can cause food in the stomach to be inhaled into the lungs. This can lead to breathing problems. - Take the drugs that your provider told you to take with a small sip of water. - Arrive at the hospital on time. You will wake up tired and groggy in the recovery or operating room. You may also feel sick to your stomach, and have a dry mouth, sore throat, or feel cold or restless until the effect of the anesthesia wears off. Your nurse will monitor these side effects, which will wear off, but it may take a few hours. Sometimes, nausea and vomiting can be treated with other medicines. Follow your surgeon's instructions while you recover and care for your surgical wound. General anesthesia is generally safe because of modern equipment, medicines, and safety standards. Most people recover completely and do not have any complications. Updated by: Mary C. Mancini, MD, PhD, Department of Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007410.htm"
+  ],
+  [
+    "What is Appendicitis?: Appendicitis is swelling (inflammation) of the appendix. The appendix is a small pouch attached to the large intestine.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000256.htm"
+  ],
+  [
+    "General anesthesia (Risks): General anesthesia is usually safe for healthy people. You may have a higher risk of problems with general anesthesia if you: - Abuse alcohol or medicines - Have allergies or a family history of being allergic to medicines - Have heart, lung, or kidney problems - Smoke Ask your doctor about these complications: - Death (rare) - Harm to your vocal cords - Heart attack - Lung infection - Mental confusion (temporary) - Stroke - Trauma to the teeth or tongue - Waking during anesthesia (rare) - Allergy to the drugs - Malignant hyperthermia (fast rise in body temperature and severe muscle contractions)",
+    "https://medlineplus.gov/ency/article/007410.htm"
+  ],
+  [
+    "What is Appendicitis?: The appendix is a small, tube-like organ attached to the first part of the large intestine. It is located in the lower right part of the abdomen. It has no known function. A blockage inside of the appendix causes appendicitis. The blockage leads to increased pressure, problems with blood flow, and inflammation. If the blockage is not treated, the appendix can burst and spread infection into the abdomen. This causes a condition called peritonitis. The main symptom is pain in the abdomen, often on the right side. It is usually sudden and gets worse over time. Other symptoms may include - Swelling in the abdomen - Loss of appetite - Nausea and vomiting - Constipation or diarrhea - Inability to pass gas - Low fever Not everyone with appendicitis has all these symptoms. Appendicitis is a medical emergency. Treatment almost always involves removing the appendix. Anyone can get appendicitis, but it is more common among people 10 to 30 years old. NIH: National Institute of Diabetes and Digestive and Kidney Diseases",
+    "https://www.nlm.nih.gov/medlineplus/appendicitis.html"
+  ],
+  [
+    "General anesthesia (Why the Procedure is Performed): General anesthesia is a safe way to stay asleep and pain-free during procedures that would: - Be too painful - Take a long time - Affect your ability to breathe - Make you uncomfortable - Cause too much anxiety You may also be able to have conscious sedation for your procedure. Sometimes, though, it is not enough to make you comfortable. Children may need general anesthesia for a medical or dental procedure to handle any pain or anxiety they may feel.",
+    "https://medlineplus.gov/ency/article/007410.htm"
+  ],
+  [
+    "General paresis: General paresis is a problem with mental function due to damage to the brain from untreated syphilis. General paresis is one form of neurosyphilis. It usually occurs in people who have had untreated syphilis for many years. Syphilis is bacterial infection that is most often spread through sexual or nonsexual contact. Today, neurosyphilis is very rare. With neurosyphilis, the syphilis bacteria attack the brain and nervous system. General paresis often begins about 10 to 30 years after the syphilis infection. Syphilis infection can damage many different nerves of the brain. With general paresis, symptoms are usually those of dementia and may include: - Memory problems - Language problems, such as saying or writing words incorrectly - Decreased mental function, such as problems thinking and with judgment - Mood changes - Personality changes, such as delusions, hallucinations, irritability, inappropriate behavior The doctor will perform a physical exam and ask about your medical history. During the exam, the doctor may check your nervous system function. Mental function tests will also be done. Tests that may be ordered to detect syphilis in the body include: - CSF-VDRL - FTA-ABS Tests of the nervous system may include: - Head CT scan and MRI - Nerve conduction tests The goals of treatment are to cure the infection and slow the disorder from getting worse. The doctor will prescribe penicillin or other antibiotics to treat the infection. Treatment will likely continue until the infection has completely cleared. Treating the infection will reduce new nerve damage. But it will not cure damage that has already occurred. Treatment of symptoms is needed for existing nervous system damage. Without treatment, a person can become disabled. People with late syphilis infections are more likely to get other infections and diseases. Complications of this condition include: - Inability to communicate or interact with others - Injury due to seizures or falls - Inability to care for yourself Call your health care provider if you know you have been exposed to syphilis or another sexually transmitted infection in the past, and have not been treated. Call your provider if you have nervous system problems (such as trouble thinking), especially if you know you have been infected with syphilis. Go to the emergency room or call the local emergency number (such as 911) if you have seizures. Treating primary syphilis and secondary syphilis infections will prevent general paresis. Practicing safer sex, such as limiting partners and using protection, may reduce the risk of getting infected with syphilis. Avoid direct skin contact with people who have secondary syphilis. Updated by: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000748.htm"
+  ],
+  [
+    "General anesthesia (Outlook (Prognosis)): General anesthesia is generally safe because of modern equipment, medicines, and safety standards. Most people recover completely and do not have any complications.",
+    "https://medlineplus.gov/ency/article/007410.htm"
+  ],
+  [
+    "General paresis (Summary): General paresis is a problem with mental function due to damage to the brain from untreated syphilis.",
+    "https://medlineplus.gov/ency/article/000748.htm"
+  ],
+  [
+    "General paresis (Prevention): Treating primary syphilis and secondary syphilis infections will prevent general paresis. Practicing safer sex, such as limiting partners and using protection, may reduce the risk of getting infected with syphilis. Avoid direct skin contact with people who have secondary syphilis.",
+    "https://medlineplus.gov/ency/article/000748.htm"
+  ],
+  [
+    "General paresis (Symptoms): Syphilis infection can damage many different nerves of the brain. With general paresis, symptoms are usually those of dementia and may include: - Memory problems - Language problems, such as saying or writing words incorrectly - Decreased mental function, such as problems thinking and with judgment - Mood changes - Personality changes, such as delusions, hallucinations, irritability, inappropriate behavior",
+    "https://medlineplus.gov/ency/article/000748.htm"
+  ],
+  [
+    "myasthenia gravis (Inheritance Pattern): In most cases, myasthenia gravis is not inherited and occurs in people with no history of the disorder in their family. About 3 to 5 percent of affected individuals have other family members with myasthenia gravis or other autoimmune disorders, but the inheritance pattern is unknown.",
+    "https://ghr.nlm.nih.gov/condition/myasthenia-gravis"
+  ],
+  [
+    "Who should get Medroxyprogesterone and why is it prescribed?: Medroxyprogesterone is used to treat abnormal menstruation (periods) or irregular vaginal bleeding. Medroxyprogesterone is also used to bring on a normal menstrual cycle in women who menstruated normally in the past but have not menstruated for at least 6 months and who are not pregnant or undergoing menopause (change of life). Medroxyprogesterone is also used to prevent overgrowth of the lining of the uterus (womb) and may decrease the risk of cancer of the uterus in patients who are taking estrogen. Medroxyprogesterone is in a class of medications called progestins. It works by stopping the growth of the lining of the uterus and by causing the uterus to produce certain hormones.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682470.html"
+  ],
+  [
+    "myasthenia gravis (Genetic Changes): Researchers believe that variations in particular genes may increase the risk of myasthenia gravis, but the identity of these genes is unknown. Many factors likely contribute to the risk of developing this complex disorder. Myasthenia gravis is an autoimmune disorder, which occurs when the immune system malfunctions and attacks the body's own tissues and organs. In myasthenia gravis, the immune system disrupts the transmission of nerve impulses to muscles by producing a protein called an antibody that attaches (binds) to proteins important for nerve signal transmission. Antibodies normally bind to specific foreign particles and germs, marking them for destruction, but the antibody in myasthenia gravis attacks a normal human protein. In most affected individuals, the antibody targets a protein called acetylcholine receptor (AChR); in others, the antibodies attack a related protein called muscle-specific kinase (MuSK). In both cases, the abnormal antibodies lead to a reduction of available AChR. The AChR protein is critical for signaling between nerve and muscle cells, which is necessary for movement. In myasthenia gravis, because of the abnormal immune response, less AChR is present, which reduces signaling between nerve and muscle cells. These signaling abnormalities lead to decreased muscle movement and the muscle weakness characteristic of this condition. It is unclear why the immune system malfunctions in people with myasthenia gravis. About 75 percent of affected individuals have an abnormally large and overactive thymus, which is a gland located behind the breastbone that plays an important role in the immune system. The thymus sometimes develops tumors (thymomas) that are usually noncancerous (benign). However, the relationship between the thymus problems and the specific immune system malfunction that occurs in myasthenia gravis is not well understood. People with myasthenia gravis are at increased risk of developing other autoimmune disorders, including autoimmune thyroid disease and systemic lupus erythematosus. Gene variations that affect immune system function likely affect the risk of developing myasthenia gravis and other autoimmune disorders. Some families are affected by an inherited disorder with symptoms similar to those of myasthenia gravis, but in which antibodies to the AChR or MuSK proteins are not present. This condition, which is not an autoimmune disorder, is called congenital myasthenic syndrome.",
+    "https://ghr.nlm.nih.gov/condition/myasthenia-gravis"
+  ],
+  [
+    "myasthenia gravis: Myasthenia gravis is a disorder that causes weakness of the skeletal muscles, which are muscles that the body uses for movement. The weakness most often starts in the muscles around the eyes, causing drooping of the eyelids (ptosis) and difficulty coordinating eye movements, which results in blurred or double vision. In a form of the disorder called ocular myasthenia, the weakness remains confined to the eye muscles. In most people with myasthenia gravis, however, additional muscles in the face and neck are affected. Affected individuals may have unusual facial expressions, difficulty holding up the head, speech impairment (dysarthria), and chewing and swallowing problems (dysphagia) that may lead to choking, gagging, or drooling. Other muscles in the body are also affected in some people with myasthenia gravis. The muscles of the arms and legs may be involved, causing affected individuals to have changes in their gait or trouble with lifting objects, rising from a seated position, or climbing stairs. The muscle weakness tends to fluctuate over time; it typically worsens with activity and improves with rest. Weakness of the muscles in the chest wall and the muscle that separates the abdomen from the chest cavity (the diaphragm) can cause breathing problems in some people with myasthenia gravis. About 10 percent of people with this disorder experience a potentially life-threatening complication in which these respiratory muscles weaken to the point that breathing is dangerously impaired, and the affected individual requires ventilation assistance. This respiratory failure, called a myasthenic crisis, may be triggered by stresses such as infections or reactions to medications. People can develop myasthenia gravis at any age. For reasons that are unknown, it is most commonly diagnosed in women younger than age 40 and men older than age 60. It is uncommon in children, but some infants born to women with myasthenia gravis show signs and symptoms of the disorder for the first few days or weeks of life. This temporary occurrence of symptoms is called transient neonatal myasthenia gravis. Myasthenia gravis affects about 20 per 100,000 people worldwide. The prevalence has been increasing in recent decades, which likely results from earlier diagnosis and better treatments leading to longer lifespans for affected individuals. Researchers believe that variations in particular genes may increase the risk of myasthenia gravis, but the identity of these genes is unknown. Many factors likely contribute to the risk of developing this complex disorder. Myasthenia gravis is an autoimmune disorder, which occurs when the immune system malfunctions and attacks the body's own tissues and organs. In myasthenia gravis, the immune system disrupts the transmission of nerve impulses to muscles by producing a protein called an antibody that attaches (binds) to proteins important for nerve signal transmission. Antibodies normally bind to specific foreign particles and germs, marking them for destruction, but the antibody in myasthenia gravis attacks a normal human protein. In most affected individuals, the antibody targets a protein called acetylcholine receptor (AChR); in others, the antibodies attack a related protein called muscle-specific kinase (MuSK). In both cases, the abnormal antibodies lead to a reduction of available AChR. The AChR protein is critical for signaling between nerve and muscle cells, which is necessary for movement. In myasthenia gravis, because of the abnormal immune response, less AChR is present, which reduces signaling between nerve and muscle cells. These signaling abnormalities lead to decreased muscle movement and the muscle weakness characteristic of this condition. It is unclear why the immune system malfunctions in people with myasthenia gravis. About 75 percent of affected individuals have an abnormally large and overactive thymus, which is a gland located behind the breastbone that plays an important role in the immune system. The thymus sometimes develops tumors (thymomas) that are usually noncancerous (benign). However, the relationship between the thymus problems and the specific immune system malfunction that occurs in myasthenia gravis is not well understood. People with myasthenia gravis are at increased risk of developing other autoimmune disorders, including autoimmune thyroid disease and systemic lupus erythematosus. Gene variations that affect immune system function likely affect the risk of developing myasthenia gravis and other autoimmune disorders. Some families are affected by an inherited disorder with symptoms similar to those of myasthenia gravis, but in which antibodies to the AChR or MuSK proteins are not present. This condition, which is not an autoimmune disorder, is called congenital myasthenic syndrome. In most cases, myasthenia gravis is not inherited and occurs in people with no history of the disorder in their family. About 3 to 5 percent of affected individuals have other family members with myasthenia gravis or other autoimmune disorders, but the inheritance pattern is unknown. Angelini C. Diagnosis and management of autoimmune myasthenia gravis. Clin Drug Investig. 2011;31(1):1-14. doi: 10.2165/11584740-000000000-00000. Review.",
+    "https://ghr.nlm.nih.gov/condition/myasthenia-gravis"
+  ],
+  [
+    "myasthenia gravis (Frequency): Myasthenia gravis affects about 20 per 100,000 people worldwide. The prevalence has been increasing in recent decades, which likely results from earlier diagnosis and better treatments leading to longer lifespans for affected individuals.",
+    "https://ghr.nlm.nih.gov/condition/myasthenia-gravis"
+  ],
+  [
+    "myasthenia gravis (Sources for This Page): Angelini C. Diagnosis and management of autoimmune myasthenia gravis. Clin Drug Investig. 2011;31(1):1-14. doi: 10.2165/11584740-000000000-00000. Review.",
+    "https://ghr.nlm.nih.gov/condition/myasthenia-gravis"
+  ],
+  [
+    "Myasthenia gravis congenital (Treatment): The resources below provide information about treatment options for this condition. If you have questions about which treatment is right for you, talk to your healthcare professional. Management Guidelines Project OrphanAnesthesia is a project whose aim is to create peer-reviewed, readily accessible guidelines for patients with rare diseases and for the anesthesiologists caring for them. The project is a collaborative effort of the German Society of Anesthesiology and Intensive Care, Orphanet, the European Society of Pediatric Anesthesia, anesthetists and rare disease experts with the aim to contribute to patient safety.",
+    "https://rarediseases.info.nih.gov/diseases/98/myasthenia-gravis-congenital"
+  ],
+  [
+    "Medicines and medication management (What Are Medicines? What Are Drugs?): Medicines, often referred to as drugs, can be:- Prescriptions. What you can get only with a doctor's order (for example, pills to lower your cholesterol or an asthma inhaler) - Over-the-counter pills, liquids, or creams. What you buy without a prescription (for example, pills for headaches or chew tablets for heartburn) - Vitamins, eye drops, or dietary supplements.Make sure your doctor knows about ALL the medicines you take. This includes those prescribed by other doctors, as well as vitamins, supplements, herbal remedies, and over-the-counter drugs you use every now and then.",
+    "https://www.nia.nih.gov/health/topics/medicines-and-medication-management"
+  ],
+  [
+    "Gastric bypass surgery - discharge (Drugs): You may need to take some medicines when you go home. - You may need to give yourself shots underneath the skin of a blood-thinning drug for 2 or more weeks. Your provider will show you how. - You may need to take medicine to prevent gallstones. - You will need to take certain vitamins that your body may not absorb well from your food. Two of these are vitamin B-12 and vitamin D. - You may need to take calcium and iron supplements as well. Aspirin, ibuprofen (Advil, Motrin), and some other drugs may harm the lining of your stomach or even cause ulcers. Talk with your provider before you take these drugs.",
+    "https://medlineplus.gov/ency/patientinstructions/000172.htm"
+  ],
+  [
+    "Hydrocodone: Hydrocodone may be habit-forming. Do not take more of it, take it more often, or take it in a different way than directed by your doctor. Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, has overused prescription medications, or if you have or have ever had depression or another mental illness. There is a greater risk that you will overuse hydrocodone if you have or have ever had any of these conditions. Do not allow anyone else to take your medication. Hydrocodone may harm or cause death to other people who take your medication, especially children. Keep hydrocodone in a safe place so that no one else can take it accidentally or on purpose. Be especially careful to keep hydrocodone out of the reach of children. Keep track of how many capsules or tablets are left so you will know if any medication is missing. Hydrocodone may cause slowed or stopped breathing, especially during the first 24 to 72 hours of your treatment and any time your dose is increased. Your doctor will monitor you carefully during your treatment. Your doctor will adjust your dose to control your pain and decrease the risk that you will experience serious breathing problems. Tell your doctor if you have or have ever had slowed breathing or asthma. Your doctor will probably tell you not to take hydrocodone. Also tell your doctor if you have or have ever had lung disease such as chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways), a head injury, or any condition that increases the amount of pressure in your brain. The risk that you will develop breathing problems may be higher if you are an older adult or are weakened or malnourished due to disease. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment: slowed breathing, long pauses between breaths, or shortness of breath. Taking certain medications or stopping treatment with certain other medications while you are taking hydrocodone may increase the risk that you will experience breathing problems, sedation, coma, or other serious, life-threatening side effects. Tell your doctor if you are taking, plan to take or plan to stop taking any of the following medications: certain antifungal medications including itraconazole (Onmel, Sporanox), ketoconazole (Extina, Nizoral, Xolegel), and voriconazole (Vfend); benzodiazepines such as alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Diastat, Valium), estazolam, flurazepam, lorazepam (Ativan), oxazepam, temazepam (Restoril), and triazolam (Halcion); carbamazepine (Carbatrol, Epitol, Equetro, Tegretol, others); cimetidine; clarithromycin (Biaxin, in Prevpac); erythromycin (E.E.S., Erythromycin, others); other narcotic pain medications; medications for mental illness or nausea; certain medications for human immunodeficiency virus (HIV) including ritonavir (Norvir, in Kaletra, in Viekira Pak); muscle relaxants; phenytoin (Dilantin, Phenytek); rifampin (Rifadin, Rimactane, in Rifamate, in Rifater); sedatives; sleeping pills; or tranquilizers. If you take hydrocodone with any of these medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own. Drinking alcohol, taking prescription or nonprescription medications that contain alcohol, or using street drugs during your treatment with hydrocodone increases the risk that you will experience these serious, life-threatening side effects. Do not drink alcohol, take prescription or nonprescription medications that contain alcohol, or use street drugs during your treatment. Swallow hydrocodone extended-release capsules or extended-release tablets whole; do not chew, break, divide, crush, or dissolve them. Hydrocodone extended-release capsules and extended-release tablets are difficult to crush, break or dissolve. If you swallow broken, chewed, or crushed extended-release capsules or extended-release tablets, you may receive too much hydrocodone at once. This may cause serious problems, including overdose and death. Tell your doctor if you are pregnant or plan to become pregnant. If you take hydrocodone regularly during your pregnancy, your baby may experience life-threatening withdrawal symptoms after birth. Tell your baby's doctor right away if your baby experiences any of the following symptoms: irritability, hyperactivity, abnormal sleep, high-pitched cry, uncontrollable shaking of a part of the body, vomiting, diarrhea, or failure to gain weight. Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with hydrocodone and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide. Talk to your doctor about the risks of taking hydrocodone. Hydrocodone is used to relieve severe pain. Hydrocodone is only used to treat people who are expected to need medication to relieve severe pain around-the-clock for a long time and who cannot be treated with other medications or treatments. Hydrocodone extended-release (long-acting) capsules or extended-release tablets should not be used to treat pain that can be controlled by medication that is taken as needed. Hydrocodone is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain. This monograph only includes information about the use of hydrocodone alone. If you are taking a hydrocodone combination product, be sure to read information about all the ingredients in the hydrocodone-combination monograph and ask your doctor or pharmacist for more information. Hydrocodone comes as an extended-release (long-acting) capsule and an extended-release (long-acting) tablet to take by mouth. The extended-release capsule is usually taken once every 12 hours. The extended-release tablet is usually taken once daily. Take hydrocodone at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take hydrocodone exactly as directed by your doctor. Swallow the extended-release capsules or extended-release tablets one at a time with plenty of water. Swallow each capsule or tablet as soon as you put it in your mouth. Do not presoak, wet, or lick the extended-release tablets before you put them in your mouth. Your doctor will probably start you on a low dose of hydrocodone and may gradually increase your dose, not more than once every 3 to 7 days if needed to control your pain. After your take hydrocodone for a period of time, your body may become used to the medication. If this happens, your doctor may increase your dose of hydrocodone or may prescribe a different medication to help control your pain. Talk to your doctor about how you are feeling during your treatment with hydrocodone. Do not stop taking hydrocodone without talking to your doctor. If you suddenly stop taking hydrocodone, you may experience withdrawal symptoms such as restlessness, teary eyes, runny nose, yawning, sweating, chills, hair standing on end, muscle pain, widened pupils (black circles in the middle of the eyes), irritability, anxiety, back or joint pain, weakness, stomach cramps, difficulty falling asleep or staying asleep, nausea, loss of appetite, vomiting, diarrhea, fast breathing, or fast heartbeat. Your doctor will probably decrease your dose gradually. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before taking hydrocodone, - tell your doctor and pharmacist if you are allergic to hydrocodone, any other medications, or any of the ingredients in hydrocodone extended-release capsules or extended-release tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following medications: antihistamines (found in cough and cold medications); amiodarone (Cordarone, Nexterone, Pacerone); azithromycin (Zithromax, Zmax); butorphanol; chlorpromazine; citalopram (Celexa); cyclobenzaprine (Amrix); dextromethorphan (found in many cough medications; in Nuedexta); dronedarone (Multaq); haloperidol (Haldol); laxatives such as lactulose (Cholac, Constulose, Enulose, others); levofloxacin (Levaquin); lithium (Lithobid); medications for irritable bowel disease, Parkinson's disease, ulcers, and urinary problems; medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, in Treximet), and zolmitriptan (Zomig); mirtazapine (Remeron); nalbuphine; pentazocine (Talwin); 5HT3 serotonin blockers such as alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran, Zuplenz), or palonosetron (Aloxi); selective serotonin-reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Prozac, Pexeva), and sertraline (Zoloft); serotonin and norepinephrine reuptake inhibitors such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor); trazodone (Oleptro); or tricyclic antidepressants ('mood elevators') such as amitriptyline, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil). Also tell your doctor or pharmacist if you are taking or receiving the following medications or have stopped taking them within the past two weeks: isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate). Many other medications may also interact with hydrocodone, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor what herbal products you are taking, especially St. John's wort and tryptophan. - tell your doctor if you have any of the conditions mentioned in the IMPORTANT WARNING section, a blockage or narrowing of your stomach or intestines, or paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you not to take hydrocodone. - tell your doctor if you have or have ever had low blood pressure, difficulty urinating, seizures, or thyroid, gall bladder, pancreas, liver, or kidney disease. If you are taking the extended-release tablets, also tell your doctor if you have or have ever had difficulty swallowing, colon cancer (cancer that begins in the large intestine), esophageal cancer (cancer that begins in the tube that connects the mouth and stomach), heart failure (HF; condition in which the heart cannot pump enough blood to other parts of the body), or heart rhythm problems such long QT syndrome (condition that increases the risk of developing an irregular heartbeat that may cause fainting or sudden death). - tell your doctor if you are breastfeeding. - you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of taking hydrocodone. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking hydrocodone. - you should know that hydrocodone may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. - you should know that hydrocodone may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking hydrocodone. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up. - you should know that hydrocodone may cause constipation. Talk to your doctor about changing your diet and using other medications to treat or prevent constipation. Unless your doctor tells you otherwise, continue your normal diet. Skip the missed dose and continue your regular dosing schedule. Do not take more than one dose of hydrocodone extended-release capsules in 12 hours or extended-release tablets in 24 hours. Hydrocodone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - stomach pain - dry mouth - tiredness - headache - back pain - muscle tightening - difficult, frequent, or painful urination - ringing in the ears - difficulty falling asleep or staying asleep - foot, leg, or ankle swelling - uncontrollable shaking of a part of the body Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING or SPECIAL PRECAUTIONS sections, call your doctor immediately or get emergency medical treatment: - chest pain - agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea - nausea, vomiting, loss of appetite, weakness, or dizziness - inability to get or keep an erection - irregular menstruation - decreased sexual desire - swelling of your eyes, face, lips, tongue, or throat - hoarseness - changes in heartbeat - hives - itching - difficulty swallowing or breathing Hydrocodone may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Flush any medication that is outdated or no longer needed down the toilet. Talk to your pharmacist about the proper disposal of your medication. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of overdose may include the following: - slowed breathing - sleepiness - muscle weakness - cold, clammy skin - narrowed or widened pupils - slowed heartbeat - coma - death Keep all appointments with your doctor and laboratory. Your doctor will order certain lab tests to check your body's response to hydrocodone. Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are taking hydrocodone. This prescription is not refillable. Be sure to schedule appointments with your doctor on a regular basis so that you do not run out of hydrocodone if your doctor wants you to continue taking this medication. If you continue to have pain after you finish your hydrocodone prescription, call your doctor. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Hysingla\u00ae - Zohydro ER\u00ae",
+    "https://medlineplus.gov/druginfo/meds/a614045.html"
+  ],
+  [
+    "What other information should I know about Hydrocodone?: Keep all appointments with your doctor. This prescription is not refillable. Be sure to schedule appointments with your doctor on a regular basis so that you do not run out of hydrocodone if your doctor wants you to continue taking this medication. If you continue to have pain after you finish your hydrocodone prescription, call your doctor. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/meds/a614045.html"
+  ],
+  [
+    "Hydrocodone Combination Products: Hydrocodone may cause serious or life-threatening breathing problems, especially during the first 24 to 72 hours of your treatment and any time your dose is increased. Your doctor will monitor you carefully during your treatment. Tell your doctor if you have or have ever had slowed breathing or asthma. Your doctor will probably tell you not to take a hydrocodone combination product. Also tell your doctor if you have or have ever had lung disease such as chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways), a head injury, or any condition that increases the amount of pressure in your brain. The risk that you will develop breathing problems may be higher if you are an older adult or are weak or malnourished due to disease. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment: slowed breathing, long pauses between breaths, or shortness of breath. Taking certain medications with a hydrocodone combination product may increase the risk of serious or life-threatening breathing problems, sedation, or coma. Tell your doctor if you are taking, plan to take or plan to stop taking any of the following medications: certain antifungal medications including itraconazole (Onmel, Sporanox), ketoconazole (Nizoral), and voriconazole (Vfend); benzodiazepines such as alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Diastat, Valium), estazolam, flurazepam, lorazepam (Ativan), oxazepam, temazepam (Restoril), and triazolam (Halcion); erythromycin (Erytab, Erythrocin); certain medications for human immunodeficiency virus (HIV) including indinavir (Crixivan), nelfinavir (Viracept), and ritonavir (Norvir, in Kaletra); medications for mental illness or nausea; other medications for pain; phenytoin (Dilantin, Phenytek); rifampin (Rifadin, Rimactane, in Rifamate); muscle relaxants; sedatives; sleeping pills; or tranquilizers. Your doctor may need to change the dosages of your medications and will monitor you carefully. If you take a hydrocodone combination product with any of these medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own. Drinking alcohol, taking prescription or nonprescription medications that contain alcohol, or using street drugs during your treatment with a hydrocodone combination product increases the risk that you will experience these serious, life-threatening side effects. Do not drink alcohol, take prescription or nonprescription medications that contain alcohol, or use street drugs during your treatment. Hydrocodone combination products may be habit-forming. Do not take more of it, take it more often, or take it in a different way than directed by your doctor. Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, or has overused prescription medications, or if you have or have ever had depression or another mental illness. There is a greater risk that you will overuse a hydrocodone combination product if you have or have ever had any of these conditions. Do not allow anyone else to take your medication. Hydrocodone may harm or cause death to other people who take your medication, especially children. Tell your doctor if you are pregnant or plan to become pregnant. If you take a hydrocodone combination product regularly during your pregnancy, your baby may experience life-threatening withdrawal symptoms after birth. Tell your baby's doctor right away if your baby experiences any of the following symptoms: irritability, hyperactivity, abnormal sleep, high-pitched cry, uncontrollable shaking of a part of the body, vomiting, diarrhea, or failure to gain weight. Talk to your doctor about the risks of taking a hydrocodone combination product. Hydrocodone is available in combination with other ingredients, and different combination products are prescribed for different uses. Some hydrocodone combination products are used to relieve moderate-to-severe pain. Other hydrocodone combination products are used to relieve cough. Hydrocodone is in a class of medications called opiate (narcotic) analgesics and in a class of medications called antitussives. Hydrocodone relieves pain by changing the way the brain and nervous system respond to pain. Hydrocodone relieves cough by decreasing activity in the part of the brain that causes coughing. Hydrocodone must be used with caution in children. Extended-release products containing hydrocodone should not be given to children younger than 6 years of age and should be used with caution in children 6 to 12 years of age. Talk to your doctor about the risks of giving hydrocodone to your child. You will take hydrocodone in combination with at least one other medication, but this monograph only provides information about hydrocodone. Be sure to read information about the other ingredients in the hydrocodone product you are taking. Ask your doctor or pharmacist if you have any questions. Hydrocodone combination products come as a tablet, a capsule, a syrup, a solution (clear liquid), an extended-release (long-acting) capsule, and an extended-release (long-acting) suspension (liquid) to take by mouth. The tablet, capsule, syrup, and solution are usually taken every 4 to 6 hours as needed. The extended-release capsule and the extended-release suspension are usually taken every 12 hours as needed. If you are taking hydrocodone on a regular schedule, take it at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Swallow the extended-release capsules whole; do not split, chew, or crush them. Shake the extended-release suspension well before each use to mix the medication evenly. Do not mix the extended-release suspension with other medications or with other liquids such as water. If you will be using hydrocodone combination solution, syrup, or extended-release suspension, do not use a household teaspoon to measure your dose. Household teaspoons are not accurate measuring devices, and you may receive too much medication or not enough medication if you measure your dose with a household teaspoon. Instead, use a properly marked measuring device such as a dropper, medicine spoon, or oral syringe. Ask your doctor or pharmacist if you need help getting or using a measuring device. Call your doctor if your symptoms are not controlled by the hydrocodone combination product you are taking. Do not increase your dose of medication on your own. You may receive a dangerous overdose if you take more medication or take your medication more often than prescribed by your doctor. If you have taken a hydrocodone combination product for several weeks or longer, do not stop taking the medication without talking to your doctor. If you suddenly stop taking a hydrocodone combination product, you may experience withdrawal symptoms. Your doctor will probably decrease your dose gradually. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient, available for certain hydrocodone combination products. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before taking a hydrocodone combination product, - tell your doctor and pharmacist if you are allergic to hydrocodone, the other medication in the hydrocodone combination product you are taking, other opiate (narcotic) medications such as morphine or codeine, any other medications, or any of the ingredients in the hydrocodone combination product you are taking. Ask your pharmacist or check the manufacturer's information for the patient for a list of the ingredients. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antidepressants; antihistamines; antipsychotics (medications for mental illness) cyclobenzaprine (Amrix); dextromethorphan (found in many cough medications; in Nuedexta); ipratropium (Atrovent); lithium (Lithobid); medications for irritable bowel disease, motion sickness, Parkinson's disease, seizures, ulcers, or urinary problems; medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, in Treximet), and zolmitriptan (Zomig); mirtazapine (Remeron); 5HT3 serotonin blockers such as alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran, Zuplenz), or palonosetron (Aloxi); selective serotonin-reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Prozac, Pexeva), and sertraline (Zoloft); serotonin and norepinephrine reuptake inhibitors such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor); tramadol, trazodone (Oleptro); and tricyclic antidepressants ('mood elevators') such as amitriptyline, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil). Also tell your doctor or pharmacist if you are taking or receiving monoamine oxidase (MAO) inhibitors or have stopped taking them within the past 2 weeks: isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate). Many other medications may also interact with hydrocodone combination products, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor what herbal products you are taking, especially St. John's wort and tryptophan. - tell your doctor if you have or have ever had any of the conditions mentioned in the IMPORTANT WARNING section or paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you not to take a hydrocodone combination product. - tell your doctor if you have or have ever had difficulty urinating; seizures; or thyroid, intestinal, liver, pancreas, gallbladder, or kidney disease. - tell your doctor if you are breastfeeding. - you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of taking a hydrocodone combination product. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking a hydrocodone combination product. - you should know that hydrocodone combination products may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. Unless your doctor tells you otherwise, continue your normal diet. This medication is usually taken as needed. If your doctor has told you to take a hydrocodone combination product regularly, take the missed dose as soon as you remember it. Then wait at least 4 hours before taking your next dose of the tablets, syrup, capsule, or solution, or at least 12 hours before taking your next dose of the extended-release capsules or extended-release solution. If it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Hydrocodone combination products may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - constipation - drowsiness - lightheadedness - fuzzy thinking - anxiety - abnormally happy or abnormally sad mood - dry throat - difficulty urinating - rash - itching - narrowing of the pupils (black circles in the center of the eyes) Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment: - slowed or irregular breathing - agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea - nausea, vomiting, loss of appetite, weakness, or dizziness - inability to get or keep an erection - irregular menstruation - decreased sexual desire - chest tightness Hydrocodone combination products may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Flush any medication that is outdated or no longer needed down the toilet so that others will not take it. Talk to your pharmacist about the proper disposal of your medication. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of overdose may include the following: - narrowed or widened pupils - slow, shallow, or stopped breathing - slowed or stopped heartbeat - cold, clammy, or blue skin - excessive sleepiness - loss of consciousness - seizures - death Keep all appointments with your doctor and laboratory. Your doctor will order certain lab tests to check your body's response to a hydrocodone combination product. Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are taking hydrocodone. This prescription is not refillable. If you continue to have pain or a cough after you finish taking your medication, call your doctor. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Allay\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Alor\u00ae (containing Aspirin, Hydrocodone)\u00b6 - Anexsia\u00ae (containing Acetaminophen, Hydrocodone) - Anolor DH5\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Atuss HD\u00ae (containing Chlorpheniramine, Hydrocodone, Phenylephrine)\u00b6 - Azdone\u00ae (containing Aspirin, Hydrocodone)\u00b6 - Baltussin HC\u00ae (containing Chlorpheniramine, Hydrocodone, Phenylephrine)\u00b6 - Bancap HC\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Ceta Plus\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Codiclear DH\u00ae (containing Guaifenesin, Hydrocodone)\u00b6 - Co-Gesic\u00ae (containing Acetaminophen, Hydrocodone) - Damason-P\u00ae (containing Aspirin, Hydrocodone)\u00b6 - Dolacet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Dolagesic\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Dolorex Forte\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Donatussin MAX\u00ae (containing Carbinoxamine, Hydrocodone, Phenylephrine)\u00b6 - DuoCet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - EndaCof XP\u00ae (containing Guaifenesin, Hydrocodone)\u00b6 - EndaCof-Plus\u00ae (containing Dexchlorpheniramine, Hydrocodone, Phenylephrine)\u00b6 - Entuss\u00ae (containing Guaifenesin, Hydrocodone)\u00b6 - Histinex HC\u00ae (containing Chlorpheniramine, Hydrocodone, Phenylephrine)\u00b6 - Hycet\u00ae (containing Acetaminophen, Hydrocodone) - Hycodan\u00ae (containing Homatropine, Hydrocodone) - Hycomed\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Hycomine Compound\u00ae (containing Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine)\u00b6 - Hycotuss\u00ae (containing Guaifenesin, Hydrocodone)\u00b6 - Hydrocet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Hydrogesic\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Hydromet\u00ae (containing Homatropine, Hydrocodone) - Hy-Phen\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Ibudone\u00ae (containing Hydrocodone, Ibuprofen) - Kwelcof\u00ae (containing Guaifenesin, Hydrocodone)\u00b6 - Liquicet\u00ae (containing Acetaminophen, Hydrocodone) - Lorcet\u00ae (containing Acetaminophen, Hydrocodone) - Lorcet Plus\u00ae (containing Acetaminophen, Hydrocodone) - Lortab\u00ae (containing Acetaminophen, Hydrocodone) - Lortuss HC\u00ae (containing Hydrocodone, Phenylephrine)\u00b6 - Margesic-H\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Maxidone\u00ae (containing Acetaminophen, Hydrocodone) - Norco\u00ae (containing Acetaminophen, Hydrocodone) - Oncet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Panacet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Panasal\u00ae (containing Aspirin, Hydrocodone)\u00b6 - Panlor\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Polygesic\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Procet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Reprexain\u00ae (containing Hydrocodone, Ibuprofen) - Rezira\u00ae (containing Hydrocodone, Pseudoephedrine) - Stagesic\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - T-Gesic\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - TussiCaps\u00ae (containing Chlorpheniramine, Hydrocodone) - Tussionex\u00ae (containing Chlorpheniramine, Hydrocodone) - Ugesic\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Vanacet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Vanex-HD\u00ae (containing Chlorpheniramine, Hydrocodone, Phenylephrine)\u00b6 - Vendone\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Vicodin\u00ae (containing Acetaminophen, Hydrocodone) - Vicodin ES\u00ae (containing Acetaminophen, Hydrocodone) - Vicodin HP\u00ae (containing Acetaminophen, Hydrocodone) - Vicoprofen\u00ae (containing Hydrocodone, Ibuprofen) - Vidone\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Vituz\u00ae (containing Chlorpheniramine, Hydrocodone) - Xodol\u00ae (containing Acetaminophen, Hydrocodone) - Zamicet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Zolvit\u00ae (containing Acetaminophen, Hydrocodone) - Zutripro\u00ae (containing Chlorpheniramine, Hydrocodone, Pseudoephedrine) - Zydone\u00ae (containing Acetaminophen, Hydrocodone)",
+    "https://medlineplus.gov/druginfo/meds/a601006.html"
+  ],
+  [
+    "Hydrocodone (How should this medicine be used?): Hydrocodone comes as an extended-release (long-acting) capsule and an extended-release (long-acting) tablet to take by mouth. The extended-release capsule is usually taken once every 12 hours. The extended-release tablet is usually taken once daily. Take hydrocodone at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take hydrocodone exactly as directed by your doctor. Swallow the extended-release capsules or extended-release tablets one at a time with plenty of water. Swallow each capsule or tablet as soon as you put it in your mouth. Do not presoak, wet, or lick the extended-release tablets before you put them in your mouth. Your doctor will probably start you on a low dose of hydrocodone and may gradually increase your dose, not more than once every 3 to 7 days if needed to control your pain. After your take hydrocodone for a period of time, your body may become used to the medication. If this happens, your doctor may increase your dose of hydrocodone or may prescribe a different medication to help control your pain. Talk to your doctor about how you are feeling during your treatment with hydrocodone. Do not stop taking hydrocodone without talking to your doctor. If you suddenly stop taking hydrocodone, you may experience withdrawal symptoms such as restlessness, teary eyes, runny nose, yawning, sweating, chills, hair standing on end, muscle pain, widened pupils (black circles in the middle of the eyes), irritability, anxiety, back or joint pain, weakness, stomach cramps, difficulty falling asleep or staying asleep, nausea, loss of appetite, vomiting, diarrhea, fast breathing, or fast heartbeat. Your doctor will probably decrease your dose gradually.",
+    "https://medlineplus.gov/druginfo/meds/a614045.html"
+  ],
+  [
+    "Hydrocodone (Why is this medication prescribed?): Hydrocodone is used to relieve severe pain. Hydrocodone is only used to treat people who are expected to need medication to relieve severe pain around-the-clock for a long time and who cannot be treated with other medications or treatments. Hydrocodone extended-release (long-acting) capsules or extended-release tablets should not be used to treat pain that can be controlled by medication that is taken as needed. Hydrocodone is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain. This monograph only includes information about the use of hydrocodone alone. If you are taking a hydrocodone combination product, be sure to read information about all the ingredients in the hydrocodone-combination monograph and ask your doctor or pharmacist for more information.",
+    "https://medlineplus.gov/druginfo/meds/a614045.html"
+  ],
+  [
+    "Hydrocodone (What special precautions should I follow?): Before taking hydrocodone, - tell your doctor and pharmacist if you are allergic to hydrocodone, any other medications, or any of the ingredients in hydrocodone extended-release capsules or extended-release tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following medications: antihistamines (found in cough and cold medications); amiodarone (Cordarone, Nexterone, Pacerone); azithromycin (Zithromax, Zmax); butorphanol; chlorpromazine; citalopram (Celexa); cyclobenzaprine (Amrix); dextromethorphan (found in many cough medications; in Nuedexta); dronedarone (Multaq); haloperidol (Haldol); laxatives such as lactulose (Cholac, Constulose, Enulose, others); levofloxacin (Levaquin); lithium (Lithobid); medications for irritable bowel disease, Parkinson's disease, ulcers, and urinary problems; medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, in Treximet), and zolmitriptan (Zomig); mirtazapine (Remeron); nalbuphine; pentazocine (Talwin); 5HT3 serotonin blockers such as alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran, Zuplenz), or palonosetron (Aloxi); selective serotonin-reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Prozac, Pexeva), and sertraline (Zoloft); serotonin and norepinephrine reuptake inhibitors such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor); trazodone (Oleptro); or tricyclic antidepressants ('mood elevators') such as amitriptyline, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil). Also tell your doctor or pharmacist if you are taking or receiving the following medications or have stopped taking them within the past two weeks: isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate). Many other medications may also interact with hydrocodone, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor what herbal products you are taking, especially St. John's wort and tryptophan. - tell your doctor if you have any of the conditions mentioned in the IMPORTANT WARNING section, a blockage or narrowing of your stomach or intestines, or paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you not to take hydrocodone. - tell your doctor if you have or have ever had low blood pressure, difficulty urinating, seizures, or thyroid, gall bladder, pancreas, liver, or kidney disease. If you are taking the extended-release tablets, also tell your doctor if you have or have ever had difficulty swallowing, colon cancer (cancer that begins in the large intestine), esophageal cancer (cancer that begins in the tube that connects the mouth and stomach), heart failure (HF; condition in which the heart cannot pump enough blood to other parts of the body), or heart rhythm problems such long QT syndrome (condition that increases the risk of developing an irregular heartbeat that may cause fainting or sudden death). - tell your doctor if you are breastfeeding. - you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of taking hydrocodone. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking hydrocodone. - you should know that hydrocodone may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. - you should know that hydrocodone may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking hydrocodone. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up. - you should know that hydrocodone may cause constipation. Talk to your doctor about changing your diet and using other medications to treat or prevent constipation.",
+    "https://medlineplus.gov/druginfo/meds/a614045.html"
+  ],
+  [
+    "Hydrocodone (What side effects can this medication cause?): Hydrocodone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - stomach pain - dry mouth - tiredness - headache - back pain - muscle tightening - difficult, frequent, or painful urination - ringing in the ears - difficulty falling asleep or staying asleep - foot, leg, or ankle swelling - uncontrollable shaking of a part of the body Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING or SPECIAL PRECAUTIONS sections, call your doctor immediately or get emergency medical treatment: - chest pain - agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea - nausea, vomiting, loss of appetite, weakness, or dizziness - inability to get or keep an erection - irregular menstruation - decreased sexual desire - swelling of your eyes, face, lips, tongue, or throat - hoarseness - changes in heartbeat - hives - itching - difficulty swallowing or breathing Hydrocodone may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).",
+    "https://medlineplus.gov/druginfo/meds/a614045.html"
+  ],
+  [
+    "Hydrocodone Combination Products (Brand names of combination products): - Allay\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Alor\u00ae (containing Aspirin, Hydrocodone)\u00b6 - Anexsia\u00ae (containing Acetaminophen, Hydrocodone) - Anolor DH5\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Atuss HD\u00ae (containing Chlorpheniramine, Hydrocodone, Phenylephrine)\u00b6 - Azdone\u00ae (containing Aspirin, Hydrocodone)\u00b6 - Baltussin HC\u00ae (containing Chlorpheniramine, Hydrocodone, Phenylephrine)\u00b6 - Bancap HC\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Ceta Plus\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Codiclear DH\u00ae (containing Guaifenesin, Hydrocodone)\u00b6 - Co-Gesic\u00ae (containing Acetaminophen, Hydrocodone) - Damason-P\u00ae (containing Aspirin, Hydrocodone)\u00b6 - Dolacet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Dolagesic\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Dolorex Forte\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Donatussin MAX\u00ae (containing Carbinoxamine, Hydrocodone, Phenylephrine)\u00b6 - DuoCet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - EndaCof XP\u00ae (containing Guaifenesin, Hydrocodone)\u00b6 - EndaCof-Plus\u00ae (containing Dexchlorpheniramine, Hydrocodone, Phenylephrine)\u00b6 - Entuss\u00ae (containing Guaifenesin, Hydrocodone)\u00b6 - Histinex HC\u00ae (containing Chlorpheniramine, Hydrocodone, Phenylephrine)\u00b6 - Hycet\u00ae (containing Acetaminophen, Hydrocodone) - Hycodan\u00ae (containing Homatropine, Hydrocodone) - Hycomed\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Hycomine Compound\u00ae (containing Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine)\u00b6 - Hycotuss\u00ae (containing Guaifenesin, Hydrocodone)\u00b6 - Hydrocet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Hydrogesic\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Hydromet\u00ae (containing Homatropine, Hydrocodone) - Hy-Phen\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Ibudone\u00ae (containing Hydrocodone, Ibuprofen) - Kwelcof\u00ae (containing Guaifenesin, Hydrocodone)\u00b6 - Liquicet\u00ae (containing Acetaminophen, Hydrocodone) - Lorcet\u00ae (containing Acetaminophen, Hydrocodone) - Lorcet Plus\u00ae (containing Acetaminophen, Hydrocodone) - Lortab\u00ae (containing Acetaminophen, Hydrocodone) - Lortuss HC\u00ae (containing Hydrocodone, Phenylephrine)\u00b6 - Margesic-H\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Maxidone\u00ae (containing Acetaminophen, Hydrocodone) - Norco\u00ae (containing Acetaminophen, Hydrocodone) - Oncet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Panacet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Panasal\u00ae (containing Aspirin, Hydrocodone)\u00b6 - Panlor\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Polygesic\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Procet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Reprexain\u00ae (containing Hydrocodone, Ibuprofen) - Rezira\u00ae (containing Hydrocodone, Pseudoephedrine) - Stagesic\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - T-Gesic\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - TussiCaps\u00ae (containing Chlorpheniramine, Hydrocodone) - Tussionex\u00ae (containing Chlorpheniramine, Hydrocodone) - Ugesic\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Vanacet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Vanex-HD\u00ae (containing Chlorpheniramine, Hydrocodone, Phenylephrine)\u00b6 - Vendone\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Vicodin\u00ae (containing Acetaminophen, Hydrocodone) - Vicodin ES\u00ae (containing Acetaminophen, Hydrocodone) - Vicodin HP\u00ae (containing Acetaminophen, Hydrocodone) - Vicoprofen\u00ae (containing Hydrocodone, Ibuprofen) - Vidone\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Vituz\u00ae (containing Chlorpheniramine, Hydrocodone) - Xodol\u00ae (containing Acetaminophen, Hydrocodone) - Zamicet\u00ae (containing Acetaminophen, Hydrocodone)\u00b6 - Zolvit\u00ae (containing Acetaminophen, Hydrocodone) - Zutripro\u00ae (containing Chlorpheniramine, Hydrocodone, Pseudoephedrine) - Zydone\u00ae (containing Acetaminophen, Hydrocodone)",
+    "https://medlineplus.gov/druginfo/meds/a601006.html"
+  ],
+  [
+    "Hydrocodone (What should I do if I forget a dose?): Skip the missed dose and continue your regular dosing schedule. Do not take more than one dose of hydrocodone extended-release capsules in 12 hours or extended-release tablets in 24 hours.",
+    "https://medlineplus.gov/druginfo/meds/a614045.html"
+  ],
+  [
+    "Lisinopril: Do not take lisinopril if you are pregnant. If you become pregnant while taking lisinopril, call your doctor immediately. Lisinopril may harm the fetus. Lisinopril is used alone or in combination with other medications to treat high blood pressure. It is used in combination with other medications to treat heart failure. Lisinopril is also used to improve survival after a heart attack. Lisinopril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently. High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys, and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation. Lisinopril comes as a tablet to take by mouth. It is usually taken once a day. To help you remember to take lisinopril, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take lisinopril exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor will probably start you on a low dose of lisinopril and gradually increase your dose. Lisinopril controls high blood pressure and heart failure but does not cure them. Continue to take lisinopril even if you feel well. Do not stop taking lisinopril without talking to your doctor. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before taking lisinopril, - tell your doctor and pharmacist if you are allergic to lisinopril; other ACE inhibitors such as enalapril (Vasotec, in Vaseretic), benazepril (Lotensin, in Lotrel), captopril (Capoten), fosinopril (Monopril), moexipril (Univasc, in Uniretic), perindopril (Aceon), quinapril (Accupril, in Accuretic, in Quinaretic), ramipril (Altace), and trandolapril (Mavik, in Tarka); any other medications; or any ingredients in lisinopril tablets. Ask your pharmacist for a list of the ingredients. - tell your doctor or pharmacist if you are taking valsartan and sacubitril (Entresto) or if you have stopped taking it within the last 36 hours. Your doctor will probably tell you not to take lisinopril, if you are also taking valsartan and sacubitril. Also, tell your doctor if you have diabetes and you are taking aliskiren (Tekturna, in Amturnide, Tekamlo, Tekturna HCT). Your doctor will probably tell you not to take lisinopril if you have diabetes and you are also taking aliskiren. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (Indocin, Tivorbex); diuretics ('water pills'); lithium (Lithobid); and potassium supplements. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor if you have or have ever had heart or kidney disease; diabetes; lupus; scleroderma (a condition in which extra tissue grows on the skin and some organs); or angioedema (a condition that causes difficulty swallowing or breathing and painful swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs). - tell your doctor if you are breastfeeding. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking lisinopril. - you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause lightheadedness and fainting. Talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully. Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Lisinopril may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - cough - dizziness - headache - excessive tiredness - nausea - diarrhea - weakness - sneezing - runny nose - decrease in sexual ability - rash Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately: - swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs - hoarseness - difficulty breathing or swallowing - fever, sore throat, chills, and other signs of infection - yellowing of the skin or eyes - lightheadedness - fainting - chest pain Lisinopril may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of overdose may include the following: - lightheadedness - fainting Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly to determine your response to lisinopril. Your doctor may order certain lab tests to check your body's response to lisinopril. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Prinivil\u00ae\u00b6 - Zestril\u00ae\u00b6",
+    "https://medlineplus.gov/druginfo/meds/a692051.html"
+  ],
+  [
+    "What other information should I know about Diclofenac?: Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/meds/a689002.html"
+  ],
+  [
+    "Lisinopril (What special precautions should I follow?): Before taking lisinopril, - tell your doctor and pharmacist if you are allergic to lisinopril; other ACE inhibitors such as enalapril (Vasotec, in Vaseretic), benazepril (Lotensin, in Lotrel), captopril (Capoten), fosinopril (Monopril), moexipril (Univasc, in Uniretic), perindopril (Aceon), quinapril (Accupril, in Accuretic, in Quinaretic), ramipril (Altace), and trandolapril (Mavik, in Tarka); any other medications; or any ingredients in lisinopril tablets. Ask your pharmacist for a list of the ingredients. - tell your doctor or pharmacist if you are taking valsartan and sacubitril (Entresto) or if you have stopped taking it within the last 36 hours. Your doctor will probably tell you not to take lisinopril, if you are also taking valsartan and sacubitril. Also, tell your doctor if you have diabetes and you are taking aliskiren (Tekturna, in Amturnide, Tekamlo, Tekturna HCT). Your doctor will probably tell you not to take lisinopril if you have diabetes and you are also taking aliskiren. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (Indocin, Tivorbex); diuretics ('water pills'); lithium (Lithobid); and potassium supplements. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor if you have or have ever had heart or kidney disease; diabetes; lupus; scleroderma (a condition in which extra tissue grows on the skin and some organs); or angioedema (a condition that causes difficulty swallowing or breathing and painful swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs). - tell your doctor if you are breastfeeding. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking lisinopril. - you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause lightheadedness and fainting.",
+    "https://medlineplus.gov/druginfo/meds/a692051.html"
+  ],
+  [
+    "Lisinopril (Why is this medication prescribed?): Lisinopril is used alone or in combination with other medications to treat high blood pressure. It is used in combination with other medications to treat heart failure. Lisinopril is also used to improve survival after a heart attack. Lisinopril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently. High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys, and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.",
+    "https://medlineplus.gov/druginfo/meds/a692051.html"
+  ],
+  [
+    "Lisinopril and Hydrochlorothiazide (How should this medicine be used?): The combination of lisinopril and hydrochlorothiazide comes as a tablet to take by mouth. It is usually taken once a day with or without food. To help you remember to take lisinopril and hydrochlorothiazide, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take lisinopril and hydrochlorothiazide exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Lisinopril and hydrochlorothiazide controls high blood pressure but does not cure it. Continue to take lisinopril and hydrochlorothiazide even if you feel well. Do not stop taking lisinopril and hydrochlorothiazide without talking to your doctor.",
+    "https://medlineplus.gov/druginfo/meds/a601070.html"
+  ],
+  [
+    "Lisinopril (What other information should I know?): Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly to determine your response to lisinopril. Your doctor may order certain lab tests to check your body's response to lisinopril. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.",
+    "https://medlineplus.gov/druginfo/meds/a692051.html"
+  ],
+  [
+    "Trisomy 13 (Summary): Trisomy 13 (also called Patau syndrome) is a genetic disorder in which a person has 3 copies of genetic material from chromosome 13, instead of the usual 2 copies. Rarely, the extra material may be attached to another chromosome (translocation).",
+    "https://medlineplus.gov/ency/article/001660.htm"
+  ],
+  [
+    "How to diagnose Conversion disorder?: Diagnostic testing does not find any physical cause for the symptoms. The doctor will do a physical exam and may order diagnostic tests. These are to make sure there are no physical causes for the symptom.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000954.htm"
+  ],
+  [
+    "trisomy 13 (Description): Trisomy 13, also called Patau syndrome, is a chromosomal condition associated with severe intellectual disability and physical abnormalities in many parts of the body. Individuals with trisomy 13 often have heart defects, brain or spinal cord abnormalities, very small or poorly developed eyes (microphthalmia), extra fingers or toes, an opening in the lip (a cleft lip) with or without an opening in the roof of the mouth (a cleft palate), and weak muscle tone (hypotonia). Due to the presence of several life-threatening medical problems, many infants with trisomy 13 die within their first days or weeks of life. Only five percent to 10 percent of children with this condition live past their first year.",
+    "https://ghr.nlm.nih.gov/condition/trisomy-13"
+  ],
+  [
+    "Trisomy 13 (Causes): Trisomy 13 occurs when extra DNA from chromosome 13 appears in some or all of the body's cells. - Trisomy 13: the presence of an extra (third) chromosome 13 in all of the cells. - Trisomy 13: mosaicism, the presence of an extra chromosome 13 in some of the cells. - Partial trisomy: the presence of a part of an extra chromosome 13 in the cells. The extra material interferes with normal development. Trisomy 13 occurs in about 1 out of every 10,000 newborns. Most cases are not passed down through families (inherited). Instead, the events that lead to trisomy 13 occur in either the sperm or the egg that forms the fetus.",
+    "https://medlineplus.gov/ency/article/001660.htm"
+  ],
+  [
+    "Trisomy 13 (Support Groups): Support groups for trisomy 13 include: - Support Organization for Trisomy 18, 13 and Related Disorders (SOFT): trisomy.org - Hope for Trisomy 13 and 18: www.hopefortrisomy13and18.org",
+    "https://medlineplus.gov/ency/article/001660.htm"
+  ],
+  [
+    "Trisomy 13 (Prevention): Trisomy 13 can be diagnosed before birth by amniocentesis with chromosome studies of the amniotic cells. Parents of infants with trisomy 13 that is caused by a translocation should have genetic testing and counseling. This may help them avoid having another child with the condition.",
+    "https://medlineplus.gov/ency/article/001660.htm"
+  ],
+  [
+    "Trisomy 13 (Exams and Tests): The infant may have a single umbilical artery at birth. There are often signs of congenital heart disease, such as: - Abnormal placement of the heart toward the right side of the chest instead of the left - Atrial septal defect - Patent ductus arteriosus - Ventricular septal defect Gastrointestinal x-rays or ultrasound may show rotation of the internal organs. MRI or CT scans of the head may reveal a problem with the structure of the brain. The problem is called holoprosencephaly. It is the joining together of the 2 sides of the brain. Chromosome studies show trisomy 13, trisomy 13 mosaicism, or partial trisomy.",
+    "https://medlineplus.gov/ency/article/001660.htm"
+  ],
+  [
+    "Trisomy 13 (When to Contact a Medical Professional): Call your health care provider if you have had a child with trisomy 13 and you plan to have another child. Genetic counseling can help families understand the condition, the risk of inheriting it, and how to care for the person.",
+    "https://medlineplus.gov/ency/article/001660.htm"
+  ],
+  [
+    "Trisomy 13 (Outlook (Prognosis)): More than 90% of children with trisomy 13 die in the first year.",
+    "https://medlineplus.gov/ency/article/001660.htm"
+  ],
+  [
+    "Leg pain (Home Care): If you have leg pain from cramps or overuse, take these steps first: - Rest as much as possible. - Elevate your leg. - Apply ice for up to 15 minutes. Do this 4 times per day, more often for the first few days. - Gently stretch and massage cramping muscles. - Take over-the-counter pain medicines like acetaminophen or ibuprofen. Other homecare will depend on the cause of your leg pain.",
+    "https://medlineplus.gov/ency/article/003182.htm"
+  ],
+  [
+    "What is the dosage of Creatine?: The following doses have been studied in scientific research: BY MOUTH: - For improving physical performance, several dosing regimens have been tried: - Creatine is typically loaded with 20 grams per day (or 0.3 grams per kg) for 5 days followed by a maintenance dose of 2 or more grams (0.03 grams per kg) daily, Although 5 day loading is typical, 2 days of loading has also been used. - A loading dose of 9 grams per day for 6 days has also been used. Some sources suggest that, instead of acutely loading, similar results can be obtained with 3 grams per day for 28 days. During creatine supplementation, the water intake should be 64 ounces per day. - For heart failure: 20 grams per day for 5-10 days. - For Parkinson's disease: - 10 grams/day. - A loading dose of creatine 20 grams/day for 6 days followed by 2 grams/day for 6 months, and then 4 grams daily for 18 months has also been used. - For improving resistance training in people with Parkinson's disease: a loading dose of 20 grams/day for 5 days, followed by 5 grams/day. - For gyrate atrophy: 1.5 grams per day. - For muscular dystrophies: 10 grams per day has been used by adults and 5 grams per day has been used by children. - For McArdles disease: 150 mg / kg daily for 5 days and then continue with 60 mg / kg / day.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/natural/873.html"
+  ],
+  [
+    "Leg pain (Causes): Leg pain can be due to a muscle cramp (also called a charley horse). Common causes of cramps include: - Dehydration or low amounts of potassium, sodium, calcium, or magnesium in the blood - Medicines (such as diuretics and statins) - Muscle fatigue or strain from overuse, too much exercise, or holding a muscle in the same position for a long time An injury can also cause leg pain from: - A torn or overstretched muscle (strain) - Hairline crack in the bone (stress fracture) - Inflamed tendon (tendinitis) - Shin splints (pain in the front of the leg from overuse) Other common causes of leg pain include: - Atherosclerosis that blocks blood flow in the arteries (this type of pain, called claudication, is generally felt when exercising or walking and is relieved by rest) - Blood clot (deep vein thrombosis) from long-term bed rest - Infection of the bone (osteomyelitis) or skin and soft tissue (cellulitis) - Inflammation of the leg joints caused by arthritis or gout - Nerve damage\u00a0common\u00a0to people with diabetes, smokers, and alcoholics - Varicose veins Less common causes include: - Cancerous bone tumors (osteosarcoma, Ewing sarcoma) - Legg-Calve-Perthes disease:\u00a0Poor blood flow to the hip that may stop or slow the normal growth of the leg - Noncancerous (benign) tumors or cysts of the femur or tibia (osteoid osteoma) - Sciatic nerve pain (radiating pain down the leg) caused by a slipped disk in the back - Slipped capital femoral epiphysis: Most often seen in boys and overweight children between ages 11 and 15",
+    "https://medlineplus.gov/ency/article/003182.htm"
+  ],
+  [
+    "Leg pain (What to Expect at Your Office Visit): Your provider will perform a physical exam and look at your legs, feet, thighs, hips, back, knees, and ankles. Your provider may ask questions such as: - Where on the leg is the pain? Is the pain in one or both legs? - Is the pain dull and aching or sharp and stabbing? Is the pain severe? Is the pain worse at any time of day? - What makes the pain feel worse? Does anything make your pain feel better? - Do you have any other symptoms such as numbness, tingling, back pain, or fever? Your provider may recommend physical therapy for some causes of leg pain.",
+    "https://medlineplus.gov/ency/article/003182.htm"
+  ],
+  [
+    "Leg pain (Summary): Leg pain is a common problem. It can be due to a cramp, injury, or other cause.",
+    "https://medlineplus.gov/ency/article/003182.htm"
+  ],
+  [
+    "Menstrual cramps (Treatment): Menstrual cramps are treatable. Your doctor may recommend: - Pain relievers. Your doctor may suggest taking over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), at regular doses starting the day before you expect your period to begin. Prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as mefenamic acid (Ponstel), also are available. If you can't take NSAIDs, acetaminophen (Tylenol, others) may lessen your pain. Start taking the pain reliever at the beginning of your period, or as soon as you feel symptoms, and continue taking the medicine as directed for two to three days, or until your symptoms have gone away. - Hormonal birth control. Oral birth control pills contain hormones that prevent ovulation and reduce the severity of menstrual cramps. These hormones can also be delivered in several other forms: an injection, a patch you wear on your skin, an implant placed under the skin of your arm, a flexible ring that you insert into your vagina, or an intrauterine device (IUD). - Surgery. If your menstrual cramps are caused by an underlying disorder, such as endometriosis or fibroids, surgery to correct the problem may help reduce your symptoms. Surgical removal of the uterus also may be an option if you're not planning to have children.",
+    "https://www.mayoclinic.org/diseases-conditions/menstrual-cramps/symptoms-causes/syc-20374938"
+  ],
+  [
+    "Muscle cramps (Home Care): If you have a muscle cramp, stop your activity and try stretching and massaging the muscle. Heat will relax the muscle when the spasm begins, but ice may be helpful when the pain has improved. If the muscle is still sore, nonsteroidal anti-inflammatory medicines can help with pain. If the muscle cramps are severe, your health care provider can prescribe other medicines. The most common cause of muscle cramps during sports activity is not getting enough fluids. Often, drinking water will ease the cramping. However, water alone does not always help. Salt tablets or sports drinks, which also replenish lost minerals, can be helpful. Other tips for relieving muscle cramps: - Change your workouts so that you are exercising within your ability. - Drink plenty of fluids while exercising and increase your potassium intake (orange juice and bananas are great sources of potassium). - Stretch to improve flexibility.",
+    "https://medlineplus.gov/ency/article/003193.htm"
+  ],
+  [
+    "Muscle cramps: Muscle cramps are when a muscle gets tight (contracts) without you trying to tighten it, and it does not relax. Cramps may involve all or part of one or more muscles. The most commonly involved muscle groups are: - Back of the lower leg/calf - Back of the thigh (hamstrings) - Front of the thigh (quadriceps) Cramps in the feet, hands, arms, abdomen, and along the rib cage are also very common. Muscle cramps are common and may be stopped by stretching the muscle. The cramping muscle may feel hard or bulging. Muscle cramps are different than muscle twitches, which are covered in a separate article. Muscle cramps are common and often occur when a muscle is overused or injured. Working out when you have not had enough fluids (dehydration) or when you have low levels of minerals such as potassium or calcium can also make you more likely to have a muscle spasm. Muscle cramps can occur while you play tennis or golf, bowl, swim, or do any other exercise. They can also be triggered by: - Alcoholism - Hypothyroidism (underactive thyroid) - Kidney failure - Medicines - Menstruation - Pregnancy If you have a muscle cramp, stop your activity and try stretching and massaging the muscle. Heat will relax the muscle when the spasm begins, but ice may be helpful when the pain has improved. If the muscle is still sore, nonsteroidal anti-inflammatory medicines can help with pain. If the muscle cramps are severe, your health care provider can prescribe other medicines. The most common cause of muscle cramps during sports activity is not getting enough fluids. Often, drinking water will ease the cramping. However, water alone does not always help. Salt tablets or sports drinks, which also replenish lost minerals, can be helpful. Other tips for relieving muscle cramps: - Change your workouts so that you are exercising within your ability. - Drink plenty of fluids while exercising and increase your potassium intake (orange juice and bananas are great sources of potassium). - Stretch to improve flexibility. Call your provider if your muscle cramps: - Are severe - Do not go away with simple stretching - Keep coming back - Last a long time Your provider will examine you and ask questions about your symptoms and medical history, such as: - When did the spasms first begin? - How long do they last? - How often do you experience muscle spasms? - What muscles are affected? - Is the cramp always in the same location? - Are you pregnant? - Have you been vomiting, had diarrhea, excessive sweating, excessive urine volume, or any other possible cause of dehydration? - What medicines do you take? - Have you been exercising heavily? - Have you been drinking alcohol heavily? Blood tests may be done to check for the following: - Calcium, potassium, or magnesium metabolism - Kidney function - Thyroid function Pain medicines may be prescribed. Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003193.htm"
+  ],
+  [
+    "Leg pain (Review Date 8/14/2015): Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003182.htm"
+  ],
+  [
+    "Dust mite allergy (Symptoms): Dust mite allergy symptoms caused by inflammation of nasal passages include: - Sneezing - Runny nose - Itchy, red or watery eyes - Nasal congestion - Itchy nose, roof of mouth or throat - Postnasal drip - Cough - Facial pressure and pain - Swollen, blue-colored skin under your eyes - In a child, frequent upward rubbing of the nose If your dust mite allergy contributes to asthma, you may also experience: - Difficulty breathing - Chest tightness or pain - An audible whistling or wheezing sound when exhaling - Trouble sleeping caused by shortness of breath, coughing or wheezing - Bouts of coughing or wheezing that are worsened by a respiratory virus such as a cold or the flu A dust mite allergy can range from mild to severe. A mild case of dust mite allergy may cause an occasional runny nose, watery eyes and sneezing. In severe cases, the condition may be ongoing (chronic), resulting in persistent sneezing, cough, congestion, facial pressure or severe asthma attack. Some signs and symptoms of dust mite allergy, such as a runny nose or sneezing, are similar to those of the common cold. Sometimes it's difficult to know whether you have a cold or an allergy. If symptoms persist for longer than one week, you might have an allergy. If your signs and symptoms are severe - such as severe nasal congestion, wheezing or difficulty sleeping - call your doctor. Seek emergency care if wheezing or shortness of breath rapidly worsens or if you are short of breath with minimal activity.",
+    "https://www.mayoclinic.org/diseases-conditions/dust-mites/symptoms-causes/syc-20352173"
+  ],
+  [
+    "Do you have information about Rape prevention: Summary : Rape is defined as a sexual act forced on a person against his or her will. The most useful tool to prevent rape is to be more aware of the issue. Always trust your instincts if you are somewhere or with someone that does not feel safe and comfortable. Information : The following safety tips may help reduce your chances of being raped: - Carry items that you can use if you need to call attention to your situation (such as whistles and personal alarms). - Consider taking a self-defense class. This may can give you self-confidence and provide useful skills and strategies for different situations. - Do not hitchhike. If your vehicle breaks down and someone offers to give you a ride, ask the person to call for help while you stay locked in your vehicle. - If someone tries to assault you, scream loudly or blow a whistle. - If you are walking or jogging, stay out of secluded or isolated areas. Arrange to do the activity with at least one other friend, rather than alone. It is best to do these kinds of activities during daylight hours. - Keep car doors locked while driving, check the back of your car for intruders before getting in, and park in open, well-lit areas. - Keep doors and windows of your home locked. - On public transportation, sit near the driver or up front if possible. Avoid sitting near groups of young men who are out together. When out by yourself: - Avoid getting isolated with people you do not know or do not trust. - Be aware of where you are and what is around you. Do not cover both of your ears with music headphones. - Keep your cell phone charged and with you. - Stay away from deserted areas. - Try to appear strong, confident, aware, and secure in your surroundings. At parties or in other social situations, take the following steps: - Go with a group of friends, if possible, or keep in contact with someone you know during the party. - Avoid drinking too much. Do not accept drinks from someone you do not know, and keep your drink or beverage close to you. - Do not go somewhere alone or leave a party with someone you do not know or feel comfortable with. If you find yourself in a situation where you are being pressured into sexual activities you do not want, things you can do include: - State clearly what you do not want to do. Remember, you do not need to feel any obligation to do something you are not comfortable doing. - Remain aware of your surroundings and how you can get away. - Have a special codeword with a friend or family member that you can say if you call them during a situation in which you are being pressured into unwanted sex. - If you need to, make up a reason why you need to leave. RESOURCES Rape, Abuse and Incest National Network - www.rainn.org",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/007461.htm"
+  ],
+  [
+    "Chiggers (Summary): Chiggers are tiny, 6-legged wingless organisms (larvae) that mature to become a type of mite. Chiggers are found in tall grass and weeds. Their bite causes severe itching.",
+    "https://medlineplus.gov/ency/article/001333.htm"
+  ],
+  [
+    "Dust mite allergy (Diagnosis): Your doctor may suspect dust mite allergy based on symptoms and your answers to questions about your home. To confirm that you're allergic to some airborne substance, your doctor may use a lighted instrument to look at the condition of the lining of your nose. If you have an allergy to something airborne, the lining of the nasal passage will be swollen and may appear pale or bluish. Your doctor may suspect a dust mite allergy if your symptoms are worse when you go to bed or while cleaning - when dust mite allergens would be temporarily airborne. If you have a pet, it may be more difficult to determine the cause of the allergy, particularly if your pet sleeps in your bedroom. - Allergy skin test. Your doctor may suggest an allergy skin test to determine what you're allergic to. You may be referred to an allergy specialist (allergist) for this test. In this test, tiny amounts of purified allergen extracts - including an extract for dust mites - are pricked onto your skin's surface. This is usually carried out on the forearm, but it may be done on the upper back. Your doctor or nurse observes your skin for signs of allergic reactions after 15 minutes. If you're allergic to dust mites, you'll develop a red, itchy bump where the dust mite extract was pricked onto your skin. The most common side effects of these skin tests are itching and redness. These side effects usually go away within 30 minutes. - Allergy blood test. Some people can't undergo a skin test because they have a skin condition or they take a medication that can affect the results. As an alternative, your doctor may order a blood test that screens for specific allergy-causing antibodies to various common allergens, including dust mites. This test may also indicate how sensitive you are to an allergen.",
+    "https://www.mayoclinic.org/diseases-conditions/dust-mites/symptoms-causes/syc-20352173"
+  ],
+  [
+    "Dust mite allergy: Dust mite allergy is an allergic reaction to tiny bugs that commonly live in house dust. Signs of dust mite allergy include those common to hay fever, such as sneezing and runny nose. Many people with dust mite allergy also experience signs of asthma, such as wheezing and difficulty breathing. Dust mites, close relatives of ticks and spiders, are too small to see without a microscope. Dust mites eat skin cells shed by people, and they thrive in warm, humid environments. In most homes, such items as bedding, upholstered furniture and carpeting provide an ideal environment for dust mites. By taking steps to reduce the number of dust mites in your home, you may get control of dust mite allergy. Medications or other treatments are sometimes necessary to relieve symptoms and manage asthma. Dust mite allergy symptoms caused by inflammation of nasal passages include: - Sneezing - Runny nose - Itchy, red or watery eyes - Nasal congestion - Itchy nose, roof of mouth or throat - Postnasal drip - Cough - Facial pressure and pain - Swollen, blue-colored skin under your eyes - In a child, frequent upward rubbing of the nose If your dust mite allergy contributes to asthma, you may also experience: - Difficulty breathing - Chest tightness or pain - An audible whistling or wheezing sound when exhaling - Trouble sleeping caused by shortness of breath, coughing or wheezing - Bouts of coughing or wheezing that are worsened by a respiratory virus such as a cold or the flu A dust mite allergy can range from mild to severe. A mild case of dust mite allergy may cause an occasional runny nose, watery eyes and sneezing. In severe cases, the condition may be ongoing (chronic), resulting in persistent sneezing, cough, congestion, facial pressure or severe asthma attack. Some signs and symptoms of dust mite allergy, such as a runny nose or sneezing, are similar to those of the common cold. Sometimes it's difficult to know whether you have a cold or an allergy. If symptoms persist for longer than one week, you might have an allergy. If your signs and symptoms are severe - such as severe nasal congestion, wheezing or difficulty sleeping - call your doctor. Seek emergency care if wheezing or shortness of breath rapidly worsens or if you are short of breath with minimal activity. Allergies occur when your immune system reacts to a foreign substance such as pollen, pet dander or dust mites. Your immune system produces proteins known as antibodies that protect you from unwanted invaders that could make you sick or cause an infection. When you have allergies, your immune system makes antibodies that identify your particular allergen as something harmful, even though it isn't. When you come into contact with the allergen, your immune system produces an inflammatory response in your nasal passages or lungs. Prolonged or regular exposure to the allergen can cause the ongoing (chronic) inflammation associated with asthma. Dust mites eat organic matter such as skin cells people have shed, and rather than drinking water, they absorb water from humidity in the atmosphere. Dust also contains the feces and decaying bodies of dust mites, and it's the proteins present in this dust mite \"debris\" that are the culprit in dust mite allergy. The following factors increase your risk of developing a dust mite allergy: - Having a family history of allergies. You're more likely to develop a sensitivity to dust mites if several members of your family have allergies. - Exposure to dust mites. Being exposed to high levels of dust mites, especially early in life, increases your risk. - Being a child or a young adult. You're more likely to develop dust mite allergy during childhood or early adulthood. Your doctor may suspect dust mite allergy based on symptoms and your answers to questions about your home. To confirm that you're allergic to some airborne substance, your doctor may use a lighted instrument to look at the condition of the lining of your nose. If you have an allergy to something airborne, the lining of the nasal passage will be swollen and may appear pale or bluish. Your doctor may suspect a dust mite allergy if your symptoms are worse when you go to bed or while cleaning - when dust mite allergens would be temporarily airborne. If you have a pet, it may be more difficult to determine the cause of the allergy, particularly if your pet sleeps in your bedroom. - Allergy skin test. Your doctor may suggest an allergy skin test to determine what you're allergic to. You may be referred to an allergy specialist (allergist) for this test. In this test, tiny amounts of purified allergen extracts - including an extract for dust mites - are pricked onto your skin's surface. This is usually carried out on the forearm, but it may be done on the upper back. Your doctor or nurse observes your skin for signs of allergic reactions after 15 minutes. If you're allergic to dust mites, you'll develop a red, itchy bump where the dust mite extract was pricked onto your skin. The most common side effects of these skin tests are itching and redness. These side effects usually go away within 30 minutes. - Allergy blood test. Some people can't undergo a skin test because they have a skin condition or they take a medication that can affect the results. As an alternative, your doctor may order a blood test that screens for specific allergy-causing antibodies to various common allergens, including dust mites. This test may also indicate how sensitive you are to an allergen. The first treatment for controlling dust mite allergy is avoiding dust mites as much as possible. When you minimize your exposure to dust mites, you can expect fewer or less severe allergic reactions. However, it's impossible to completely eliminate dust mites from your environment. You may also need medications to control symptoms. Allergy medications Your doctor may direct you to take one of the following medications to improve nasal allergy symptoms: - Antihistamines reduce the production of an immune system chemical that is active in an allergic reaction. These drugs relieve itching, sneezing and runny nose. Over-the-counter antihistamine tablets, such as fexofenadine (Allegra Allergy), loratadine (Alavert, Claritin,), cetirizine (Zyrtec) and others, as well as antihistamine syrups for children, are available. Prescription antihistamines taken as a nasal spray include azelastine (Astelin, Astepro) and olopatadine (Patanase). - Corticosteroids delivered as a nasal spray can reduce inflammation and control symptoms of hay fever. These drugs include fluticasone propionate (Flonase), mometasone furoate (Nasonex), triamcinolone (Nasacort Allergy 24HR), ciclesonide (Omnaris) and others. Nasal corticosteroids provide a low dose of the drug and have a much lower risk of side effects compared with oral corticosteroids. - Decongestants can help shrink swollen tissues in your nasal passages and make it easier to breathe through your nose. Some over-the-counter allergy tablets combine an antihistamine with a decongestant. Oral decongestants can increase blood pressure and shouldn't be taken if you have severe high blood pressure, glaucoma or cardiovascular disease. In men with an enlarged prostate, the drug can worsen the condition. Talk to your doctor about whether you can safely take a decongestant. Over-the-counter decongestants taken as a nasal spray may briefly reduce allergy symptoms. If you use a decongestant spray for more than three days in a row, however, it can actually make nasal congestion worse. - Leukotriene modifiers block the action of certain immune system chemicals. Your doctor may prescribe the leukotriene modifier montelukast (Singulair), which comes in tablet form. Possible side effects of montelukast include upper respiratory infection, headache and fever. Less common side effects include behavior or mood changes, such as anxiousness or depression. Other therapies - Immunotherapy. You can \"train\" your immune system not to be sensitive to an allergen. This is done through a series of allergy shots called immunotherapy. One to two weekly shots expose you to very small doses of the allergen, in this case, the dust mite proteins that cause the allergic reaction. The dose is gradually increased, usually during a three- to six-month period. Maintenance shots are needed every four weeks for three to five years. Immunotherapy is usually used when other simple treatments are not satisfactory. - Nasal irrigation. You can use a neti pot or a specially designed squeeze bottle to flush thickened mucus and irritants from your sinuses with a prepared saltwater (saline) rinse. If you're preparing the saline solution yourself, use water that's contaminant-free - distilled, sterile, previously boiled and cooled, or filtered with a filter that has an absolute pore size of 1 micron or smaller. Be sure to rinse the irrigation device after each use with contaminant-free water, and leave open to air-dry. Avoiding exposure to dust mites is the best strategy for controlling dust mite allergy. While you can't completely eliminate dust mites from your home, you can significantly reduce their number. Here's how: - Use allergen-proof bed covers. Keep your mattress and pillows in dustproof or allergen-blocking covers. These covers, made of tightly woven fabric, prevent dust mites from colonizing or escaping from the mattress or pillows. Encase box springs in allergen-proof covers. - Wash bedding weekly. Wash all sheets, blankets, pillowcases and bedcovers in hot water that is at least 130 F (54.4 C) to kill dust mites and remove allergens. If bedding can't be washed hot, put the items in the dryer for at least 15 minutes at a temperature above 130 F (54.4 C) to kill the mites. Then wash and dry the bedding to remove allergens. Freezing nonwashable items for 24 hours also can kill dust mites, but this won't remove the allergens. - Keep humidity low. Maintain a relative humidity below 50 percent in your home. A dehumidifier or air conditioner can help keep humidity low, and a hygrometer (available at hardware stores) can measure humidity levels. - Choose bedding wisely. Avoid bedcovers that trap dust easily and are difficult to clean frequently. - Buy washable stuffed toys. Wash them often in hot water and dry thoroughly. Also, keep stuffed toys off beds. - Remove dust. Use a damp or oiled mop or rag rather than dry materials to clean up dust. This prevents dust from becoming airborne and resettling. - Vacuum regularly. Vacuuming carpeting and upholstered furniture removes surface dust - but vacuuming isn't effective at removing most dust mites and dust mite allergens. Use a vacuum cleaner with a double-layered microfilter bag or a high-efficiency particulate air (HEPA) filter to help decrease house-dust emissions from the cleaner. If your allergies are severe, stay out of the area being vacuumed while someone else does the work. Wait about two hours before going back in the vacuumed room. - Cut clutter. If it collects dust, it also collects dust mites. Remove knickknacks, tabletop ornaments, books, magazines and newspapers from your bedroom. - Remove carpeting and other dust mite habitats. Carpeting provides a comfortable habitat for dust mites. This is especially true if carpeting is over concrete, which holds moisture easily and provides a humid environment for mites. If possible, replace wall-to-wall bedroom carpeting with tile, wood, linoleum or vinyl flooring. Consider replacing other dust-collecting furnishings in bedrooms, such as upholstered furniture, nonwashable curtains and horizontal blinds. - Install a high-efficiency media filter in your furnace and air conditioning unit. Look for a filter with a Minimum Efficiency Reporting Value (MERV) of 11 or 12 and leave the fan on to create a whole house air filter. Be sure to change the filter every three months.",
+    "https://www.mayoclinic.org/diseases-conditions/dust-mites/symptoms-causes/syc-20352173"
+  ],
+  [
+    "Dust mite allergy (Risk factors): The following factors increase your risk of developing a dust mite allergy: - Having a family history of allergies. You're more likely to develop a sensitivity to dust mites if several members of your family have allergies. - Exposure to dust mites. Being exposed to high levels of dust mites, especially early in life, increases your risk. - Being a child or a young adult. You're more likely to develop dust mite allergy during childhood or early adulthood.",
+    "https://www.mayoclinic.org/diseases-conditions/dust-mites/symptoms-causes/syc-20352173"
+  ],
+  [
+    "Chiggers: Chiggers are tiny, 6-legged wingless organisms (larvae) that mature to become a type of mite. Chiggers are found in tall grass and weeds. Their bite causes severe itching. Chiggers are found in certain outdoor areas, such as: - Berry patches - Tall grass and weeds - Edges of woodlands Chiggers bite humans around the waist, ankles, or in warm skin folds. Bites commonly occur in the summer and fall months. The main symptoms of chigger bites are: - Severe itching - Red pimple-like bumps or hives Itching usually occurs several hours after the chiggers attach to the skin. The bite is painless. A skin rash may appear on the parts of the body that were exposed to the sun. It may stop where the underwear meets the legs. This is often a clue that the rash is due to chigger bites. Your health care provider can usually diagnose chiggers by examining the rash. You'll likely be asked about your outdoor activity. A special magnifying scope may be used to find the chiggers on the skin. This helps confirm the diagnosis. The goal of treatment is to stop the itching. Antihistamines and corticosteroid creams or lotions may be helpful. Antibiotics are not necessary unless you also have another skin infection. A secondary infection may occur from scratching. Call your provider if the rash itches very badly, or if your symptoms get worse or do not\u00a0improve with treatment. Avoid outdoor areas that you know are contaminated with chiggers. Applying bug spray containing DEET to skin and clothing can help prevent chigger bites. Updated by: Arnold Lentnek, MD, Infectious Diseases Medical Practice of NY and Clinical Research Centers of CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/001333.htm"
+  ],
+  [
+    "Dust mite allergy (Causes): Allergies occur when your immune system reacts to a foreign substance such as pollen, pet dander or dust mites. Your immune system produces proteins known as antibodies that protect you from unwanted invaders that could make you sick or cause an infection. When you have allergies, your immune system makes antibodies that identify your particular allergen as something harmful, even though it isn't. When you come into contact with the allergen, your immune system produces an inflammatory response in your nasal passages or lungs. Prolonged or regular exposure to the allergen can cause the ongoing (chronic) inflammation associated with asthma. Dust mites eat organic matter such as skin cells people have shed, and rather than drinking water, they absorb water from humidity in the atmosphere. Dust also contains the feces and decaying bodies of dust mites, and it's the proteins present in this dust mite \"debris\" that are the culprit in dust mite allergy.",
+    "https://www.mayoclinic.org/diseases-conditions/dust-mites/symptoms-causes/syc-20352173"
+  ],
+  [
+    "Dust mite allergy (Treatment): The first treatment for controlling dust mite allergy is avoiding dust mites as much as possible. When you minimize your exposure to dust mites, you can expect fewer or less severe allergic reactions. However, it's impossible to completely eliminate dust mites from your environment. You may also need medications to control symptoms. Allergy medications Your doctor may direct you to take one of the following medications to improve nasal allergy symptoms: - Antihistamines reduce the production of an immune system chemical that is active in an allergic reaction. These drugs relieve itching, sneezing and runny nose. Over-the-counter antihistamine tablets, such as fexofenadine (Allegra Allergy), loratadine (Alavert, Claritin,), cetirizine (Zyrtec) and others, as well as antihistamine syrups for children, are available. Prescription antihistamines taken as a nasal spray include azelastine (Astelin, Astepro) and olopatadine (Patanase). - Corticosteroids delivered as a nasal spray can reduce inflammation and control symptoms of hay fever. These drugs include fluticasone propionate (Flonase), mometasone furoate (Nasonex), triamcinolone (Nasacort Allergy 24HR), ciclesonide (Omnaris) and others. Nasal corticosteroids provide a low dose of the drug and have a much lower risk of side effects compared with oral corticosteroids. - Decongestants can help shrink swollen tissues in your nasal passages and make it easier to breathe through your nose. Some over-the-counter allergy tablets combine an antihistamine with a decongestant. Oral decongestants can increase blood pressure and shouldn't be taken if you have severe high blood pressure, glaucoma or cardiovascular disease. In men with an enlarged prostate, the drug can worsen the condition. Talk to your doctor about whether you can safely take a decongestant. Over-the-counter decongestants taken as a nasal spray may briefly reduce allergy symptoms. If you use a decongestant spray for more than three days in a row, however, it can actually make nasal congestion worse. - Leukotriene modifiers block the action of certain immune system chemicals. Your doctor may prescribe the leukotriene modifier montelukast (Singulair), which comes in tablet form. Possible side effects of montelukast include upper respiratory infection, headache and fever. Less common side effects include behavior or mood changes, such as anxiousness or depression. Other therapies - Immunotherapy. You can \"train\" your immune system not to be sensitive to an allergen. This is done through a series of allergy shots called immunotherapy. One to two weekly shots expose you to very small doses of the allergen, in this case, the dust mite proteins that cause the allergic reaction. The dose is gradually increased, usually during a three- to six-month period. Maintenance shots are needed every four weeks for three to five years. Immunotherapy is usually used when other simple treatments are not satisfactory. - Nasal irrigation. You can use a neti pot or a specially designed squeeze bottle to flush thickened mucus and irritants from your sinuses with a prepared saltwater (saline) rinse. If you're preparing the saline solution yourself, use water that's contaminant-free - distilled, sterile, previously boiled and cooled, or filtered with a filter that has an absolute pore size of 1 micron or smaller. Be sure to rinse the irrigation device after each use with contaminant-free water, and leave open to air-dry.",
+    "https://www.mayoclinic.org/diseases-conditions/dust-mites/symptoms-causes/syc-20352173"
+  ],
+  [
+    "Dust mite allergy (Lifestyle and home remedies): Avoiding exposure to dust mites is the best strategy for controlling dust mite allergy. While you can't completely eliminate dust mites from your home, you can significantly reduce their number. Here's how: - Use allergen-proof bed covers. Keep your mattress and pillows in dustproof or allergen-blocking covers. These covers, made of tightly woven fabric, prevent dust mites from colonizing or escaping from the mattress or pillows. Encase box springs in allergen-proof covers. - Wash bedding weekly. Wash all sheets, blankets, pillowcases and bedcovers in hot water that is at least 130 F (54.4 C) to kill dust mites and remove allergens. If bedding can't be washed hot, put the items in the dryer for at least 15 minutes at a temperature above 130 F (54.4 C) to kill the mites. Then wash and dry the bedding to remove allergens. Freezing nonwashable items for 24 hours also can kill dust mites, but this won't remove the allergens. - Keep humidity low. Maintain a relative humidity below 50 percent in your home. A dehumidifier or air conditioner can help keep humidity low, and a hygrometer (available at hardware stores) can measure humidity levels. - Choose bedding wisely. Avoid bedcovers that trap dust easily and are difficult to clean frequently. - Buy washable stuffed toys. Wash them often in hot water and dry thoroughly. Also, keep stuffed toys off beds. - Remove dust. Use a damp or oiled mop or rag rather than dry materials to clean up dust. This prevents dust from becoming airborne and resettling. - Vacuum regularly. Vacuuming carpeting and upholstered furniture removes surface dust - but vacuuming isn't effective at removing most dust mites and dust mite allergens. Use a vacuum cleaner with a double-layered microfilter bag or a high-efficiency particulate air (HEPA) filter to help decrease house-dust emissions from the cleaner. If your allergies are severe, stay out of the area being vacuumed while someone else does the work. Wait about two hours before going back in the vacuumed room. - Cut clutter. If it collects dust, it also collects dust mites. Remove knickknacks, tabletop ornaments, books, magazines and newspapers from your bedroom. - Remove carpeting and other dust mite habitats. Carpeting provides a comfortable habitat for dust mites. This is especially true if carpeting is over concrete, which holds moisture easily and provides a humid environment for mites. If possible, replace wall-to-wall bedroom carpeting with tile, wood, linoleum or vinyl flooring. Consider replacing other dust-collecting furnishings in bedrooms, such as upholstered furniture, nonwashable curtains and horizontal blinds. - Install a high-efficiency media filter in your furnace and air conditioning unit. Look for a filter with a Minimum Efficiency Reporting Value (MERV) of 11 or 12 and leave the fan on to create a whole house air filter. Be sure to change the filter every three months.",
+    "https://www.mayoclinic.org/diseases-conditions/dust-mites/symptoms-causes/syc-20352173"
+  ],
+  [
+    "Port-wine stain: A port-wine stain is a birthmark in which swollen blood vessels create a reddish-purplish discoloration of the skin. Port-wine stains are caused by an abnormal formation of tiny blood vessels in the skin. In rare cases, port-wine stains\u00a0are a sign of Sturge-Weber syndrome or Klippel-Trenaunay-Weber syndrome. Early-stage port-wine stains are usually flat and pink. As the child gets older, the stain grows with the child and the color may deepen to dark red or purple. Port-wine stains occur most often on the face, but can appear anywhere on the body. Over time, the area can become thickened and take on a cobblestone-like appearance. The health care provider can usually diagnose a port-wine stain by looking at the skin. In a few cases, a skin biopsy is needed. Depending on the location of the birthmark and other symptoms, the provider may want to do an intraocular pressure test or x-ray of the skull. An MRI or CT scan of the brain may also be done. Many treatments have been tried for port-wine stains, including freezing, surgery, radiation, and tattooing. Laser therapy\u00a0is most successful\u00a0in\u00a0removing port-wine stains. It is the only method that can destroy the tiny blood vessels in the skin without\u00a0causing much\u00a0damage to\u00a0the skin. The exact type of laser used depends on the person's age, skin type,\u00a0and particular port-wine stain. Stains on the face respond better to laser therapy than those on the arms, legs, or middle of the body. Older stains may be more difficult to treat. Complications may include: - Deformity and increasing disfigurement - Emotional and social problems related to their appearance - Development of glaucoma\u00a0in people with port-wine stains involving upper and lower eyelids - Neurologic problems when port-wine stain is associated with a disorder such as Sturge-Weber syndrome All birthmarks should be evaluated by the provider during a routine examination. Updated by: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/001475.htm"
+  ],
+  [
+    "Alcohol use and safe drinking: Alcohol use involves drinking beer, wine, or hard liquor. Alcohol is one of the most widely used drug substances in the world. TEEN DRINKING Alcohol use is not only an adult problem. Most American high school seniors have had an alcoholic drink within the past month. This is in spite of the fact that the legal drinking age is 21 years old in the United States. About 1 in 5 teens are considered \"problem drinkers.\" This means that they: - Get drunk - Have accidents related to alcohol use - Get into trouble with the law, family members, friends, school, or dates because of alcohol THE EFFECTS OF ALCOHOL Alcoholic drinks have different amounts of alcohol in them. - Beer is about 5% alcohol, although some beers can have more. - Wine is usually 12% to 15% alcohol. - Hard liquor is about 45% alcohol. Alcohol gets into your bloodstream quickly. The amount and type of food in your stomach can change how quickly this occurs. For example, high-carbohydrate and high-fat foods can make your body absorb alcohol more slowly. Certain types of alcoholic drinks get into your bloodstream faster.\u00a0Stronger drinks tend to be absorbed faster. Alcohol slows your breathing rate, heart rate, and how well your brain functions. These effects may appear within 10 minutes and peak at around 40 to 60 minutes. Alcohol stays in your bloodstream until it is broken down by the liver. The amount of alcohol in your blood is called your blood alcohol level. If you drink alcohol faster than the liver can break it down, this level rises. Your blood alcohol level is used to legally define whether or not you are drunk. The legal limit for blood alcohol usually falls between 0.08 and 0.10 in most states. Below is a list of blood alcohol levels and the likely symptoms: - 0.05 -- reduced inhibitions - 0.10 -- slurred speech - 0.20 -- euphoria and motor impairment - 0.30 -- confusion - 0.40 -- stupor - 0.50 -- coma - 0.60 -- breathing stops and death You can have symptoms of being drunk at blood alcohol levels below the legal definition of being drunk. Also, people who drink alcohol frequently may not have symptoms until a higher blood alcohol level is reached. HEALTH RISKS OF ALCOHOL Alcohol increases the risk of: - Alcoholism - Falls, drownings, and other accidents - Head, neck, stomach, colon, breast, and other cancers - Motor vehicle accidents - Risky sex behaviors, unplanned or unwanted pregnancy, and sexually transmitted infections (STIs) - Suicide and homicide Drinking during pregnancy can harm the developing baby. Severe birth defects or fetal alcohol syndrome are possible. RESPONSIBLE DRINKING If you drink alcohol, it is best to do so in moderation. Moderation means the drinking is not getting you intoxicated (or drunk) and you are drinking no more than 1 drink per day if you are a woman and no more than 2 if you are a man. A drink is defined as 12 ounces (350 milliliters) of beer, 5 ounces (150 milliliters) of wine, or\u00a01.5 ounces (45 milliliters) of liquor. Here are some ways to drink responsibly, provided you do not have a drinking problem, are of legal age to drink alcohol, and are not pregnant: - Never drink alcohol and drive a car. - If you are going to drink, have a designated driver, or plan an alternative way home, such as a taxi or bus. - DO NOT drink on an empty stomach. Snack before and while drinking alcohol. If you are taking medicines, including over-the-counter drugs, check with your health care provider before drinking alcohol. Alcohol can make the effects of many medicines stronger. It can also interact with other medicines, making them ineffective or dangerous or make you sick. If alcohol use runs in your family, you may be at increased risk of developing this disease yourself. So, you may want to avoid drinking alcohol altogether. CALL YOUR HEALTH CARE PROVIDER IF: - You are concerned about your personal alcohol use or that of a family member - You are interested in more information regarding alcohol use or support groups - You are unable to reduce or stop your alcohol consumption, in spite of attempts to stop drinking Other resources include: - Local Alcoholics Anonymous or Al-anon/Alateen groups - Local hospitals - Public or private mental health agencies - School or work counselors - Student or employee health centers Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/001944.htm"
+  ],
+  [
+    "Wine and heart health: Studies have shown that adults who drink light to moderate amounts of alcohol may be less likely to develop heart disease than those who do not drink at all or are heavy drinkers. However, people who do not drink alcohol should not start just because they want to avoid developing heart disease. There is a fine line between healthy drinking and risky drinking. DO NOT begin drinking or drink more often just to lower your risk of heart disease. Heavier drinking can harm the heart and liver. Heart disease is the leading cause of death in people who abuse alcohol. Health care providers recommend that if you drink alcohol, drink only light to moderate amounts: - For men, limit alcohol to 1 to 2 drinks a day. - For women, limit alcohol to 1 drink a day. One drink is defined as: - 4 ounces (118 milliliters, mL) of wine - 12 ounces (355 mL) of beer - 1 1/2 ounces (44 mL) of 80-proof spirits - 1 ounce (30 mL) of 100-proof spirits Though research has found that alcohol may help prevent heart disease, much more effective ways to prevent heart disease include: - Controlling blood pressure and cholesterol - Exercising and following a low-fat, healthy diet - Not smoking - Maintaining an ideal weight Anyone who has heart disease or heart failure should talk to their provider before drinking alcohol. Alcohol can make heart failure and other heart problems worse. Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Internal review and update on 07/24/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/001963.htm"
+  ],
+  [
+    "Heart disease and intimacy (When is it Safe?): Both you and your provider may be concerned that having sex will bring on a heart attack. Your provider can tell you when it is safe to have sex again. After a heart attack or heart procedure: - You may have an exercise test, to see how your heart reacts to exercise. - Sometimes, at least the first 2 weeks or so after a heart attack, your provider may advise avoiding sex. Make sure you know the symptoms that could mean your heart is working too hard. They include: - Chest pain or pressure - Feeling lightheaded, dizzy, or faint - Nausea - Trouble breathing - Uneven or fast pulse If you have any of these symptoms during the day, avoid sex and talk to your doctor. If you notice these symptoms during (or soon after) having sex, stop the activity. Call your provider to discuss your symptoms.",
+    "https://medlineplus.gov/ency/patientinstructions/000540.htm"
+  ],
+  [
+    "Tips to Help You Get Active (Be safe.): Be sure to play it safe, regardless of which activities you choose. An injury could cause a setback, keep you from meeting your physical activity goals, and affect how active you are in the future.Start slowly. If you are starting a new physical activity program, go slowly at first. Even if you are doing an activity that you once did well, begin little by little to lower your chance of injury or burnout. Stay hydrated. Remember to drink liquids. Water is an option. Sports beverages have a lot of sugar, will add extra calories, and aren\u2019t necessary for most moderate activity. Listen to your body. Take it easy at first and see how you feel before trying more challenging workouts. Stop if you feel out of breath, dizzy, faint, or nauseated, or if you have chest pain or any other type of pain. Address existing health issues. If you have an injury or health problem such as diabetes or heart disease, talk with your health care professional about how to add physical activity to your life safely. Think ahead and plan for setbacks. Have options ready in advance in case of bad weather, injury, or other unusual events. If you do get off track, don\u2019t give up. Regroup and focus on meeting your goal again as soon as you can.",
+    "https://www.niddk.nih.gov/health-information/weight-management/tips-get-active"
+  ],
+  [
+    "A guide to herbal remedies (Natural Does not Mean Safe): Many people think that using plants to treat illness is safer than taking medicine. People have been using plants in folk medicine for centuries. So it is easy to see the appeal. Yet \"natural\" does not mean safe. Unless taken as directed, some herbals can interact with other medicines or be toxic at high doses. Also, some may cause side effects. Here are some examples: - Kava is an herb used for anxiety, insomnia, symptoms of menopause, and other ailments. Some studies show it may work for anxiety. But kava can also cause severe liver damage. The FDA has issued a warning against its use. - St. John's Wort may work for mild to moderate depression. However, it can interact with birth control pills, antidepressants, and other drugs. It can also cause side effects such as stomach upset and anxiety. - Yohimbe is a bark used to treat erectile dysfunction. The bark can cause high blood pressure, increased heart rate, anxiety, and other side effects. It can interact with certain medicines for depression. Taking it in high does or for a long time can be dangerous. Of course, some herbals have been tested and work well for their intended purpose. Many are also quite safe, but the word \"natural\" will not tell you which ones are safe and which ones are not safe.",
+    "https://medlineplus.gov/ency/patientinstructions/000868.htm"
+  ],
+  [
+    "Alzheimer's Disease and Related Dementias (Stay Safe): In the early stage of Alzheimer's, people's eating habits usually do not change. When changes do occur, living alone may not be safe anymore. Look for these signs to see if living alone is no longer safe for the person with Alzheimer's:- The person forgets to eat. - Food has burned because it was left on the stove. - The oven isn't turned off.Other difficulties, such as not sitting down long enough for meals and refusing to eat, can arise in the middle and late stages of the disease. These changes can lead to poor nourishment, dehydration, abnormally low blood pressure, and other problems.Caregivers should monitor the person's weight and eating habits to make sure he or she is not eating too little or too much. Other things to look for include appetite changes, the person's level of physical activity, and problems with chewing or swallowing. Talk with the person's doctor about changes in eating habits.Read about this topic in Spanish. Lea sobre este tema en espanol.",
+    "https://www.nia.nih.gov/health/alzheimers/caregiving"
+  ],
+  [
+    "Outdoor fitness routine (Staying Safe): Whenever you exercise outside, you should take a few precautions to make sure you stay safe. - Watch the weather. While you can exercise in most types of weather, extreme heat or cold can be dangerous. In cold weather, dress in layers, and wear a hat and gloves. In hot weather, wear plenty of sunscreen, choose lightweight clothing, and drink lots of water. - Use caution on streets. Walk or jog facing oncoming traffic and wear bright clothing so drivers can see you. If you are out when it is dark, wear reflective clothing or carry a flashlight. - Be prepared. Carry an ID and a cell phone, just in case.",
+    "https://medlineplus.gov/ency/patientinstructions/000891.htm"
+  ],
+  [
+    "Epidural block - pregnancy (Is an Epidural Safe?): Many studies have shown that an epidural is a safe way to manage pain during childbirth. While rare, there are some risks. Your blood pressure may drop for a short while. This might cause the baby's heart rate to slow down. - To avoid this, you will receive fluids through an intravenous (IV) line to help keep your blood pressure stable. - If your blood pressure shows a drop, you may need to lie on your side to keep the blood moving throughout your body. - Your provider may also give you medicine to raise your blood pressure. An epidural block may change or alter labor and delivery. - If you are very numb from the block, you may have a harder time bearing down to push your baby through the birth canal. - Contractions may lessen or slow down for a little while, but labor will still move along as it should. In some cases, it may even go faster. If your labor slows down, your doctor can give you medicine to speed up your contractions. It is best to wait until you are in active labor to have the epidural placed. Other rare side effects are: - You may get a headache after your epidural but this is rare. - Medicine could enter your spinal fluid. For a short while, it could make you feel dizzy, or you might have a hard time breathing. You could also have a seizure. This is also rare.",
+    "https://medlineplus.gov/ency/patientinstructions/000484.htm"
+  ],
+  [
+    "Aging in place (Be a Safe Driver): Maybe you already know that driving at night, on the highway, or in bad weather is a problem for you. Some older drivers also have problems when yielding the right of way, turning (especially making left turns), changing lanes, passing, and using expressway ramps.Safe driving tips:- Have your driving skills checked by a driving rehabilitation specialist, occupational therapist, or other trained professional. - Take a defensive driving course. Some car insurance companies may lower your bill when you pass this type of class. Organizations like AARP, American Automobile Association (AAA), or your car insurance company can help you find a class near you. - When in doubt, don't go out. Bad weather like rain, ice, or snow can make it hard for anyone to drive. Try to wait until the weather is better, or use buses, taxis, or other transportation services. - Avoid areas where driving can be a problem. For example, choose a route that avoids highways or other high-speed roadways. Or, find a way to go that requires few or no left turns. - Ask your doctor if any of your health problems or medications might make it unsafe for you to drive. Together, you can make a plan to help you keep driving and decide when it is no longer safe to drive.",
+    "https://www.nia.nih.gov/health/topics/aging-place"
+  ],
+  [
+    "Gastric bypass surgery - discharge (Drugs): You may need to take some medicines when you go home. - You may need to give yourself shots underneath the skin of a blood-thinning drug for 2 or more weeks. Your provider will show you how. - You may need to take medicine to prevent gallstones. - You will need to take certain vitamins that your body may not absorb well from your food. Two of these are vitamin B-12 and vitamin D. - You may need to take calcium and iron supplements as well. Aspirin, ibuprofen (Advil, Motrin), and some other drugs may harm the lining of your stomach or even cause ulcers. Talk with your provider before you take these drugs.",
+    "https://medlineplus.gov/ency/patientinstructions/000172.htm"
+  ],
+  [
+    "What is Glucosamine hydrochloride?: Glucosamine is an amino sugar that is produced naturally in humans. It is also found in seashells, or it can be made in the laboratory. Glucosamine hydrochloride is one of several forms of glucosamine. It is important to read the labels of glucosamine products carefully since several different forms of glucosamine are sold as supplements. These products may contain glucosamine sulfate, glucosamine hydrochloride, or N-acetyl-glucosamine. These different chemicals have some similarities. But they may not have the same effects when taken as a dietary supplement. Most of the scientific research on glucosamine has been done using glucosamine sulfate. See the separate listing for glucosamine sulfate. The information on this page is about glucosamine hydrochloride. Dietary supplements that contain glucosamine often contain additional ingredients. These additional ingredients are frequently chondroitin sulfate, MSM, or shark cartilage. Some people think these combinations work better than taking just glucosamine alone. So far, researchers have found no proof that combining the additional ingredients with glucosamine adds any benefit. Products that contain glucosamine and glucosamine plus chondroitin vary a great deal. Some do not contain what the label claims. The difference can range from 25% to 115%. Some products in the US that are labeled glucosamine sulfate are actually glucosamine hydrochloride with added sulfate. This product will likely have different effects than one containing glucosamine sulfate. People take glucosamine hydrochloride by mouth for osteoarthritis, rheumatoid arthritis, glaucoma, a jaw disorder called temporomandibular disorder (TMD), joint pain, back pain, and weight loss. Glucosamine hydrochloride is applied to the skin in combination with chondroitin sulfate, shark cartilage, and camphor for osteoarthritis. Glucosamine hydrochloride is used parenterally and short-term to reduce osteoarthritis symptoms.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/natural/747.html"
+  ],
+  [
+    "Substance use - prescription drugs (Types of Drugs That are Misused): Common kinds of drugs that are misused include depressants, opioids, and stimulants. DEPRESSANTS These medicines are also known as tranquilizers and sedatives. They are prescribed to treat anxiety and sleep problems. Types of drugs and their street names include: - Barbiturates, such as Amytal, Nembutal, phenobarbital, Seconal. Street names include barbs, phennies, reds, red birds, tooies, yellows, yellow jackets - Benzodiazepines, such as Ativan, Halcion, Klonopin Librium, Valium, Xanax. Street names include benzos, blues, candy, chill pills, french fries, downers, sleeping pills, totem poles, tranks, z-bar - Other sleep medicines, such as Ambien, Sonata, Lunesta. Street names include A-, zombie pills When used to get high, they cause feelings of well-being, intense happiness, and excitement. As street drugs, depressants come in pills or capsules and are usually swallowed. Harmful effects of depressants on the body include: - Decreased attention span - Impaired judgment - Lack of coordination - Lowered blood pressure - Memory problems - Slurred speech Long-time users may have life-threatening withdrawal symptoms if they try to stop the drug abruptly. OPIOIDS Opioids are powerful painkillers. They are prescribed to treat pain after surgery or a dental procedure. Sometimes they are used to treat severe cough or diarrhea. Types of opioids and their street names include: - Codeine. There are many medicines that contain codeine as an ingredient, especially ones for cough such as Robitussin A-C and Tylenol with codeine. Street names for codeine alone include captain cody, cody, little c, and school boy. For Tylenol with codeine, street names include T1, T2, T3, T4, and dors and fours. Codeine syrup mixed with soda can have street namses such as purple drank, sizzup, or Texas tea. - Fentanyl. Drugs include Actiq, Duragesic, Onsolis, and Sublimaze. Street names include apache, china girl, china white, dance fever, friend, goodfella, jackpot, murder 8, percopop, tango and cash. - Hydrocodone: Drugs include Lorcet, Lortab, and Vicodin. Street names include fluff, hydros, v-itamin, vic, vike, Watson-387. - Morphine. Drugs include Avinza, Duramorph, Kadian, Ormorph, Roxanol. Street names include dreamer, first line, god's drug, M, miss emma, mister blue, monkey, morf, morpho, vitamin m, white stuff. - Oxycodone. Drugs include Oxycontin, Percocet, Percodan, Tylox. Street names include cotton, hillbilly heroin, o.c., ox, oxy, oxycet, oxycotton, percs, pills. When used to get high, opioids cause a person to feel relaxed and intensely happy. As street drugs, they come as powder, pills or capsules, syrup. They can be swallowed, injected, smoked, put into the rectum, or inhaled through the nose (snorted). Harmful effects of opioids on the body include: - Constipation - Dry mouth - Confusion - Lack of coordination - Lowered blood pressure - Weakness, dizziness, sleepiness In high doses, opioid intoxication can result, which can cause breathing problems, coma, or death. STIMULANTS These are drugs that stimulate the brain and body. They make the messages between the brain and body move faster. As a result, the person is more alert and physically active. Stimulants such as amphetamines are prescribed to treat health problems such as obesity, narcolepsy, or attention deficit hyperactivity disorder (ADHD). Types of stimulants and their street names include: - Amphetamines, such as Adderall, Biphetamine, and Dexedrine. Street names include bennies, black beauties, crosses, hearts, LA turnaround, speed, truck drivers, uppers. - Methylphenidate, such as Concerta, Metadate, Quillivant, and Ritalin. Street names include JIF, kibbles and bits, MPH, pineapple, r-ball, skippy, the smart drug, vitamin R. When used to get high, stimulants cause a person to feel excited, very alert, and have increased energy. Some people use the drugs, especially amphetamines, to help them stay awake on the job or to study for a test. Others use them to boost their performance in sports. As street drugs, they come as pills. They can be swallowed, injected, smoked, or inhaled through the nose (snorted). Harmful effects of stimulants on the body include: - Heart problems, such as fast heart rate, irregular heartbeat, increased blood pressure - High body temperature and skin flushing - Loss of appetite and weight loss - Memory loss and problems thinking clearly - Mood and emotional problems, such as aggressive or violent behavior - Restlessness and tremors",
+    "https://medlineplus.gov/ency/patientinstructions/000798.htm"
+  ],
+  [
+    "Types of chemotherapy (Chemotherapy Drugs): There are more than 100 different chemotherapy drugs. Below are the seven main types of chemotherapy, the types of cancer they treat, and examples. The caution includes things that differ from typical chemotherapy side effects. ALKYLATING AGENTS Used to treat: - Leukemia - Lymphoma - Hodgkin disease - Multiple myeloma - Sarcoma - Cancers of the lung, breast, and ovary Examples: - Busulfan (Busulfex, Myleran) - Cyclophosphamide (Cytoxan) - Temozolamide (Temodar) Caution: - May damage bone marrow, which can lead to leukemia. ANTIMETABOLITES Used to treat: - Leukemia - Cancer of the breast, ovary, and intestinal tract Examples: - 5-fluorouracil (5-FU) - 6-mercaptopurine (6-MP) - Capecitabine (Xeoloda) - Gemcitabine (Gemzar) Caution: None ANTI-TUMOR ANTIBIOTICS Used to treat: - Many types of cancer. Examples: - Actinomycin-D (Cosmegen) - Bleomycin - Daunorubicin (Cerubidine, Rubidomycin) - Doxorubicin (Adriamycin PFS, Adriamycin RDF) Caution: - High doses can damage the heart. TOPOISOMERASE INHIBITORS Used to treat: - Leukemia - Lung, ovarian, gastrointestinal, and other cancers Examples: - Etoposide (Toposar, VePesid) - Irinotechan (Camptosa) - Teniposide (Vumon) - Topotecan (Hycamtin) Caution: - Some can make a person more likely to get a second cancer, called acute myeloid leukemia, within two to three years. MITOTIC INHIBITORS Used to treat: - Myeloma - Lymphomas - Leukemias - Breast or lung cancer Examples: - Docetaxel (Taxotere) - Eribulin (Halaven) - Ixabepilone (Ixempra) - Paclitaxel (Taxol) - Vinblastine (Velban, Velsar) Caution: - More likely than other types of chemotherapy to cause painful nerve damage.",
+    "https://medlineplus.gov/ency/patientinstructions/000910.htm"
+  ],
+  [
+    "Protecting yourself from cancer scams (Investigational Drugs): There is a difference between an unproven treatment and investigational drugs. These are drugs that are being studied to see if they work well to treat cancer. Cancer patients may take investigational drugs as part of a clinical trial. This is a study to test how well the drug works, and to check its side effects and safety. Clinical trials are the last step before a drug can get approval from the FDA.",
+    "https://medlineplus.gov/ency/patientinstructions/000847.htm"
+  ],
+  [
+    "Pharmacology (How are drugs approved?): The U.S. Food and Drug Administration (FDA) is the federal agency responsible for labeling medications and supplements. However, the approval process is different for prescription and for over-the-counter medications. Prescription Drugs The FDA must regulate and approve new prescription drugs before they can be sold to the public. In 2011, the last year for which information is available, the FDA approved 35 new drugs for use by the general public. Although this number may seem small, the approval process for drugs is extensive. The manufacturer or sponsor follows a series of important steps, through animal studies and clinical trials in humans, to ensure that the medication is safe, does what it claims to do, and will provide a health benefit. Testing is performed first in laboratories and on animals to determine that the drug is safe and try to understand how the drug might work in humans. \"Clinical trial\" is the scientific term for a test or study of a drug or medical device in people. These tests are done to see if the product is safe and effective for people to use. Sometimes, multiple trials are completed to measure the effectiveness of a particular medication. Participants in the studies are often followed over a period of time. For comparison purposes, some are given a placebo, an inactive or \"dummy\" medication, while others are given the actual drug. The NICHD and other institutes of the NIH help conduct and support the research but are not involved in the approval or labeling process. The clinical trial phase can take years to complete. However, once research has shown that the drug is safe and useful, the FDA typically reviews and either approves or denies an application for a new drug within 6 months. View a PDF of the FDA drug approval process. (PDF - 2.79 MB) Over-the-Counter Drugs, Dietary and Herbal Supplements Over-the-counter drugs and dietary and herbal supplements are not formally approved through the FDA. The active ingredients and labeling of medications and supplements in certain classes (like antacids, for example) are reviewed by the FDA to ensure that acceptable ingredients are used and that they are safe. Drug companies must conform to the requirements in the medication or supplement class, but they do not need formal FDA approval to make and sell over-the-counter medications and supplements. The label will indicate whether a drug or supplement has been FDA approved. Talk to your health care provider about any medications you are currently taking or are considering taking to ensure that they are safe. Generic Drugs A generic drug is a medicine that is contains the same active pharmaceutical ingredient as a name-brand drug but is not sold under a brand name. FDA-approved generic drugs meet the same strict standards for safety, efficacy, and quality as name-brand drugs. Consumers usually can buy generic drugs at a much lower price than brand-name drugs. Generic versions are not available for every medicine, and in some cases may not be able to be substituted for a brand name product. When a pharmaceutical company develops a new drug, it is protected under a patent, usually for 20 years. During this time, no other company is allowed to make or sell it. Once the patent expires, that company or another company can make and test another version of the drug. After testing and FDA approval, the company can sell the drug as a generic. Consumers can learn whether a generic drug is FDA-approved by using the drug approval references on the FDA website. \u00ab Why is it important? Other FAQs \u00bb",
+    "https://www.nichd.nih.gov/health/topics/pharma"
+  ],
+  [
+    "Glucosamine Hydrochloride (Are there interactions with herbs and supplements?): Chondroitin sulfate Taking chondroitin sulfate together with glucosamine hydrochloride might reduce blood levels of glucosamine. In theory, taking glucosamine hydrochloride with chondroitin sulfate might reduce the absorption of glucosamine hydrochloride.",
+    "https://medlineplus.gov/druginfo/natural/747.html"
+  ],
+  [
+    "Antiplatelet drugs - P2Y12 inhibitors (Who Should Take Antiplatelet Drugs): Antiplatelet drugs may be used to: - Prevent heart attack or stroke for those with PAD. - Clopidogrel (Plavix, generic) may be used in place of aspirin for patients who have narrowing of the coronary arteries or who have had a stent inserted. - Sometimes two anti-platelet drugs (one of which is almost always aspirin) are prescribed for patients with unstable angina, acute coronary syndrome (unstable angina or early signs of heart attack), or those who have received a stent during PCI. - For heart disease primary and secondary prevention, daily aspirin is generally the first choice for antiplatelet therapy. Clopidogrel is prescribed instead of aspirin for patients who are aspirin allergic or who cannot tolerate aspirin. - Clopidogrel and aspirin is recommended for patients who are undergoing angioplasty with or without stenting. - Prevent or treat heart attacks. - Prevent stroke or transient ischemic attacks (TIAs are early warning signs of stroke. The are also called \"mini-strokes.\") - Prevent clots from forming inside stents put inside your arteries to open them. - Acute coronary syndrome. - After bypass graft surgery that uses a man-made or prosthetic graft performed on arteries below the knee. Your health care provider will choose which one of these drugs are best for your problem. At times, you may be asked to take low dose aspirin along with one of these drugs.",
+    "https://medlineplus.gov/ency/patientinstructions/000100.htm"
+  ],
+  [
+    "Hypoglycemia: Hypoglycemia is a condition caused by a very low level of blood sugar (glucose), your body's main energy source. Hypoglycemia is often related to the treatment of diabetes. However, a variety of conditions - many rare - can cause low blood sugar in people without diabetes. Like fever, hypoglycemia isn't a disease itself - it's an indicator of a health problem. Immediate treatment of hypoglycemia is necessary when blood sugar levels are at 70 milligrams per deciliter (mg/dL) or 3.9 millimoles per liter (mmol/L) or below. Treatment involves quick steps to get your blood sugar level back into a normal range either with high-sugar foods or drinks or with medications. Long-term treatment requires identifying and treating the underlying cause of hypoglycemia. If blood sugar levels become too low, signs and symptoms may include: - An irregular heart rhythm - Fatigue - Pale skin - Shakiness - Anxiety - Sweating - Hunger - Irritability - Tingling sensation around the mouth - Crying out during sleep As hypoglycemia worsens, signs and symptoms may include: - Confusion, abnormal behavior or both, such as the inability to complete routine tasks - Visual disturbances, such as blurred vision - Seizures - Loss of consciousness People with severe hypoglycemia may appear as if they're intoxicated. They may slur their words and move clumsily. When to see a doctor Seek a doctor's help immediately if: - You have what may be symptoms of hypoglycemia and you don't have diabetes. - You have diabetes and hypoglycemia isn't responding to treatment. Initial treatment of hypoglycemia is drinking juice or regular soft drinks, eating candy or taking glucose tablets. If this treatment doesn't raise your blood sugar and improve your symptoms, contact your doctor right away. Seek emergency help if: - Someone with diabetes or a history of recurring hypoglycemia has symptoms of severe hypoglycemia or loses consciousness Hypoglycemia occurs when your blood sugar (glucose) level falls too low. There are several reasons why this may happen, the most common is a side effect of drugs used to treat diabetes. Blood sugar regulation But to understand how hypoglycemia happens, it helps to know how your body normally processes blood sugar. When you eat, your body breaks down carbohydrates from foods - such as bread, rice, pasta, vegetables, fruit and milk products - into various sugar molecules, including glucose. Glucose is the main energy source for your body, but it can't enter the cells of most of your tissues without the help of insulin - a hormone secreted by your pancreas. When glucose levels rise, certain cells (beta cells) in your pancreas release insulin. This allows glucose to enter the cells and provide the fuel your cells need to function properly. Any extra glucose is stored in your liver and muscles in the form of glycogen. If you haven't eaten for several hours and your blood sugar level drops, another hormone from your pancreas called glucagon signals your liver to break down the stored glycogen and release glucose back into your bloodstream. This keeps your blood sugar level within a normal range until you eat again. Aside from your liver breaking down glycogen into glucose, your body also has the ability to manufacture glucose. This process occurs primarily in your liver, but also in your kidneys. Possible causes, with diabetes People with diabetes may not make enough insulin (type 1 diabetes) or may be less responsive to it (type 2 diabetes). As a result, glucose tends to build up in the bloodstream and may reach dangerously high levels. To correct this problem, someone with diabetes may take insulin or other drugs to lower blood sugar levels. But too much insulin or other diabetes medications may cause your blood sugar level to drop too low, causing hypoglycemia. Hypoglycemia may also happen if you don't eat as much food as usual after taking diabetes medication, or if you exercise more than you normally would. Possible causes, without diabetes Hypoglycemia in people without diabetes is much less common. Causes may include the following: - Medications. Taking someone else's oral diabetes medication accidentally is a possible cause of hypoglycemia. Other medications may cause hypoglycemia, especially in children or in people with kidney failure. One example is quinine (Qualaquin), which is used to treat malaria. - Excessive alcohol consumption. Drinking heavily without eating can block your liver from releasing stored glucose into your bloodstream, causing hypoglycemia. - Some critical illnesses. Severe illnesses of the liver, such as severe hepatitis, can cause hypoglycemia. Disorders of the kidney, which can keep your body from properly excreting medications, can affect glucose levels due to a buildup of those medications. Long-term starvation, as may occur in the eating disorder anorexia nervosa, can result in the depletion of substances your body needs to generate glucose (gluconeogenesis), causing hypoglycemia. - Insulin overproduction. A rare tumor of the pancreas (insulinoma) may cause overproduction of insulin, resulting in hypoglycemia. Other tumors may result in excessive production of insulin-like substances. Enlargement of beta cells of the pancreas that produce insulin (nesidioblastosis) may result in excessive insulin release, causing hypoglycemia. - Hormone deficiencies. Certain disorders of the adrenal glands and the pituitary gland can result in a deficiency of key hormones that regulate glucose production. Children may experience hypoglycemia if they have a deficiency of growth hormone. Hypoglycemia after meals Hypoglycemia usually occurs when you haven't eaten (when you're in a fasting state), but that's not always the case. Sometimes hypoglycemia occurs after meals because the body produces more insulin than is needed. This type of hypoglycemia, called reactive or postprandial hypoglycemia, may occur in people who have had stomach surgery. It may also occur in people who haven't had this surgery. If you ignore the symptoms of hypoglycemia too long, you may lose consciousness. That's because your brain needs glucose to function properly. Recognize the signs and symptoms of hypoglycemia early because untreated hypoglycemia can lead to: - Seizure - Loss of consciousness - Death Hypoglcemia can also contribute to: - Falls - Injuries - Motor vehicle accidents Hypoglycemia unawareness Over time, repeated episodes of hypoglycemia can lead to hypoglycemia unawareness. The body and brain no longer produce signs and symptoms that warn of a low blood sugar, such as shakiness or irregular heartbeats. When this happens, the risk of severe, life-threatening hypoglycemia is increased. Undertreated diabetes If you have diabetes, episodes of low blood sugar are uncomfortable and can be frightening. Repeated episodes of hypoglycemia may cause you to take less insulin to ensure that your blood sugar level doesn't go too low. But long-term high blood sugar levels can be dangerous too, possibly causing damage to your nerves, blood vessels and various organs. If you use insulin or another diabetes medication known to lower blood sugar, and you have signs and symptoms of hypoglycemia, test your blood sugar levels with a blood glucose meter. If the result shows low blood sugar (under 70 mg/dL), treat accordingly. If you don't use medications known to cause hypoglycemia, your doctor will want to know: - What were your signs and symptoms? You may not exhibit signs and symptoms of hypoglycemia during your initial visit with your doctor. In this case, your doctor may have you fast overnight (or for a longer period). This will allow low blood sugar symptoms to occur so that he or she can make a diagnosis. It's also possible that you'll need to undergo an extended fast in a hospital setting. Or if your symptoms occur after a meal, your doctor will want to test your glucose levels after a meal. - What is your blood sugar level when you're having symptoms? Your doctor will draw a sample of your blood to be analyzed in the laboratory. - Do your symptoms disappear when blood sugar levels increase? In addition, your doctor will likely conduct a physical examination and review your medical history. Treatment of hypoglycemia involves: - Immediate initial treatment to raise your blood sugar level - Treatment of the underlying condition that's causing your hypoglycemia to prevent it from recurring Immediate initial treatment The initial treatment depends on your symptoms. Early symptoms can usually be treated by consuming 15 to 20 grams of a fast-acting carbohydrate. Fast-acting carbohydrates are foods that are easily converted to sugar in the body, such as glucose tablets or gel, fruit juice, regular - not diet - soft drinks, and sugary candy such as licorice. Foods containing fat or protein aren't good treatments for hypoglycemia, because they affect the body's absorption of sugar. Recheck blood sugar levels 15 minutes after treatment. If blood sugar levels are still under 70 mg/dL (3.9 mmol/L), treat with another 15 to 20 grams of fast-acting carbohydrate, and recheck the blood sugar level again in 15 minutes. Repeat these steps until the blood sugar is above 70 mg/dL (3.9 mmol/L). Once the blood sugar levels are back to normal, it's important to have a snack or meal to help stabilize your blood sugar. This also helps the body replenish glycogen stores that may have been depleted during hypoglycemia. If your symptoms are more severe, impairing your ability to take sugar by mouth, you may need an injection of glucagon or intravenous glucose. Do not give food or drink to someone who is unconscious, as he or she may aspirate these substances into the lungs. If you're prone to severe episodes of hypoglycemia, ask your doctor if a home glucagon kit might be appropriate for you. In general, people with diabetes who are treated with insulin should have a glucagon kit for low blood sugar emergencies. Family and friends need to know where to find the kit, and need to be taught how to use it before an emergency occurs. Treatment of the underlying condition Preventing recurrent hypoglycemia requires your doctor to identify the underlying condition and treat it. Depending on the underlying cause, treatment may involve: - Medications. If a medication is the cause of your hypoglycemia, your doctor will likely suggest changing the medication or adjusting the dosage. - Tumor treatment. A tumor in your pancreas is treated by surgical removal of the tumor. In some cases, partial removal of the pancreas is necessary.",
+    "https://www.mayoclinic.org/diseases-conditions/hypoglycemia/symptoms-causes/syc-20373685"
+  ],
+  [
+    "What is Steps to take before you get pregnant?: Most women know they need to see a doctor and make lifestyle changes while pregnant. But, it is just as important to start making changes before you get pregnant. These steps will help you prepare yourself and your body for pregnancy andgive you a better chance of having a healthy baby.",
+    "https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000513.htm"
+  ],
+  [
+    "congenital hyperinsulinism: Congenital hyperinsulinism is a condition that causes individuals to have abnormally high levels of insulin, which is a hormone that helps control blood sugar levels. People with this condition have frequent episodes of low blood sugar (hypoglycemia). In infants and young children, these episodes are characterized by a lack of energy (lethargy), irritability, or difficulty feeding. Repeated episodes of low blood sugar increase the risk for serious complications such as breathing difficulties, seizures, intellectual disability, vision loss, brain damage, and coma. The severity of congenital hyperinsulinism varies widely among affected individuals, even among members of the same family. About 60 percent of infants with this condition experience a hypoglycemic episode within the first month of life. Other affected children develop hypoglycemia by early childhood. Unlike typical episodes of hypoglycemia, which occur most often after periods without food (fasting) or after exercising, episodes of hypoglycemia in people with congenital hyperinsulinism can also occur after eating. Congenital hyperinsulinism affects approximately 1 in 50,000 newborns. This condition is more common in certain populations, affecting up to 1 in 2,500 newborns. Congenital hyperinsulinism is caused by mutations in genes that regulate the release (secretion) of insulin, which is produced by beta cells in the pancreas. Insulin clears excess sugar (in the form of glucose) from the bloodstream by passing glucose into cells to be used as energy. Gene mutations that cause congenital hyperinsulinism lead to over-secretion of insulin from beta cells. Normally, insulin is secreted in response to the amount of glucose in the bloodstream: when glucose levels rise, so does insulin secretion. However, in people with congenital hyperinsulinism, insulin is secreted from beta cells regardless of the amount of glucose present in the blood. This excessive secretion of insulin results in glucose being rapidly removed from the bloodstream and passed into tissues such as muscle, liver, and fat. A lack of glucose in the blood results in frequent states of hypoglycemia in people with congenital hyperinsulinism. Insufficient blood glucose also deprives the brain of its primary source of fuel. Mutations in at least nine genes have been found to cause congenital hyperinsulinism. Mutations in the ABCC8 gene are the most common known cause of the disorder. They account for this condition in approximately 40 percent of affected individuals. Less frequently, mutations in the KCNJ11 gene have been found in people with congenital hyperinsulinism. Mutations in each of the other genes associated with this condition account for only a small percentage of cases. In approximately half of people with congenital hyperinsulinism, the cause is unknown. Congenital hyperinsulinism can have different inheritance patterns, usually depending on the form of the condition. At least two forms of the condition have been identified. The most common form is the diffuse form, which occurs when all of the beta cells in the pancreas secrete too much insulin. The focal form of congenital hyperinsulinism occurs when only some of the beta cells over-secrete insulin. Most often, the diffuse form of congenital hyperinsulinism is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition. Less frequently, the diffuse form is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder. The inheritance of the focal form of congenital hyperinsulinism is more complex. For most genes, both copies are turned on (active) in all cells, but for a small subset of genes, one of the two copies is turned off (inactive). Most people with the focal form of this condition inherit one copy of the mutated, inactive gene from their unaffected father. During embryonic development, a mutation occurs in the other, active copy of the gene. This second mutation is found within only some cells in the pancreas. As a result, some pancreatic beta cells have abnormal insulin secretion, while other beta cells function normally. Huopio H, Shyng SL, Otonkoski T, Nichols CG. K(ATP) channels and insulin secretion disorders. Am J Physiol Endocrinol Metab. 2002 Aug;283(2):E207-16. Review.",
+    "https://ghr.nlm.nih.gov/condition/congenital-hyperinsulinism"
+  ],
+  [
+    "Diabetic hypoglycemia: For people with diabetes, low blood sugar (hypoglycemia) occurs when there's too much insulin and not enough sugar (glucose) in the blood. Hypoglycemia is defined as blood sugar below 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L). Several factors can cause hypoglycemia in people with diabetes, including taking too much insulin or other diabetes medications, skipping a meal, or exercising harder than usual. Pay attention to early warning signs, so you can treat low blood sugar promptly. Treatment involves short-term solutions - such as taking glucose tablets - to raise your blood sugar into a normal range. Untreated, diabetic hypoglycemia can lead to seizures and loss of consciousness - a medical emergency. Rarely, it can be deadly. Tell family and friends what symptoms to look for and what to do in case you're not able to treat the condition yourself. Early warning signs and symptoms Early signs and symptoms of diabetic hypoglycemia include: - Shakiness - Dizziness - Sweating - Hunger - Irritability or moodiness - Anxiety or nervousness - Headache Nighttime symptoms Diabetic hypoglycemia can also occur while you sleep. Signs and symptoms, which can awaken you, include: - Damp sheets or bedclothes due to perspiration - Nightmares - Tiredness, irritability or confusion upon waking Severe symptoms If diabetic hypoglycemia goes untreated, signs and symptoms of severe hypoglycemia can occur. These include: - Clumsiness or jerky movements - Muscle weakness - Difficulty speaking or slurred speech - Blurry or double vision - Drowsiness - Confusion - Convulsions or seizures - Unconsciousness - Death Take your symptoms seriously. Diabetic hypoglycemia can increase the risk of serious - even deadly - accidents. Identifying and correcting the factors contributing to hypoglycemia, such as medications you take or irregular mealtimes, can prevent serious complications. Informing people you trust, such as family, friends and co-workers, about hypoglycemia is important. Their knowing what symptoms to look for and what to do in case you're not able to help yourself can make a potentially difficult situation easier to manage. It's also important that they know how to give you a glucagon injection, in case it becomes necessary. Symptoms can differ from person to person or from time to time, so it's important to monitor your blood sugar levels regularly and keep track of how you're feeling when your blood sugar is low. Some people don't have or don't recognize early symptoms (hypoglycemia unawareness). If you have hypoglycemia unawareness, you may require a higher glucose goal range. When to see a doctor Hypoglycemia can leave you confused or even unconscious, which requires emergency care. Make sure your family, friends and co-workers know what to do. If you lose consciousness or can't swallow: - You shouldn't be given fluids or food, which could cause choking - You need an injection of glucagon - a hormone that stimulates the release of sugar into the blood - You need emergency treatment in a hospital if a glucagon injection isn't on hand If you have symptoms of hypoglycemia several times a week, see your doctor. You may need to change your medication or your dosage or otherwise adjust your diabetes treatment program. Hypoglycemia is most common among people who take insulin, but it can also occur if you're taking certain oral diabetes medications. Common causes of diabetic hypoglycemia include: - Taking too much insulin or diabetes medication - Not eating enough - Postponing or skipping a meal or snack - Increasing exercise or physical activity without eating more or adjusting your medications - Drinking alcohol Blood sugar regulation The hormone insulin lowers glucose levels when glucose is elevated. If you have type 1 or type 2 diabetes and need insulin to control your blood sugar, taking more insulin than you need can cause your blood sugar level to drop too low and result in hypoglycemia. Hypoglycemia also may result if, after taking your diabetes medication, you eat less than usual or exercise more than you normally do. Your doctor can work with you to prevent this imbalance by finding the dose that fits your regular eating and activity patterns. If you ignore the symptoms of hypoglycemia too long, you may lose consciousness. That's because your brain needs glucose to function. Recognize the signs and symptoms of hypoglycemia early because if untreated, hypoglycemia can lead to: - Seizures - Loss of consciousness - Death On the other hand, be careful not to overtreat your low blood sugar. If you do, you may cause your blood sugar level to rise too high (hyperglycemia), which can become a problem with repeated episodes of hypoglycemia. You can determine if you have low blood sugar by using a blood glucose meter - a small computerized device that measures and displays your blood sugar level. You have hypoglycemia when your blood sugar level drops below 70 mg/dL (3.9 mmol/L). It's important to record the date, time, test results, medication and dosage, and diet and exercise information each time you test your blood. Also, note any low blood sugar reactions. Your doctor diagnoses hypoglycemia using your records and looks for patterns to see how your medications and lifestyle affect your blood sugar. Hypoglycemic management If you think your blood sugar may be dipping too low, check your blood sugar level with a blood glucose meter. Then eat or drink something that's mostly sugar or carbohydrates to raise your blood sugar level quickly. Foods with a lot of fat, such as chocolate, don't work as well. Examples of foods that will raise your blood sugar level quickly include: - Five to six pieces of hard candy - Four ounces (120 milliliters) of fruit juice or regular - not diet - soda - One tablespoon (15 milliliters) of sugar, jelly or honey - Three glucose tablets (available without a prescription at most pharmacies) - A serving of glucose gel (read the label for amount) If you have symptoms of low blood sugar but can't check your blood sugar level right away, then act as though you have hypoglycemia. You might want to carry at least one sugary item with you at all times. It's also a good idea to wear a bracelet that identifies you as someone who has diabetes. Check your blood sugar level again 15 to 20 minutes later. If it's still too low, eat or drink something sugary. When you feel better, eat meals and snacks as usual. Difficult-to-manage hypoglycemia Some people have frequent and severe hypoglycemia despite medication adjustments. In these circumstances, your doctor may recommend a higher glucose goal range and prescribe glucagon, a hormone that causes blood glucose to rise. Glucagon, available only by prescription, comes in an emergency syringe kit. It contains one dose that has to be mixed before injecting. Store the glucagon at room temperature and be aware of the expiration date. If you're unconscious, someone who gives you the injection should turn you on your side to prevent choking in case you vomit. In 15 minutes, you should be alert and able to swallow. You then need to eat. If you don't respond within 15 minutes, you need emergency medical care.",
+    "https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/symptoms-causes/syc-20371525"
+  ],
+  [
+    "Low Blood Glucose (Hypoglycemia) (How can I prevent hypoglycemia if I have diabetes?): If you are taking insulin, a sulfonylurea, or a meglitinide, using your diabetes management plan and working with your health care team to adjust your plan as needed can help you prevent hypoglycemia. The following actions can also help prevent hypoglycemia:Check blood glucose levelsKnowing your blood glucose level can help you decide how much medicine to take, what food to eat, and how physically active to be. To find out your blood glucose level, check yourself with a blood glucose meter as often as your doctor advises.Hypoglycemia unawareness. Sometimes people with diabetes don\u2019t feel or recognize the symptoms of hypoglycemia, a problem called hypoglycemia unawareness. If you have had hypoglycemia without feeling any symptoms, you may need to check your blood glucose more often so you know when you need to treat your hypoglycemia or take steps to prevent it. Be sure to check your blood glucose before you drive.If you have hypoglycemia unawareness or have hypoglycemia often, ask your health care provider about a continuous glucose monitor (CGM). A CGM checks your blood glucose level at regular times throughout the day and night. CGMs can tell you if your blood glucose is falling quickly and sound an alarm if your blood glucose falls too low. CGM alarms can wake you up if you have hypoglycemia during sleep.Eat regular meals and snacksYour meal plan is key to preventing hypoglycemia. Eat regular meals and snacks with the correct amount of carbohydrates to help keep your blood glucose level from going too low. Also, if you drink alcoholic beverages, it\u2019s best to eat some food at the same time.Be physically active safelyPhysical activity can lower your blood glucose during the activity and for hours afterward. To help prevent hypoglycemia, you may need to check your blood glucose before, during, and after physical activity and adjust your medicine or carbohydrate intake. For example, you might eat a snack before being physically active or decrease your insulin dose as directed by your health care provider to keep your blood glucose from dropping too low.Work with your health care teamTell your health care team if you have had hypoglycemia. Your health care team may adjust your diabetes medicines or other aspects of your management plan. Learn about balancing your medicines, eating plan, and physical activity to prevent hypoglycemia. Ask if you should have a glucagon emergency kit to carry with you at all times.You can help prevent hypoglycemia by working with your health care team.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia"
+  ],
+  [
+    "Exercise-induced hyperinsulinemic hypoglycemia: Exercise induced hyperinsulinemic hypoglycemia is characterized by a sudden and exaggerated spike in insulin and drop in blood sugar levels. The condition is triggered by vigorous exercise. Signs and symptoms include fainting (syncope), [1] shakiness, nervousness, sweating, dizziness or light-headedness, sleepiness, confusion, difficulty speaking, anxiety, and weakness. [2] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Autosomal dominant inheritance - Heterogeneous - Hyperinsulinemic hypoglycemia - Hypoglycemic coma - Hypoglycemic seizures - Pancreatic islet- cell hyperplasia - Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional.",
+    "https://rarediseases.info.nih.gov/diseases/9932/exercise-induced-hyperinsulinemic-hypoglycemia"
+  ],
+  [
+    "Leucine-sensitive hypoglycemia of infancy: The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Ataxia - Autosomal dominant inheritance - Autosomal recessive inheritance - Coma - Drowsiness - Hyperinsulinemic hypoglycemia - Hyperreflexia - Hypoglycemia - Intellectual disability - Irritability - Spasticity - Strabismus - View complete list of signs and symptoms... The resources below provide information about treatment options for this condition. If you have questions about which treatment is right for you, talk to your healthcare professional. Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions.",
+    "https://rarediseases.info.nih.gov/diseases/9915/leucine-sensitive-hypoglycemia-of-infancy"
+  ],
+  [
+    "Low Blood Glucose (Hypoglycemia) (What causes hypoglycemia in diabetes?): Hypoglycemia can be a side effect of insulin or other types of diabetes medicines that help your body make more insulin. Two types of diabetes pills can cause hypoglycemia: sulfonylureas and meglitinides. Ask your health care team if your diabetes medicine can cause hypoglycemia.Although other diabetes medicines don\u2019t cause hypoglycemia by themselves, they can increase the chances of hypoglycemia if you also take insulin, a sulfonylurea, or a meglitinide.If you take insulin or some other diabetes medicines, your blood glucose level can drop too low.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia"
+  ],
+  [
+    "Low Blood Glucose (Hypoglycemia) (What is hypoglycemia?): Hypoglycemia, also called low blood glucose or low blood sugar, occurs when the level of glucose in your blood drops below normal. For many people with diabetes, that means a level of 70 milligrams per deciliter (mg/dL) or less. Your numbers might be different, so check with your health care provider to find out what level is too low for you.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia"
+  ],
+  [
+    "Low blood sugar - newborns: A low blood sugar level in newborn babies is also called neonatal hypoglycemia. It refers to low blood sugar (glucose) in the first few days after birth. Babies need blood sugar (glucose) for energy. Most of that glucose is used by the brain. The baby gets glucose from the mother through the placenta before birth. After birth, the baby gets glucose from the mother through her milk or from formula, and the baby also produces it in the liver. Glucose level can drop if: - There is too much insulin in the blood. Insulin is a hormone that pulls glucose from the blood. - The baby is not producing enough glucose. - The baby's body is using more glucose than is being produced. - The baby is not able to feed enough to keep the glucose level up. Neonatal hypoglycemia occurs when the newborn's glucose level causes symptoms or is below the level considered safe for the baby's age. It occurs in about 1 to 3 out of every 1,000 births. Low blood sugar level is more likely in infants with one or more of these risk factors: - Born early, has a serious infection, or needed oxygen right after delivery - Mother has diabetes (these infants are often larger than normal) - Have slower than usual growth in the womb during pregnancy - Are smaller in size than normal for their gestational age Infants with low blood sugar may not have symptoms. If your baby has one of the risk factors for low blood sugar, nurses in the hospital will check your baby's blood sugar level, even if there are no symptoms. Also, blood sugar level is very often checked for babies with these symptoms: - Bluish-colored or pale skin - Breathing problems, such as pauses in breathing (apnea), rapid breathing, or a grunting sound - Irritability or listlessness - Loose or floppy muscles - Poor feeding or vomiting - Problems keeping the body warm - Tremors, shakiness, sweating, or seizures Newborns at risk for hypoglycemia should have a blood test to measure blood sugar level every few hours after birth. This will be done using a heel stick. The health care provider should continue taking blood tests until the baby's glucose level stays normal for about 12 to 24 hours. Other possible tests: - Newborn screening for metabolic disorders, including blood and urine tests Infants with a low blood sugar level will need to receive extra feedings with mother's milk or formula. Babies who are breast-fed may need to receive extra formula if the mother is not able to produce enough milk. (Hand expression and massage can help mothers express more milk.) The infant may need a sugar solution given through a vein (intravenously) if unable to eat by mouth, or if the blood sugar level is very low. Treatment will be continued until the baby can maintain blood sugar level. This may take hours or days. Infants who were born early, have an infection, or were born at a low weight may need to be treated for a longer period of time. If the low blood sugar continues, in rare cases, the baby may also receive medicine to increase blood sugar level. In very rare cases, newborns with very severe hypoglycemia who do not improve with treatment may need surgery to remove part of the pancreas (to reduce insulin production). The outlook is good for newborns who do not have symptoms, or who respond well to treatment. However, low blood sugar level can return in a small number of babies after treatment. The condition is more likely to return when babies are taken off feedings given through a vein before they are fully ready to eat by mouth. Babies with more severe symptoms are more likely to develop learning problems. This is more often true for babies who are at a lower-than-average weight or whose mother has diabetes. Severe or persistent low blood sugar level may affect the baby's mental function. In rare cases, heart failure or seizures may occur. However, these problems may also be due to the underlying cause of the low blood sugar, rather than a result of the low blood sugar itself. If you have diabetes during pregnancy, work with your health care provider to control your blood sugar level. Be sure that your newborn's blood sugar level is monitored after birth. Updated by: Kimberly G. Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M.",
+    "https://medlineplus.gov/ency/article/007306.htm"
+  ],
+  [
+    "Diverticulitis (Diagnosis): Diverticulitis is usually diagnosed during an acute attack. Because abdominal pain can indicate a number of problems, your doctor will need to rule out other causes for your symptoms. Your doctor will likely start with a physical examination, including checking your abdomen for tenderness. Women, in addition, generally have a pelvic examination to rule out pelvic disease. After that, your doctor will likely recommend: - Blood and urine tests, to check for signs of infection. - Pregnancy test for women of childbearing age, to rule out pregnancy as a cause of abdominal pain. - Liver function tests, to rule out other causes of abdominal pain. - Stool test, to rule out infection in people who have diarrhea. - CT scan, which can indicate inflamed or infected pouches and confirm a diagnosis of diverticulitis. CT can also indicate the severity of diverticulitis and guide treatment. Diagnosis at Mayo Clinic Diverticulitis can be difficult to diagnose because abdominal pain is a symptom of many digestive disorders. Mayo Clinic has radiologists who specialize in digestive disorders and have experience distinguishing diverticulitis from other conditions. Mayo's digestive disease specialists (gastroenterologists) have experience diagnosing the severity of diverticulitis. Precise diagnosis is important for appropriate treatment.",
+    "https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758"
+  ],
+  [
+    "What is Diverticulosis and Diverticulitis?: Diverticula are small pouches that bulge outward through the colon, or large intestine. If you have these pouches, you have a condition called diverticulosis. It becomes more common as people age. About half of all people over age 60 have it. Doctors believe the main cause is a low-fiber diet. Most people with diverticulosis don't have symptoms. Sometimes it causes mild cramps, bloating or constipation. Diverticulosis is often found through tests ordered for something else. For example, it is often found during a colonoscopy to screen for cancer. A high-fiber diet and mild pain reliever will often relieve symptoms. If the pouches become inflamed or infected, you have a condition called diverticulitis. The most common symptom is abdominal pain, usually on the left side. You may also have fever, nausea, vomiting, chills, cramping, and constipation. In serious cases, diverticulitis can lead to bleeding, tears, or blockages. Your doctor will do a physical exam and imaging tests to diagnose it. Treatment may include antibiotics, pain relievers, and a liquid diet. A serious case may require a hospital stay or surgery. NIH: National Institute of Diabetes and Digestive and Kidney Diseases",
+    "https://www.nlm.nih.gov/medlineplus/diverticulosisanddiverticulitis.html"
+  ],
+  [
+    "Diverticulitis: Diverticula are small, bulging sacs or pouches that form on the inner wall of the intestine. Diverticulitis occurs when these pouches become inflamed or infected. Most often, these pouches are in the large intestine (colon). The formation of pouches or sacs on the intestinal lining is called diverticulosis. It is found in more than half of Americans over age 60. However, no one knows exactly what causes the pouches to form. Eating a low-fiber diet mostly made up of processed foods may be a cause. Constipation and hard stools are more likely when you do not eat enough fiber. Straining to pass stools increases the pressure in the colon or intestines, which may lead to the formation of these pouches. Diverticulitis is caused by small pieces of stool (feces) that become trapped in these pouches, causing infection or inflammation. People with diverticulosis often have no symptoms, but they may have bloating and cramping in the lower part of the belly. Rarely, they may notice blood in their stool or on toilet paper. Symptoms of diverticulitis are more severe and often start suddenly, but they may become worse over a few days. They include: - Tenderness, usually in the left lower side of the abdomen - Bloating or gas - Fever and chills - Nausea and vomiting - Not feeling hungry and not eating Your health care provider will examine you. You may need blood tests to see if you have an infection. Other tests that help diagnose diverticulitis may include: - CT scan - Ultrasound of the abdomen - X-rays of the abdomen The treatment of diverticulitis depends on how serious the symptoms are. Some people may need to be in the hospital, but most of the time, the problem can be treated at home. To help with the pain, your provider may suggest that you: - Rest in bed and use a heating pad on your belly. - Take pain medicines (ask your provider which ones you should use). - Drink only fluids for a day or two, and then slowly begin drinking thicker liquids and then eating foods. The provider may treat you with antibiotics. After you are better, your provider will suggest that you add more fiber to your diet. Eating more fiber can help prevent future attacks. If you have bloating or gas, reduce the amount of fiber you eat for a few days. Once these pouches have formed, you will have them for life. Diverticulitis can return, but some providers think a high-fiber diet may lessen your chances of a recurrence. Most often, this is a mild condition that responds well to treatment. Some people will have more than 1 attack of diverticulitis. Surgery may be needed in some cases. Many times, providers will recommend that you have a colonoscopy after diverticulitis has healed. More serious problems that may develop are: - Abnormal connections that form between parts of the colon or between the colon and another part of the body (fistula) - Hole or tear in the colon (perforation) - Narrowed area in the colon (stricture) - Pocket filled with pus or infection (abscess) - Bleeding from the diverticula Call your provider if symptoms of diverticulitis occur. Also call if you have diverticulitis and you have: - Blood in your stools - Fever above 100.4\u00b0F (38\u00b0C) that does not go away - Nausea, vomiting, or chills - Sudden belly or back pain that gets worse or is very severe Updated by: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000257.htm"
+  ],
+  [
+    "Diverticulitis: Diverticula are small, bulging pouches that can form in the lining of your digestive system. They are found most often in the lower part of the large intestine (colon). Diverticula are common, especially after age 40, and seldom cause problems. Sometimes, however, one or more of the pouches become inflamed or infected. That condition is known as diverticulitis (die-vur-tik-yoo-LIE-tis). Diverticulitis can cause severe abdominal pain, fever, nausea and a marked change in your bowel habits. Mild diverticulitis can be treated with rest, changes in your diet and antibiotics. Severe or recurring diverticulitis may require surgery. The signs and symptoms of diverticulitis include: - Pain, which may be constant and persist for several days. Pain is usually felt in the lower left side of the abdomen, but may occur on the right, especially in people of Asian descent. - Nausea and vomiting. - Fever. - Abdominal tenderness. - Constipation or, less commonly, diarrhea. Diverticula usually develop when naturally weak places in your colon give way under pressure. This causes marble-sized pouches to protrude through the colon wall. Diverticulitis occurs when diverticula tear, resulting in inflammation or infection or both. Several factors may increase your risk of developing diverticulitis: - Aging. The incidence of diverticulitis increases with age. - Obesity. Being seriously overweight increases your odds of developing diverticulitis. Morbid obesity may increase your risk of needing more-invasive treatments for diverticulitis. - Smoking. People who smoke cigarettes are more likely than nonsmokers to experience diverticulitis. - Lack of exercise. Vigorous exercise appears to lower your risk of diverticulitis. - Diet high in animal fat and low in fiber, although the role of low fiber alone isn't clear. - Certain medications. Several drugs are associated with an increased risk of diverticulitis, including steroids, opiates and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve). Diverticulitis is usually diagnosed during an acute attack. Because abdominal pain can indicate a number of problems, your doctor will need to rule out other causes for your symptoms. Your doctor will likely start with a physical examination, including checking your abdomen for tenderness. Women, in addition, generally have a pelvic examination to rule out pelvic disease. After that, your doctor will likely recommend: - Blood and urine tests, to check for signs of infection. - Pregnancy test for women of childbearing age, to rule out pregnancy as a cause of abdominal pain. - Liver function tests, to rule out other causes of abdominal pain. - Stool test, to rule out infection in people who have diarrhea. - CT scan, which can indicate inflamed or infected pouches and confirm a diagnosis of diverticulitis. CT can also indicate the severity of diverticulitis and guide treatment. Diagnosis at Mayo Clinic Diverticulitis can be difficult to diagnose because abdominal pain is a symptom of many digestive disorders. Mayo Clinic has radiologists who specialize in digestive disorders and have experience distinguishing diverticulitis from other conditions. Mayo's digestive disease specialists (gastroenterologists) have experience diagnosing the severity of diverticulitis. Precise diagnosis is important for appropriate treatment. Treatment depends on the severity of your signs and symptoms. Uncomplicated diverticulitis If your symptoms are mild, you may be treated at home. Your doctor is likely to recommend: - Antibiotics, to treat infection. - A liquid diet for a few days while your bowel heals. Once your symptoms improve, you can gradually add solid food to your diet. - An over-the-counter pain reliever, such as acetaminophen (Tylenol, others). This treatment is successful in 70 to 100 percent of people with uncomplicated diverticulitis. Complicated diverticulitis If you have a severe attack or have other health problems, you'll likely need to be hospitalized. Treatment generally involves: - Intravenous antibiotics - Insertion of a tube to drain an abscess, if one has formed Surgery You'll likely need surgery to treat diverticulitis if: - You have a complication, such as perforation, abscess, fistula or bowel obstruction - You have had multiple episodes of uncomplicated diverticulitis - You are immune compromised There are two main types of surgery: - Primary bowel resection. The surgeon removes diseased segments of your intestine and then reconnects the healthy segments (anastomosis). This allows you to have normal bowel movements. Depending on the amount of inflammation, you may have open surgery or a minimally invasive (laparoscopic) procedure. - Bowel resection with colostomy. If you have so much inflammation that it's not possible to rejoin your colon and rectum, the surgeon will perform a colostomy. An opening (stoma) in your abdominal wall is connected to the healthy part of your colon. Waste passes through the opening into a bag. Once the inflammation has eased, the colostomy may be reversed and the bowel reconnected. Follow-up care Your doctor may recommend colonoscopy six weeks after you recover from diverticulitis, especially if you haven't had the test in the previous year. There doesn't appear to be a direct link between diverticular disease and colon or rectal cancer. But colonoscopy - which isn't possible during a diverticulitis attack - can exclude colon cancer as a cause of your symptoms. Sometimes, surgery is recommended. But previous recommendations for surgery based on the number of attacks have been questioned, since most people do well even after two or more attacks. The decision on surgery is an individual one, and is often based on the frequency of attacks and whether complications have occurred. Treatment at Mayo Clinic Mayo Clinic specialists have experience treating both mild and severe diverticulitis. If you need surgery, Mayo surgeons can offer minimally invasive options - including laparoscopic, hand-assisted laparoscopic and robotic procedures - if appropriate. To help prevent diverticulitis: - Exercise regularly. Exercise promotes normal bowel function and reduces pressure inside your colon. Try to exercise at least 30 minutes on most days. - Eat more fiber. High-fiber foods, such as fresh fruits and vegetables and whole grains, soften waste material and help it pass more quickly through your colon. This reduces pressure inside your digestive tract. However, it isn't clear whether a high-fiber diet decreases the risk of diverticulitis. Eating seeds and nuts isn't associated with developing diverticulitis. - Drink plenty of fluids. Fiber works by absorbing water and increasing the soft, bulky waste in your colon. But if you don't drink enough liquid to replace what's absorbed, fiber can be constipating. Some experts suspect that people who develop diverticulitis may not have enough good bacteria in their colons. Probiotics - foods or supplements that contain beneficial bacteria - are sometimes suggested as a way to prevent diverticulitis. But that advice hasn't been scientifically validated.",
+    "https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758"
+  ],
+  [
+    "Diverticulitis - what to ask your doctor (Questions): What causes diverticulitis? What are the symptoms of diverticulitis? What type of diet should I be eating? - How do I get more fiber in my diet? - Are there foods that I should not be eating? - Is it OK to drink coffee or tea, or alcohol? What should I do if my symptoms become worse? - Do I need to change what I eat? - Are there medicines that I should take? - When should I call the doctor? What are the complications of diverticulitis? Will I ever need surgery?",
+    "https://medlineplus.gov/ency/patientinstructions/000302.htm"
+  ],
+  [
+    "Diverticulitis - what to ask your doctor: Diverticulitis is inflammation of small pouches (diverticula) that can form in the walls of your large intestine. This leads to fever and pain in your belly, most often the lower left part. Below are some questions you may want to ask your health care provider about diverticulitis. What causes diverticulitis? What are the symptoms of diverticulitis? What type of diet should I be eating? - How do I get more fiber in my diet? - Are there foods that I should not be eating? - Is it OK to drink coffee or tea, or alcohol? What should I do if my symptoms become worse? - Do I need to change what I eat? - Are there medicines that I should take? - When should I call the doctor? What are the complications of diverticulitis? Will I ever need surgery? Updated by: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000302.htm"
+  ],
+  [
+    "Diverticulitis (Risk factors): Several factors may increase your risk of developing diverticulitis: - Aging. The incidence of diverticulitis increases with age. - Obesity. Being seriously overweight increases your odds of developing diverticulitis. Morbid obesity may increase your risk of needing more-invasive treatments for diverticulitis. - Smoking. People who smoke cigarettes are more likely than nonsmokers to experience diverticulitis. - Lack of exercise. Vigorous exercise appears to lower your risk of diverticulitis. - Diet high in animal fat and low in fiber, although the role of low fiber alone isn't clear. - Certain medications. Several drugs are associated with an increased risk of diverticulitis, including steroids, opiates and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve).",
+    "https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758"
+  ],
+  [
+    "Diverticulitis (Treatment): Treatment depends on the severity of your signs and symptoms. Uncomplicated diverticulitis If your symptoms are mild, you may be treated at home. Your doctor is likely to recommend: - Antibiotics, to treat infection. - A liquid diet for a few days while your bowel heals. Once your symptoms improve, you can gradually add solid food to your diet. - An over-the-counter pain reliever, such as acetaminophen (Tylenol, others). This treatment is successful in 70 to 100 percent of people with uncomplicated diverticulitis. Complicated diverticulitis If you have a severe attack or have other health problems, you'll likely need to be hospitalized. Treatment generally involves: - Intravenous antibiotics - Insertion of a tube to drain an abscess, if one has formed Surgery You'll likely need surgery to treat diverticulitis if: - You have a complication, such as perforation, abscess, fistula or bowel obstruction - You have had multiple episodes of uncomplicated diverticulitis - You are immune compromised There are two main types of surgery: - Primary bowel resection. The surgeon removes diseased segments of your intestine and then reconnects the healthy segments (anastomosis). This allows you to have normal bowel movements. Depending on the amount of inflammation, you may have open surgery or a minimally invasive (laparoscopic) procedure. - Bowel resection with colostomy. If you have so much inflammation that it's not possible to rejoin your colon and rectum, the surgeon will perform a colostomy. An opening (stoma) in your abdominal wall is connected to the healthy part of your colon. Waste passes through the opening into a bag. Once the inflammation has eased, the colostomy may be reversed and the bowel reconnected. Follow-up care Your doctor may recommend colonoscopy six weeks after you recover from diverticulitis, especially if you haven't had the test in the previous year. There doesn't appear to be a direct link between diverticular disease and colon or rectal cancer. But colonoscopy - which isn't possible during a diverticulitis attack - can exclude colon cancer as a cause of your symptoms. Sometimes, surgery is recommended. But previous recommendations for surgery based on the number of attacks have been questioned, since most people do well even after two or more attacks. The decision on surgery is an individual one, and is often based on the frequency of attacks and whether complications have occurred. Treatment at Mayo Clinic Mayo Clinic specialists have experience treating both mild and severe diverticulitis. If you need surgery, Mayo surgeons can offer minimally invasive options - including laparoscopic, hand-assisted laparoscopic and robotic procedures - if appropriate.",
+    "https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758"
+  ],
+  [
+    "Diverticulitis (Exams and Tests): Your health care provider will examine you. You may need blood tests to see if you have an infection. Other tests that help diagnose diverticulitis may include: - CT scan - Ultrasound of the abdomen - X-rays of the abdomen",
+    "https://medlineplus.gov/ency/article/000257.htm"
+  ],
+  [
+    "Etiology: Etiology describes the cause or causes of a disease. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002356.htm"
+  ],
+  [
+    "How many people are affected by achondrogenesis?: Achondrogenesis types 1A and 1B are rare genetic disorders; their incidence is unknown. Combined, achondrogenesis type 2 and hypochondrogenesis (a similar skeletal disorder) occur in 1 in 40,000 to 60,000 newborns.",
+    "https://ghr.nlm.nih.gov/condition/achondrogenesis"
+  ],
+  [
+    "Germs and Hygiene (Summary): Summary When you cough or sneeze, you send tiny germ-filled droplets into the air. Colds and flu usually spread that way. You can help stop the spread of germs by - Covering your mouth and nose when you sneeze or cough. Sneeze or cough into your elbow, not your hands. - Cleaning your hands often - always before you eat or prepare food, and after you use the bathroom or change a diaper - Avoiding touching your eyes, nose or mouth Hand washing is one of the most effective and most overlooked ways to stop disease. Soap and water work well to kill germs. Wash for at least 20 seconds and rub your hands briskly. Disposable hand wipes or gel sanitizers also work well.",
+    "#"
+  ],
+  [
+    "Common Cold (Summary): Summary Sneezing, sore throat, a stuffy nose, coughing - everyone knows the symptoms of the common cold. It is probably the most common illness. In the course of a year, people in the United States suffer 1 billion colds. You can get a cold by touching your eyes or nose after you touch surfaces with cold germs on them. You can also inhale the germs. Symptoms usually begin 2 or 3 days after infection and last 2 to 14 days. Washing your hands and staying away from people with colds will help you avoid colds. There is no cure for the common cold. For relief, try - Getting plenty of rest - Drinking fluids - Gargling with warm salt water - Using cough drops or throat sprays - Taking over-the-counter pain or cold medicines However, do not give aspirin to children. And do not give cough medicine to children under four. NIH: National Institute of Allergy and Infectious Diseases",
+    "#"
+  ],
+  [
+    "Cleaning to prevent the spread of germs (Summary): Germs from a person may be found on any object the person touched or on equipment that was used during the person's care. Some germs can live up to 5 months on a dry surface. Germs on any surface can pass to you or another person. Cleaning helps prevent the spread of germs. Your workplace has policies about how to clean: - Patient rooms - Spills or contamination - Supplies and equipment that are reusable",
+    "https://medlineplus.gov/ency/patientinstructions/000454.htm"
+  ],
+  [
+    "Cold urticaria: Cold urticaria is a condition that affects the skin. Signs and symptoms generally include reddish, itchy welts ( hives) and/or swelling when skin is exposed to the cold (i.e. cold weather or swimming in cold water). This rash is usually apparent within 2-5 minutes after exposure and can last for 1-2 hours. The exact cause of cold urticaria is poorly understood in most cases. Rarely, it may be associated with an underlying blood condition or infectious disease . Treatment generally consists of patient education, avoiding exposures that may trigger a reaction, and/or medications. [1] [2] [3] The signs and symptoms of cold urticaria and the severity of the condition vary. Affected people generally develop reddish, itchy welts ( hives) and/or swelling when skin is exposed to the cold (i.e. cold weather or swimming in cold water). This rash is usually apparent within 2-5 minutes after exposure and lasts for 1-2 hours. Other signs and symptoms may include: [1] [3] [2] Headache Anxiety Tiredness Fainting Heart palpitations Wheezing Joint pain Low blood pressure In very severe cases,\u00a0exposure to cold could lead to loss of consciousness, shock or even death. [3] In most cases of cold urticaria, the underlying cause is poorly understood. Although the symptoms are triggered by exposure of the skin to the cold (most often when the temperature is\u00a0lower than 39 degrees Fahrenheit), it is unclear why this exposure leads to such a significant reaction. [2] [1] Rarely, cold urticaria is associated with blood conditions or infectious disease such as cryoglobulinemia, chronic lymphocytic leukaemia, lymphosarcoma, chicken pox, viral hepatitis, and mononucleosis. [2] [1] Cold urticaria is not thought to be inherited . Most cases occur sporadically in people with no family history of the condition. A diagnosis of cold urticaria is typically suspected based on the presence of characteristic signs and symptoms. Additional testing can then be ordered to confirm the diagnosis and determine if there are other associated conditions. This generally involves a cold simulation test in which a cold object (such as an ice cube) is applied against the skin of the forearm for 1-5 minutes. In people affected by cold urticaria, a distinct red and swollen rash will generally develop within minutes of exposure. A complete blood count and/or metabolic tests may also be performed to determine associated diseases. [1] [2] The treatment of cold urticaria generally consists of patient education, avoiding scenarios that may trigger a reaction (i.e. cold temperatures, cold water), and/or medications. Prophylactic treatment with high-dose antihistimines may be recommended when exposure to cold is expected and can not be avoided. Additionally, affected people are often told to carry an epinephrine autoinjector due to the increased risk of anaphylaxis. [2] [1] Several other therapies have reportedly been used to treat cold urticaria with varying degrees of success. These include: [2] [1] Leukotriene antagonists Ciclosporin Systemic corticosteroids Dapsone Oral antibiotics Synthetic hormones Danazol The long-term outlook ( prognosis ) for people with cold urticaria varies. In approximately 50% of cases, the condition either completely resolves or drastically improves within five to six years. However, some people have the disorder for many years or even lifelong. [1]",
+    "https://rarediseases.info.nih.gov/diseases/6131/cold-urticaria"
+  ],
+  [
+    "Cold intolerance: Cold intolerance is an abnormal sensitivity to a cold environment or cold temperatures. Cold intolerance can be a symptom of a problem with metabolism. Some people (often very thin women) do not tolerate cold temperatures because they have very little body fat to help keep them warm. Some causes of cold intolerance are: - Anemia - Anorexia nervosa - Blood vessel problems, such as Raynaud phenomenon - Chronic severe illness - General poor health - Underactive thyroid (hypothyroidism) - Problem with the hypothalamus (a part of the brain that controls many body functions, including body temperature) Follow the recommended therapy for treating the cause of the problem. Call your health care provider if you have long-term or extreme intolerance to cold. Your provider will take a medical history and perform a physical examination. Your provider's questions may include the following topics. Time pattern: - Have you always been intolerant of cold? - Has this developed recently? - Has it been getting worse? - Do you often feel cold when other people do not complain of being cold? Medical history: - What is your diet like? - How is your general health? - What are your height and weight? - What other symptoms do you have? Tests that may be performed include: - Complete blood count (CBC) - Serum TSH - Thyroid hormone levels If your provider diagnoses cold intolerance, you may want to include the diagnosis in your personal medical record. Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003095.htm"
+  ],
+  [
+    "Cold urticaria (Treatment): The treatment of cold urticaria generally consists of patient education, avoiding scenarios that may trigger a reaction (i.e. cold temperatures, cold water), and/or medications. Prophylactic treatment with high-dose antihistimines may be recommended when exposure to cold is expected and can not be avoided. Additionally, affected people are often told to carry an epinephrine autoinjector due to the increased risk of anaphylaxis. [2] [1] Several other therapies have reportedly been used to treat cold urticaria with varying degrees of success. These include: [2] [1] Leukotriene antagonists Ciclosporin Systemic corticosteroids Dapsone Oral antibiotics Synthetic hormones Danazol",
+    "https://rarediseases.info.nih.gov/diseases/6131/cold-urticaria"
+  ],
+  [
+    "Cold intolerance (What to Expect at Your Office Visit): Your provider will take a medical history and perform a physical examination. Your provider's questions may include the following topics. Time pattern: - Have you always been intolerant of cold? - Has this developed recently? - Has it been getting worse? - Do you often feel cold when other people do not complain of being cold? Medical history: - What is your diet like? - How is your general health? - What are your height and weight? - What other symptoms do you have? Tests that may be performed include: - Complete blood count (CBC) - Serum TSH - Thyroid hormone levels If your provider diagnoses cold intolerance, you may want to include the diagnosis in your personal medical record.",
+    "https://medlineplus.gov/ency/article/003095.htm"
+  ],
+  [
+    "Type 2 diabetes: Type 2 diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your body's important source of fuel. With type 2 diabetes, your body either resists the effects of insulin - a hormone that regulates the movement of sugar into your cells - or doesn't produce enough insulin to maintain a normal glucose level. More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases. There's no cure for type 2 diabetes, but you may be able to manage the condition by eating well, exercising and maintaining a healthy weight. If diet and exercise aren't enough to manage your blood sugar well, you also may need diabetes medications or insulin therapy. Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can have type 2 diabetes for years and not know it. Look for: - Increased thirst and frequent urination. Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink - and urinate - more than usual. - Increased hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger. - Weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine. - Fatigue. If your cells are deprived of sugar, you may become tired and irritable. - Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus. - Slow-healing sores or frequent infections. Type 2 diabetes affects your ability to heal and resist infections. - Areas of darkened skin. Some people with type 2 diabetes have patches of dark, velvety skin in the folds and creases of their bodies - usually in the armpits and neck. This condition, called acanthosis nigricans, may be a sign of insulin resistance. When to see a doctor See your doctor if you notice any type 2 diabetes symptoms. Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin. Exactly why this happens is unknown, although genetics and environmental factors, such as excess weight and inactivity, seem to be contributing factors. How insulin works Insulin is a hormone that comes from the gland situated behind and below the stomach (pancreas). - The pancreas secretes insulin into the bloodstream. - The insulin circulates, enabling sugar to enter your cells. - Insulin lowers the amount of sugar in your bloodstream. - As your blood sugar level drops, so does the secretion of insulin from your pancreas. The role of glucose Glucose - a sugar - is a main source of energy for the cells that make up muscles and other tissues. - Glucose comes from two major sources: food and your liver. - Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin. - Your liver stores and makes glucose. - When your glucose levels are low, such as when you haven't eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range. In type 2 diabetes, this process doesn't work well. Instead of moving into your cells, sugar builds up in your bloodstream. As blood sugar levels increase, the insulin-producing beta cells in the pancreas release more insulin, but eventually these cells become impaired and can't make enough insulin to meet the body's demands. In the much less common type 1 diabetes, the immune system destroys the beta cells, leaving the body with little to no insulin. Researchers don't fully understand why some people develop type 2 diabetes and others don't. It's clear, however, that certain factors increase the risk, including: - Weight. Being overweight is a primary risk factor for type 2 diabetes. The more fatty tissue you have, the more resistant your cells become to insulin. However, you don't have to be overweight to develop type 2 diabetes. - Fat distribution. If your body stores fat primarily in your abdomen, your risk of type 2 diabetes is greater than if your body stores fat elsewhere, such as your hips and thighs. - Inactivity. The less active you are, the greater your risk of type 2 diabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin. - Family history. The risk of type 2 diabetes increases if your parent or sibling has type 2 diabetes. - Race. Although it's unclear why, people of certain races - including blacks, Hispanics, American Indians and Asian-Americans - are more likely to develop type 2 diabetes than whites are. - Age. The risk of type 2 diabetes increases as you get older, especially after age 45. That's probably because people tend to exercise less, lose muscle mass and gain weight as they age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults. - Prediabetes. Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as diabetes. Left untreated, prediabetes often progresses to type 2 diabetes. - Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing type 2 diabetes increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes. - Polycystic ovarian syndrome. For women, having polycystic ovarian syndrome - a common condition characterized by irregular menstrual periods, excess hair growth and obesity - increases the risk of diabetes. Type 2 diabetes can be easy to ignore, especially in the early stages when you're feeling fine. But diabetes affects many major organs, including your heart, blood vessels, nerves, eyes and kidneys. Controlling your blood sugar levels can help prevent these complications. Although long-term complications of diabetes develop gradually, they can eventually be disabling or even life-threatening. Some of the potential complications of diabetes include: - Heart and blood vessel disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of arteries (atherosclerosis) and high blood pressure. - Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood sugar can eventually cause you to lose all sense of feeling in the affected limbs. Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue. - Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which often eventually requires dialysis or a kidney transplant. - Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma. - Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections, which may heal poorly. Severe damage might require toe, foot or leg amputation. - Hearing impairment. Hearing problems are more common in people with diabetes. - Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections. - Alzheimer's disease. Type 2 diabetes may increase the risk of Alzheimer's disease. The poorer your blood sugar control, the greater the risk appears to be. The exact connection between these two conditions still remains unclear. To diagnose type 2 diabetes, you'll be given a: - Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent. If the A1C test isn't available, or if you have certain conditions - such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) - that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes: - Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst. - Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. - Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes. A reading of 200 mg/dL (11.1 mmol/L) or higher after two hours may indicate diabetes. The American Diabetes Association recommends routine screening for type 2 diabetes beginning at age 45, especially if you're overweight. If the results are normal, repeat the test every three years. If the results are borderline, ask your doctor when to come back for another test. Screening is also recommended for people who are under 45 and overweight if there are other heart disease or diabetes risk factors present, such as a sedentary lifestyle, a family history of type 2 diabetes, a personal history of gestational diabetes or blood pressure above 140/90 millimeters of mercury (mm Hg). If you're diagnosed with diabetes, the doctor may do other tests to distinguish between type 1 and type 2 diabetes - since the two conditions often require different treatments. After the diagnosis A1C levels need to be checked between two and four times a year. Your target A1C goal may vary depending on your age and other factors. However, for most people, the American Diabetes Association recommends an A1C level below 7 percent. Ask your doctor what your A1C target is. Compared with repeated daily blood sugar tests, the A1C test is a better indicator of how well your diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your medication, meal plan or activity level. In addition to the A1C test, your doctor will take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function. The doctor will also assess your blood pressure. Regular eye and foot exams also are important. Management of type 2 diabetes includes: - Healthy eating - Regular exercise - Possibly, diabetes medication or insulin therapy - Blood sugar monitoring These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications. Healthy eating Contrary to popular perception, there's no specific diabetes diet. However, it's important to center your diet on these high-fiber, low-fat foods: - Fruits - Vegetables - Whole grains You'll also need to eat fewer animal products, refined carbohydrates and sweets. Low glycemic index foods also may be helpful. The glycemic index is a measure of how quickly a food causes a rise in your blood sugar. Foods with a high glycemic index raise your blood sugar quickly. Low glycemic index foods may help you achieve a more stable blood sugar. Foods with a low glycemic index typically are foods that are higher in fiber. A registered dietitian can help you put together a meal plan that fits your health goals, food preferences and lifestyle. He or she can also teach you how to monitor your carbohydrate intake and let you know about how many carbohydrates you need to eat with your meals and snacks to keep your blood sugar levels more stable. Physical activity Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exception. Get your doctor's OK before you start an exercise program. Then choose activities you enjoy, such as walking, swimming and biking. What's most important is making physical activity part of your daily routine. Aim for at least 30 minutes of aerobic exercise five days of the week. Stretching and strength training exercises are important, too. If you haven't been active for a while, start slowly and build up gradually. A combination of exercises - aerobic exercises, such as walking or dancing on most days, combined with resistance training, such as weightlifting or yoga twice a week - often helps control blood sugar more effectively than either type of exercise alone. Remember that physical activity lowers blood sugar. Check your blood sugar level before any activity. You might need to eat a snack before exercising to help prevent low blood sugar if you take diabetes medications that lower your blood sugar. Monitoring your blood sugar Depending on your treatment plan, you may need to check and record your blood sugar level every now and then or, if you're on insulin, multiple times a day. Ask your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. Sometimes, blood sugar levels can be unpredictable. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to food, exercise, alcohol, illness and medication. Diabetes medications and insulin therapy Some people who have type 2 diabetes can achieve their target blood sugar levels with diet and exercise alone, but many also need diabetes medications or insulin therapy. The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might even combine drugs from different classes to help you control your blood sugar in several different ways. Examples of possible treatments for type 2 diabetes include: - Metformin (Glucophage, Glumetza, others). Generally, metformin is the first medication prescribed for type 2 diabetes. It works by improving the sensitivity of your body tissues to insulin so that your body uses insulin more effectively. Metformin also lowers glucose production in the liver. Metformin may not lower blood sugar enough on its own. Your doctor will also recommend lifestyle changes, such as losing weight and becoming more active. Nausea and diarrhea are possible side effects of metformin. These side effects usually go away as your body gets used to the medicine. If metformin and lifestyles changes aren't enough to control your blood sugar level, other oral or injected medications can be added. - Sulfonylureas. These medications help your body secrete more insulin. Examples of medications in this class include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl). Possible side effects include low blood sugar and weight gain. - Meglitinides. These medications work like sulfonylureas by stimulating the pancreas to secrete more insulin, but they're faster acting, and the duration of their effect in the body is shorter. They also have a risk of causing low blood sugar, but this risk is lower than with sulfonylureas. Weight gain is a possibility with this class of medications as well. Examples include repaglinide (Prandin) and nateglinide (Starlix). - Thiazolidinediones. Like metformin, these medications make the body's tissues more sensitive to insulin. This class of medications has been linked to weight gain and other more-serious side effects, such as an increased risk of heart failure and fractures. Because of these risks, these medications generally aren't a first-choice treatment. Rosiglitazone (Avandia) and pioglitazone (Actos) are examples of thiazolidinediones. - DPP-4 inhibitors. These medications help reduce blood sugar levels, but tend to have a modest effect. They don't cause weight gain. Examples of these medications are sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta). - GLP-1 receptor agonists. These medications slow digestion and help lower blood sugar levels, though not as much as sulfonylureas. Their use is often associated with some weight loss. This class of medications isn't recommended for use by itself. Exenatide (Byetta) and liraglutide (Victoza) are examples of GLP-1 receptor agonists. Possible side effects include nausea and an increased risk of pancreatitis. - SGLT2 inhibitors. These are the newest diabetes drugs on the market. They work by preventing the kidneys from reabsorbing sugar into the blood. Instead, the sugar is excreted in the urine. Examples include canagliflozin (Invokana) and dapagliflozin (Farxiga). Side effects may include yeast infections and urinary tract infections, increased urination and hypotension. - Insulin therapy. Some people who have type 2 diabetes need insulin therapy as well. In the past, insulin therapy was used as a last resort, but today it's often prescribed sooner because of its benefits. Because normal digestion interferes with insulin taken by mouth, insulin must be injected. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night. Often, people with type 2 diabetes start insulin use with one long-acting shot at night. Insulin injections involve using a fine needle and syringe or an insulin pen injector - a device that looks similar to an ink pen, except the cartridge is filled with insulin. There are many types of insulin, and they each work in a different way. Options include: - Insulin glulisine (Apidra) - Insulin lispro (Humalog) - Insulin aspart (Novolog) - Insulin glargine (Lantus) - Insulin detemir (Levemir) - Insulin isophane (Humulin N, Novolin N) Discuss the pros and cons of different drugs with your doctor. Together you can decide which medication is best for you after considering many factors, including costs and other aspects of your health. In addition to diabetes medications, your doctor might prescribe low-dose aspirin therapy as well as blood pressure and cholesterol-lowering medications to help prevent heart and blood vessel disease. Bariatric surgery If you have type 2 diabetes and your body mass index (BMI) is greater than 35, you may be a candidate for weight-loss surgery (bariatric surgery). Blood sugar levels return to normal in 55 to 95 percent of people with diabetes, depending on the procedure performed. Surgeries that bypass a portion of the small intestine have more of an effect on blood sugar levels than do other weight-loss surgeries. Drawbacks to the surgery include its high cost, and there are risks involved, including a risk of death. Additionally, drastic lifestyle changes are required and long-term complications may include nutritional deficiencies and osteoporosis. Pregnancy Women with type 2 diabetes may need to alter their treatment during pregnancy. Many women will require insulin therapy during pregnancy. Cholesterol-lowering medications and some blood pressure drugs can't be used during pregnancy. If you have signs of diabetic retinopathy, it may worsen during pregnancy. Visit your ophthalmologist during the first trimester of your pregnancy and at one year postpartum. Signs of trouble Because so many factors can affect your blood sugar, problems sometimes arise that require immediate care, such as: - High blood sugar (hyperglycemia). Your blood sugar level can rise for many reasons, including eating too much, being sick or not taking enough glucose-lowering medication. Check your blood sugar level often, and watch for signs and symptoms of high blood sugar - frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you have hyperglycemia, you'll need to adjust your meal plan, medications or both. - Hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Signs and symptoms of this life-threatening condition include a blood sugar reading higher than 600 mg/dL (33.3 mmol/L), dry mouth, extreme thirst, fever greater than 101 F (38 C), drowsiness, confusion, vision loss, hallucinations and dark urine. Your blood sugar monitor may not be able to give you an exact reading at such high levels and may instead just read \"high.\" HHNS is caused by sky-high blood sugar that turns blood thick and syrupy. It tends to be more common in older people with type 2 diabetes, and it's often preceded by an illness or infection. HHNS usually develops over days or weeks. Call your doctor or seek immediate medical care if you have signs or symptoms of this condition. - Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your body may begin to break down fat. This produces toxic acids known as ketones. Watch for thirst or a very dry mouth, frequent urination, vomiting, shortness of breath, fatigue and fruity-smelling breath. You can check your urine for excess ketones with an over-the-counter ketones test kit. If you have excess ketones in your urine, consult your doctor right away or seek emergency care. This condition is more common in people with type 1 diabetes but can sometimes occur in people with type 2 diabetes. - Low blood sugar (hypoglycemia). If your blood sugar level drops below your target range, it's known as low blood sugar (hypoglycemia). Your blood sugar level can drop for many reasons, including skipping a meal, inadvertently taking more medication than usual or getting more physical activity than normal. Low blood sugar is most likely if you take glucose-lowering medications that promote the secretion of insulin or if you're taking insulin. Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar - sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, slurred speech, drowsiness, confusion and seizures. If you develop hypoglycemia during the night, you might wake with sweat-soaked pajamas or a headache. Due to a natural rebound effect, nighttime hypoglycemia might cause an unusually high blood sugar reading first thing in the morning. If you have signs or symptoms of low blood sugar, drink or eat something that will quickly raise your blood sugar level - fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. Retest in 15 minutes to be sure your blood glucose levels have normalized. If they haven't, treat again and retest in another 15 minutes. If you lose consciousness, a family member or close contact may need to give you an emergency injection of glucagon, a hormone that stimulates the release of sugar into the blood. Careful management of type 2 diabetes can reduce your risk of serious - even life-threatening - complications. Consider these tips: - Commit to managing your diabetes. Learn all you can about type 2 diabetes. Make healthy eating and physical activity part of your daily routine. Establish a relationship with a diabetes educator, and ask your diabetes treatment team for help when you need it. - Schedule a yearly physical exam and regular eye exams. Your regular diabetes checkups aren't meant to replace regular physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications, as well as screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma. - Identify yourself. Wear a necklace or bracelet that says you have diabetes. - Keep your immunizations up to date. High blood sugar can weaken your immune system. Get a flu shot every year, and your doctor will likely recommend the pneumonia vaccine, as well. The Centers for Disease Control and Prevention (CDC) also recommends the hepatitis B vaccination if you haven't previously received this vaccine and you're an adult age 19 to 59 with type 1 or type 2 diabetes. The CDC advises vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes. If you are age 60 or older, have diabetes and haven't previously received the vaccine, talk to your doctor about whether it's right for you. - Take care of your teeth. Diabetes may leave you prone to more-serious gum infections. Brush your teeth at least twice a day, floss your teeth once a day and schedule regular dental exams. Consult your dentist right away if your gums bleed or look red or swollen. - Pay attention to your feet. Wash your feet daily in lukewarm water. Dry them gently, especially between the toes, and moisturize with lotion. Check your feet every day for blisters, cuts, sores, redness and swelling. Consult your doctor if you have a sore or other foot problem that isn't healing. - Keep your blood pressure and cholesterol under control. Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Medication also may be needed. - If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications. Talk to your doctor about ways to stop smoking or to stop using other types of tobacco. - If you drink alcohol, do so responsibly. Alcohol, as well as drink mixers, can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, do so in moderation and always with a meal. The recommendation is no more than one drink daily for women, no more than two drinks daily for men age 65 and younger, and one drink a day for men over 65. If you're on insulin or other medications that lower your blood sugar, check your blood sugar before you go to sleep to make sure you're at a safe level. Numerous alternative medicine substances have been shown to improve insulin sensitivity in some studies, while other studies fail to find any benefit for blood sugar control or in lowering A1C levels. Because of the conflicting findings, no alternative therapies are recommended to help with blood sugar management. If you decide to try an alternative therapy, don't stop taking the medications that your doctor has prescribed. Be sure to discuss the use of any of these therapies with your doctor to make sure that they won't cause adverse reactions or interact with your medications. No treatments - alternative or conventional - can cure diabetes. So it's critical that people who are using insulin therapy for diabetes don't stop using insulin unless directed to do so by their physicians.",
+    "https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193"
+  ],
+  [
+    "Do I need to see a doctor for Gestational diabetes - self-care?: Call your health care provider for the following diabetes-related problems: - Your baby seems to be moving less in your belly - Blurred vision - More thirst than normal - Nausea and vomiting",
+    "https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000598.htm"
+  ],
+  [
+    "Type 2 diabetes (Treatment): Management of type 2 diabetes includes: - Healthy eating - Regular exercise - Possibly, diabetes medication or insulin therapy - Blood sugar monitoring These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications. Healthy eating Contrary to popular perception, there's no specific diabetes diet. However, it's important to center your diet on these high-fiber, low-fat foods: - Fruits - Vegetables - Whole grains You'll also need to eat fewer animal products, refined carbohydrates and sweets. Low glycemic index foods also may be helpful. The glycemic index is a measure of how quickly a food causes a rise in your blood sugar. Foods with a high glycemic index raise your blood sugar quickly. Low glycemic index foods may help you achieve a more stable blood sugar. Foods with a low glycemic index typically are foods that are higher in fiber. A registered dietitian can help you put together a meal plan that fits your health goals, food preferences and lifestyle. He or she can also teach you how to monitor your carbohydrate intake and let you know about how many carbohydrates you need to eat with your meals and snacks to keep your blood sugar levels more stable. Physical activity Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exception. Get your doctor's OK before you start an exercise program. Then choose activities you enjoy, such as walking, swimming and biking. What's most important is making physical activity part of your daily routine. Aim for at least 30 minutes of aerobic exercise five days of the week. Stretching and strength training exercises are important, too. If you haven't been active for a while, start slowly and build up gradually. A combination of exercises - aerobic exercises, such as walking or dancing on most days, combined with resistance training, such as weightlifting or yoga twice a week - often helps control blood sugar more effectively than either type of exercise alone. Remember that physical activity lowers blood sugar. Check your blood sugar level before any activity. You might need to eat a snack before exercising to help prevent low blood sugar if you take diabetes medications that lower your blood sugar. Monitoring your blood sugar Depending on your treatment plan, you may need to check and record your blood sugar level every now and then or, if you're on insulin, multiple times a day. Ask your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. Sometimes, blood sugar levels can be unpredictable. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to food, exercise, alcohol, illness and medication. Diabetes medications and insulin therapy Some people who have type 2 diabetes can achieve their target blood sugar levels with diet and exercise alone, but many also need diabetes medications or insulin therapy. The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might even combine drugs from different classes to help you control your blood sugar in several different ways. Examples of possible treatments for type 2 diabetes include: - Metformin (Glucophage, Glumetza, others). Generally, metformin is the first medication prescribed for type 2 diabetes. It works by improving the sensitivity of your body tissues to insulin so that your body uses insulin more effectively. Metformin also lowers glucose production in the liver. Metformin may not lower blood sugar enough on its own. Your doctor will also recommend lifestyle changes, such as losing weight and becoming more active. Nausea and diarrhea are possible side effects of metformin. These side effects usually go away as your body gets used to the medicine. If metformin and lifestyles changes aren't enough to control your blood sugar level, other oral or injected medications can be added. - Sulfonylureas. These medications help your body secrete more insulin. Examples of medications in this class include glyburide (DiaBeta, Glynase), glipizide (Glucotrol) and glimepiride (Amaryl). Possible side effects include low blood sugar and weight gain. - Meglitinides. These medications work like sulfonylureas by stimulating the pancreas to secrete more insulin, but they're faster acting, and the duration of their effect in the body is shorter. They also have a risk of causing low blood sugar, but this risk is lower than with sulfonylureas. Weight gain is a possibility with this class of medications as well. Examples include repaglinide (Prandin) and nateglinide (Starlix). - Thiazolidinediones. Like metformin, these medications make the body's tissues more sensitive to insulin. This class of medications has been linked to weight gain and other more-serious side effects, such as an increased risk of heart failure and fractures. Because of these risks, these medications generally aren't a first-choice treatment. Rosiglitazone (Avandia) and pioglitazone (Actos) are examples of thiazolidinediones. - DPP-4 inhibitors. These medications help reduce blood sugar levels, but tend to have a modest effect. They don't cause weight gain. Examples of these medications are sitagliptin (Januvia), saxagliptin (Onglyza) and linagliptin (Tradjenta). - GLP-1 receptor agonists. These medications slow digestion and help lower blood sugar levels, though not as much as sulfonylureas. Their use is often associated with some weight loss. This class of medications isn't recommended for use by itself. Exenatide (Byetta) and liraglutide (Victoza) are examples of GLP-1 receptor agonists. Possible side effects include nausea and an increased risk of pancreatitis. - SGLT2 inhibitors. These are the newest diabetes drugs on the market. They work by preventing the kidneys from reabsorbing sugar into the blood. Instead, the sugar is excreted in the urine. Examples include canagliflozin (Invokana) and dapagliflozin (Farxiga). Side effects may include yeast infections and urinary tract infections, increased urination and hypotension. - Insulin therapy. Some people who have type 2 diabetes need insulin therapy as well. In the past, insulin therapy was used as a last resort, but today it's often prescribed sooner because of its benefits. Because normal digestion interferes with insulin taken by mouth, insulin must be injected. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night. Often, people with type 2 diabetes start insulin use with one long-acting shot at night. Insulin injections involve using a fine needle and syringe or an insulin pen injector - a device that looks similar to an ink pen, except the cartridge is filled with insulin. There are many types of insulin, and they each work in a different way. Options include: - Insulin glulisine (Apidra) - Insulin lispro (Humalog) - Insulin aspart (Novolog) - Insulin glargine (Lantus) - Insulin detemir (Levemir) - Insulin isophane (Humulin N, Novolin N) Discuss the pros and cons of different drugs with your doctor. Together you can decide which medication is best for you after considering many factors, including costs and other aspects of your health. In addition to diabetes medications, your doctor might prescribe low-dose aspirin therapy as well as blood pressure and cholesterol-lowering medications to help prevent heart and blood vessel disease. Bariatric surgery If you have type 2 diabetes and your body mass index (BMI) is greater than 35, you may be a candidate for weight-loss surgery (bariatric surgery). Blood sugar levels return to normal in 55 to 95 percent of people with diabetes, depending on the procedure performed. Surgeries that bypass a portion of the small intestine have more of an effect on blood sugar levels than do other weight-loss surgeries. Drawbacks to the surgery include its high cost, and there are risks involved, including a risk of death. Additionally, drastic lifestyle changes are required and long-term complications may include nutritional deficiencies and osteoporosis. Pregnancy Women with type 2 diabetes may need to alter their treatment during pregnancy. Many women will require insulin therapy during pregnancy. Cholesterol-lowering medications and some blood pressure drugs can't be used during pregnancy. If you have signs of diabetic retinopathy, it may worsen during pregnancy. Visit your ophthalmologist during the first trimester of your pregnancy and at one year postpartum. Signs of trouble Because so many factors can affect your blood sugar, problems sometimes arise that require immediate care, such as: - High blood sugar (hyperglycemia). Your blood sugar level can rise for many reasons, including eating too much, being sick or not taking enough glucose-lowering medication. Check your blood sugar level often, and watch for signs and symptoms of high blood sugar - frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you have hyperglycemia, you'll need to adjust your meal plan, medications or both. - Hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Signs and symptoms of this life-threatening condition include a blood sugar reading higher than 600 mg/dL (33.3 mmol/L), dry mouth, extreme thirst, fever greater than 101 F (38 C), drowsiness, confusion, vision loss, hallucinations and dark urine. Your blood sugar monitor may not be able to give you an exact reading at such high levels and may instead just read \"high.\" HHNS is caused by sky-high blood sugar that turns blood thick and syrupy. It tends to be more common in older people with type 2 diabetes, and it's often preceded by an illness or infection. HHNS usually develops over days or weeks. Call your doctor or seek immediate medical care if you have signs or symptoms of this condition. - Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your body may begin to break down fat. This produces toxic acids known as ketones. Watch for thirst or a very dry mouth, frequent urination, vomiting, shortness of breath, fatigue and fruity-smelling breath. You can check your urine for excess ketones with an over-the-counter ketones test kit. If you have excess ketones in your urine, consult your doctor right away or seek emergency care. This condition is more common in people with type 1 diabetes but can sometimes occur in people with type 2 diabetes. - Low blood sugar (hypoglycemia). If your blood sugar level drops below your target range, it's known as low blood sugar (hypoglycemia). Your blood sugar level can drop for many reasons, including skipping a meal, inadvertently taking more medication than usual or getting more physical activity than normal. Low blood sugar is most likely if you take glucose-lowering medications that promote the secretion of insulin or if you're taking insulin. Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar - sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, slurred speech, drowsiness, confusion and seizures. If you develop hypoglycemia during the night, you might wake with sweat-soaked pajamas or a headache. Due to a natural rebound effect, nighttime hypoglycemia might cause an unusually high blood sugar reading first thing in the morning. If you have signs or symptoms of low blood sugar, drink or eat something that will quickly raise your blood sugar level - fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. Retest in 15 minutes to be sure your blood glucose levels have normalized. If they haven't, treat again and retest in another 15 minutes. If you lose consciousness, a family member or close contact may need to give you an emergency injection of glucagon, a hormone that stimulates the release of sugar into the blood.",
+    "https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193"
+  ],
+  [
+    "Metformin (How should this medicine be used?): Metformin comes as a liquid, a tablet, and an extended-release (long-acting) tablet to take by mouth. The liquid is usually taken with meals one or two times a day. The regular tablet is usually taken with meals two or three times a day. The extended-release tablet is usually taken once daily with the evening meal. To help you remember to take metformin, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take metformin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Swallow metformin extended-release tablets whole; do not split, chew, or crush them. Your doctor may start you on a low dose of metformin and gradually increase your dose not more often than once every 1\u20132 weeks. You will need to monitor your blood sugar carefully so your doctor will be able to tell how well metformin is working. Metformin controls diabetes but does not cure it. Continue to take metformin even if you feel well. Do not stop taking metformin without talking to your doctor. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.",
+    "https://medlineplus.gov/druginfo/meds/a696005.html"
+  ],
+  [
+    "Type 2 diabetes (Diagnosis): To diagnose type 2 diabetes, you'll be given a: - Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent. If the A1C test isn't available, or if you have certain conditions - such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) - that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes: - Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst. - Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. - Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes. A reading of 200 mg/dL (11.1 mmol/L) or higher after two hours may indicate diabetes. The American Diabetes Association recommends routine screening for type 2 diabetes beginning at age 45, especially if you're overweight. If the results are normal, repeat the test every three years. If the results are borderline, ask your doctor when to come back for another test. Screening is also recommended for people who are under 45 and overweight if there are other heart disease or diabetes risk factors present, such as a sedentary lifestyle, a family history of type 2 diabetes, a personal history of gestational diabetes or blood pressure above 140/90 millimeters of mercury (mm Hg). If you're diagnosed with diabetes, the doctor may do other tests to distinguish between type 1 and type 2 diabetes - since the two conditions often require different treatments. After the diagnosis A1C levels need to be checked between two and four times a year. Your target A1C goal may vary depending on your age and other factors. However, for most people, the American Diabetes Association recommends an A1C level below 7 percent. Ask your doctor what your A1C target is. Compared with repeated daily blood sugar tests, the A1C test is a better indicator of how well your diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your medication, meal plan or activity level. In addition to the A1C test, your doctor will take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function. The doctor will also assess your blood pressure. Regular eye and foot exams also are important.",
+    "https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193"
+  ],
+  [
+    "Preventing Type 2 Diabetes: Research such as the Diabetes Prevention Program shows that you can do a lot to reduce your chances of developing type 2 diabetes. Here are some things you can change to lower your risk:Lose weight and keep it off. You may be able to prevent or delay diabetes by losing 5 to 7 percent of your starting weight.1\u00a0For instance, if you weigh 200 pounds, your goal would be to lose about 10 to 14 pounds. Move more. Get at least 30 minutes of physical activity 5 days a week. If you have not been active, talk with your health care professional about which activities are best. Start slowly to build up to your goal. Eat healthy foods most of the time. Eat smaller portions to reduce the amount of calories you eat each day and help you lose weight. Choosing foods with less fat is another way to reduce calories. Drink water instead of sweetened beverages.Ask your health care professional about what other changes you can make to prevent or delay type 2 diabetes.Most often, your best chance for preventing type 2 diabetes is to make lifestyle changes that work for you long term. Get started with Your Game Plan to Prevent Type 2 Diabetes.Losing weight through healthy eating and regular physical activity can help you prevent type 2 diabetes. Prediabetes is when your blood glucose, also called blood sugar, levels are higher than normal, but not high enough to be called diabetes. Having prediabetes is serious because it raises your chance of developing type 2 diabetes. Many of the same factors that raise your chance of developing type 2 diabetes put you at risk for prediabetes.Other names for prediabetes include impaired fasting glucose or impaired glucose tolerance. Some people call prediabetes \u201cborderline diabetes.\u201dAbout 1 in 3 Americans has prediabetes, according to recent diabetes statistics from the Centers for Disease Control and Prevention. You won\u2019t know if you have prediabetes unless you are tested.If you have prediabetes, you can lower your chance of developing type 2 diabetes. Lose weight if you need to, become more physically active, and follow a reduced-calorie eating plan.Get started with Your Game Plan to Prevent Type 2 Diabetes. For more support, you can find a lifestyle change program near you through the National Diabetes Prevention Program.Being physically active is one way to help prevent prediabetes from progressing to type 2 diabetes. Gestational diabetes is a type of diabetes that develops during pregnancy. Most of the time, gestational diabetes goes away after your baby is born. Even if your gestational diabetes goes away, you still have a greater chance of developing type 2 diabetes within 5 to 10 years. Your child may also be more likely to become obese and develop type 2 diabetes later in life. Making healthy choices helps the whole family and may protect your child from becoming obese or developing diabetes.Being physically active together is a great way to lower your own and your child\u2019s chance of developing type 2 diabetes.Here are steps you should take for yourself and your child if you had gestational diabetes:Get tested for diabetes 6 to 12 weeks after your baby is born. If your blood glucose is still high, you may have type 2 diabetes. If your blood glucose is normal, you should get tested every 3 years to see if you have developed type 2 diabetes. Be more active and make healthy food choices to get back to a healthy weight. Breastfeed your baby. Breastfeeding gives your baby the right balance of nutrients and helps you burn calories. Ask your doctor if you should take the diabetes drug metformin to help prevent type 2 diabetes.1 [1] Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. The Lancet Diabetes and Endocrinology. 2015;3(11):866\u2012875. You can find more information about this study at the Diabetes Prevention Program Outcomes Study website.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-type-2-diabetes"
+  ],
+  [
+    "Metformin: Metformin may rarely cause a serious, life-threatening condition called lactic acidosis. Tell your doctor if you have kidney disease. Your doctor will probably tell you not to take metformin. Also, tell your doctor if you are over 65 years old and if you have ever had a heart attack; stroke; diabetic ketoacidosis (blood sugar that is high enough to cause severe symptoms and requires emergency medical treatment); a coma; or heart or liver disease. Taking certain other medications with metformin may increase the risk of lactic acidosis. Tell your doctor if you are taking acetazolamide (Diamox), dichlorphenamide (Keveyis), methazolamide, topiramate (Topamax, in Qsymia), or zonisamide (Zonegran). Tell your doctor if you have recently had any of the following conditions, or if you develop them during treatment: serious infection; severe diarrhea, vomiting, or fever; or if you drink much less fluid than usual for any reason. You may have to stop taking metformin until you recover. If you are having surgery, including dental surgery, or any major medical procedure, tell the doctor that you are taking metformin. Also, tell your doctor if you plan to have any x-ray procedure in which dye is injected, especially if you drink or have ever drunk large amounts of alcohol or have or have had liver disease or heart failure. You may need to stop taking metformin before the procedure and wait 48 hours to restart treatment. Your doctor will tell you exactly when you should stop taking metformin and when you should start taking it again. If you experience any of the following symptoms, stop taking metformin and call your doctor immediately: extreme tiredness, weakness, or discomfort; nausea; vomiting; stomach pain; decreased appetite; deep and rapid breathing or shortness of breath; dizziness; lightheadedness; fast or slow heartbeat; flushing of the skin; muscle pain; or feeling cold, especially in your hands or feet. Tell your doctor if you regularly drink alcohol or sometimes drink large amounts of alcohol in a short time (binge drinking). Drinking alcohol increases your risk of developing lactic acidosis or may cause a decrease in blood sugar. Ask your doctor how much alcohol is safe to drink while you are taking metformin. Keep all appointments with your doctor and the laboratory. Your doctor will order certain tests before and during treatment to check how well your kidneys are working and your body's response to metformin. Talk to your doctor about the risk(s) of taking metformin. Metformin is used alone or with other medications, including insulin, to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood). Metformin is in a class of drugs called biguanides. Metformin helps to control the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver. Metformin also increases your body's response to insulin, a natural substance that controls the amount of glucose in the blood. Metformin is not used to treat type 1 diabetes (condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood). Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes. Metformin comes as a liquid, a tablet, and an extended-release (long-acting) tablet to take by mouth. The liquid is usually taken with meals one or two times a day. The regular tablet is usually taken with meals two or three times a day. The extended-release tablet is usually taken once daily with the evening meal. To help you remember to take metformin, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take metformin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Swallow metformin extended-release tablets whole; do not split, chew, or crush them. Your doctor may start you on a low dose of metformin and gradually increase your dose not more often than once every 1\u20132 weeks. You will need to monitor your blood sugar carefully so your doctor will be able to tell how well metformin is working. Metformin controls diabetes but does not cure it. Continue to take metformin even if you feel well. Do not stop taking metformin without talking to your doctor. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before taking metformin, - tell your doctor and pharmacist if you are allergic to metformin, any of the ingredients of metformin liquid or tablets, or any other medications. Ask your pharmacist or check the manufacturer's patient information for a list of the ingredients. - tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: amiloride (Midamor); angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin, in Lotrel), captopril, enalapril (Vasotec, in Vaseretic), fosinopril, lisinopril (in Zestoretic), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik); beta-blockers such as atenolol (Tenormin), labetalol (Trandate), metoprolol (Lopressor, Toprol XL), nadolol (Corgard, in Corzide), and propranolol (Hemangeol, Inderal, InnoPran); calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem, Cartia, Diltzac, others), felodipine, isradipine, nicardipine (Cardene), nifedipine (Adalat, Afeditab CR, Procardia), nimodipine (Nymalize), nisoldipine (Sular), and verapamil (Calan, Covera, Verelan, in Tarka); cimetidine (Tagamet); digoxin (Lanoxin); diuretics ('water pills'); furosemide (Lasix); hormone replacement therapy; insulin or other medications for diabetes; isoniazid (Laniazid, in Rifamate, in Rifater); medications for asthma and colds; medications for mental illness and nausea; medications for thyroid disease; morphine (MS Contin, others); niacin; oral contraceptives ('birth control pills'); oral steroids such as dexamethasone, methylprednisolone (Medrol), and prednisone (Rayos); phenytoin (Dilantin, Phenytek); procainamide; quinidine (in Nuedexta); quinine; ranitidine (Zantac); triamterene (Dyrenium, in Maxzide, others); trimethoprim (Primsol); or vancomycin (Vancocin). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor if you have or have ever had any medical condition, especially those mentioned in the IMPORTANT WARNING section. - tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking metformin, call your doctor. - tell your doctor if you eat less or exercise more than usual. This can affect your blood sugar. Your doctor will give you instructions if this happens. Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. It is important to eat a healthful diet. Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. This medication may cause changes in your blood sugar. You should know the symptoms of low and high blood sugar and what to do if you have these symptoms. Metformin may cause side effects. Tell your doctor if any of these symptoms are severe, do not go away, go away and come back, or do not begin for some time after you begin taking metformin: - diarrhea - bloating - stomach pain - gas - indigestion - constipation - unpleasant metallic taste in mouth - heartburn - headache - flushing of the skin - nail changes - muscle pain Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency treatment: - chest pain - rash Metformin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light, excess heat, and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of overdose may include hypoglycemia symptoms as well as the following: - extreme tiredness - weakness - discomfort - vomiting - nausea - stomach pain - decreased appetite - deep, rapid breathing - shortness of breath - dizziness - lightheadedness - abnormally fast or slow heartbeat - flushing of the skin - muscle pain - feeling cold Your doctor will tell you how to check your response to this medication by measuring your blood sugar levels at home. Follow these instructions carefully. If you are taking the extended-release tablets, you may notice something that looks like a tablet in your stool. This is just the empty tablet shell, and this does not mean that you did not get your complete dose of medication. You should always wear a diabetic identification bracelet to be sure you get proper treatment in an emergency. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Fortamet\u00ae - Glucophage\u00ae - Glumetza\u00ae - Riomet\u00ae - Kazano\u00ae (as a combination product containing Metformin, Alogliptin) - Synjardy\u00ae (as a combination product containing Metformin, Empagliflozin) - Actoplus Met\u00ae (containing Metformin, Pioglitazone) - Avandamet\u00ae (containing Metformin, Rosiglitazone) - Invokamet\u00ae (containing Canagliflozin, Metformin) - Janumet\u00ae (containing Metformin, Sitagliptin) - Jentadueto\u00ae (containing Linagliptin, Metformin) - Kombiglyze\u00ae XR (containing Metformin, Saxagliptin) - Metaglip\u00ae (containing Glipizide, Metformin)\u00b6 - Prandimet\u00ae (containing Metformin, Repaglinide) - Xigduo\u00ae XR (containing Dapagliflozin, Metformin)",
+    "https://medlineplus.gov/druginfo/meds/a696005.html"
+  ],
+  [
+    "Metformin (Why is this medication prescribed?): Metformin is used alone or with other medications, including insulin, to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood). Metformin is in a class of drugs called biguanides. Metformin helps to control the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver. Metformin also increases your body's response to insulin, a natural substance that controls the amount of glucose in the blood. Metformin is not used to treat type 1 diabetes (condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood). Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes.",
+    "https://medlineplus.gov/druginfo/meds/a696005.html"
+  ],
+  [
+    "Subacute sclerosing panencephalitis: Subacute sclerosing panencephalitis (SSPE) is a progressive, disabling, and deadly brain disorder related to measles (rubeola) infection. The disease develops many years after the measles infection. Normally, the measles virus does not cause brain damage. But an abnormal immune response to measles or, possibly, certain mutant forms of the virus may cause severe illness and death. This response leads to brain inflammation (swelling and irritation) that may last for years. SSPE has been reported in all parts of the world, but in western countries it is a rare disease. Very few cases are seen in the U.S. since the nationwide measles vaccination program. SSPE tends to occur several years after a person has measles, even though the person seems to have fully recovered from the illness. Males are more often affected than females. The disease generally occurs in children and adolescents. Symptoms of SSPE occur in four general stages. With each stage, the symptoms are worse than the stage before: - Stage I: There may be personality changes, mood swings, or depression. Fever and headache may also be present. This stage may last up to 6 months. - Stage II: There may be uncontrolled movement problems including jerking and muscle spasms. Other symptoms that may occur in this stage are loss of vision, dementia, and seizures. - Stage III: Jerking movements are replaced by writhing (twisting) movements and rigidity. Death may occur from complications. - Stage IV: Areas of the brain that control breathing, heart rate, and blood pressure are damaged. This leads to coma and then death. There may be a history of measles in an unvaccinated child. A physical examination may reveal: - Damage to the optic nerve, which is responsible for sight - Damage to the retina, the part of the eye that receives light - Muscle twitching - Poor performance on motor (movement) coordination tests The following tests may be performed: - Electroencephalogram (EEG) - Brain MRI - Serum antibody titer to look for signs of previous measles infection - Spinal tap No cure for SSPE exists. However, certain antiviral drugs and drugs that boost the immune system may slow the progression of the disease. SSPE is always fatal. People with this disease die 1 to 3 years after diagnosis. Some people may survive longer. Call your health care provider if your child has not completed their scheduled vaccines. The measles vaccine is included in the MMR vaccine. Immunization against measles is the only known prevention for SSPE. The measles vaccine has been highly effective in reducing the numbers of affected children. Measles immunization should be done according to the recommended American Academy of Pediatrics and Centers for Disease Control schedule. Updated by: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/001419.htm"
+  ],
+  [
+    "What are the complications of Measles?: Complications of measles infection may include: - Bronchitis - Encephalitis - Ear infection (otitis media) - Pneumonia",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/001569.htm"
+  ],
+  [
+    "Subacute sclerosing panencephalitis: Subacute sclerosing panencephalitis (SSPE) a rare condition that is caused by a measles infection acquired earlier in life. Signs and symptoms of the condition primarily affect the central nervous system and often develop approximately 7 to 10 years after a person recovers from the measles. Affected people may initially experience behavioral changes, dementia , and disturbances in motor function. In the late stages of the disease, affected people often progress to a comatose state, and then to a persistent vegetative state. Ultimately, many people with SSPE succumb to fever, heart failure, or the brain's inability to continue controlling the autonomic nervous system. [1] [2] It is unclear why some people develop SSPE after they have seemingly recovered from the measles while others do not. Researchers suspect that SSPE may be due to an abnormal immune response or a mutant form of the measles virus that causes a persistent infection within the central nervous system. [1] [2] [3] Treatment is supportive and primarily based on the signs and symptoms present in each person. Recent studies have shown that certain medications (called antiviral and immunomodulatory drugs) may slow the progression of the condition, although the best treatment regimen and their long-term effects in people with SSPE are currently unknown. [2] [4] Subacute sclerosing panencephalitis (SSPE) generally develops approximately seven to ten years after a person recovers from the measles. Early signs and symptoms of the condition can\u00a0include behavioral changes and mild mental deterioration (affecting memory, thinking, language, and judgment). As the condition progresses, affected people may experience disturbances in motor function, such as an unsteady gait (style of walking) and myoclonic jerks (uncontrollable involuntary jerking movements of the head, trunk, or limbs). Some affected people may also become blind and/or develop seizures . The muscles of the leg can be very tense or lack tone, and some affected people experiencing weakness and spasms in both legs. Because this can interfere with the ability to walk, people with SSPE may require devices to assist with mobility. In the late stages of the disease, affected people often progress to a comatose state, and then to a persistent vegetative state. Ultimately, many people with SSPE succumb to fever, heart failure, or the brain's inability to continue controlling the autonomic nervous system. [1] [2] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Autosomal recessive inheritance - Encephalitis - Subacute sclerosing panencephalitis (SSPE) is caused by a measles infection that is acquired earlier in life (often 7-10 years prior to the onset of SSPE symptoms). It is unclear why some people develop SSPE after they have seemingly recovered from the measles while others do not. Researchers suspect that SSPE may be due to an abnormal immune response or a mutant form of the measles virus that causes a persistent infection within the central nervous system (brain and spinal cord). [1] [2] [3] Although the underlying cause of SSPE is poorly understood, several risk factors appear to be associated with the condition. SSPE affects males more often than females and is generally diagnosed in children and adolescents. The risk of developing SSPE may be higher for a person who gets measles before they are two years of age. [1] [5] A diagnosis of subacute sclerosing panencephalitis is often suspected based on the presence of characteristic signs and symptoms in a person with a history of the measles. Additional testing can then be offered to confirm the diagnosis. This may include: [1] [3] Electroencephalogram (EEG) Imaging studies, such as MRI or CT scan Serum antibody titer to look for signs of previous measles infection Spinal tap Unfortunately, there is currently no cure for subacute sclerosing panencephalitis (SSPE). Treatment is supportive and primarily based on the signs and symptoms present in each person. For example, anticonvulsant and antispasmodic drugs may be given, as needed, to address some of the motor disturbances associated with the condition. [2] [4] Recent studies have shown that certain medications (called antiviral and immunomodulatory drugs) may slow the progression of the condition when given alone or in combination. Although these drugs can prolong life, the best treatment regimen and their long-term effects in people with SSPE are currently unknown. [2] [4] The long-term outlook ( prognosis ) for people with subacute sclerosing panencephalitis (SSPE) is poor. The condition is always fatal. Although most affected people die within one to three years, the average lifespan following diagnosis can vary. Studies show that a small group of people with SSPE will have a rapidly progressive form of the condition, leading to death within three months of diagnosis. Although rare, another small group will have a chronic, slowly progressive form that is associated with a relapsing and remitting course. [2] [3] In developed countries, subacute sclerosing panencephalitis (SSPE) is considered a rare disease. For example, fewer than 10 cases per year are reported in the United States. Furthermore, studies show that the number of SSPE cases diagnosed each year has declined by at least 90 percent in countries that have practiced widespread immunization with measles vaccine. The risk of having the condition is significantly higher in developing countries, such as India (over 20 cases per million people each year) and Eastern Europe. [1] [2] SSPE affects males more often than females and is generally diagnosed in children and adolescents. The risk of developing SSPE may be higher for a person who gets measles before they are two years of age. [1] [5]",
+    "https://rarediseases.info.nih.gov/diseases/7708/subacute-sclerosing-panencephalitis"
+  ],
+  [
+    "Subacute sclerosing panencephalitis (Cause): Subacute sclerosing panencephalitis (SSPE) is caused by a measles infection that is acquired earlier in life (often 7-10 years prior to the onset of SSPE symptoms). It is unclear why some people develop SSPE after they have seemingly recovered from the measles while others do not. Researchers suspect that SSPE may be due to an abnormal immune response or a mutant form of the measles virus that causes a persistent infection within the central nervous system (brain and spinal cord). [1] [2] [3] Although the underlying cause of SSPE is poorly understood, several risk factors appear to be associated with the condition. SSPE affects males more often than females and is generally diagnosed in children and adolescents. The risk of developing SSPE may be higher for a person who gets measles before they are two years of age. [1] [5]",
+    "https://rarediseases.info.nih.gov/diseases/7708/subacute-sclerosing-panencephalitis"
+  ],
+  [
+    "Subacute sclerosing panencephalitis (Prevention): Immunization against measles is the only known prevention for SSPE. The measles vaccine has been highly effective in reducing the numbers of affected children. Measles immunization should be done according to the recommended American Academy of Pediatrics and Centers for Disease Control schedule.",
+    "https://medlineplus.gov/ency/article/001419.htm"
+  ],
+  [
+    "Subacute sclerosing panencephalitis (Statistics): In developed countries, subacute sclerosing panencephalitis (SSPE) is considered a rare disease. For example, fewer than 10 cases per year are reported in the United States. Furthermore, studies show that the number of SSPE cases diagnosed each year has declined by at least 90 percent in countries that have practiced widespread immunization with measles vaccine. The risk of having the condition is significantly higher in developing countries, such as India (over 20 cases per million people each year) and Eastern Europe. [1] [2] SSPE affects males more often than females and is generally diagnosed in children and adolescents. The risk of developing SSPE may be higher for a person who gets measles before they are two years of age. [1] [5]",
+    "https://rarediseases.info.nih.gov/diseases/7708/subacute-sclerosing-panencephalitis"
+  ],
+  [
+    "Subacute sclerosing panencephalitis (Outlook (Prognosis)): SSPE is always fatal. People with this disease die 1 to 3 years after diagnosis. Some people may survive longer.",
+    "https://medlineplus.gov/ency/article/001419.htm"
+  ],
+  [
+    "Subacute sclerosing panencephalitis (Treatment): No cure for SSPE exists. However, certain antiviral drugs and drugs that boost the immune system may slow the progression of the disease.",
+    "https://medlineplus.gov/ency/article/001419.htm"
+  ],
+  [
+    "Klippel-Trenaunay syndrome (Treatment): Although there's no cure for Klippel-Trenaunay syndrome, your doctor can help you manage symptoms and prevent complications. Because KTS may affect many systems in the body, your health care team may include specialists in vascular medicine and surgery, skin diseases (dermatology), interventional radiology, orthopedic surgery, physical therapy and rehabilitation, and other areas as needed. You and your doctor can work together to determine which of the following treatments are most appropriate for you. Treatments may include: - Compression therapy. Bandages or elastic garments are wrapped around affected limbs to help prevent swelling, problems with varicose veins and skin ulcers. These bandages or elastic garments often need to be custom-fit. Intermittent pneumatic compression devices - leg or arm sleeves that automatically inflate and deflate at set intervals - may be used. - Physical therapy. Massage, compression and limb movement as appropriate may help relieve lymphedema in arms or legs and swelling of the blood vessels. - Orthopedic devices. These may include orthopedic shoes or shoe inserts to compensate for differences in leg length. - Epiphysiodesis (ep-ih-fiz-e-OD-uh-sis). This is an orthopedic surgical procedure that effectively can stop length overgrowth of the lower limb. - Embolization. This procedure, performed through small catheters placed into the veins or arteries, blocks blood flow to certain blood vessels. - Laser therapy. This procedure may be used to lighten port-wine stains and to treat early blebs on the skin. - Laser or radiofrequency ablation of veins. This minimally invasive procedure is used to close off abnormal veins. - Sclerotherapy. A solution is injected into a vein, which creates scar tissue that helps close the vein. - Surgery. In some cases, surgical removal or reconstruction of affected veins, removal of excess tissue, and correction of the overgrowth of bone may be beneficial. - Medication. Early research indicates that a drug called sirolimus (Rapamune) may help to treat symptomatic complex vascular malformations, but it may have significant side effects and more studies are needed. In addition, treatment may be needed for complications such as bleeding, pain, infection, blood clots or skin ulcers.",
+    "https://www.mayoclinic.org/diseases-conditions/klippel-trenaunay/symptoms-causes/syc-20374152"
+  ],
+  [
+    "Do you have information about Radiation therapy: Summary : Radiation therapy uses high-powered x-rays, particles, or radioactive seeds to kill cancer cells. Information : Cancer cells multiply faster than normal cells in the body. Because radiation is most harmful toquickly growing cells, radiation therapy damages cancer cells more than normal cells. This prevents the cancer cells from growing and dividing, and leads to cell death. Radiation therapy is used to fight many types of cancer. Sometimes, radiation is the only treatment needed. It may also be used to: - Shrink a tumor as much as possible before surgery - Help prevent the cancer from coming back after surgery or chemotherapy - Relieve symptoms caused by a tumor - Treat cancers that cannot be removed with surgery TYPES OF RADIATION THERAPY External beam radiation is the most common form. This method carefully aims high-powered x-rays or particles directly at the tumor from outside of the body. Internal beam radiation is placed inside of your body. - One method uses radioactive seeds that are placed directly into or near the tumor. This method is called brachytherapy, and is used to treat prostate cancer. It is used less often to treat breast, cervical, lung, and other cancers. - Another method involves receiving radiation by drinking it, swallowing a pill, or through an IV. Liquid radiation travels throughout your body, seeking out and killing cancer cells. Thyroid cancer may be treated this way. SIDE EFFECTS OF RADIATION THERAPY Radiation therapy can also damage or kill healthy cells. The death of healthy cells can lead to side effects. These side effects depend on the dose of radiation, and how often you have the therapy. External beam radiation may cause skin changes, such as hair loss, red or burning skin, thinning of skin tissue, or even shedding of the outer layer of skin. Other side effects depend on the part of body receiving radiation: - Abdomen - Brain - Breast - Chest - Mouth and neck - Pelvic (between the hips) - Prostate",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/001918.htm"
+  ],
+  [
+    "Klippel-Trenaunay syndrome: Klippel-Trenaunay (klih-PEL tray-no-NAY) syndrome -- also called KTS -- is a rare disorder found at birth (congenital) involving abnormal development of blood vessels, soft tissues (such as skin and muscles), bones, and the lymphatic system. The main features include a red birthmark (port-wine stain), overgrowth of tissues and bones, and vein malformations with or without lymphatic abnormalities. Although there is no cure for KTS, the goal is to manage symptoms and prevent complications. People who have Klippel-Trenaunay syndrome may have the following features, which can range from mild to more extensive: - Port-wine stain. This pink to reddish-purple birthmark is caused by extra tiny blood vessels (capillaries) in the top layer of skin. The birthmark usually covers part of one leg, but can involve any portion of the skin, and may get darker or lighter with age. - Vein malformations. These include swollen, twisted veins (varicose veins) usually on the surface of the legs. Deeper abnormal veins in the arms, legs, abdomen and pelvis can occur. There may be spongy tissue filled with small veins in or under the skin. Venous abnormalities may become more prominent with age. - Overgrowth of bones and soft tissue. This begins in infancy and is usually limited to one leg, but it can occur in an arm or, rarely, in the trunk or face. This overgrowth of bone and tissue creates a larger and longer extremity. Rarely, fusion of fingers or toes, or having extra fingers or toes occurs. - Lymphatic system abnormalities. The lymphatic system - part of the immune system that protects against infection and disease and transports lymphatic fluid - can be abnormal. Extra lymphatic vessels can be present that don't work properly and can lead to leakage and swelling. - Other conditions. KTS can also include cataracts, glaucoma, hip dislocation at birth and blood-clotting problems. When to see a doctor Klippel-Trenaunay syndrome is usually identified at birth. It's important to get a prompt, accurate diagnosis and appropriate care to treat symptoms and prevent complications. Klippel-Trenaunay syndrome is a genetic condition. It involves genetic changes (mutations) most commonly in the PIK3CA gene. These genetic changes are responsible for development of tissues in the body, resulting in overgrowth. KTS is not usually inherited. The gene mutations occur randomly during cell division in early development before birth. Family history doesn't seem to be a risk factor, so it's unlikely that parents of one child with Klippel-Trenaunay syndrome will have another child with the disorder, even if one of the parents has KTS. Diagnosis of Klippel-Trenaunay syndrome begins with a physical exam. Referral to a vascular malformations specialist is helpful for evaluation and treatment recommendations. During the evaluation your doctor: - Asks questions about your family and medical history - Does an exam to look for swelling, varicose veins and port-wine stains - Visually evaluates growth of bones and soft tissues Several diagnostic tests can help your doctor evaluate and identify the type and severity of the condition and help determine treatment. Some tests include: - Duplex scanning. This test uses high-frequency sound waves to create detailed images of blood vessels. - Scanogram. Also called scanner photography, this X-ray technique helps to see images of bones and measure their lengths. - MRI and magnetic resonance angiography. These procedures help differentiate between bone, fat, muscle and blood vessels. - CT scan. A CT scan creates 3-D images of the body that helps look for blood clots in veins. - Contrast venography. This procedure involves injecting a dye into veins and taking X-rays that can reveal abnormal veins, blockages or blood clots. Although there's no cure for Klippel-Trenaunay syndrome, your doctor can help you manage symptoms and prevent complications. Because KTS may affect many systems in the body, your health care team may include specialists in vascular medicine and surgery, skin diseases (dermatology), interventional radiology, orthopedic surgery, physical therapy and rehabilitation, and other areas as needed. You and your doctor can work together to determine which of the following treatments are most appropriate for you. Treatments may include: - Compression therapy. Bandages or elastic garments are wrapped around affected limbs to help prevent swelling, problems with varicose veins and skin ulcers. These bandages or elastic garments often need to be custom-fit. Intermittent pneumatic compression devices - leg or arm sleeves that automatically inflate and deflate at set intervals - may be used. - Physical therapy. Massage, compression and limb movement as appropriate may help relieve lymphedema in arms or legs and swelling of the blood vessels. - Orthopedic devices. These may include orthopedic shoes or shoe inserts to compensate for differences in leg length. - Epiphysiodesis (ep-ih-fiz-e-OD-uh-sis). This is an orthopedic surgical procedure that effectively can stop length overgrowth of the lower limb. - Embolization. This procedure, performed through small catheters placed into the veins or arteries, blocks blood flow to certain blood vessels. - Laser therapy. This procedure may be used to lighten port-wine stains and to treat early blebs on the skin. - Laser or radiofrequency ablation of veins. This minimally invasive procedure is used to close off abnormal veins. - Sclerotherapy. A solution is injected into a vein, which creates scar tissue that helps close the vein. - Surgery. In some cases, surgical removal or reconstruction of affected veins, removal of excess tissue, and correction of the overgrowth of bone may be beneficial. - Medication. Early research indicates that a drug called sirolimus (Rapamune) may help to treat symptomatic complex vascular malformations, but it may have significant side effects and more studies are needed. In addition, treatment may be needed for complications such as bleeding, pain, infection, blood clots or skin ulcers. Strategies to help manage Klippel-Trenaunay syndrome symptoms include: - Keep appointments. Regularly scheduled appointments can help your doctor identify and address problems early. Ask your doctor about a schedule of appointments appropriate for you. - Use orthopedic shoes, if recommended. Orthopedic shoes or shoe inserts may improve your physical function. - Follow your doctor's recommendations on physical activity. Encouraging use of affected limbs as appropriate may help relieve lymphedema and swelling of the blood vessels. - Elevate affected limbs. When possible, raising your leg or other affected limb can help reduce lymphedema. - Notify your doctor of changes. Work with your doctor to manage your symptoms and prevent complications. Contact your doctor if you have symptoms of blood clots or an infection or if you experience increased pain or swelling.",
+    "https://www.mayoclinic.org/diseases-conditions/klippel-trenaunay/symptoms-causes/syc-20374152"
+  ],
+  [
+    "Klippel-Trenaunay syndrome (Risk factors): Family history doesn't seem to be a risk factor, so it's unlikely that parents of one child with Klippel-Trenaunay syndrome will have another child with the disorder, even if one of the parents has KTS.",
+    "https://www.mayoclinic.org/diseases-conditions/klippel-trenaunay/symptoms-causes/syc-20374152"
+  ],
+  [
+    "Klippel-Trenaunay syndrome (Symptoms): People who have Klippel-Trenaunay syndrome may have the following features, which can range from mild to more extensive: - Port-wine stain. This pink to reddish-purple birthmark is caused by extra tiny blood vessels (capillaries) in the top layer of skin. The birthmark usually covers part of one leg, but can involve any portion of the skin, and may get darker or lighter with age. - Vein malformations. These include swollen, twisted veins (varicose veins) usually on the surface of the legs. Deeper abnormal veins in the arms, legs, abdomen and pelvis can occur. There may be spongy tissue filled with small veins in or under the skin. Venous abnormalities may become more prominent with age. - Overgrowth of bones and soft tissue. This begins in infancy and is usually limited to one leg, but it can occur in an arm or, rarely, in the trunk or face. This overgrowth of bone and tissue creates a larger and longer extremity. Rarely, fusion of fingers or toes, or having extra fingers or toes occurs. - Lymphatic system abnormalities. The lymphatic system - part of the immune system that protects against infection and disease and transports lymphatic fluid - can be abnormal. Extra lymphatic vessels can be present that don't work properly and can lead to leakage and swelling. - Other conditions. KTS can also include cataracts, glaucoma, hip dislocation at birth and blood-clotting problems. When to see a doctor Klippel-Trenaunay syndrome is usually identified at birth. It's important to get a prompt, accurate diagnosis and appropriate care to treat symptoms and prevent complications.",
+    "https://www.mayoclinic.org/diseases-conditions/klippel-trenaunay/symptoms-causes/syc-20374152"
+  ],
+  [
+    "Klippel-Trenaunay syndrome (Causes): Klippel-Trenaunay syndrome is a genetic condition. It involves genetic changes (mutations) most commonly in the PIK3CA gene. These genetic changes are responsible for development of tissues in the body, resulting in overgrowth. KTS is not usually inherited. The gene mutations occur randomly during cell division in early development before birth.",
+    "https://www.mayoclinic.org/diseases-conditions/klippel-trenaunay/symptoms-causes/syc-20374152"
+  ],
+  [
+    "Klippel-Trenaunay Syndrome (KTS): Klippel-Trenaunay syndrome (KTS) is a rare congenital malformation involving blood and lymph vessels and abnormal growth of soft and bone tissue. \u00a0Typical symptoms include hemangiomas (abnormal benign growths on the skin consisting of masses of blood vessels) and varicose veins. \u00a0Fused toes or fingers, or extra toes or fingers, may be present. \u00a0In some cases, internal bleeding may occur as a result of blood vessel malformations involving organs such as the stomach, rectum, vagina, liver, spleen, bladder, kidneys, lungs, or heart. \u00a0Individuals are also at risk for blood clots. The cause of the disorder is unknown. A similar port-wine stain disorder in which individuals have vascular anomalies on the face as well as in the brain is Sturge-Weber syndrome. These individuals may experience seizures and mental deficiency. \u00a0In some cases, features of the Klippel-Trenaunay syndrome and Sturge-Weber syndrome coincide. \u00a0Another overlapping condition is the Parkes-Weber syndrome, which is characterized by abnormal connectivity between the arterial and venous system (arteriovenous fistulas). There is no cure for KTS. Treatment is symptomatic. Laser surgery can diminish or erase some skin lesions. Surgery may correct discrepancies in limb size, but orthopedic devices may be more appropriate. KTS is often a progressive disorder, and complications may be life-threatening. \u00a0However, many individuals can live well while managing their symptoms.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Klippel-Trenaunay-Syndrome-KTS-Information-Page"
+  ],
+  [
+    "Klippel-Trenaunay syndrome (Diagnosis): Diagnosis of Klippel-Trenaunay syndrome begins with a physical exam. Referral to a vascular malformations specialist is helpful for evaluation and treatment recommendations. During the evaluation your doctor: - Asks questions about your family and medical history - Does an exam to look for swelling, varicose veins and port-wine stains - Visually evaluates growth of bones and soft tissues Several diagnostic tests can help your doctor evaluate and identify the type and severity of the condition and help determine treatment. Some tests include: - Duplex scanning. This test uses high-frequency sound waves to create detailed images of blood vessels. - Scanogram. Also called scanner photography, this X-ray technique helps to see images of bones and measure their lengths. - MRI and magnetic resonance angiography. These procedures help differentiate between bone, fat, muscle and blood vessels. - CT scan. A CT scan creates 3-D images of the body that helps look for blood clots in veins. - Contrast venography. This procedure involves injecting a dye into veins and taking X-rays that can reveal abnormal veins, blockages or blood clots.",
+    "https://www.mayoclinic.org/diseases-conditions/klippel-trenaunay/symptoms-causes/syc-20374152"
+  ],
+  [
+    "Iron overdose: Iron is a mineral found in many over-the-counter supplements. Iron overdose occurs when someone takes more than the normal or recommended amount of this mineral. This can be by accident or on purpose. Iron overdose is especially dangerous for children. A severe overdose can happen if a child eats adult multivitamins, such as prenatal vitamins. If the child eats too many pediatric multivitamins, the effect is usually minor. This is for information only and not for use in the treatment or management of an actual overdose. DO NOT use it to treat or manage an actual overdose. If you or someone you are with overdoses, call your local emergency number (such as 911), or your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. Iron can be harmful in large amounts. Iron is an ingredient in many mineral and vitamin supplements. Iron supplements are also sold by themselves. Types include: - Ferrous sulfate (Feosol, Slow Fe) - Ferrous gluconate (Fergon) - Ferrous fumarate (Femiron, Feostat) Other products may also contain iron. Below are symptoms of an iron overdose in different parts of the body. AIRWAYS AND LUNGS - Buildup of fluids in the lungs STOMACH AND INTESTINES - Black, and possibly bloody stools - Diarrhea - Liver damage - Metallic taste in mouth - Nausea - Vomiting blood HEART AND BLOOD - Dehydration - Low blood pressure - Fast and weak pulse - Shock NERVOUS SYSTEM - Chills - Coma (decreased level of consciousness and lack of responsiveness, may occur within 1/2 hour to 1 hour after overdose) - Convulsions - Dizziness - Drowsiness - Fever - Headache - Lack of desire to do anything SKIN - Bluish-colored lips and fingernails - Flushing - Loss of color from the skin (pallor) Note: Symptoms may go away in a few hours, then return again after 1 day or later. Have this information ready: - Person's age, weight, and condition - Name of the product (ingredients and strength, if known) - Time it was swallowed - Amount swallowed - If the medicine was prescribed for the person Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions. This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week. Take the container to the hospital with you, if possible. The health care provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated. The person may receive: - Blood and urine tests, including tests to check iron levels - Breathing support, including tube through the mouth into the lungs, and breathing machine (ventilator) - Camera and tube down the throat to see the esophagus and the stomach and remove pills or stop internal bleeding - EKG (electrocardiogram, or heart tracing) - Fluids through a vein (by IV) - Medicine to help remove iron from the body and treat symptoms - Whole bowel irrigation with a special solution to quickly flush the iron through the stomach and intestines (taken by mouth or through a tube through the nose into the stomach) - X-ray to detect and track iron tablets through the stomach and intestines There is a good chance of recovery if the person's symptoms are gone 48 hours after the iron overdose. But, severe liver damage can occur 2 to 5 days after the overdose. Some people have died up to a week after an iron overdose. The more quickly the person receives treatment, the better the chance for survival. Iron overdose can be very severe in children. Children may sometimes eat large amounts of iron pills because they look like candy. Many manufacturers have changed their pills so they no longer look like candy. Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002659.htm"
+  ],
+  [
+    "Iron overdose (Outlook (Prognosis)): There is a good chance of recovery if the person's symptoms are gone 48 hours after the iron overdose. But, severe liver damage can occur 2 to 5 days after the overdose. Some people have died up to a week after an iron overdose. The more quickly the person receives treatment, the better the chance for survival. Iron overdose can be very severe in children. Children may sometimes eat large amounts of iron pills because they look like candy. Many manufacturers have changed their pills so they no longer look like candy.",
+    "https://medlineplus.gov/ency/article/002659.htm"
+  ],
+  [
+    "Iron-deficiency anemia (What do I need to know about iron pills?): Your doctor may recommend iron pills to help build up your iron levels. Do not take these pills without talking to your doctor or nurse first. Taking iron pills can cause side effects, including an upset stomach, constipation, and diarrhea. If taken as a liquid, iron supplements may stain your teeth. You can reduce side effects from iron pills by taking these steps:",
+    "https://www.womenshealth.gov/a-z-topics/iron-deficiency-anemia"
+  ],
+  [
+    "Iron overdose (Symptoms): Below are symptoms of an iron overdose in different parts of the body. AIRWAYS AND LUNGS - Buildup of fluids in the lungs STOMACH AND INTESTINES - Black, and possibly bloody stools - Diarrhea - Liver damage - Metallic taste in mouth - Nausea - Vomiting blood HEART AND BLOOD - Dehydration - Low blood pressure - Fast and weak pulse - Shock NERVOUS SYSTEM - Chills - Coma (decreased level of consciousness and lack of responsiveness, may occur within 1/2 hour to 1 hour after overdose) - Convulsions - Dizziness - Drowsiness - Fever - Headache - Lack of desire to do anything SKIN - Bluish-colored lips and fingernails - Flushing - Loss of color from the skin (pallor) Note: Symptoms may go away in a few hours, then return again after 1 day or later.",
+    "https://medlineplus.gov/ency/article/002659.htm"
+  ],
+  [
+    "Iron overdose (What to Expect at the Emergency Room): Take the container to the hospital with you, if possible. The health care provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated. The person may receive: - Blood and urine tests, including tests to check iron levels - Breathing support, including tube through the mouth into the lungs, and breathing machine (ventilator) - Camera and tube down the throat to see the esophagus and the stomach and remove pills or stop internal bleeding - EKG (electrocardiogram, or heart tracing) - Fluids through a vein (by IV) - Medicine to help remove iron from the body and treat symptoms - Whole bowel irrigation with a special solution to quickly flush the iron through the stomach and intestines (taken by mouth or through a tube through the nose into the stomach) - X-ray to detect and track iron tablets through the stomach and intestines",
+    "https://medlineplus.gov/ency/article/002659.htm"
+  ],
+  [
+    "Iron overdose (Where Found): Iron is an ingredient in many mineral and vitamin supplements. Iron supplements are also sold by themselves. Types include: - Ferrous sulfate (Feosol, Slow Fe) - Ferrous gluconate (Fergon) - Ferrous fumarate (Femiron, Feostat) Other products may also contain iron.",
+    "https://medlineplus.gov/ency/article/002659.htm"
+  ],
+  [
+    "Iron overdose (Poisonous Ingredient): Iron can be harmful in large amounts.",
+    "https://medlineplus.gov/ency/article/002659.htm"
+  ],
+  [
+    "Iron-deficiency anemia (Can I get more iron than my body needs?): Yes, your body can get too much iron. Extra iron can damage the liver, heart, and pancreas. Try to get no more than 45 milligrams of iron a day, unless your doctor prescribes more. Some people get too much iron because of a condition called hemochromatosis that runs in families. Learn more about hemochromatosis, who is at risk, and how it is treated. You can also get too much iron from iron pills (if you also get iron from food) or from repeated blood transfusions.",
+    "https://www.womenshealth.gov/a-z-topics/iron-deficiency-anemia"
+  ],
+  [
+    "Iron-deficiency anemia: Iron-deficiency anemia means that your body does not have enough iron. Your body needs iron to help carry oxygen through your blood to all parts of your body. Iron-deficiency anemia affects more women than men and is more common during pregnancy. Iron-deficiency anemia is the most common type of anemia, a condition that happens when your body does not make enough healthy red blood cells or the blood cells do not work correctly. Iron-deficiency anemia happens when you don't have enough iron in your body. Your body needs iron to make hemoglobin, the part of the red blood cell that carries oxygen through your blood to all parts of your body. Iron-deficiency anemia affects more women than men. The risk of iron-deficiency anemia is highest for women who: Infants, small children, and teens are also at high risk for iron-deficiency anemia. Learn how much iron children need at different ages. Iron-deficiency anemia often develops slowly. In the beginning, you may not have any symptoms, or they may be mild. As it gets worse, you may notice one or more of these symptoms:3 If you think you may have iron-deficiency anemia, talk to your doctor or nurse. Women can have low iron levels for several reasons: Talk to your doctor if you think you might have iron-deficiency anemia. Your doctor may: If you have iron-deficiency anemia, your doctor may want to do other tests to find out what is causing it. Maybe. Talk to your doctor about getting tested as part of your regular health exam if you have heavy menstrual periods or a health problem such as Crohn's disease or celiac disease. Treatment for iron-deficiency anemia depends on the cause: If you have severe bleeding or symptoms of chest pain or shortness of breath, your doctor may recommend iron or red blood cell transfusions. Transfusions are for severe iron deficiencies only and are much less common. Your doctor may recommend iron pills to help build up your iron levels. Do not take these pills without talking to your doctor or nurse first. Taking iron pills can cause side effects, including an upset stomach, constipation, and diarrhea. If taken as a liquid, iron supplements may stain your teeth. You can reduce side effects from iron pills by taking these steps: If left untreated, iron-deficiency anemia can cause serious health problems. Having too little oxygen in the body can damage organs. With anemia, the heart must work harder to make up for the lack of red blood cells or hemoglobin. This extra work can harm the heart. Iron-deficiency anemia can also cause problems during pregnancy. You can help prevent iron-deficiency anemia with the following steps: The chart below lists how much iron you need every day. The recommended amounts are listed in milligrams (mg). See a list of good sources of iron. Age Women Pregnant women Breastfeeding women Vegetarian women* 14-18 years 15 mg 27 mg 10 mg 27 mg 19-50 years 18 mg 27 mg 9 mg 32 mg 51+ years 8 mg n/a n/a 14 mg Source: Adapted from Institute of Medicine, Food and Nutrition Board6 *Vegetarians need more iron from food than people who eat meat do. This is because the body can absorb iron from meat better than from plant-based foods. Food sources of iron include: Find more sources of iron. Yes. During pregnancy, your body needs more iron to support your growing baby. In fact, pregnant women need almost twice as much iron as women who are not pregnant do. Not getting enough iron during pregnancy raises your risk for premature birth or a low-birth-weight baby (less than 5 1/2 pounds). Premature birth is the most common cause of infant death. Both premature birth and low birth weight raise your baby's risk for health and developmental problems at birth and during childhood. If you're pregnant, talk to your doctor about these steps: No, you do not need more iron during breastfeeding. In fact, you need less iron than before you were pregnant. The amount of iron women need during breastfeeding is 10 milligrams per day for young mothers 14 to 18 and 9 milligrams per day for breastfeeding women older than 18. You need less iron while breastfeeding because you likely will not lose a lot through your menstrual cycle. Many breastfeeding women do not have a period or may have only a light period. Also, if you got enough iron during pregnancy (27 milligrams a day), your breastmilk will supply enough iron for your baby. It might. If you still get your period and take menopausal hormone therapy, you may need more iron than women who are postmenopausal and do not take menopausal hormone therapy. Talk to your doctor or nurse. It could. Hormonal birth control, such as the pill, the patch, the shot, or the hormonal intrauterine device (IUD), is often used to treat women with heavy menstrual periods. Lighter menstrual periods may reduce your risk for iron-deficiency anemia. Also, the non-hormonal, copper IUD (Paragard) may make your menstrual flow heavier. This raises your risk for iron-deficiency anemia. Talk to your doctor or nurse about your risk for anemia and whether hormonal birth control may help. You can help make sure you get enough iron by choosing foods that contain iron more often. Vegetarians need more iron from food than people who eat meat. This is because the body can absorb iron from meat better than from plant-based foods. Vegetarian sources of iron include:8 Talk to your doctor or nurse about whether you get enough iron. Most people get enough iron from food. Yes, your body can get too much iron. Extra iron can damage the liver, heart, and pancreas. Try to get no more than 45 milligrams of iron a day, unless your doctor prescribes more. Some people get too much iron because of a condition called hemochromatosis that runs in families. Learn more about hemochromatosis, who is at risk, and how it is treated. You can also get too much iron from iron pills (if you also get iron from food) or from repeated blood transfusions. For more information about iron-deficiency anemia, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:",
+    "https://www.womenshealth.gov/a-z-topics/iron-deficiency-anemia"
+  ],
+  [
+    "Genetic counseling: Genetics is the study of heredity, the process of a parent passing certain genes on to their children. - A person's appearance, such as height, hair color, skin color, and eye color, are determined by genes. - Birth defects and certain diseases are also often determined by genes. Genetic counseling is the process where parents can learn more about: - How likely it will be that their child would have a genetic disorder - What tests can check for genetic defects or disorders - Deciding whether or not you would like to haven these tests Couples who want to have a baby can have tests before they get pregnant. Health care providers can also test a fetus (unborn baby) to see if the baby will have a genetic disorder, such as cystic fibrosis or Down syndrome. It is up to you whether or not to have genetic counseling and testing. You will want to think about your personal desires, religious beliefs, and family circumstances. Some people have a greater risk than others for passing on genetic disorders to their children. They are: - People who have family members or children with genetic or birth defects - Jews of Eastern European descent. They may have a high risk of having babies with Tay-Sachs or Canavan's disease. - African-Americans, who may risk passing sickle-cell anemia (blood disease) on to their children - People of Southeast Asian or Mediterranean origin, who are at a higher risk of having children with thalassemia, a blood disease - Women who were exposed to toxins (poisons) that could cause birth defects - Women with a health problem, such as diabetes, that may affect their fetus - Couples who have had three of more miscarriages (fetus dies before 20 weeks of pregnancy) Testing is also suggested for: - Women who are over the age of 35, though genetic screening is now recommended for women of all ages. - Women who have had abnormal results on pregnancy screening, such as alpha-fetoprotein (AFP) Talk about genetic counseling with your provider and your family. Ask questions you may have about the test and what the results will mean for you. Keep in mind that genetic tests that are done before you get pregnant (conceive) can most often only tell you the odds of having a child with a certain birth defect. For instance, you may learn that you and your partner have a 1 in 4 chance of having a child with a certain disease or defect. If you decide to conceive, you will need more tests to see if your baby will have the defect or not. For those who may be at risk, test results can help answer such questions as: - Are the chances of having a baby with a genetic defect so high that we should look at other ways to start a family? - If you have a baby with a genetic disorder, are there treatments or surgeries that can help the baby? - How do we prepare ourselves for the chance we might have a child with a genetic problem? Are there classes or support groups for the disorder? Are there providers nearby who treat children with the disorder? - Should we continue the pregnancy? Are the baby's problems so severe that we might choose to end the pregnancy? You can prepare by finding out if any medical problems like these run in your family: - Child development problems - Miscarriages - Stillbirth - Severe childhood illnesses Steps in genetic counseling include: - You will fill out an in-depth family history form and talk to the counselor about health problems that run in your family. - You may also get blood tests to look at your chromosomes or other genes. - Your family history and test results will help the counselor look at genetic defects you may pass on to your children. If you choose to be tested after you become pregnant, tests that may be done during the pregnancy (either on the mother or fetus) include: - Amniocentesis, in which fluid is withdrawn from the amniotic sac (fluid that surrounds the baby) - Chorionic villus sampling (CVS), which takes a sample of the cells from the placenta - Percutaneous umbilical blood sampling (PUBS), which tests blood from the umbilical cord (the cord that connects the mother to the baby) - Noninvasive prenatal screening, which looks in the mother's blood for DNA from the baby that may have an extra or missing chromosome These tests have some risks. They may cause infection, harm the fetus, or cause a miscarriage. If you are worried about these risks, talk to your provider. The purpose of genetic counseling is simply to help parents make informed decisions. A genetic counselor will help you figure out how to use the information you get from your tests. If you are at risk, or if you find out that your baby has a disorder, your counselor and provider will talk to you about options and resources. But the decisions are yours to make. Updated by: Chad Haldeman-Englert, MD, FACMG, Fullerton Genetics Center, Asheville, NC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000510.htm"
+  ],
+  [
+    "Is monilethrix inherited?: Monilethrix can have multiple patterns of inheritance. When the condition is caused by a mutation in one of the keratin genes, it is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder. In rare cases, the condition results from a new mutation in the gene and is not inherited. When the condition is caused by mutations in the DSG4 gene, it is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition.",
+    "https://ghr.nlm.nih.gov/condition/monilethrix"
+  ],
+  [
+    "Alagille Syndrome (Genetic Disorders): Each cell contains thousands of genes that provide the instructions for making proteins for growth and repair of the body. If a gene has a mutation, the protein made by that gene may not function properly, which sometimes creates a genetic disorder. Not all gene mutations cause a disorder.People have two copies of most genes; one copy is inherited from each parent. A genetic disorder occurs when one or both parents pass a mutated gene to a child at conception. A genetic disorder can also occur through a spontaneous gene mutation, meaning neither parent carries a copy of the mutated gene. Once a spontaneous gene mutation has occurred in a person, it can be passed to the person's children.Read more about genes and genetic conditions at the U.S. National Library of Medicine's (NLM's) Genetics Home Reference at www.ghr.nlm.nih.gov.www.ghr.nlm.nih.gov",
+    "https://www.niddk.nih.gov/health-information/liver-disease/alagille-syndrome"
+  ],
+  [
+    "Dandy-Walker malformation (Genetic Changes): Researchers have found mutations in a few genes that are thought to cause Dandy-Walker malformation, but these mutations account for only a small number of cases. Dandy-Walker malformation has also been associated with many chromosomal abnormalities. This condition can be a feature of some conditions in which there is an extra copy of one chromosome in each cell (trisomy). Dandy-Walker malformation most often occurs in people with trisomy 18 (an extra copy of chromosome 18), but can also occur in people with trisomy 13, trisomy 21, or trisomy 9. This condition can also be associated with missing (deletions) or copied (duplications) pieces of certain chromosomes. Dandy-Walker malformation can also be a feature of genetic syndromes that are caused by mutations in specific genes. However, the brain malformations associated with Dandy-Walker malformation often occur as an isolated feature (not associated with other health problems), and in these cases the cause is frequently unknown. Research suggests that Dandy-Walker malformation could be caused by environmental factors that affect early development before birth. For example, exposure of the fetus to substances that cause birth defects (teratogens) may be involved in the development of this condition. In addition, a mother with diabetes is more likely than a healthy mother to have a child with Dandy-Walker malformation.",
+    "https://ghr.nlm.nih.gov/condition/dandy-walker-malformation"
+  ],
+  [
+    "Rocky Mountain Spotted Fever (How Is NIAID Addressing This Critical Topic?): Because of the work started by Dr. Ricketts in the early 1900s, NIAID Rocky Mountain Laboratories (RML) remains a thriving center for infectious disease research on tickborne diseases, such as Lyme disease and relapsing fever. RML also continues to do research on rickettsial diseases.",
+    "https://www.niaid.nih.gov/diseases-conditions/rocky-mountain-spotted-fever"
+  ],
+  [
+    "intrauterine growth restriction, metaphyseal dysplasia, adrenal hypoplasia congenita, and genital anomalies (Genetic Changes): IMAGe syndrome is caused by mutations in the CDKN1C gene. This gene provides instructions for making a protein that helps control growth before birth. The mutations that cause IMAGe syndrome alter the structure and function of the CDKN1C protein, which inhibits normal growth starting in the early stages of development before birth. Researchers are working to determine how these genetic changes underlie the bone abnormalities, adrenal gland underdevelopment, and other signs and symptoms of this condition. People inherit one copy of most genes from their mother and one copy from their father. For most genes, both copies are fully turned on (active) in cells. The CDKN1C gene, however, is most active when it is inherited from a person's mother. The copy of CDKN1C inherited from a person's father is active at much lower levels in most tissues. This sort of parent-specific difference in gene activation is caused by a phenomenon called genomic imprinting. When genomic imprinting reduces the activity of the copy of a gene inherited from the father, that gene is said to be paternally imprinted.",
+    "https://ghr.nlm.nih.gov/condition/intrauterine-growth-restriction-metaphyseal-dysplasia-adrenal-hypoplasia-congenita-and-genital-anomalies"
+  ],
+  [
+    "Beckwith-Wiedemann syndrome (Genetic Changes): The genetic causes of Beckwith-Wiedemann syndrome are complex. The condition usually results from the abnormal regulation of genes in a particular region of chromosome 11. People normally inherit one copy of this chromosome from each parent. For most genes on chromosome 11, both copies of the gene are expressed, or \"turned on,\" in cells. For some genes, however, only the copy inherited from a person's father (the paternally inherited copy) is expressed. For other genes, only the copy inherited from a person's mother (the maternally inherited copy) is expressed. These parent-specific differences in gene expression are caused by a phenomenon called genomic imprinting. Abnormalities involving genes on chromosome 11 that undergo genomic imprinting are responsible for most cases of Beckwith-Wiedemann syndrome. At least half of all cases result from changes in a process called methylation. Methylation is a chemical reaction that attaches small molecules called methyl groups to certain segments of DNA. In genes that undergo genomic imprinting, methylation is one way that a gene's parent of origin is marked during the formation of egg and sperm cells. Beckwith-Wiedemann syndrome is often associated with changes in regions of DNA on chromosome 11 called imprinting centers (ICs). ICs control the methylation of several genes that are involved in normal growth, including the CDKN1C, H19, IGF2, and KCNQ1OT1 genes. Abnormal methylation disrupts the regulation of these genes, which leads to overgrowth and the other characteristic features of Beckwith-Wiedemann syndrome. About twenty percent of cases of Beckwith-Wiedemann syndrome are caused by a genetic change known as paternal uniparental disomy (UPD). Paternal UPD causes people to have two active copies of paternally inherited genes rather than one active copy from the father and one inactive copy from the mother. People with paternal UPD are also missing genes that are active only on the maternally inherited copy of the chromosome. In Beckwith-Wiedemann syndrome, paternal UPD usually occurs early in embryonic development and affects only some of the body's cells. This phenomenon is called mosaicism. Mosaic paternal UPD leads to an imbalance in active paternal and maternal genes on chromosome 11, which underlies the signs and symptoms of the disorder. Less commonly, mutations in the CDKN1C gene cause Beckwith-Wiedemann syndrome. This gene provides instructions for making a protein that helps control growth before birth. Mutations in the CDKN1C gene prevent this protein from restraining growth, which leads to the abnormalities characteristic of Beckwith-Wiedemann syndrome. About 1 percent of all people with Beckwith-Wiedemann syndrome have a chromosomal abnormality such as a rearrangement (translocation), abnormal copying (duplication), or loss (deletion) of genetic material from chromosome 11. Like the other genetic changes responsible for Beckwith-Wiedemann syndrome, these abnormalities disrupt the normal regulation of certain genes on this chromosome.",
+    "https://ghr.nlm.nih.gov/condition/beckwith-wiedemann-syndrome"
+  ],
+  [
+    "congenital hemidysplasia with ichthyosiform erythroderma and limb defects (Genetic Changes): Mutations in the NSDHL gene cause CHILD syndrome. This gene provides instructions for making an enzyme that is involved in the production of cholesterol. Cholesterol is a type of fat that is produced in the body and obtained from foods that come from animals, particularly egg yolks, meat, fish, and dairy products. Although high cholesterol levels are a well-known risk factor for heart disease, the body needs some cholesterol to develop and function normally both before and after birth. Cholesterol is an important component of cell membranes and the protective substance covering nerve cells (myelin). Additionally, cholesterol plays a role in the production of certain hormones and digestive acids. The mutations that underlie CHILD syndrome eliminate the activity of the NSDHL enzyme, which disrupts the normal production of cholesterol within cells. A shortage of this enzyme may also allow potentially toxic byproducts of cholesterol production to build up in the body's tissues. Researchers suspect that low cholesterol levels and/or an accumulation of other substances disrupt the growth and development of many parts of the body. It is not known, however, how a disturbance in cholesterol production leads to the specific features of CHILD syndrome.",
+    "https://ghr.nlm.nih.gov/condition/congenital-hemidysplasia-with-ichthyosiform-erythroderma-and-limb-defects"
+  ],
+  [
+    "Mitochondrial genetic disorders: Mitochondrial genetic disorders refer to a group of conditions that affect the mitochondria (the structures in each cell of the body that are responsible for making energy). People with these conditions can present at any age with almost any affected body system; however, the brain, muscles, heart, liver, nerves, eyes, ears and kidneys are the organs and tissues most commonly affected. Symptom severity can also vary widely. [1] [2] Mitochondrial genetic disorders can be caused by changes ( mutations ) in either the mitochondrial DNA or nuclear DNA that lead to dysfunction of the mitochondria and inadequate production of energy. Those caused by mutations in mitochondrial DNA are transmitted by maternal inheritance, while those caused by mutations in nuclear DNA may follow an autosomal dominant , autosomal recessive , or X-linked pattern of inheritance. [1] [3] Treatment varies based on the specific type of condition and the signs and symptoms present in each person. [1] [4] People with mitochondrial genetic disorders can present at any age with almost any affected body system. While some conditions\u00a0may only affect a single organ , many involve multiple organ systems\u00a0including\u00a0the brain, muscles, heart, liver, nerves, eyes, ears and/or kidneys. Symptom severity can also vary widely. The most common signs and symptoms include: [1] [2] Poor growth Loss of muscle coordination Muscle weakness Seizures Autism Problems with vision and/or hearing Developmental delay Learning disabilities Heart, liver, and/or kidney disease Gastrointestinal disorders Diabetes Increased risk of infection Thyroid and/or adrenal abnormalities Autonomic dysfunction Dementia The United Mitochondrial Disease Foundation's website features a comprehensive list of possible symptoms ( click here to see this information) and symptoms categorized by type of mitochondrial genetic disorder ( click here to access this page). Mitochondrial genetic disorders can be caused by changes ( mutations ) in either the mitochondrial DNA or nuclear DNA that lead to dysfunction of the mitochondria . Most DNA (hereditary material that is passed from parent to child) is packaged within the nucleus of each cell (known as nuclear DNA). However, mitochondria (the structures in each cell that produce energy) contain a small amount of their own DNA, which is known as mitochondrial DNA. [1] [2] When the mitochondria are not working properly, the body does not have enough energy to carry out its normal functions. This can lead to the variety of health problems associated with mitochondrial genetic disorders. [1] [2] Mitochondrial genetic disorder can be inherited in a variety of manners depending on the type of condition and the location of the disease-causing change ( mutation ). Those caused by mutations in mitochondrial DNA are transmitted by maternal inheritance. [1] [3] Only egg cells (not sperm cells) contribute mitochondria to the next generation, so only females can pass on mitochondrial mutations to their children. Conditions resulting from mutations in mitochondrial DNA can appear in every generation of a family and can affect both males and females. In some cases, the condition results from a new ( de novo) mutation in a mitochondrial gene and occurs in a person with no history of the condition in the family. Mitochondrial genetic disorders caused by mutations in nuclear DNA may follow an autosomal dominant , autosomal recessive , or X-linked pattern of inheritance. [1] [3] In autosomal dominant conditions, one\u00a0mutated copy of the responsible gene in each cell is enough to cause signs or symptoms of the condition. In some cases, an affected person inherits the mutation from an affected parent. Other cases may result from new mutations in the gene. These cases occur in people with no history of the disorder in their family. A person with an autosomal dominant condition has a 50% chance with each pregnancy of passing along the altered gene to his or her child. When a condition is inherited in an autosomal recessive manner, a person must have a change in both copies of the responsible gene in each cell. The parents of an affected person usually each carry one mutated copy of the gene and are referred to as carriers . Carriers typically do not show signs or symptoms of the condition. When two carriers of an autosomal recessive condition have children, each child has a 25% (1 in 4) risk to have the condition, a 50% (1 in 2) risk to be a carrier like each of the parents, and a 25% chance to not have the condition and not be a carrier. A condition is considered X-linked if the mutated gene that causes the condition is located on the X chromosome , one of the two sex chromosomes (the Y chromosome is the other sex chromosome ). Women have two X chromosomes and men have an X and a Y chromosome. X-linked conditions can be X-linked dominant or X-linked recessive . The inheritance is X-linked dominant if one copy of the altered gene in each cell is sufficient to cause the condition. Women with an X-linked dominant condition have a 50% chance of passing the condition on to a son or a daughter with each pregnancy. Men with an X-linked dominant condition will pass the condition on to all of their daughters and none of their sons. The inheritance is X-linked recessive if a gene on the X chromosome causes the condition in men with one gene mutation (they have only one X chromosome) and in females with two gene mutations (they have two X chromosomes). A woman with an X-linked condition will pass the mutation on to all of her sons and daughters. This means that all of her sons will have the condition and all of her daughters will be carriers. A man with an X-linked recessive condition will pass the mutation to all of his daughters (carriers) and none of his sons. Unfortunately, mitochondrial genetic disorders can be difficult to diagnose, and many affected people may never receive a specific diagnosis. They are often suspected in people who have a condition that effects multiple, unrelated systems of the body. In some cases, the pattern of symptoms may be suggestive of a specific mitochondrial condition. If the disease-causing gene (s) associated with the particular condition is known, the diagnosis can then be confirmed with genetic testing . [1] [5] If a mitochondrial genetic disorder is suspected but the signs and symptoms do not suggest a specific diagnosis, a more extensive work-up may be required. In these cases, a physician may start by evaluating the levels of certain substances in a sample of blood or cerebrospinal fluid. Other tests that can support a diagnosis include: [1] Exercise testing Magnetic resonance spectroscopy (detects abnormalities in the brain's chemical makeup) Imaging studies\u00a0of the brain such as MRI or CT scan Electroencephalography (EEG) Tests that evaluate the heart including electrocardiography and echocardiography Muscle biopsy When possible, confirming a diagnosis with genetic testing can have important implications for family members. Identifying the disease-causing gene(s) will give the family information about the inheritance pattern and the risk to other family members. It will also allow other at-risk family members to undergo\u00a0genetic testing. [1] For more information regarding the diagnosis of mitochondrial genetic disorders, please visit the United Mitochondrial Disease Foundation's \"Getting a Diagnosis\"\u00a0Web page. GeneReviews also provides information on establishing a diagnosis of a mitochondrial disorder. Click on the link to view the article on this topic. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. Treatment for mitochondrial genetic disorders varies significantly based on the specific type of condition and the signs and symptoms present in each person. The primary aim of treatment is to alleviate symptoms and slow the progression of the condition. For example, a variety of vitamins and other supplements have been used to treat people affected by mitochondrial conditions with varying degrees of success. Other examples of possible interventions include medications to treat diabetes mellitus , surgery for cataracts , and cochlear implantation for hearing loss . [4] [1] For more general information about the treatment of mitochondrial genetic disorders, please visit GeneReviews. Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions.",
+    "https://rarediseases.info.nih.gov/diseases/7048/mitochondrial-genetic-disorders"
+  ],
+  [
+    "Fibromyalgia (Treatment): In general, treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health. No one treatment works for all symptoms. Medications Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include: - Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Your doctor might suggest a prescription pain reliever such as tramadol (Ultram). Narcotics are not advised, because they can lead to dependence and may even worsen the pain over time. - Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or the muscle relaxant cyclobenzaprine to help promote sleep. - Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia. Therapy A variety of different therapies can help reduce the effect that fibromyalgia has on your body and your life. Examples include: - Physical therapy. A physical therapist can teach you exercises that will improve your strength, flexibility and stamina. Water-based exercises might be particularly helpful. - Occupational therapy. An occupational therapist can help you make adjustments to your work area or the way you perform certain tasks that will cause less stress on your body. - Counseling. Talking with a counselor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations.",
+    "https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780"
+  ],
+  [
+    "Do you have information about Medicare Prescription Drug Coverage: Summary : Part D is the name of Medicare's prescription drug coverage. It's insurance that helps people pay for prescription drugs. It is available to everyone who has Medicare. It provides protection if you pay high drug costs or have unexpected prescription drug bills. It doesn't cover all costs. You have to pay part of the cost of prescription drugs. Most people also have to pay an additional monthly cost. Private companies provide Medicare prescription drug coverage. You choose the drug plan you like best. Whether or not you should sign up depends on how good your current coverage is. You need to sign up as soon as you are eligible for Medicare. Otherwise, there may be additional charges. Centers for Medicare and Medicaid Services",
+    "https://www.nlm.nih.gov/medlineplus/medicareprescriptiondrugcoverage.html"
+  ],
+  [
+    "Juvenile fibromyalgia (Treatment): A multidisciplinary approach that incorporates clinicians, psychologists and rehabilitation specialists and that offers a combination of pharmacological, cognitive behavioral and physical interventions, along with patient education, has been shown to be most effective in treating children and teens with fibromyalgia. Medications Medications can help reduce the pain of fibromyalgia and improve sleep. Data on the use of medications in the treatment of juvenile fibromyalgia are limited. However, agents that have shown benefit in adults also have been used in children, and are sometimes effective. Common choices include: - Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Other antidepressants, such as amitriptyline and fluoxetine (Prozac), are sometimes prescribed and appear to help promote sleep. - Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Pain reliever such as tramadol (Ultram, Conzip) are also sometimes prescribed. Use of opioids and narcotics should be avoided in treating juvenile fibromyalgia. - Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin, Gralise) and pregabalin (Lyrica) are sometimes prescribed for adults to reduce fibromyalgia symptoms. Cognitive behavioral therapy Cognitive behavioral therapy (CBT) is an intervention that has been well-studied in the treatment of chronic pain in children, and has been found to help reduce disability and depression. CBT focuses on helping people with fibromyalgia manage their pain using adaptive coping skills. These include the use of relaxation-based treatments, distraction, activity pacing, scheduling pleasant activities, problem-solving, and replacing negative and catastrophic thoughts with more calming and realistic appraisals. For children and adolescents with fibromyalgia, parents usually participate in some CBT sessions to learn how to coach and support their children's use of these coping skills at home.",
+    "https://www.mayoclinic.org/diseases-conditions/juvenile-fibromyalgia/symptoms-causes/syc-20374053"
+  ],
+  [
+    "Fibromyalgia (Treatment): The goals of treatment are to help relieve pain and other symptoms, and to help a person cope with the symptoms. The first type of treatment may involve: - Physical therapy - Exercise and fitness program - Stress-relief methods, including light massage and relaxation techniques If these treatments do not work, your health care provider may also prescribe an antidepressant or muscle relaxant. - The goal of these medicines is to improve your sleep and help you better tolerate pain. - Medicine should be used along with exercise and behavior therapy. - Duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella) are drugs that are approved specifically for treating fibromyalgia. Other drugs are also used to treat the condition, such as: - Anti-seizure drugs, such as gabapentin. - Other antidepressants, such as amytriptyline. - Muscle relaxants, such as cyclobenzeprine. - Pain relievers, but avoid narcotics, since they usually do not help. - Sleeping aids: If you have sleep apnea, an apparatus called CPAP may be prescribed. Cognitive-behavioral therapy is an important part of treatment. This therapy helps you learn how to: - Deal with negative thoughts. - Keep a diary of pain and symptoms. - Recognize what makes your symptoms worse. - Seek out enjoyable activities. - Set limits. Support groups may also be helpful. Things you can do to help take care of yourself include: - Eat a well-balanced diet. - Avoid caffeine. - Practice a good sleep routine to improve quality of sleep. - Exercise regularly, starting with low-level exercise. - Try acupressure and acupuncture treatments. Your doctor may refer you to a pain clinic if your condition is severe.",
+    "https://medlineplus.gov/ency/article/000427.htm"
+  ],
+  [
+    "Fibromyalgia: Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals. Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event. Women are more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression. While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help. Symptoms of fibromyalgia include: - Widespread pain. The pain associated with fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist. - Fatigue. People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea. - Cognitive difficulties. A symptom commonly referred to as \"fibro fog\" impairs the ability to focus, pay attention and concentrate on mental tasks. Fibromyalgia often co-exists with other painful conditions, such as: - Irritable bowel syndrome - Migraine and other types of headaches - Interstitial cystitis or painful bladder syndrome - Temporomandibular joint disorders Doctors don't know what causes fibromyalgia, but it most likely involves a variety of factors working together. These may include: - Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder. - Infections. Some illnesses appear to trigger or aggravate fibromyalgia. - Physical or emotional trauma. Fibromyalgia can sometimes be triggered by a physical trauma, such as a car accident. Psychological stress may also trigger the condition. Why does it hurt? Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals. Risk factors for fibromyalgia include: - Your sex. Fibromyalgia is diagnosed more often in women than in men. - Family history. You may be more likely to develop fibromyalgia if a relative also has the condition. - Other disorders. If you have osteoarthritis, rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia. In the past, doctors would check 18 specific points on a person's body to see how many of them were painful when pressed firmly. Newer guidelines don't require a tender point exam. Instead, a fibromyalgia diagnosis can be made if a person has had widespread pain for more than three months - with no underlying medical condition that could cause the pain. Blood tests While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include: - Complete blood count - Erythrocyte sedimentation rate - Cyclic citrullinated peptide test - Rheumatoid factor - Thyroid function tests In general, treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health. No one treatment works for all symptoms. Medications Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include: - Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Your doctor might suggest a prescription pain reliever such as tramadol (Ultram). Narcotics are not advised, because they can lead to dependence and may even worsen the pain over time. - Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or the muscle relaxant cyclobenzaprine to help promote sleep. - Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia. Therapy A variety of different therapies can help reduce the effect that fibromyalgia has on your body and your life. Examples include: - Physical therapy. A physical therapist can teach you exercises that will improve your strength, flexibility and stamina. Water-based exercises might be particularly helpful. - Occupational therapy. An occupational therapist can help you make adjustments to your work area or the way you perform certain tasks that will cause less stress on your body. - Counseling. Talking with a counselor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations. Self-care is critical in the management of fibromyalgia. - Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than do those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation. - Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping. - Exercise regularly. At first, exercise may increase your pain. But doing it gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful. - Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Moderation means not overdoing it on your good days, but likewise it means not self-limiting or doing too little on the days when symptoms flare. - Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day. Complementary and alternative therapies for pain and stress management aren't new. Some, such as meditation and yoga, have been practiced for thousands of years. But their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia. Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining acceptance in mainstream medicine. But many practices remain unproved because they haven't been adequately studied. - Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. Some studies indicate that acupuncture helps relieve fibromyalgia symptoms, while others show no benefit. - Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body's muscles and soft tissues. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body's natural painkillers. It often helps relieve stress and anxiety. - Yoga and tai chi. These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.",
+    "https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780"
+  ],
+  [
+    "Fibromyalgia (What causes fibromyalgia?): Researchers are not sure exactly what causes fibromyalgia. Genetics may play a role. Studies also show that the brains of people with fibromyalgia may not process pain in the same way as people who do not have fibromyalgia. Lower levels of certain brain neurotransmitters, such as serotonin or norepinephrine, may cause you to be more sensitive to pain and have a more severe reaction to pain. Imaging studies of the brain show that people with fibromyalgia feel pain when people without fibromyalgia do not.10 Some medicines prescribed to treat fibromyalgia try to bring the levels of those neurotransmitters back into balance.",
+    "https://www.womenshealth.gov/a-z-topics/fibromyalgia"
+  ],
+  [
+    "MTHFR gene variant (Summary): MTHFR is a gene . We all carry two copies of MTHFR. MTHFR tells our body how to create an enzyme involved in breaking down the amino acid homocysteine. [1] [2] [3] As is true for any gene, the DNA code of the\u00a0 MTHFR\u00a0gene can vary. When we identify a part of the sequence that varies, we call it a \"variant.\" Genetic research aims to identify specific variants that cause harm or benefit to health. There are two MTHFR gene variants, called C677T and A1298C, that have been an active area of study. These variants are common. In America, about 25% of people who are Hispanic, and 10-15% of people who are Caucasian have two copies of C677T. [4] Studies have found that women with two C677T gene variants have an increased risk for having a child with a neural tube defect. [4] Studies have also found that men and women with two C677T gene variants and elevated homocysteine levels may be at a mild increased risk for blood clots (venous thromboembolism). [4] Many studies on MTHFR and other health risks have been completed, but with conflicting results. [5] [6] For information about rare disease causing MTHFR gene variants, visit our page: Homocystinuria due to MTHFR Deficiency.",
+    "https://rarediseases.info.nih.gov/diseases/10953/mthfr-gene-variant"
+  ],
+  [
+    "What is Health Problems in Pregnancy?: Every pregnancy has some risk of problems. The causes can be conditions you already have or conditions you develop. They also include being pregnant with more than one baby, previous problem pregnancies, or being over age 35. They can affect your health and the health of your baby. If you have a chronic condition, you should talk to your health care provider about how to minimize your risk before you get pregnant. Once you are pregnant, you may need a health care team to monitor your pregnancy. Examples of common conditions that can complicate a pregnancy include - Heart disease - High blood pressure - Kidney problems - Autoimmune disorders - Sexually transmitted diseases - Diabetes - Cancer - Infections Other conditions that can make pregnancy risky can happen while you are pregnant - for example, gestational diabetes and Rh incompatibility. Good prenatal care can help detect and treat them. Some discomforts, like nausea, back pain, and fatigue, are common during pregnancy. Sometimes it is hard to know what is normal. Call your doctor or midwife if something is bothering or worrying you.",
+    "https://www.nlm.nih.gov/medlineplus/healthproblemsinpregnancy.html"
+  ],
+  [
+    "MTHFR gene variant (Inheritance): Because each person has two copies of the MTHFR gene , people can inherit one copy of a\u00a0 MTHFR\u00a0gene variant or two copies of it (one from each parent). People who inherit two copies of C677T have a higher risk for having a child with a neural tube defect. Having two C677T variants and elevated homocysteine levels may cause a slightly higher risk for blood clots. [7]\u00a0 Risks associated with having one C677T and one A1298C is the same, or possibly slightly lower than, that of having two C677T gene changes. [7] [4] Rare MTHFR gene variants can lead to homocystinuria, which is inherited in an autosomal recessive \u00a0manner. [12] Visit our \" Homocystinuria due to MTHFR deficiency\" webpage.",
+    "https://rarediseases.info.nih.gov/diseases/10953/mthfr-gene-variant"
+  ],
+  [
+    "MTHFR gene variant (Diagnosis): Genetic testing is available for MTHFR gene variants, however testing is rarely recommended. The American Congress of Obstetricians and Gynecologists (ACOG) and the American College of Medical Genetics recommends against testing for common MTHFR gene variants. Common MTHFR gene variants have not been proven to be a concerning risk factor for blood clots, pregnancy loss, or other negative pregnancy outcomes. [6] The American Heart Association recommends against testing for the common MTHFR\u00a0gene variants or homocysteine as a screen for increased risk of cardiovascular conditions. [13] [7] [6] The Association does not consider MTHFR a major risk factor for heart disease. The College of American Pathologists , the American College of Medical Genetics, and the American Heart Association recommend against testing for C677T and A1298C in people with blood clots. This is because results have little impact on a persons medical management. [13] [7] [4] Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional.",
+    "https://rarediseases.info.nih.gov/diseases/10953/mthfr-gene-variant"
+  ],
+  [
+    "MTHFR gene: The MTHFR gene provides instructions for making an enzyme called methylenetetrahydrofolate reductase. This enzyme plays a role in processing amino acids, the building blocks of proteins. Methylenetetrahydrofolate reductase is important for a chemical reaction involving forms of the vitamin folate (also called vitamin B9). Specifically, this enzyme converts a molecule called 5,10-methylenetetrahydrofolate to a molecule called 5-methyltetrahydrofolate. This reaction is required for the multistep process that converts the amino acid homocysteine to another amino acid, methionine. The body uses methionine to make proteins and other important compounds. At least 40 mutations in the MTHFR gene have been identified in people with homocystinuria, a disorder in which the body is unable to process homocysteine and methionine properly. People with this condition often develop eye problems, abnormal blood clotting, skeletal abnormalities, and cognitive problems. Most of the mutations that cause homocystinuria change single amino acids in methylenetetrahydrofolate reductase. These changes impair the function of the enzyme, and some cause the enzyme to be turned off (inactivated). Other mutations lead to the production of an abnormally small, nonfunctional version of the enzyme. Without functional methylenetetrahydrofolate reductase, homocysteine cannot be converted to methionine. As a result, homocysteine builds up in the bloodstream, and the amount of methionine is reduced. Some of the excess homocysteine is excreted in urine (homocystinuria). Researchers have not determined how altered levels of homocysteine and methionine lead to the various health problems affecting multiple parts of the body in people with homocystinuria. At least 40 mutations in the MTHFR gene have been identified in people with homocystinuria, a disorder in which the body is unable to process homocysteine and methionine properly. People with this condition often develop eye problems, abnormal blood clotting, skeletal abnormalities, and cognitive problems. Most of the mutations that cause homocystinuria change single amino acids in methylenetetrahydrofolate reductase. These changes impair the function of the enzyme, and some cause the enzyme to be turned off (inactivated). Other mutations lead to the production of an abnormally small, nonfunctional version of the enzyme. Without functional methylenetetrahydrofolate reductase, homocysteine cannot be converted to methionine. As a result, homocysteine builds up in the bloodstream, and the amount of methionine is reduced. Some of the excess homocysteine is excreted in urine (homocystinuria). Researchers have not determined how altered levels of homocysteine and methionine lead to the various health problems affecting multiple parts of the body in people with homocystinuria. Several variations (polymorphisms) in the MTHFR gene have been associated with an increased risk of neural tube defects, a group of birth defects that occur during the development of the brain and spinal cord. Anencephaly is one of the most common types of neural tube defect. Affected individuals are missing large parts of the brain and have missing or incompletely formed skull bones. The most well-studied polymorphism related to neural tube defects changes a single DNA building block (nucleotide) in the MTHFR gene. Specifically, it replaces the nucleotide cytosine with the nucleotide thymine at position 677 (written as 677C>T). This common variant results in a form of methylenetetrahydrofolate reductase that has reduced activity at higher temperatures (thermolabile). People with the 677C>T polymorphism, particularly those with two copies of the genetic change, have elevated levels of homocysteine in their blood resulting from the reduced activity of methylenetetrahydrofolate reductase. Researchers have studied MTHFR gene polymorphisms in individuals with neural tube defects and in their mothers, but it remains unclear how these variations could affect the developing brain and spinal cord. The increased risk of neural tube defects may be related to differences in the ability of methylenetetrahydrofolate reductase to process folate; a shortage of this vitamin is an established risk factor for neural tube defects. Although MTHFR gene polymorphisms are associated with an increased risk of neural tube defects, these variations are common in many populations worldwide. Most people with MTHFR gene polymorphisms do not have neural tube defects, and their children are also typically unaffected. Changes in the MTHFR gene are only one of many genetic and environmental factors that are thought to contribute to these complex conditions. Polymorphisms in the MTHFR gene are also associated with an increased risk of spina bifida, another common type of neural tube defect. In people with this condition, when the spine forms, the bones of the spinal column do not close completely around the developing nerves of the spinal cord. As a result, part of the spinal cord may protrude through an opening in the spine, leading to permanent nerve damage. As described above, variations in the MTHFR gene may increase the risk of neural tube defects by changing the ability of methylenetetrahydrofolate reductase to process folate. However, these variations are common in many populations worldwide. Most people with MTHFR gene polymorphisms do not have neural tube defects, nor do their children. Polymorphisms in the MTHFR gene have also been studied as possible risk factors for a variety of common conditions. These include heart disease, stroke, high blood pressure (hypertension), high blood pressure during pregnancy (preeclampsia), an eye disorder called glaucoma, psychiatric disorders, and certain types of cancer. Research indicates that individuals who have the 677C>T polymorphism on both copies of the MTHFR gene have an increased risk of developing vascular disease, including heart disease and stroke. The 677C>T polymorphism has also been suggested as a risk factor for cleft lip and palate, a birth defect in which there is a split in the upper lip and an opening in the roof of the mouth. Many of the MTHFR gene polymorphisms alter or decrease the activity of methylenetetrahydrofolate reductase, leading to an increase of homocysteine in the blood. This increase in homocysteine levels may contribute to the development of many of these conditions. Studies of MTHFR gene variations in people with these disorders have had mixed results, with associations found in some studies but not in others. Therefore, it remains unclear what role changes in the MTHFR gene play in these disorders. It is likely that additional factors influence the processing of homocysteine and that variations in homocysteine levels play a role in whether a person develops any of these conditions. A large number of genetic and environmental factors, most of which remain unknown, likely determine the risk of developing most common, complex conditions. Bhargava S, Ali A, Parakh R, Saxena R, Srivastava LM. Higher incidence of C677T polymorphism of the MTHFR gene in North Indian patients with vascular disease. Vascular. 2012 Apr;20(2):88-95. doi: 10.1258/vasc.2011.oa0320. Epub 2012 Feb 28.",
+    "https://ghr.nlm.nih.gov/gene/MTHFR"
+  ],
+  [
+    "MTHFR gene (anencephaly): Several variations (polymorphisms) in the MTHFR gene have been associated with an increased risk of neural tube defects, a group of birth defects that occur during the development of the brain and spinal cord. Anencephaly is one of the most common types of neural tube defect. Affected individuals are missing large parts of the brain and have missing or incompletely formed skull bones. The most well-studied polymorphism related to neural tube defects changes a single DNA building block (nucleotide) in the MTHFR gene. Specifically, it replaces the nucleotide cytosine with the nucleotide thymine at position 677 (written as 677C>T). This common variant results in a form of methylenetetrahydrofolate reductase that has reduced activity at higher temperatures (thermolabile). People with the 677C>T polymorphism, particularly those with two copies of the genetic change, have elevated levels of homocysteine in their blood resulting from the reduced activity of methylenetetrahydrofolate reductase. Researchers have studied MTHFR gene polymorphisms in individuals with neural tube defects and in their mothers, but it remains unclear how these variations could affect the developing brain and spinal cord. The increased risk of neural tube defects may be related to differences in the ability of methylenetetrahydrofolate reductase to process folate; a shortage of this vitamin is an established risk factor for neural tube defects. Although MTHFR gene polymorphisms are associated with an increased risk of neural tube defects, these variations are common in many populations worldwide. Most people with MTHFR gene polymorphisms do not have neural tube defects, and their children are also typically unaffected. Changes in the MTHFR gene are only one of many genetic and environmental factors that are thought to contribute to these complex conditions.",
+    "https://ghr.nlm.nih.gov/gene/MTHFR"
+  ],
+  [
+    "MTHFR gene (other disorders): Polymorphisms in the MTHFR gene have also been studied as possible risk factors for a variety of common conditions. These include heart disease, stroke, high blood pressure (hypertension), high blood pressure during pregnancy (preeclampsia), an eye disorder called glaucoma, psychiatric disorders, and certain types of cancer. Research indicates that individuals who have the 677C>T polymorphism on both copies of the MTHFR gene have an increased risk of developing vascular disease, including heart disease and stroke. The 677C>T polymorphism has also been suggested as a risk factor for cleft lip and palate, a birth defect in which there is a split in the upper lip and an opening in the roof of the mouth. Many of the MTHFR gene polymorphisms alter or decrease the activity of methylenetetrahydrofolate reductase, leading to an increase of homocysteine in the blood. This increase in homocysteine levels may contribute to the development of many of these conditions. Studies of MTHFR gene variations in people with these disorders have had mixed results, with associations found in some studies but not in others. Therefore, it remains unclear what role changes in the MTHFR gene play in these disorders. It is likely that additional factors influence the processing of homocysteine and that variations in homocysteine levels play a role in whether a person develops any of these conditions. A large number of genetic and environmental factors, most of which remain unknown, likely determine the risk of developing most common, complex conditions.",
+    "https://ghr.nlm.nih.gov/gene/MTHFR"
+  ],
+  [
+    "MTHFR gene variant (Treatment): Having MTHFR gene variants alone does not impact treatment. If a person has high homocysteine levels they should be carefully evaluated to identify all causes. Very high homocysteine levels rarely result from having the common variants alone. People with very high homocysteine levels should be carefully evaluated for other factors known to affect homocysteine, such as: [8] [9] [10] Low thyroid hormones (hypothyroidism) Chronic conditions (obesity, diabetes, high cholesterol, physical inactivity, high blood pressure ) Medications (atorvastatin, fenofibrate, methotrexate, andnicotinic acid) Dietary deficiencies (folate, vitamin B6, vitamin B12) Smoking Advanced age Treatments and life-style changes are given based upon the patient's circumstances. As mentioned above,\u00a0homocysteine levels can rise in people with and without MTHFR gene variants if they lack folate,\u00a0 choline, or B vitamins ( B12,\u00a0 B6, and\u00a0 riboflavin). [8] [9] People with concerns about their nutrition should speak with a healthcare professional. Supplements may be recommended if the person is found to have a nutritional deficiency. [3] [8] Current clinical guidelines do not recommend changes in prenatal care or prenatal vitamins based upon MTHFR gene variant status alone. Women of childbearing age should take the standard dose of folate supplementation to reduce the risk of neural tube defects. [4] [6] [14] Women with a previous child with a neural tube defect or a family history of neural tube defect should talk to their doctors about requirements for extra folate supplementation. [6] We recommend you speak with a trusted healthcare professional before taking any supplement.",
+    "https://rarediseases.info.nih.gov/diseases/10953/mthfr-gene-variant"
+  ],
+  [
+    "PACS1-related syndrome (Prognosis): Because PACS1-related syndrome is so rare, there is not a lot of information about the long-term outlook for children and adults with the syndrome. PACS1-related syndrome is not known to shorten a person\u2019s lifespan. [3] People with PACS1-related syndrome will likely need extra help in school, such as special education classes. They will also need to be monitored throughout their lives to make sure they do not develop any additional health issues. [2]",
+    "https://rarediseases.info.nih.gov/diseases/13043/pacs1-related-syndrome"
+  ],
+  [
+    "Family Issues (Summary): Summary There are many kinds of families. Some have two parents, while others have a single parent. Sometimes there is no parent and grandparents raise grandchildren. Some children live in foster families, adoptive families, or in stepfamilies. Families are much more than groups of people who share the same genes or the same address. They should be a source of love and support. This does not mean that everyone gets along all the time. Conflicts are a part of family life. Many things can lead to conflict, such as illness, disability, addiction, job loss, school problems, and marital issues. Listening to each other and working to resolve conflicts are important in strengthening the family.",
+    "#"
+  ],
+  [
+    "Vitamin D Deficiency (Summary): Summary What is vitamin D deficiency? Vitamin D deficiency means that you are not getting enough vitamin D to stay healthy. Why do I need vitamin D and how do I get it? Vitamin D helps your body absorb calcium. Calcium is one of the main building blocks of bone. Vitamin D also has a role in your nervous, muscle, and immune systems. You can get vitamin D in three ways: through your skin, from your diet, and from supplements. Your body forms vitamin D naturally after exposure to sunlight. But too much sun exposure can lead to skin aging and skin cancer, so many people try to get their vitamin D from other sources. How much vitamin D do I need? The amount of vitamin D you need each day depends on your age. The recommended amounts, in international units (IU), are - Birth to 12 months: 400 IU - Children 1-13 years: 600 IU - Teens 14-18 years: 600 IU - Adults 19-70 years: 600 IU - Adults 71 years and older: 800 IU - Pregnant and breastfeeding women: 600 IU People at high risk of vitamin D deficiency may need more. Check with your health care provider about how much you need. What causes vitamin D deficiency? You can become deficient in vitamin D for different reasons: - You don't get enough vitamin D in your diet - You don't absorb enough vitamin D from food (a malabsorption problem) - You don't get enough exposure to sunlight. - Your liver or kidneys cannot convert vitamin D to its active form in the body. - You take medicines that interfere with your body's ability to convert or absorb vitamin D Who is at risk of vitamin D deficiency? Some people are at higher risk of vitamin D deficiency: - Breastfed infants, because human milk is a poor source of vitamin D. If you are breastfeeding, give your infant a supplement of 400 IU of vitamin D every day. - Older adults, because your skin doesn't make vitamin D when exposed to sunlight as efficiently as when you were young, and your kidneys are less able to convert vitamin D to its active form. - People with dark skin, which has less ability to produce vitamin D from the sun. - People with disorders such as Crohn's disease or celiac disease who don't handle fat properly, because vitamin D needs fat to be absorbed. - People who are obese, because their body fat binds to some vitamin D and prevents it from getting into the blood. - People who have had gastric bypass surgery - People with osteoporosis - People with chronic kidney or liver disease. - People with hyperparathyroidism (too much of a hormone that controls the body's calcium level) - People with sarcoidosis, tuberculosis, histoplasmosis, or other granulomatous disease (disease with granulomas, collections of cells caused by chronic inflammation) - People with some lymphomas, a type of cancer. - People who take medicines that affect vitamin D metabolism, such as cholestyramine (a cholesterol drug), anti-seizure drugs, glucocorticoids, antifungal drugs, and HIV/AIDS medicines. Talk with your health care provider if you are at risk for vitamin D deficiency. There is a blood test which can measure how much vitamin D is in your body. What problems does vitamin D deficiency cause? Vitamin D deficiency can lead to a loss of bone density, which can contribute to osteoporosis and fractures. Severe vitamin D deficiency can also lead to other diseases. In children, it can cause rickets. Rickets is a rare disease that causes the bones to become soft and bend. African American infants and children are at higher risk of getting rickets. In adults, severe vitamin D deficiency leads to osteomalacia. Osteomalacia causes weak bones, bone pain, and muscle weakness. Researchers are studying vitamin D for its possible connections to several medical conditions, including diabetes, high blood pressure, cancer, and autoimmune conditions such as multiple sclerosis. They need to do more research before they can understand the effects of vitamin D on these conditions. How can I get more vitamin D? There are a few foods that naturally have some vitamin D: - Fatty fish such as salmon, tuna, and mackerel - Beef liver - Cheese - Mushrooms - Egg yolks You can also get vitamin D from fortified foods. You can check the food labels to find out whether a food has vitamin D. Foods that often have added vitamin D include - Milk - Breakfast cereals - Orange juice - Other dairy products, such as yogurt - Soy drinks Vitamin D is in many multivitamins. There are also vitamin D supplements, both in pills and a liquid for babies. If you have vitamin D deficiency, the treatment is with supplements. Check with your health care provider about how much you need to take, how often you need to take it, and how long you need to take it. Can too much vitamin D be harmful? Getting too much vitamin D (known as vitamin D toxicity) can be harmful. Signs of toxicity include nausea, vomiting, poor appetite, constipation, weakness, and weight loss. Excess vitamin D can also damage the kidneys. Too much vitamin D also raises the level of calcium in your blood. High levels of blood calcium (hypercalcemia) can cause confusion, disorientation, and problems with heart rhythm. Most cases of vitamin D toxicity happen when someone overuses vitamin D supplements. Excessive sun exposure doesn't cause vitamin D poisoning because the body limits the amount of this vitamin it produces.",
+    "#"
+  ],
+  [
+    "How effective is Vitamin K?: Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate. The effectiveness ratings for VITAMIN K are as follows: Effective for... - Preventing bleeding problems in newborns with low levels of vitamin K (hemorrhagic disease). Giving vitamin K1 by mouth or as an injection into the muscles can prevent bleeding problems in newborns. - Treating and preventing bleeding problems in people with low levels of the blood clotting protein prothrombin. Taking vitamin K1 by mouth or as an injection into the vein can prevent and treat bleeding problems in people with low levels of prothrombin due to using certain medications. - An inherited bleeding disorder called vitamin K-dependent clotting factors deficiency (VKCFD). Taking vitamin K by mouth or injecting it intravenously (by IV) helps prevent bleeding in individuals with VKCFD. - Reversing the effects of too much warfarin used to prevent blood clotting. Taking vitamin K1 by mouth or as in injection into the vein can counteract too much anticoagulation caused by warfarin. However, injecting vitamin K1 under the skin does not seem to be effective. Taking vitamin K along with warfarin also seems to help stabilize blood clotting time in people taking warfarin, especially those who have low vitamin K levels. Possibly ineffective for... - Bleeding within the fluid-filled areas (ventricles) of the brain (intraventricular hemorrhage). Giving vitamin K to women at risk for very preterm births might reduce the severity of intraventricular hemorrhage in preterm infants. However, it does not seem to prevent intraventricular hemorrhage nor the brain injuries associated with intraventricular hemorrhage. Insufficient evidence to rate effectiveness for... - Breast cancer. Population research suggests that higher dietary intake of vitamin K2 is linked with a lower risk of developing breast cancer. - Cancer. Population research suggests that higher dietary intake of vitamin K2 is linked with a lower risk of cancer-related death. However, it does not seem to be linked with a lower risk of developing cancer. Higher dietary intake of vitamin K1 does not seem to be linked with a lower risk of cancer or cancer-related death. - Heart disease. Research suggests that higher dietary intake of vitamin K2 is associated with a lower risk of coronary calcification, which occurs when the inner lining of the coronary arteries develops a layer of plaque, as well as a lower risk of death caused by coronary heart disease. Dietary vitamin K2 can be obtained from cheese, other milk products, and meat. Dietary intake of vitamin K1 does not seem to have an effect on heart disease risk. However supplementation with vitamin K1 seems to prevent or reduce the advancement of coronary calcification. - Cystic fibrosis. People with cystic fibrosis can have low levels of vitamin K due to problems digesting fat. Taking a combination of vitamins A, D, E, and K seems to improve vitamin K levels in people with cystic fibrosis who have trouble digesting fat. Also, early research suggests that taking vitamin K by mouth for can enhance the production of osteocalcin, which plays a role in the bodys bone-building and metabolic regulation. However, there is no reliable evidence suggesting it improves overall health in people with cystic fibrosis. - Diabetes. Early research suggests that taking a multivitamin fortified with vitamin K1 does not lower the risk of developing diabetes compared to taking a regular multivitamin. - High cholesterol. There is early evidence that vitamin K2 might lower cholesterol in people on dialysis with high cholesterol levels. - Liver cancer. Taking vitamin K2 does not seem to prevent liver cancer from recurring after curative or possibly curative treatment. However, some early research suggests that vitamin K2 might prevent the development of liver cancer in people with liver cirrhosis. - Lung cancer. Early research suggests that higher dietary intake of vitamin K2 is linked with a reduced risk of lung cancer and lung cancer-related death. Dietary intake of vitamin K1 does not seem to be linked with a reduced risk of these events. - Weak bones (osteoporosis). So far, research results on the effects of vitamin K on bone strength and fracture risk in people with osteoporosis dont agree. - Prostate cancer. Early research suggests that higher dietary intake of vitamin K2, but not vitamin K1, is linked with a reduced risk of prostate cancer. - Stroke. Population research suggests that dietary intake of vitamin K1 is not linked with a reduced risk of stroke. - Spider veins. - Bruises. - Scars. - Stretch marks. - Burns. - Swelling. - Other conditions. More evidence is needed to rate vitamin K for these uses.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/natural/983.html"
+  ],
+  [
+    "Vitamin D (Side Effects): Too much vitamin D can make the intestines absorb too much calcium. This may cause high levels of calcium in the blood. High blood calcium can lead to: - Calcium deposits in soft tissues such as the heart and lungs - Confusion and disorientation - Damage to the kidneys - Kidney stones - Nausea, vomiting, constipation, poor appetite, weakness, and weight loss",
+    "https://medlineplus.gov/ency/article/002405.htm"
+  ],
+  [
+    "Vitamin C and colds (Summary): Popular belief is that vitamin C can cure the common cold. However, research about this claim is conflicting. Although not fully proven, large doses of vitamin C may help reduce how long a cold lasts. They do not protect against getting a cold. Vitamin C may also be helpful for those exposed to brief periods of severe or extreme physical activity. The likelihood of success may vary from person to person. Some people improve, while others do not. Taking 1000 to 2000 mg per day can be safely tried by most people. Taking too much can cause stomach upset. People with kidney disease should NOT take vitamin C supplements. Large doses of vitamin C supplementation are not recommended during pregnancy. A balanced diet almost always provides the required vitamin and minerals for the day.",
+    "https://medlineplus.gov/ency/article/002145.htm"
+  ],
+  [
+    "Shingles (Prevention): Do not touch the rash and blisters on people with shingles or chickenpox if you have never had chickenpox or the chickenpox vaccine. A shingles vaccine is available. It is different than the chickenpox vaccine. Older adults who receive the herpes zoster vaccine are less likely to have complications from shingles.",
+    "https://medlineplus.gov/ency/article/000858.htm"
+  ],
+  [
+    "How to prevent Shingles?: A Vaccine for Adults 60 and Older In May 2006, the U.S. Food and Drug Administration approved a vaccine (Zostavax) to prevent shingles in people age 60 and older. The vaccine is designed to boost the immune system and protect older adults from getting shingles later on. Even if you have had shingles, you can still get the shingles vaccine to help prevent future occurrences of the disease. There is no maximum age for getting the vaccine, and only a single dose is recommended. In a clinical trial involving thousands of adults 60 years old or older, the vaccine reduced the risk of shingles by about half. A One-time Dose To reduce the risk of shingles, adults 60 years old or older should talk to their healthcare professional about getting a one-time dose of the shingles vaccine. Even if the shingles vaccine doesnt prevent you from getting shingles, it can still reduce the chance of having long-term pain. If you have had shingles before, you can still get the shingles vaccine to help prevent future occurrences of the disease. There is no maximum age for getting the vaccine. Side Effects Vaccine side effects are usually mild and temporary. In most cases, shingles vaccine causes no serious side effects. Some people experience mild reactions that last up to a few days, such as headache or redness, soreness, swelling, or itching where the shot was given. When To Get the Vaccine The decision on when to get vaccinated should be made with your health care provider. The shingles vaccine is not recommended if you have active shingles or pain that continues after the rash is gone. Although there is no specific time that you must wait after having shingles before receiving the shingles vaccine, you should generally make sure that the shingles rash has disappeared before getting vaccinated. Where To Get the Vaccine The shingles vaccine is available in doctors offices, pharmacies, workplaces, community health clinics, and health departments. Most private health insurance plans cover recommended vaccines. Check with your insurance provider for details and for a list of vaccine providers. Medicare Part D plans cover shingles vaccine, but there may be costs to you depending on your specific plan. If you do not have health insurance, visit www.healthcare.gov to learn more about health insurance options. Who Should Not Get the Vaccine? You should NOT get the shingles vaccine if you - have an active case of shingles or have pain that continues after the rash is gone - have ever had a life-threatening or severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of the shingles vaccine. Tell your doctor if you have any severe allergies. - have a weakened immune system because of: -- HIV/AIDS or another disease that affects the immune system -- treatment with drugs that affect the immune system, such as steroids -- cancer treatment such as radiation or chemotherapy -- cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma. have an active case of shingles or have pain that continues after the rash is gone have ever had a life-threatening or severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of the shingles vaccine. Tell your doctor if you have any severe allergies. have a weakened immune system because of: -- HIV/AIDS or another disease that affects the immune system -- treatment with drugs that affect the immune system, such as steroids -- cancer treatment such as radiation or chemotherapy -- cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma. - are pregnant or might be pregnant. are pregnant or might be pregnant. To learn more about the vaccine, see Zostavax: Questions and Answers. Could Vaccines Make Shingles a Rare Disease? The shingles vaccine is basically a stronger version of the chickenpox vaccine, which became available in 1995. The chickenpox shot prevents chickenpox in 70 to 90 percent of those vaccinated, and 95 percent of the rest have only mild symptoms. Millions of children and adults have already received the chickenpox shot. Interestingly, the chickenpox vaccine may reduce the shingles problem. Widespread use of the chickenpox vaccine means that fewer people will get chickenpox in the future. And if people do not get chickenpox, they cannot get shingles. Use of the shingles and chickenpox vaccines may one day make shingles a rare disease. To find out more, visit Shingles Vaccination: What You Need to Know or Shingles Vaccine)",
+    "http://nihseniorhealth.gov/shingles/toc.html"
+  ],
+  [
+    "Shingles (Outlook (Prognosis)): Herpes zoster usually clears in 2 to 3 weeks and rarely returns. If the virus affects the nerves that control movement (the motor nerves), you may have temporary or permanent weakness or paralysis. Sometimes the pain in the area where the shingles occurred may last from months to years. This pain is called postherpetic neuralgia. It occurs when the nerves have been damaged after an outbreak of shingles. Pain ranges from mild to very severe. Postherpetic neuralgia is more likely to occur in people over age 60.",
+    "https://medlineplus.gov/ency/article/000858.htm"
+  ],
+  [
+    "Shingles: Shingles (herpes zoster) is a painful, blistering skin rash. It is caused by the varicella-zoster virus. This is\u00a0the virus that also causes chickenpox. After you get chickenpox, the virus remains inactive (becomes dormant) in certain nerves in the body. Shingles occurs after the virus becomes active again in these nerves after many years. Many people had such a mild case of chickenpox that they\u00a0do not\u00a0realize they have had the infection. The reason the virus suddenly becomes active again is not clear. Often only one attack occurs. Shingles can develop in any age group. You are more likely to develop the condition if: - You are older than age 60 - You had chickenpox before age 1 - Your immune system is weakened by medicines or disease If an adult or child has direct contact with the shingles rash and did not have chickenpox as a child or get\u00a0the chickenpox vaccine, they can develop chickenpox, not shingles. The first symptom is usually pain, tingling, or burning that occurs on one side of the body. The pain and burning may be severe and\u00a0are usually present before any rash appears. Red patches on the skin, followed by small blisters, form in most people: - The blisters break, forming small\u00a0sores that begin to dry and form crusts. The crusts fall off in 2 to 3 weeks. Scarring is rare. - The rash usually involves a narrow area from the spine around to the front of the abdomen or chest. - The rash may involve the\u00a0face, eyes, mouth, and ears. Other symptoms may include: - Fever and chills - General ill feeling - Headache - Joint pain - Swollen glands (lymph nodes) You may also have pain, muscle weakness, and a rash involving different parts of your face if shingles affects a nerve in your face. The symptoms may include: - Difficulty moving some of the muscles in the face - Drooping eyelid (ptosis) - Hearing loss - Loss of eye motion - Taste problems - Vision problems Your health care provider can make the diagnosis by looking at your skin and asking about your medical history. Tests are rarely needed, but may include taking a skin sample to see if the skin is infected with the virus. Blood tests may show an increase in white blood cells and antibodies to the chickenpox virus. But the tests\u00a0cannot confirm that the rash is due to shingles. Your provider may prescribe a medicine that fights the virus, called an antiviral drug. This drug helps reduce pain, prevent complications, and shorten the course of the disease. The medicines are most effective when started within 72 hours of when you first feel pain or burning. It is best to start taking them before the blisters appear. The medicines are usually given in pill form. Some people may need to receive the medicine through a vein (by IV). Strong anti-inflammatory medicines called corticosteroids, such as prednisone, may be used to reduce swelling and pain. These medicines\u00a0do not\u00a0work in all people. Other medicines may include: - Antihistamines to reduce itching (taken by mouth or applied to the skin) - Pain medicines - Zostrix, a cream containing capsaicin (an extract of pepper) to reduce pain Follow your provider's instructions about how to care for yourself at home. Other measures may include: - Caring for your skin by applying cool, wet compresses to reduce pain, and taking soothing baths - Resting in bed until the fever goes down Stay away from people while your sores are oozing to avoid infecting those who have never had chickenpox -- especially pregnant women. Herpes zoster usually clears in 2 to 3 weeks and rarely returns. If the virus affects the nerves that control movement (the motor nerves), you may have temporary or permanent weakness or paralysis. Sometimes the pain in the area where the shingles occurred may last from months to years. This pain is called postherpetic neuralgia. It occurs when the nerves have been damaged after an outbreak of shingles. Pain ranges from mild to very severe. Postherpetic neuralgia is more likely to occur in people over age 60. Complications may include: - Another attack of shingles - Bacterial skin infections - Blindness (if shingles occurs in the eye) - Deafness - Infection, including encephalitis of sepsis (blood infection) in people with a weakened immune system - Ramsay Hunt syndrome if shingles affects the nerves of the face or ear Call your provider if you have symptoms of shingles, particularly if you have a weakened immune system or if your symptoms persist or worsen. Shingles that affects the eye may lead to permanent blindness if you\u00a0do not receive emergency medical care. Do not touch the rash and blisters on people with shingles or chickenpox if you have never had chickenpox or the chickenpox vaccine. A shingles vaccine is available. It is different than the chickenpox vaccine. Older adults who receive the herpes zoster vaccine are less likely to have complications from shingles.\u00a0 Updated by: Arnold Lentnek, MD, Infectious Diseases Medical Practice of NY and Clinical Research Centers of CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000858.htm"
+  ],
+  [
+    "Shingles (Prognosis): For most healthy people who receive treatment soon after the outbreak of blisters, the lesions heal, the pain subsides within 3 to 5 weeks, and the blisters often leave no scars.\u00a0 However, shingles is a serious threat in immunosuppressed individuals \u2014 for example, those with HIV infection or who are receiving cancer treatments that can weaken their immune systems.\u00a0 People who receive organ transplants are also vulnerable to shingles because they are given drugs that suppress the immune system. \u00a0 A person with a shingles rash can pass the virus to someone, usually a child, who has never had chickenpox, but the child will develop chickenpox, not shingles. \u00a0A person with chickenpox cannot give shingles to someone else. \u00a0Shingles comes from the virus hiding inside the person's body, not from an outside source.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Herpes-Zoster-Information-Page"
+  ],
+  [
+    "Shingles: Shingles (herpes zoster) is an outbreak of rash or blisters on the skin that is caused by the same virus that causes chickenpox \u2014 the varicella-zoster virus. The first sign of shingles is often burning or tingling pain (which can be severe), or sometimes numbness or itch,generally on one side of the body. After several days or a week, a rash of fluid-filled blisters, similar to chickenpox, appears in one area on one side of the body. Shingles pain can be mild or intense. \u00a0Some people have mostly itching; some feel pain from the gentlest touch or breeze. \u00a0The most common location for shingles is a band, called a dermatome, spanning one side of the trunk around the waistline. Anyone who has had chickenpox is at risk for shingles.\u00a0 Scientists think that some of the virus particles from the original exposure to the varicella-zoster virus,leave the skin blisters and move into the nervous system.\u00a0 When the varicella-zoster virus reactivates, the virus moves back down the long nerve fibers that extend from the sensory cell bodies to the skin. \u00a0The viruses multiply, the tell-tale rash erupts, and the person now has shingles. The severity and duration of an attack of shingles can be significantly reduced by immediate treatment with antiviral drugs, which include acyclovir, valcyclovir, or famcyclovir. Antiviral drugs may also help stave off the painful after-effects of shingles known as\u00a0postherpetic neuralgia. Other treatments for postherpetic neuralgia include steroids, antidepressants, anticonvulsants (including pregabalin and gabapentin enacarbil), and topical agents. \u00a0The varicella zoster virus vaccine (Zostavax) has been approved by the food and Drug Administration for adults age 50 and older. \u00a0Researchers found that giving older adults the vaccine reduced the expected number of later cases of shingles by half. \u00a0And in people who still got the disease despite immunization, the severity and complications of shingles were dramatically reduced. The shingles vaccine is a preventive therapy and not a treatment for those who already have shingles or long-lasting nerve pain (postherpetic neuralgia). For most healthy people who receive treatment soon after the outbreak of blisters, the lesions heal, the pain subsides within 3 to 5 weeks, and the blisters often leave no scars.\u00a0 However, shingles is a serious threat in immunosuppressed individuals \u2014 for example, those with HIV infection or who are receiving cancer treatments that can weaken their immune systems.\u00a0 People who receive organ transplants are also vulnerable to shingles because they are given drugs that suppress the immune system. \u00a0 A person with a shingles rash can pass the virus to someone, usually a child, who has never had chickenpox, but the child will develop chickenpox, not shingles. \u00a0A person with chickenpox cannot give shingles to someone else. \u00a0Shingles comes from the virus hiding inside the person's body, not from an outside source.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Herpes-Zoster-Information-Page"
+  ],
+  [
+    "Leg pain: Leg pain is a common problem. It can be due to a cramp, injury, or other cause. Leg pain can be due to a muscle cramp (also called a charley horse). Common causes of cramps include: - Dehydration or low amounts of potassium, sodium, calcium, or magnesium in the blood - Medicines (such as diuretics and statins) - Muscle fatigue or strain from overuse, too much exercise, or holding a muscle in the same position for a long time An injury can also cause leg pain from: - A torn or overstretched muscle (strain) - Hairline crack in the bone (stress fracture) - Inflamed tendon (tendinitis) - Shin splints (pain in the front of the leg from overuse) Other common causes of leg pain include: - Atherosclerosis that blocks blood flow in the arteries (this type of pain, called claudication, is generally felt when exercising or walking and is relieved by rest) - Blood clot (deep vein thrombosis) from long-term bed rest - Infection of the bone (osteomyelitis) or skin and soft tissue (cellulitis) - Inflammation of the leg joints caused by arthritis or gout - Nerve damage\u00a0common\u00a0to people with diabetes, smokers, and alcoholics - Varicose veins Less common causes include: - Cancerous bone tumors (osteosarcoma, Ewing sarcoma) - Legg-Calve-Perthes disease:\u00a0Poor blood flow to the hip that may stop or slow the normal growth of the leg - Noncancerous (benign) tumors or cysts of the femur or tibia (osteoid osteoma) - Sciatic nerve pain (radiating pain down the leg) caused by a slipped disk in the back - Slipped capital femoral epiphysis: Most often seen in boys and overweight children between ages 11 and 15 If you have leg pain from cramps or overuse, take these steps first: - Rest as much as possible. - Elevate your leg. - Apply ice for up to 15 minutes. Do this 4 times per day, more often for the first few days. - Gently stretch and massage cramping muscles. - Take over-the-counter pain medicines like acetaminophen or ibuprofen. Other homecare will depend on the cause of your leg pain. Call your health care provider if: - The painful leg is swollen or red. - You have a fever. - Your pain gets worse when you walk or exercise and improves with rest. - The leg is black and blue. - The leg is cold and pale. - You are taking medicines that may be causing leg pain. DO NOT stop taking or change any of your medicines without talking to your provider. - Self-care steps do not help. Your provider will perform a physical exam and look at your legs, feet, thighs, hips, back, knees, and ankles. Your provider may ask questions such as: - Where on the leg is the pain? Is the pain in one or both legs? - Is the pain dull and aching or sharp and stabbing? Is the pain severe? Is the pain worse at any time of day? - What makes the pain feel worse? Does anything make your pain feel better? - Do you have any other symptoms such as numbness, tingling, back pain, or fever? Your provider may recommend physical therapy for some causes of leg pain. Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003182.htm"
+  ],
+  [
+    "What to do for Finger pain?: Often, care at home is enough to relieve finger pain. Start by avoiding activities that cause finger pain. If finger pain is due to a minor injury: - Remove any rings in case of swelling. - Rest the finger joints so they can heal. - Apply ice and elevate the finger. - Use over-the-counter pain relievers such as ibuprofen (Motrin) or naprosyn (Aleve) to reduce both pain and swelling. - If needed, buddy tape the injured finger to the one next to it. This will help protect the injured finger as it heals. Don't tape it too tight, which can cut off circulation. - If you have a lot of swelling or the swelling does not go away in a day or so, see your health care provider. Small fractures or tendon or ligament tears can occur, and can lead to problems in the future if not treated correctly. If finger pain is due to a medical condition, follow your provider's instructions for self care. For example, if you have Raynaud's, take steps to protect your hands from the cold.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/003248.htm"
+  ],
+  [
+    "Leg pain (What to Expect at Your Office Visit): Your provider will perform a physical exam and look at your legs, feet, thighs, hips, back, knees, and ankles. Your provider may ask questions such as: - Where on the leg is the pain? Is the pain in one or both legs? - Is the pain dull and aching or sharp and stabbing? Is the pain severe? Is the pain worse at any time of day? - What makes the pain feel worse? Does anything make your pain feel better? - Do you have any other symptoms such as numbness, tingling, back pain, or fever? Your provider may recommend physical therapy for some causes of leg pain.",
+    "https://medlineplus.gov/ency/article/003182.htm"
+  ],
+  [
+    "Leg pain (Summary): Leg pain is a common problem. It can be due to a cramp, injury, or other cause.",
+    "https://medlineplus.gov/ency/article/003182.htm"
+  ],
+  [
+    "Leg pain (Review Date 8/14/2015): Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003182.htm"
+  ],
+  [
+    "Peripheral artery disease - legs (Treatment): Things you can do to control PAD include: - Balance exercise with rest. Walk or do another activity to the point of pain and alternate it with rest periods. Over time, your circulation may improve as new, small blood vessels form. Always talk to the provider before starting an exercise program. - Stop smoking. Smoking narrows the arteries, decreases the blood's ability to carry oxygen, and increases the risk of forming clots (thrombi and emboli). - Take care of your feet, especially if you also have diabetes. Wear shoes that fit properly. Pay attention to any cuts, scrapes, or injuries, and see your provider right away. Tissues heal slowly and are more likely to get infected when there is decreased circulation. - Make sure your blood pressure is well-controlled. - If you are overweight, reduce your weight. - If your cholesterol is high, eat a low-cholesterol and low-fat diet. - Monitor your blood sugar level if you have diabetes, and keep it under control. Medicines may be needed to control the disorder, including: - Aspirin or a medicine called clopidogrel (Plavix), which keeps your blood from forming clots in your arteries. DO NOT stop taking these medicines without first talking with your provider. - Cilostazol, a drug that works to enlarge (dilate) the affected artery or arteries for moderate-to-severe cases that are not candidates for surgery. - Medicine to help lower your cholesterol. - Pain relievers. If you are taking medicines for high blood pressure or diabetes, take them as your provider has prescribed. Surgery may be performed if the condition is severe and is affecting your ability to work or do important activities, you are having pain at rest, or you have sores or ulcers on your leg that do not heal. Options are: - Procedure to open narrowed or blocked blood vessels that supply blood to your legs - Surgery to reroute the blood supply around a blocked artery Some people with PAD may need to have the limb removed (amputated).",
+    "https://medlineplus.gov/ency/article/000170.htm"
+  ],
+  [
+    "Shin splints - self-care: Shin splints occurs when you have pain in the front of your lower leg. The pain of shin splints is from the inflammation of the muscles, tendons, and bone tissue around your shin. Shin splints are a common problem for runners, gymnasts, dancers, and military recruits. However, there are things you can do to heal from shin splints and prevent them from getting worse. Shin splints are an exercise problem. You get shin splints from overloading your leg muscles, tendons or shin bone. Shin splints happen from overuse with too much activity or an increase in training. Most often, the activity is high impact and repetitive exercise of your lower legs. This is why runners, dancers, and gymnasts often get shin splints. Common activities that cause shin splints are: - Running, especially on hills. If you are a new runner, you are at greater risk for shin splints. - Increasing your days of training. - Increasing the intensity of training, or going a longer distance. - Doing exercise that has frequent stops and starts, such as dancing, basketball, or military training. You are more at risk for shin splints if you: - Have flat feet or a very rigid foot arches. - Work out on hard surfaces, such as running on the street or playing basketball or tennis on a hard court. - Do not wear the proper shoes. - Wear worn out shoes. Running shoes lose over half of their shock absorbing ability after 250 miles (400 kilometers) of use. Symptoms include: - Pain in one or both legs - Sharp or dull, aching pain in the front of your shin - Pain when you push on your shins - Pain that gets worse during and after exercise - Pain that gets better with rest If you have severe shin splints, your legs may hurt even when you are not walking. Expect that you need at least 2 to 4 weeks of rest from your sport or exercise. - Avoid repetitive exercise of your lower leg for 1 to 2 weeks. Keep your activity to just the walking that you do during your regular day. - Try other low impact activities as long as you do not have pain, such as swimming or biking. After 2 to 4 weeks, if the pain is gone, you can start your usual activities. Increase your activity level slowly. If the pain returns, stop exercising right away. Know that shin splints can take 3 to 6 months to heal. DO NOT rush back into your sport or exercise. You could injure yourself again. Things you can do to ease discomfort include: - Ice your shins. Ice several times a day for 3 days or until pain is gone. - Do stretching exercises. - Take ibuprofen, naproxen, or aspirin to decrease swelling and to help with pain. Know these medicines have side effects and can cause ulcers and bleeding. Talk to your doctor about how much you can take. - Use arch supports. Talk with your doctor and physical therapist about wearing the proper shoes, and about special shock-absorbing insoles or orthotics to wear inside your shoes. - Work with a physical therapist. They can use therapies that may help with the pain. They can teach you exercises to strengthen your leg muscles. To prevent shin splints from recurring: - Be pain-free for at least 2 weeks before returning to your exercise routine. - DO NOT overdo your exercise routine. DO NOT return to your previous level of intensity. Go slower, for a shorter time. Increase your training slowly. - Warm up and stretch before and after exercise. - Ice your shins after exercise to decrease swelling. - Avoid hard surfaces. - Wear proper shoes with good support and padding. - Consider changing the surface that you do training. - Cross train and add in low impact exercise, such as swimming or biking. Shin splints are most often not serious. Call your health care provider if: - You have pain even with rest, icing, and pain relievers after several weeks. - You are not sure whether your pain is caused by shin splints. - Swelling in your lower legs is getting worse. - Your shin is red and feels hot to the touch. Your provider may take an x-ray or perform other tests to make sure you do not have a stress fracture. You will also be checked to make sure you do not have another shin problem, such as tendonitis or compartment syndrome. Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000654.htm"
+  ],
+  [
+    "Thyroid nodule (Causes): Thyroid nodules are growths of cells in the thyroid gland. These growths can be: - Not cancer (benign) or thyroid cancer (malignant) - Fluid-filled (cysts) - One nodule or a group of small nodules - Producing thyroid hormones (hot nodule) or not making thyroid hormones (cold nodule) Thyroid nodules are more common in women than in men. A person's chance of getting a thyroid nodule increases with age. Only a few thyroid nodules are due to thyroid cancer. A thyroid nodule is more likely to be cancer if you: - Have a hard nodule - Have a nodule that is stuck to nearby structures - Have a family history of thyroid cancer - Have noticed a change in your voice - Are younger than 20 or older than 70 - Have a history of radiation exposure to the head or neck - Are male Causes of thyroid nodules are not always found, but can include: - Hashimoto's disease - Lack of iodine in the diet",
+    "https://medlineplus.gov/ency/article/007265.htm"
+  ],
+  [
+    "What are the treatments for Thyroid cancer?: Treatment depends on the type of thyroid cancer. Surgery is most often done. The entire thyroid gland is usually removed. If the doctor suspects that the cancer has spread to lymph nodes in the neck, these will also be removed. Radiation therapy may be done with or without surgery. It may be performed by: - Aiming external beam (x-ray) radiation at the thyroid - Taking radioactive iodine by mouth After treatment for thyroid cancer, you must take thyroid hormone pills for the rest of your life. The dosage is usually slightly higher than what your body needs. This helps keep the cancer from coming back. The pills also replace the thyroid hormone your body needs to function normally. If the cancer does not respond to surgery or radiation, and has spread to other parts of the body, chemotherapy may be used. This is only effective for a small number of patients.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/001213.htm"
+  ],
+  [
+    "Thyroid nodule (Outlook (Prognosis)): Noncancerous thyroid nodules are not life-threatening. Many do not require treatment. Follow-up exams are enough. The outlook for thyroid cancer depends on the type of cancer. For most common kinds of thyroid cancer, the outlook is very good after treatment.",
+    "https://medlineplus.gov/ency/article/007265.htm"
+  ],
+  [
+    "Thyroid nodule (Symptoms): Most thyroid nodules do not cause symptoms. Large nodules can press against other structures in the neck. This can cause symptoms such as: - A visible goiter (enlarged thyroid gland) - Hoarseness or changing voice - Pain in the neck - Problems breathing, especially when lying down flat - Problems swallowing food Nodules that produce thyroid hormones will likely cause symptoms of overactive thyroid gland, including: - Warm, sweaty skin - Fast pulse - Increased appetite - Nervousness - Restlessness - Skin blushing or flushing - Weight loss - Irregular menstrual periods Older people with a nodule that produces too much thyroid hormone may have only vague symptoms, including: - Fatigue - Palpitations - Chest pain - Memory loss Thyroid nodules are sometimes found in people who have Hashimoto's disease. This may cause symptoms of an underactive thyroid gland, such as: - Dry skin - Face swelling - Fatigue - Hair loss - Feeling cold when other people do not - Weight gain - Irregular menstrual periods Very often, nodules produce no symptoms. Health care providers find thyroid nodules only during a routine physical exam or imaging tests that are done for another reason. A few people have thyroid nodules that are big enough that they notice the nodule on their own, and ask a provider to examine their neck.",
+    "https://medlineplus.gov/ency/article/007265.htm"
+  ],
+  [
+    "Thyroid nodule (Summary): A thyroid nodule is a growth (lump) in the thyroid gland. The thyroid gland is located at the front of the neck, just above where your collarbones meet in the middle.",
+    "https://medlineplus.gov/ency/article/007265.htm"
+  ],
+  [
+    "Thyroid nodule (Exams and Tests): If a provider finds a nodule or you have symptoms of a nodule, the following tests may be done: - TSH level and other thyroid blood tests - Thyroid ultrasound - Thyroid scan (nuclear medicine) - Fine needle aspiration biopsy of the nodule or of multiple nodules",
+    "https://medlineplus.gov/ency/article/007265.htm"
+  ],
+  [
+    "Thyroid nodule (When to Contact a Medical Professional): Call your health care provider if you feel or see a lump in your neck, or if you have any symptoms of a thyroid nodule. If you have been exposed to radiation in the face or neck area, call your provider. A neck ultrasound can be done to look for thyroid nodules.",
+    "https://medlineplus.gov/ency/article/007265.htm"
+  ],
+  [
+    "Thyroid nodules (Diagnosis): In assessing a lump or nodule in your neck, one of your doctor's main goals is to rule out the possibility of cancer. But your doctor will also want to know if your thyroid is functioning properly. Tests include: - Physical exam. You'll likely be asked to swallow while your doctor examines your thyroid because a nodule in your thyroid gland will usually move up and down during swallowing. Your doctor will also look for signs and symptoms of hyperthyroidism, such as tremor, overly active reflexes, and a rapid or irregular heartbeat; and signs and symptoms of hypothyroidism, such as a slow heartbeat, dry skin and facial swelling. - Thyroid function tests. Tests that measure blood levels of thyroxine and triiodothyronine, hormones produced by your thyroid gland, and thyroid-stimulating hormone (TSH), which is released by your pituitary gland, can indicate whether your thyroid is producing too much thyroxine (hyperthyroidism) or too little (hypothyroidism). - Ultrasonography. This imaging technique uses high-frequency sound waves rather than radiation to produce images. It provides the best information about the shape and structure of nodules. It may be used to distinguish cysts from solid nodules or to determine if multiple nodules are present. It may also be used as a guide in performing a fine-needle aspiration biopsy. - Fine-needle aspiration (FNA) biopsy. Nodules are often biopsied to make sure no cancer is present. FNA biopsy helps to distinguish between benign and malignant thyroid nodules. During the procedure, your doctor inserts a very thin needle in the nodule and removes a sample of cells. The procedure, which is carried out in your doctor's office, takes about 20 minutes and has few risks. Often, your doctor will use ultrasound to help guide the placement of the needle. The samples are then sent to a laboratory and analyzed under a microscope. - Thyroid scan. In some cases, your doctor may recommend a thyroid scan to help evaluate thyroid nodules. During this test, an isotope of radioactive iodine is injected into a vein in your arm. You then lie on a table while a special camera produces an image of your thyroid on a computer screen. Nodules that produce excess thyroid hormone - called hot nodules - show up on the scan because they take up more of the isotope than normal thyroid tissue does. Cold nodules are nonfunctioning and appear as defects or holes in the scan. Hot nodules are almost always noncancerous, but a few cold nodules are cancerous. The disadvantage of a thyroid scan is that it can't distinguish between benign and malignant cold nodules. The length of a thyroid scan varies, depending on how long it takes the isotope to reach your thyroid gland. You may have some neck discomfort because your neck is stretched back during the scan, and you'll be exposed to a small amount of radiation.",
+    "https://www.mayoclinic.org/diseases-conditions/thyroid-nodules/symptoms-causes/syc-20355262"
+  ],
+  [
+    "Diabetes (What is diabetes?): Diabetes is a disease caused by high levels of blood sugar (glucose) in your body. This can happen when your body does not make insulin or does not use insulin correctly. Insulin is a hormone made in the pancreas, an organ near your stomach. Insulin helps the glucose from food get into your body's cells for energy. If your body does not make enough insulin, or your body does not use the insulin correctly, the glucose stays and builds up in your blood. Over time, this extra glucose can lead to prediabetes or diabetes. Diabetes puts you at risk for other serious and life-threatening health problems, such as heart disease, stroke, blindness, and kidney damage.",
+    "https://www.womenshealth.gov/a-z-topics/diabetes"
+  ],
+  [
+    "What is Diagnosis of Diabetes and Prediabetes?: 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. Insulin is made in the pancreas, an organ located behind the stomach. As the blood glucose level rises after a meal, the pancreas is triggered to release insulin. Within the pancreas, clusters of cells called islets contain beta cells, which make the insulin and release it into the blood. Diabetes develops when the body doesnt make enough insulin or is not able to use insulin effectively, or both. As a result, glucose builds up in the blood instead of being absorbed by cells in the body. The bodys cells are then 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. Main Types of Diabetes The three main types of diabetes are type 1, type 2, and gestational diabetes: - Type 1 diabetes, formerly called juvenile diabetes, is usually first diagnosed in children, teenagers, and young adults. In this type of diabetes, the beta cells of the pancreas no longer make insulin because the bodys immune system has attacked and destroyed them. - Type 2 diabetes, formerly called adult-onset diabetes, is the most common type of diabetes. About 90 to 95 percent of people with diabetes have type 2.1 People can develop type 2 diabetes at any age, even during childhood, but this type of diabetes is most often associated with older age. Type 2 diabetes is also associated with excess weight, physical inactivity, family history of diabetes, previous history of gestational diabetes, and certain ethnicities. Type 2 diabetes usually begins with insulin resistance, a condition linked to excess weight in which muscle, liver, and fat cells do not use insulin properly. As a result, the body needs more insulin to help glucose enter cells to be used for energy. At first, the pancreas keeps up with the added demand by producing more insulin. But in time, the pancreas loses its ability to produce enough insulin in response to meals, and blood glucose levels rise. - Gestational diabetes is a type of diabetes that develops only during pregnancy. The hormones produced during pregnancy increase the amount of insulin needed to control blood glucose levels. If the body cant meet this increased need for insulin, women can develop gestational diabetes during the late stages of pregnancy. Gestational diabetes usually goes away after the baby is born. Shortly after pregnancy, 5 to 10 percent of women with gestational diabetes continue to have high blood glucose levels and are diagnosed as having diabetes, usually type 2.1 Research has shown that lifestyle changes and the diabetes medication, metformin, can reduce or delay the risk of type 2 diabetes in these women. Babies born to mothers who had gestational diabetes are also more likely to develop obesity and type 2 diabetes as they grow up. More information about gestational diabetes is provided in the NIDDK health topic, What I need to know about Gestational Diabetes,or by calling 18008608747. Other Types of Diabetes Many other types of diabetes exist, and a person can exhibit characteristics of more than one type. For example, in latent autoimmune diabetes in adults, people show signs of both type 1 and type 2 diabetes. Other types of diabetes include those caused by genetic defects, diseases of the pancreas, excess amounts of certain hormones resulting from some medical conditions, medications that reduce insulin action, chemicals that destroy beta cells, infections, rare autoimmune disorders, and genetic syndromes associated with diabetes. More information about other types of diabetes is provided in the NIDDK health topic, Causes of Diabetes, or by calling 18008608747.",
+    "http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diagnosis-diabetes-prediabetes/Pages/index.aspx"
+  ],
+  [
+    "Diabetes: Diabetes is a condition in which the body\u2019s levels of blood sugar and the hormone insulin are out of balance. It is one of the most common diseases in the United States, and its numbers are constantly rising. There are three main forms of diabetes: The NICHD is one of many federal agencies and NIH Institutes that supports research on diabetes. Although the Institute studies different aspects of all three types of diabetes, the NICHD is not the primary resource for patient information about type 1 or type 2 diabetes. The National Diabetes Information Clearinghouse at http://diabetes.niddk.nih.gov and the National Diabetes Education Program at http://ndep.nih.gov provide detailed patient information about type 1 and type 2 diabetes. The patient information provided in this topic focuses on gestational diabetes. In addition, the Research Information section of this topic describes the NICHD\u2019s research efforts related to all three types of diabetes\u2014type 1 diabetes (also known as juvenile diabetes), type 2 diabetes, and gestational diabetes. The Institute also studies factors that contribute to diabetes, such as obesity, and conditions that are associated with diabetes, such as polycystic ovary syndrome. What is diabetes? Diabetes is a disease of metabolism, which is the way your body uses food for energy and growth. In particular, it's related to one of the food nutrients that supply energy, called carbohydrates. Normally, your stomach and intestines digest the carbohydrates in your food into a sugar called glucose. Glucose is your body's main source of energy. After digestion, the glucose moves into your blood to give your body energy. To get the glucose out of your blood and into the cells of your body, your pancreas makes a hormone called insulin. If you have diabetes, either your body doesn't make enough insulin, or your cells can't use it the way they should. Instead, the glucose builds up in your blood, causing diabetes, otherwise known as high blood sugar. Diabetes is generally divided into three categories: - Type 1\u2014Also known as juvenile diabetes, type 1 diabetes is a condition in which the pancreas does not make enough insulin. - Type 2\u2014This develops when the body becomes resistant insulin, and as a result the pancreas can no longer make enough insulin to keep blood sugar levels in balance. It used to be known as adult-onset diabetes, because it was seen mainly in adults, especially older ones (age 40 and up). Today, many obese children are developing type 2 diabetes. - Gestational diabetes\u2014Also known as gestational diabetes mellitus, this is a type of diabetes that only occurs in pregnant women. If a pregnant woman develops diabetes, but she didn\u2019t have it before becoming pregnant, then she has gestational diabetes. What are common symptoms? \u00bb \u200b\u200b One of the key dangers of diabetes is that it often doesn\u2019t display any symptoms at all, making it hard to diagnose until it\u2019s severe. Common symptoms generally include: - Unusual thirst - Fatigue - Frequent urination - Extreme hunger - Irritability, mood changes Other symptoms that can occur: - Cuts that are difficult or slow to heal - Tingling/numbness in hands and/or feet - Blurred vision - Frequent infections For pregnant women, swelling in the hands and face and may also be symptoms of gestational diabetes. Although the NICHD studies different aspects of all types of diabetes, the NICHD is not the primary resource for patient information about type 1 or type 2 diabetes. The National Diabetes Information Clearinghouse at http://diabetes.niddk.nih.gov and the National Diabetes Education Program at http://ndep.nih.gov provide detailed patient information about type 1 and type 2 diabetes, including their symptoms. \u00ab Condition Information How many people are affected/at risk? \u00bb \u200b\u200b According to the Centers for Disease Control and Prevention, diabetes is now estimated to affect 25.8 million Americans, or 8.3% of the population. Seven million of these people are undiagnosed. More specifically, the number of people affected or at risk are: - Type 1: Approximately 215,000 people age 20 or younger have this form of diabetes and it\u2019s estimated that close to 16,000 more are diagnosed every year. About 1 million people in the United States have type 1 diabetes. - Type 2: - Type 2 diabetes is the most common form of diabetes in the United States, accounting for almost all of the 25.8 million total: 25.6 million American adults aged 20 and older have it. - It is more common in certain ethnic groups: specifically African Americans, Latinos, Native Americans, Alaskan natives, Asian Americans, and Native Hawaiians and other Pacific Islanders. At 18.7%, African Americans are the largest segment of ethnicities affected, or 77% higher than whites. - Older adults, especially ages 65 and up, are most often affected: 10.9 million\u2014almost 27%\u2014develop it.2 - Gestational: Although current estimates suggest that gestational diabetes develops in approximately 5% of all U.S. pregnancies, or about 200,000 cases a year, the definition of gestational diabetes is currently in flux. Research findings from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) suggest that the definition of gestational diabetes might need to change, which would in turn affect the number of pregnancies affected by the condition. Also, 79 million adults ages 20 and older are already in the stage known as prediabetes and are at risk for type 2 diabetes. \u00ab What are common symptoms? What causes it? \u00bb \u200b\u200b Diabetes is a disease of metabolism, which is the way the body uses food for energy and growth. In particular, it\u2019s related to one of the food nutrients that supply energy, called carbohydrates. Normally, the stomach and intestines digest the carbohydrates in food into a sugar called glucose. Glucose is the body\u2019s main source of energy. After digestion, the glucose moves into the blood to give the body energy. To get the glucose out of blood and into the body\u2019s cells, the pancreas makes a hormone called insulin. In diabetes, either the body doesn\u2019t make enough insulin, or the cells can\u2019t use it the way they should. Instead, the glucose builds up in the blood, causing diabetes, otherwise known as high blood sugar. The exact causes of diabetes are not fully understood and typically involve multiple factors, such as genetics and interactions with the environment. The majority of cases of type 1 diabetes are \"sporadic\" meaning there is no family history of the condition. Likewise, the rates of type 1 diabetes in both members of set of identical twins is lower than would be expected if the condition was caused by genetics alone. The environmental component is strong and could result from a combination of factors, such as exposure to viruses in the small intestine or to foreign proteins from foods at a time when the immune system of the digestive tract is too immature to process them. Researchers leading the Trial to Reduce the Incidence of Type 1 Diabetes Mellitus in the Genetically at Risk (TRIGR), which is supported in part by the NICHD, are examining whether exposure to foreign proteins from cow\u2019s milk or cow milk-based infant formula can cause type 1 diabetes, especially in children who are at high risk for the condition based on their family history and genetic profile. The Trial aims to determine whether a nutritional intervention\u2014feeding cow milk-based formulas that have been specially processed to remove the foreign proteins\u2014during infancy can delay or prevent the onset of \u200btype 1 diabetes in children at high risk for the condition. Obesity is a major factor in developing type 2 diabetes. More than 80% of Americans with type 2 diabetes are obese or overweight. Obesity lessens the body\u2019s ability to control blood sugar, so the body overproduces insulin to compensate\u2014and a cycle develops. Pregnancy causes many different changes to the body, including changes to metabolism that result in gestational diabetes. These changes are usually the result of hormones produced during pregnancy that keep insulin from doing its job. \u00ab How many people are affected/at risk? How is it diagnosed? \u00bb \u200b\u200b The most common test for diagnosing any kind of diabetes is a one-step approach called the oral glucose tolerance test. Prior to the test, you can\u2019t eat or drink anything (except water) for between 4 and 8 hours. A health provider tests your initial sugar level and then gives you a sugar drink. Then your sugar level is checked every 30 to 60 minutes for up to 3 hours. Although the NICHD studies different aspects of all types of diabetes, the NICHD is not the primary resource for patient information about type 1 or type 2 diabetes. The National Diabetes Information Clearinghouse and the National Diabetes Education Program provide detailed information about type 1 and type 2 diabetes, including specific information about diagnosis and glucose levels. Risk for type 1 diabetes Health care providers can use a test to check for certain blood markers that can predict how likely it is that someone will develop type 1 diabetes. These blood markers signal that the immune system is attacking the beta cells of the pancreas. Having two or more of these markers, called antibodies, is associated with higher risk of developing type 1 diabetes over the next 10 years. Testing for gestational diabetes Health care providers will consider a woman\u2019s risk factors and current health before testing for gestational diabetes. If a woman is at high risk for gestational diabetes, her health care provider will test her as soon as she knows she is pregnant. If a woman is at low risk for gestational diabetes, her health care provider might not test her at all, or will test her between 24 weeks and 28 weeks of pregnancy. For more information about testing for gestational diabetes, see the NICHD\u2019s Am I at risk for gestational diabetes? brochure. \u00ab What causes it? What are the treatments? \u00bb There are two main types of treatment for diabetes: - Lifestyle changes\u2014These include changing your diet to something healthier and improving your exercise/activity level. More information on lifestyle changes to control diabetes can be found at the National Diabetes Education Program. - Medication\u2014Oral medicines and sometimes injections with insulin may be used. For more information on medications to control diabetes, visit the National Diabetes Information Clearinghouse. The National Diabetes Information Clearinghouse and the National Diabetes Education Program provide detailed patient information about type 1 and type 2 diabetes, including specific information about treatments. The NICHD offers some general information about managing gestational diabetes. This information should not replace the advice and care from a health care provider. \u00ab How is it diagnosed? Other FAQs \u00bb - Can diabetes be prevented? - Are there disorders or conditions that can contribute to or are associated with diabetes? - What other health problems can diabetes cause? - If I have diabetes, will I be able to get pregnant? - Does having diabetes or gestational diabetes affect my infant? Can diabetes be prevented? Type 1 diabetes and gestational diabetes cannot currently be prevented, but this is an active area of research. The Trial to Reduce the Incidence of Type 1 Diabetes Mellitus in the Genetically at Risk (TRIGR), supported in part by the NICHD, is examining whether exposure to proteins from cow\u2019s milk or cow\u2019s milk-based infant formula can cause type 1 diabetes, especially in children who are at high risk for the condition based on their family history and genetic profile. The Trial aims to determine whether a nutritional intervention\u2014feeding cow\u2019s milk-based formulas that have been processed to remove the foreign proteins\u2014during infancy can delay or prevent the onset of type 1 diabetes in children at high risk for the condition. This research is still ongoing, but a small pilot study of 230 at-risk infants had encouraging results: The infants who received the processed formula had a lower autoimmune (self-attacking) response against the insulin-producing beta cells of the pancreas. This indicates that they may be at a lower risk of developing type 1 diabetes. Research also shows that there may be ways to prevent type 2 diabetes in some people. Lifestyle changes are a good way to start. In one large study called the Diabetes Prevention Program, people at high risk for type 2 diabetes who made these types of lifestyle changes lowered their risk of getting type 2 diabetes by 58%. Also, remember that such changes can lower risks of developing other health problems associated with diabetes. Ask your health care provider or a diabetes educator for other ideas to meet your specific needs. Are there disorders or conditions that can contribute to or are associated with diabetes? Yes, starting with overweight. When you\u2019re overweight or obese, your risk for diabetes is higher. Other conditions that can increase diabetes risk include: - High cholesterol - High blood pressure - Heart disease - Your blood glucose is already affected, known as impaired glucose tolerance - You\u2019ve already had gestational diabetes Also, polycystic ovary syndrome (PCOS), a leading cause of infertility in women, is associated with diabetes, meaning that women who have PCOS are at higher risk for diabetes. What other health problems can diabetes cause? Diabetes can lead to quite a number of health problems, especially if it is not well controlled. Among the problems diabetes can cause: - Eye problems - Nerve damage, including neuropathy (pronounced noo-rop-uh-thee),which leads to tingling, even numbness, especially in feet - Heart disease - High blood pressure - Depression - Gum disease - Poor bladder control in women - Male impotence For more information on other health problems caused by diabetes, visit the National Diabetes Information Clearinghouse. If I have diabetes, will I be able to get pregnant? Yes, women with diabetes can and do get pregnant. Pregnant women with diabetes are considered to have a High-Risk Pregnancy because the diabetes increases the risk for some complications. However, most women with diabetes have healthy pregnancies and healthy babies because they follow a health care provider\u2019s recommendations for diabetes management. If you have diabetes and are thinking about getting pregnant, discuss the subject with your health care provider. You might also want to consult a specialist with expertise dealing with both pregnancy and women with diabetes, as well as experts who can help you make healthy nutritional choices, such as a registered dietitian with a background in diabetes, or a diabetes educator. Does having diabetes or gestational diabetes affect my infant? Most women who have diabetes and become pregnant or who have gestational diabetes have healthy pregnancies and deliver healthy babies because they manage their diabetes. However, diabetes and especially uncontrolled diabetes are associated with several complications, including (but not limited to): - Jaundice (pronounced JAWN-diss)\u2014This yellowish tint to the infant\u2019s skin is treatable and typically has no lasting effects. - Hypoglycemia (pronounced hahy-poh-glahy-SEE-mee-uh)\u2014Infant\u2019s blood sugar is too low. You many need to breastfeed quickly, or find other ways to get more sugar into his/her system. - Macrosomia (pronounced mak-row-SOHM-ee-uh)\u2014Infant is large, which increases the likelihood of a cesarean or surgical delivery. - Respiratory distress syndrome\u2014Infant has trouble breathing and may require oxygen or other treatments. - Low calcium and magnesium levels\u2014Infant may need supplements to avoid other complications. Working with your health care provider to control diabetes can help reduce the risk of these and other complications. In addition, children whose mothers had gestational diabetes are at higher lifetime risk for type 2 diabetes, and for having it at a younger age than children whose mothers didn\u2019t have the condition. \u00ab What are the treatments? \u200b\u200b",
+    "https://www.nichd.nih.gov/health/topics/diabetes"
+  ],
+  [
+    "What is Diagnosis of Diabetes and Prediabetes?: Prediabetes is when blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Prediabetes means a person is at increased risk for developing type 2 diabetes, as well as for heart disease and stroke. Many people with prediabetes develop type 2 diabetes within 10 years. However, modest weight loss and moderate physical activity can help people with prediabetes delay or prevent type 2 diabetes.",
+    "http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diagnosis-diabetes-prediabetes/Pages/index.aspx"
+  ],
+  [
+    "Diabetes: Diabetes is a chronic disease in which the body cannot regulate the amount of sugar in the blood. Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both. To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested: - A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body. - An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be stored or used as fuel. People with diabetes have high blood sugar because their body cannot move sugar from the blood into muscle and fat cells to be burned or stored for energy, and/or because their liver makes too much glucose and releases it into the blood. This is because either: - Their pancreas does not make enough insulin - Their cells do not respond to insulin normally - Both of the above There are two major types of diabetes. The causes and risk factors are different for each type: - Type 1 diabetes can occur at any age, but it is most often diagnosed in children, teens, or young adults. In this disease, the body makes little or no insulin. This is because the pancreas cells that make insulin stop working. Daily injections of insulin are needed. The exact cause is unknown. - Type 2 diabetes is much more common. It most often occurs in adulthood, but because of high obesity rates, children and teens are now being diagnosed with this disease. Some people with type 2 diabetes do not know they have it. With type 2 diabetes, the body is resistant to insulin and doesn't use insulin as well as it should. - There are other causes of diabetes, and some people cannot be classified as type 1 or type 2. Gestational diabetes is high blood sugar that develops at any time during pregnancy in a woman who does not have diabetes. If your parent, brother, or sister has diabetes, you may be more likely to develop the disease. A high blood sugar level can cause several symptoms, including: - Blurry vision - Excess thirst - Fatigue - Frequent urination - Hunger - Weight loss Because type 2 diabetes develops slowly, some people with high blood sugar have no symptoms. Symptoms of type 1 diabetes develop over a short period. People may be very sick by the time they are diagnosed. After many years, diabetes can lead to other serious problems. These problems are known as diabetes complications, and include: - Eye problems, including trouble seeing (especially at night), light sensitivity, and blindness - Sores and infections of the leg or foot, which if untreated, can lead to amputation of the leg or foot - Damage to nerves in the body, causing pain, tingling, a loss of feeling, problems digesting food, and erectile dysfunction - Kidney problems, which can lead to kidney failure - Weakened immune system, which can lead to more frequent infections - Increased chance of having a heart attack or stroke A urine analysis may show high blood sugar. But a urine test alone does not diagnose diabetes. Your health care provider may suspect that you have diabetes if your blood sugar level is higher than 200 mg/dL (11.1 mmol/L). To confirm the diagnosis, one or more of the following tests must be done. Blood tests: - Fasting blood glucose level. Diabetes is diagnosed if the fasting glucose level is higher than 126 mg/dL (7.0 mmol/L) on two different tests. Levels between 100 and 126 mg/dL (5.5 and 7.0 mmol/L) are called impaired fasting glucose or prediabetes. These levels are risk factors for type 2 diabetes. - Hemoglobin A1c (A1C) test. Normal is less than 5.7%; prediabetes is 5.7% to 6.4%; and diabetes is 6.5% or higher. - Oral glucose tolerance test. Diabetes is diagnosed if the glucose level is higher than 200 mg/dL (11.1 mmol/L) 2 hours after drinking a sugar drink (this test is used more often for type 2 diabetes). Screening for type 2 diabetes in people who have no symptoms is recommended for: - Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 3 years. - Overweight adults (BMI of 25 or higher) who have other risk factors such as having high blood pressure, or having a mother, father, sister or brother with diabetes. - Adults over age 45, repeated every 3 years. Type 2 diabetes may be reversed with lifestyle changes, especially losing weight with exercise and by eating healthier foods. Some cases of type 2 diabetes can also be improved with weight loss surgery. There is no cure for type 1 diabetes. Treating either type 1 diabetes or type 2 diabetes involves medicines, diet, and exercise to control blood sugar level. Everyone with diabetes should receive proper education and support about the best ways to manage their diabetes. Ask your provider about seeing a diabetes nurse educator. Getting better control over your blood sugar, cholesterol, and blood pressure levels helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke. To prevent diabetes complications, visit your provider at least 2 to 4 times a year. Talk about any problems you are having. Follow your provider's instructions on managing your diabetes. Many resources can help you understand more about diabetes. If you have diabetes, you can also learn ways to manage your condition and prevent diabetes complications. Diabetes is a lifelong disease and there is no cure. Tight control of blood glucose can prevent or delay diabetes complications. But these problems can occur, even in people with good diabetes control. After many years, diabetes can lead to serious health problems: - You could have eye problems, including trouble seeing (especially at night), and light sensitivity. You could become blind. - Your feet and skin can develop sores and infections. After a long time, your foot or leg may need to be amputated. Infection can also cause pain and itching in other parts of the body. - Diabetes may make it harder to control your blood pressure and cholesterol. This can lead to a heart attack, stroke, and other problems. It can become harder for blood to flow to your legs and feet. - Nerves in your body can get damaged, causing pain, tingling, and numbness. - Because of nerve damage, you could have problems digesting the food you eat. You could feel weakness or have trouble going to the bathroom. Nerve damage can make it harder for men to have an erection. - High blood sugar and other problems can lead to kidney damage. Your kidneys may not work as well as they used to. They may even stop working so that you need dialysis or a kidney transplant. Keeping an ideal body weight and an active lifestyle may prevent or delay the start of type 2 diabetes. If you're overweight, losing just 5% to 7% of your body weight even helps. Some medicines can also be used to delay or prevent the start of type 2 diabetes. At this time, type 1 diabetes cannot be prevented. But there is promising research that shows type 1 diabetes may be delayed in some high risk people. Updated by: Robert Hurd, MD, Professor of Endocrinology and Health Care Ethics, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/001214.htm"
+  ],
+  [
+    "Diabetes: Diabetes is a disease in which blood sugar (glucose) levels in your body are too high. Diabetes can cause serious health problems, including heart attack or stroke, blindness, problems during pregnancy, and kidney failure. More than 13 million women have diabetes, or about one in 10 women ages 20 and older.1 Diabetes is a disease caused by high levels of blood sugar (glucose) in your body. This can happen when your body does not make insulin or does not use insulin correctly. Insulin is a hormone made in the pancreas, an organ near your stomach. Insulin helps the glucose from food get into your body's cells for energy. If your body does not make enough insulin, or your body does not use the insulin correctly, the glucose stays and builds up in your blood. Over time, this extra glucose can lead to prediabetes or diabetes. Diabetes puts you at risk for other serious and life-threatening health problems, such as heart disease, stroke, blindness, and kidney damage. The three main types of diabetes are: A risk factor is something that puts you at a higher risk for a disease compared with an average person. Risk factors for type 1 diabetes in women and girls include: Risk factors for type 2 diabetes in women and girls include:4 If you have any of these risk factors, talk to your doctor about ways to lower your risk for diabetes. You can also take the Diabetes Risk Test and talk about the results with your doctor. Type 1 diabetes usually develops in childhood, but it can happen at any age. It is more common in whites than in other racial or ethnic groups. About 5% of adults with diabetes have type 1 diabetes.1 Genes you inherit from your parents play an important role in the development of type 1 diabetes. However, where you live may also affect your risk. Type 1 diabetes develops more often in winter and in people who live in colder climates. Type 2 diabetes is more common in adults, especially in people who are overweight and have a family history of diabetes. About 95% of adults with diabetes have type 2 diabetes.1 Type 2 diabetes is becoming more common in children and teens as more of them become overweight and obese.5 Yes. Certain racial and ethnic groups have a higher risk for type 2 diabetes. These groups include: Diabetes affects women and men in almost equal numbers. However, diabetes affects women differently than men. Compared with men with diabetes, women with diabetes have:9 Yes. The longer you have type 2 diabetes, the higher your risk for developing serious medical problems from diabetes. Also, if you smoke and have diabetes, you are even more likely to develop serious medical problems from diabetes, compared with people who have diabetes and do not smoke.11 The extra glucose in the blood that leads to diabetes can damage your nerves and blood vessels. Nerve damage from diabetes can lead to pain or a permanent loss of feeling in your hands, feet, and other parts of your body.12 Blood vessel damage from diabetes can also lead to: Women with diabetes are also at higher risk for: Researchers do not know the exact causes of type 1 and type 2 diabetes. Researchers do know that inheriting certain genes from your family can raise your risk for developing diabetes. Obesity is also a major risk factor for type 2 diabetes. Smoking can also cause type 2 diabetes. And the more you smoke the higher your risk for type 2 diabetes and other serious health problems if you already have diabetes.13 Weight loss can help control type 2 diabetes so that you are healthier. Quitting smoking can also help you control your blood sugar levels. Being a healthy weight and not smoking can help all women be healthier. But, obesity and smoking do not always cause diabetes. Some women who are overweight or obese or smoke never develop diabetes. Also, women who are a normal weight or only slightly overweight can develop diabetes if they have other risk factors, such as a family history of diabetes. Type 1 diabetes symptoms are usually more severe and may develop suddenly. Type 2 diabetes may not cause any signs or symptoms at first. Symptoms can develop slowly over time. You may not notice them right away. Common signs and symptoms of type 1 and type 2 diabetes include: Maybe. You should be tested for diabetes if you are between 40 and 70 years old and are overweight or obese. Your doctor may recommend testing earlier than age 40 if you also have other risk factors for diabetes. Also, talk to your doctor about diabetes testing if you have signs or symptoms of diabetes. Your doctor will use a blood test to see if you have diabetes. If the testing shows that your blood sugar levels are high, you can begin making healthy changes to your eating habits and getting more physical activity to help prevent diabetes. Prediabetes means your blood sugar (glucose) level is higher than normal, but it is lower than the diabetes range. It also means you are at higher risk of getting type 2 diabetes and heart disease. As many as 27 million American women have prediabetes.14 If you have prediabetes, you can make healthy changes, such as doing some type of physical activity on most days, to lower your risk of getting diabetes and return to normal blood sugar levels. Losing 7% of your body weight (or 14 pounds if you weigh 200 pounds) can lower your risk for type 2 diabetes by more than half. If you have prediabetes, get your blood glucose checked every year by a doctor or nurse.15 Diabetes treatment includes managing your blood sugar levels to control your symptoms. You can help control your blood sugar levels by eating healthy and getting regular physical activity. With type 1 diabetes, you also will need to take insulin through shots or an insulin pump. Insulin cannot be taken as a pill. Type 2 diabetes treatment also may include taking medicine to control your blood sugar. Over time, people with type 2 diabetes make less and less of their own insulin. This may mean that you will need to increase your medicines or start taking insulin shots to keep your diabetes in control. Learn more about controlling diabetes at the National Diabetes Education Program website. Researchers do not know how to prevent type 1 diabetes. Researchers are still looking for ways to prevent type 1 diabetes in women and girls by studying their close relatives who have diabetes. Yes. Many studies, including the large Diabetes Prevention Program study, have proven that you can prevent diabetes by losing weight. Weight loss through healthy eating and more physical activity improves the way your body uses insulin and glucose. Learn how to eat healthier and get more physical activity. Yes. If you have type 1 or type 2 diabetes, you can have a healthy pregnancy. If you have diabetes and you want to have a baby, you need to plan ahead, before you get pregnant. Talk to your doctor before you get pregnant. He or she can talk to you about steps you can take to keep your baby healthy. This may include a diabetes education program to help you better understand your diabetes and how to control it during pregnancy. For more information about diabetes, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:",
+    "https://www.womenshealth.gov/a-z-topics/diabetes"
+  ],
+  [
+    "What is Diabetes?: The most common types of diabetes are type 1, type 2, and gestational diabetes.Type 1 diabetesIf you have type 1 diabetes, your body does not make insulin. Your immune system attacks and destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. People with type 1 diabetes need to take insulin every day to stay alive.Type 2 diabetesIf you have type 2 diabetes, your body does not make or use insulin well. You can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people. Type 2 is the most common type of diabetes.Gestational diabetesGestational diabetes develops in some women when they are pregnant. Most of the time, this type of diabetes goes away after the baby is born. However, if you\u2019ve had gestational diabetes, you have a greater chance of developing type 2 diabetes later in life. Sometimes diabetes diagnosed during pregnancy is actually type 2 diabetes.Other types of diabetesLess common types include monogenic diabetes, which is an inherited form of diabetes, and cystic fibrosis-related diabetes. As of 2015, 30.3 million people in the United States, or 9.4 percent of the population, had diabetes. More than 1 in 4 of them didn\u2019t know they had the disease. Diabetes affects 1 in 4 people over the age of 65. About 90-95 percent of cases in adults are type 2 diabetes.1 You are more likely to develop type 2 diabetes if you are age 45 or older, have a family history of diabetes, or are overweight. Physical inactivity, race, and certain health problems such as high blood pressure also affect your chance of developing type 2 diabetes. You are also more likely to develop type 2 diabetes if you have prediabetes or had gestational diabetes when you were pregnant. Learn more about risk factors for type 2 diabetes. Over time, high blood glucose leads to problems such asheart disease stroke kidney disease eye problems dental disease nerve damage foot problemsYou can take steps to lower your chances of developing these diabetes-related health problems. [1] Centers for Disease Control and Prevention. National diabetes statistics report, 2017. Centers for Disease Control and Prevention website. www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf (PDF, 1.3 MB) . Updated July, 18 2017. Accessed August 1, 2017.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes"
+  ],
+  [
+    "Diabetes: Diabetes is a serious disease. People get diabetes when their blood glucose level, sometimes called blood sugar, is too high. The good news is that there are things you can do to take control of diabetes and prevent its problems. And, if you are worried about getting diabetes, there are things you can do to lower your risk. Diabetes is a serious disease. People get diabetes when their blood glucose level, sometimes called blood sugar, is too high. The good news is that there are things you can do to take control of diabetes and prevent its problems. And, if you are worried about getting diabetes, there are things you can do to lower your risk. Our bodies turn the food we eat into glucose. Insulin helps glucose get into our cells, where it can be used to make energy. If you have diabetes, your body may not make enough insulin, may not use insulin in the right way, or both. That can cause too much glucose in the blood. Your family doctor may refer you to a doctor who specializes in taking care of people with diabetes, called an endocrinologist. There are two main kinds of diabetes.- Type 1 diabetes. In type 1 diabetes, the body makes little or no insulin. Although adults can develop this type of diabetes, it occurs most often in children and young adults. - Type 2 diabetes. In type 2 diabetes, the body makes insulin but doesn't use it the right way. It is the most common kind of diabetes. It occurs most often in middle-aged and older adults, but it can also affect children. Your chance of getting type 2 diabetes is higher if you are overweight, inactive, or have a family history of diabetes.Diabetes can affect many parts of your body. It's important to keep diabetes under control. Over time, it can cause serious health problems like heart disease, stroke, kidney disease, blindness, nerve damage, and circulation problems that may lead to amputation. People with type 2 diabetes also have a greater risk for Alzheimer's disease. Many people have \"prediabetes.\" This means their glucose levels are higher than normal but not high enough to be called diabetes. Prediabetes is a serious problem because people who have it are at high risk for developing type 2 diabetes.There are things you can do to prevent or delay getting type 2 diabetes. Losing weight may help. Healthy eating and being physically active can make a big difference. Work with your doctor to set up a plan for good nutrition and regular exercise. Make sure to ask how often you should have your glucose levels checked. Some people with type 2 diabetes may not know they have it. But, they may feel tired, hungry, or thirsty. They may lose weight without trying, urinate often, or have trouble with blurred vision. They may also get skin infections or heal slowly from cuts and bruises. See your doctor right away if you have one or more of these symptoms. Doctors use several blood tests to help diagnose diabetes:- Random plasma glucose test-given at any time during the day - A1C test-given at any time during the day; shows your glucose level for the past 3 months - Fasting plasma glucose test-taken after you have gone without food for at least 8 hours - Oral glucose tolerance test-taken after fasting overnight and then again 2 hours after having a sugary drinkYour doctor may want you to be tested for diabetes twice before making a diagnosis. Once you've been told you have diabetes, your doctor will choose the best treatment based on the type of diabetes you have, your everyday routine, and any other health problems you have. Many people with type 2 diabetes can control their blood glucose levels with diet and exercise alone. Others need diabetes medicines or insulin injections. Over time, people with diabetes may need both lifestyle changes and medication.Share this infographic and help spread the word about the everyday benefits of exercise and physical activity.You can keep control of your diabetes by:- Tracking your glucose levels. Very high glucose levels or very low glucose levels (called hypoglycemia) can be risky to your health. Talk to your doctor about how to check your glucose levels at home. - Making healthy food choices. Learn how different foods affect glucose levels. For weight loss, check out foods that are low in fat and sugar. Let your doctor know if you want help with meal planning. - Getting exercise. Daily exercise can help improve glucose levels in older people with diabetes. Ask your doctor to help you plan an exercise program. - Taking your diabetes medicines even when you feel good. Tell your doctor if you have any side effects or cannot afford your medicines.Your doctor may want you to see other healthcare providers who can help manage some of the extra problems caused by diabetes. He or she can also give you a schedule for other tests that may be needed. Talk to your doctor about how to stay healthy.Here are some ways to stay healthy with diabetes:- Find out your average blood glucose level. At least twice a year, get the A1C blood test. The result will show your average glucose level for the past 3 months. - Watch your blood pressure. Get your blood pressure checked often. - Check your cholesterol. At least once a year, get a blood test to check your cholesterol and triglyceride levels. High levels may increase your risk for heart problems. - Stop smoking. Smoking raises your risk for many health problems, including heart attack and stroke. - Have yearly eye exams. Finding and treating eye problems early may keep your eyes healthy. - Check your kidneys yearly. Diabetes can affect your kidneys. A urine and blood test will show if your kidneys are okay. - Get flu shots every year and the pneumonia vaccine. A yearly flu shot will help keep you healthy. If you're over 65, make sure you have had the pneumonia vaccine. If you were younger than 65 when you had the pneumonia vaccine, you may need another one. Ask your doctor. - Care for your teeth and gums. Brush your teeth and floss daily. Have your teeth and gums checked twice a year by a dentist to avoid serious problems. - Protect your skin. Keep your skin clean and use skin softeners for dryness. Take care of minor cuts and bruises to prevent infections. - Look at your feet. Take time to look at your feet every day for any red patches. Ask someone else to check your feet if you can't. If you have sores, blisters, breaks in the skin, infections, or build-up of calluses, see a foot doctor, called a podiatrist.Be Prepared Make sure you always have at least 3 days' worth of supplies on hand for testing and treating your diabetes in case of an emergency. Medicare may pay to help you learn how to care for your diabetes. It may also help pay for diabetes tests, supplies, flu and pneumonia shots, special shoes, foot exams, eye tests, and meal planning.For more information about what Medicare covers, call 1-800-633-4227 (1-800-MEDICARE) or visit the Medicare website.Read about this topic in Spanish. Lea sobre este tema en espanol.",
+    "https://www.nia.nih.gov/health/topics/diabetes"
+  ],
+  [
+    "Diabetes: Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel. If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the causes may differ. Too much glucose can lead to serious health problems. Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes - when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes - and gestational diabetes, which occurs during pregnancy but may resolve after the baby is delivered. Diabetes symptoms vary depending on how much your blood sugar is elevated. Some people, especially those with prediabetes or type 2 diabetes, may not experience symptoms initially. In type 1 diabetes, symptoms tend to come on quickly and be more severe. Some of the signs and symptoms of type 1 and type 2 diabetes are: - Increased thirst - Frequent urination - Extreme hunger - Unexplained weight loss - Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin) - Fatigue - Irritability - Blurred vision - Slow-healing sores - Frequent infections, such as gums or skin infections and vaginal infections Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age, though it's more common in people older than 40. When to see a doctor - If you suspect you or your child may have diabetes. If you notice any possible diabetes symptoms, contact your doctor. The earlier the condition is diagnosed, the sooner treatment can begin. - If you've already been diagnosed with diabetes. After you receive your diagnosis, you'll need close medical follow-up until your blood sugar levels stabilize. To understand diabetes, first you must understand how glucose is normally processed in the body. How insulin works Insulin is a hormone that comes from a gland situated behind and below the stomach (pancreas). - The pancreas secretes insulin into the bloodstream. - The insulin circulates, enabling sugar to enter your cells. - Insulin lowers the amount of sugar in your bloodstream. - As your blood sugar level drops, so does the secretion of insulin from your pancreas. The role of glucose Glucose - a sugar - is a source of energy for the cells that make up muscles and other tissues. - Glucose comes from two major sources: food and your liver. - Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin. - Your liver stores and makes glucose. - When your glucose levels are low, such as when you haven't eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range. Causes of type 1 diabetes The exact cause of type 1 diabetes is unknown. What is known is that your immune system - which normally fights harmful bacteria or viruses - attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream. Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what many of those factors are is still unclear. Causes of prediabetes and type 2 diabetes In prediabetes - which can lead to type 2 diabetes - and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells where it's needed for energy, sugar builds up in your bloodstream. Exactly why this happens is uncertain, although it's believed that genetic and environmental factors play a role in the development of type 2 diabetes. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight. Causes of gestational diabetes During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin. Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can't keep up. When this happens, too little glucose gets into your cells and too much stays in your blood, resulting in gestational diabetes. Risk factors for diabetes depend on the type of diabetes. Risk factors for type 1 diabetes Although the exact cause of type 1 diabetes is unknown, factors that may signal an increased risk include: - Family history.Your risk increases if a parent or sibling has type 1 diabetes. - Environmental factors. Circumstances such as exposure to a viral illness likely play some role in type 1 diabetes. - The presence of damaging immune system cells (autoantibodies). Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes autoantibodies. If you have these autoantibodies, you have an increased risk of developing type 1 diabetes. But not everyone who has these autoantibodies develops diabetes. - Dietary factors. These include low vitamin D consumption, early exposure to cow's milk or cow's milk formula, and exposure to cereals before 4 months of age. None of these factors has been shown to directly cause type 1 diabetes. - Geography. Certain countries, such as Finland and Sweden, have higher rates of type 1 diabetes. Risk factors for prediabetes and type 2 diabetes Researchers don't fully understand why some people develop prediabetes and type 2 diabetes and others don't. It's clear that certain factors increase the risk, however, including: - Weight. The more fatty tissue you have, the more resistant your cells become to insulin. - Inactivity. The less active you are, the greater your risk. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin. - Family history. Your risk increases if a parent or sibling has type 2 diabetes. - Race. Although it's unclear why, people of certain races - including blacks, Hispanics, American Indians and Asian-Americans - are at higher risk. - Age. Your risk increases as you get older. This may be because you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes is also increasing dramatically among children, adolescents and younger adults. - Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes later increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes. - Polycystic ovary syndrome. For women, having polycystic ovary syndrome - a common condition characterized by irregular menstrual periods, excess hair growth and obesity - increases the risk of diabetes. - High blood pressure. Having blood pressure over 140/90 millimeters of mercury (mm Hg) is linked to an increased risk of type 2 diabetes. - Abnormal cholesterol and triglyceride levels. If you have low levels of high-density lipoprotein (HDL), or \"good,\" cholesterol, your risk of type 2 diabetes is higher. Triglycerides are another type of fat carried in the blood. People with high levels of triglycerides have an increased risk of type 2 diabetes. Your doctor can let you know what your cholesterol and triglyceride levels are. Risk factors for gestational diabetes Any pregnant woman can develop gestational diabetes, but some women are at greater risk than are others. Risk factors for gestational diabetes include: - Age. Women older than age 25 are at increased risk. - Family or personal history. Your risk increases if you have prediabetes - a precursor to type 2 diabetes - or if a close family member, such as a parent or sibling, has type 2 diabetes. You're also at greater risk if you had gestational diabetes during a previous pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth. - Weight. Being overweight before pregnancy increases your risk. - Race. For reasons that aren't clear, women who are black, Hispanic, American Indian or Asian are more likely to develop gestational diabetes. Long-term complications of diabetes develop gradually. The longer you have diabetes - and the less controlled your blood sugar - the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include: - Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you are more likely to have heart disease or stroke. - Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction. - Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant. - Eye damage (retinopathy). Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma. - Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation. - Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections. - Hearing impairment. Hearing problems are more common in people with diabetes. - Alzheimer's disease. Type 2 diabetes may increase the risk of Alzheimer's disease. The poorer your blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved. Complications of gestational diabetes Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby. Complications in your baby can occur as a result of gestational diabetes, including: - Excess growth. Extra glucose can cross the placenta, which triggers your baby's pancreas to make extra insulin. This can cause your baby to grow too large (macrosomia). Very large babies are more likely to require a C-section birth. - Low blood sugar. Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal. - Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life. - Death. Untreated gestational diabetes can result in a baby's death either before or shortly after birth. Complications in the mother can also occur as a result of gestational diabetes, including: - Preeclampsia.This condition is characterized by high blood pressure, excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby. - Subsequent gestational diabetes. Once you've had gestational diabetes in one pregnancy, you're more likely to have it again with the next pregnancy. You're also more likely to develop diabetes - typically type 2 diabetes - as you get older. Complications of prediabetes Prediabetes may develop into type 2 diabetes. Symptoms of type 1 diabetes often appear suddenly and are often the reason for checking blood sugar levels. Because symptoms of other types of diabetes and prediabetes come on more gradually or may not be evident, the American Diabetes Association (ADA) has recommended screening guidelines. The ADA recommends that the following people be screened for diabetes: - Anyone with a body mass index higher than 25, regardless of age, who has additional risk factors, such as high blood pressure, a sedentary lifestyle, a history of polycystic ovary syndrome, having delivered a baby who weighed more than 9 pounds, a history of diabetes in pregnancy, high cholesterol levels, a history of heart disease, and having a close relative with diabetes. - Anyone older than age 45 is advised to receive an initial blood sugar screening, and then, if the results are normal, to be screened every three years thereafter. Tests for type 1 and type 2 diabetes and prediabetes - Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal. If the A1C test results aren't consistent, the test isn't available, or if you have certain conditions that can make the A1C test inaccurate - such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) - your doctor may use the following tests to diagnose diabetes: - Random blood sugar test. A blood sample will be taken at a random time. Regardless of when you last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) - 11.1 millimoles per liter (mmol/L) - or higher suggests diabetes. - Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. - Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes. If type 1 diabetes is suspected, your urine will be tested to look for the presence of a byproduct produced when muscle and fat tissue are used for energy when the body doesn't have enough insulin to use the available glucose (ketones). Your doctor will also likely run a test to see if you have the destructive immune system cells associated with type 1 diabetes called autoantibodies. Tests for gestational diabetes Your doctor will likely evaluate your risk factors for gestational diabetes early in your pregnancy: - If you're at high risk of gestational diabetes - for example, if you were obese at the start of your pregnancy, you had gestational diabetes during a previous pregnancy, or you have a mother, father, sibling or child with diabetes - your doctor may test for diabetes at your first prenatal visit. - If you're at average risk of gestational diabetes, you'll likely have a screening test for gestational diabetes sometime during your second trimester - typically between 24 and 28 weeks of pregnancy. Your doctor may use the following screening tests: - Initial glucose challenge test. You'll begin the glucose challenge test by drinking a syrupy glucose solution. One hour later, you'll have a blood test to measure your blood sugar level. A blood sugar level below 140 mg/dL (7.2 to 7.8 mmol/L) is usually considered normal on a glucose challenge test, although this may vary at specific clinics or labs. If your blood sugar level is higher than normal, it only means you have a higher risk of gestational diabetes. Your doctor will order a follow-up test to determine if you have gestational diabetes. - Follow-up glucose tolerance testing. For the follow-up test, you'll be asked to fast overnight and then have your fasting blood sugar level measured. Then you'll drink another sweet solution - this one containing a higher concentration of glucose - and your blood sugar level will be checked every hour for a period of three hours. If at least two of the blood sugar readings are higher than the normal values established for each of the three hours of the test, you'll be diagnosed with gestational diabetes. Depending on what type of diabetes you have, blood sugar monitoring, insulin and oral medications may play a role in your treatment. Eating a healthy diet, maintaining a healthy weight and participating in regular activity also are important factors in managing diabetes. Treatments for all types of diabetes An important part of managing diabetes - as well as your overall health - is maintaining a healthy weight through a healthy diet and exercise plan: - Healthy eating. Contrary to popular perception, there's no specific diabetes diet. You'll need to center your diet on more fruits, vegetables and whole grains - foods that are high in nutrition and fiber and low in fat and calories - and cut down on animal products, refined carbohydrates and sweets. In fact, it's the best eating plan for the entire family. Sugary foods are OK once in a while, as long as they're counted as part of your meal plan. Yet understanding what and how much to eat can be a challenge. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle. This will likely include carbohydrate counting, especially if you have type 1 diabetes. - Physical activity. Everyone needs regular aerobic exercise, and people who have diabetes are no exception. Exercise lowers your blood sugar level by moving sugar into your cells, where it's used for energy. Exercise also increases your sensitivity to insulin, which means your body needs less insulin to transport sugar to your cells. Get your doctor's OK to exercise. Then choose activities you enjoy, such as walking, swimming or biking. What's most important is making physical activity part of your daily routine. Aim for at least 30 minutes or more of aerobic exercise most days of the week. If you haven't been active for a while, start slowly and build up gradually. Treatments for type 1 and type 2 diabetes Treatment for type 1 diabetes involves insulin injections or the use of an insulin pump, frequent blood sugar checks, and carbohydrate counting. Treatment of type 2 diabetes primarily involves monitoring of your blood sugar, along with diabetes medications, insulin or both. - Monitoring your blood sugar. Depending on your treatment plan, you may check and record your blood sugar as often as several times a week to as many as four to eight times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. People who receive insulin therapy also may choose to monitor their blood sugar levels with a continuous glucose monitor. Although this technology doesn't yet replace the glucose meter, it can provide important information about trends in blood sugar levels. Even with careful management, blood sugar levels can sometimes change unpredictably. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to food, physical activity, medications, illness, alcohol, stress - for women, fluctuations in hormone levels. In addition to daily blood sugar monitoring, your doctor will likely recommend regular A1C testing to measure your average blood sugar level for the past two to three months. Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working overall. An elevated A1C level may signal the need for a change in your insulin regimen or meal plan. Your target A1C goal may vary depending on your age and various other factors. However, for most people with diabetes, the American Diabetes Association recommends an A1C of below 7 percent. Ask your doctor what your A1C target is. - Insulin. People with type 1 diabetes need insulin therapy to survive. Many people with type 2 diabetes or gestational diabetes also need insulin therapy. Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night. Insulin can't be taken orally to lower blood sugar because stomach enzymes interfere with insulin's action. Often insulin is injected using a fine needle and syringe or an insulin pen - a device that looks like a large ink pen. An insulin pump may also be an option. The pump is a device about the size of a cellphone worn on the outside of your body. A tube connects the reservoir of insulin to a catheter that's inserted under the skin of your abdomen. A tubeless pump that works wirelessly is also now available. You program an insulin pump to dispense specific amounts of insulin. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level. An emerging treatment approach, not yet available, is closed loop insulin delivery, also known as the artificial pancreas. It links a continuous glucose monitor to an insulin pump. The device automatically delivers the correct amount of insulin when the monitor indicates the need for it. There are a number of different versions of the artificial pancreas, and clinical trials have had encouraging results. More research needs to be done before a fully functional artificial pancreas can receive regulatory approval. However, the first step toward an artificial pancreas was approved in 2013. Combining a continuous glucose monitor with an insulin pump, this system stops insulin delivery when blood sugar levels drop too low. Studies on the device found that it could prevent low blood sugar levels overnight without significantly increasing morning blood sugar levels. - Oral or other medications. Sometimes other oral or injected medications are prescribed as well. Some diabetes medications stimulate your pancreas to produce and release more insulin. Others inhibit the production and release of glucose from your liver, which means you need less insulin to transport sugar into your cells. Still others block the action of stomach or intestinal enzymes that break down carbohydrates or make your tissues more sensitive to insulin. Metformin (Glucophage, Glumetza, others) is generally the first medication prescribed for type 2 diabetes. - Transplantation. In some people who have type 1 diabetes, a pancreas transplant may be an option. Islet transplants are being studied as well. With a successful pancreas transplant, you would no longer need insulin therapy. But transplants aren't always successful - and these procedures pose serious risks. You need a lifetime of immune-suppressing drugs to prevent organ rejection. These drugs can have serious side effects, including a high risk of infection, organ injury and cancer. Because the side effects can be more dangerous than the diabetes, transplants are usually reserved for people whose diabetes can't be controlled or those who also need a kidney transplant. - Bariatric surgery. Although it is not specifically considered a treatment for type 2 diabetes, people with type 2 diabetes who also have a body mass index higher than 35 may benefit from this type of surgery. People who've undergone gastric bypass have seen significant improvements in their blood sugar levels. However, this procedure's long-term risks and benefits for type 2 diabetes aren't yet known. Treatment for gestational diabetes Controlling your blood sugar level is essential to keeping your baby healthy and avoiding complications during delivery. In addition to maintaining a healthy diet and exercising, your treatment plan may include monitoring your blood sugar and, in some cases, using insulin or oral medications. Your health care provider will also monitor your blood sugar level during labor. If your blood sugar rises, your baby may release high levels of insulin - which can lead to low blood sugar right after birth. Treatment for prediabetes If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back to normal or at least keep it from rising toward the levels seen in type 2 diabetes. Maintaining a healthy weight through exercise and healthy eating can help. Exercising at least 150 minutes a week and losing 5 to 10 percent of your body weight may prevent or delay type 2 diabetes. Sometimes medications - such as metformin (Glucophage, Glumetza, others) - also are an option if you're at high risk of diabetes, including when your prediabetes is worsening or if you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome. In other cases, medications to control cholesterol - statins, in particular - and high blood pressure medications are needed. Your doctor might prescribe low-dose aspirin therapy to help prevent cardiovascular disease if you're at high risk. Healthy lifestyle choices remain key, however. Signs of trouble in any type of diabetes Because so many factors can affect your blood sugar, problems may sometimes arise that require immediate care, such as: - High blood sugar (hyperglycemia). Your blood sugar level can rise for many reasons, including eating too much, being sick or not taking enough glucose-lowering medication. Check your blood sugar level as directed by your doctor, and watch for signs and symptoms of high blood sugar - frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you have hyperglycemia, you'll need to adjust your meal plan, medications or both. - Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your body may begin to break down fat. This produces toxic acids known as ketones. Watch for loss of appetite, weakness, vomiting, fever, stomach pain and a sweet, fruity breath. You can check your urine for excess ketones with an over-the-counter ketones test kit. If you have excess ketones in your urine, consult your doctor right away or seek emergency care. This condition is more common in people with type 1 diabetes. - Hyperglycemic hyperosmolar nonketotic syndrome. Signs and symptoms of this life-threatening condition include a blood sugar reading over 600 mg/dL (33.3 mmol/L), dry mouth, extreme thirst, fever, drowsiness, confusion, vision loss and hallucinations. Hyperosmolar syndrome is caused by sky-high blood sugar that turns blood thick and syrupy. It tends to be more common in people with type 2 diabetes, and it's often preceded by an illness. Call your doctor or seek immediate medical care if you have signs or symptoms of this condition. - Low blood sugar (hypoglycemia). If your blood sugar level drops below your target range, it's known as low blood sugar (hypoglycemia). Your blood sugar level can drop for many reasons, including skipping a meal and getting more physical activity than normal. However, low blood sugar is most likely if you take glucose-lowering medications that promote the secretion of insulin by your pancreas or if you're receiving insulin therapy. Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar - sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, irritability, slurred speech, drowsiness, confusion, fainting and seizures. Low blood sugar is treated with quickly absorbed carbohydrates, such as fruit juice or glucose tablets. Diabetes is a serious disease. Following your diabetes treatment plan takes round-the-clock commitment. Careful management of diabetes can reduce your risk of serious - even life-threatening - complications. No matter what type of diabetes you have: - Make a commitment to managing your diabetes. Learn all you can about diabetes. Establish a relationship with a diabetes educator, and ask your diabetes treatment team for help when you need it. - Choose healthy foods and maintain a healthy weight. Losing just 7 percent of your body weight if you're overweight can make a significant difference in your blood sugar control. A healthy diet is one with plenty of fruits, vegetables, whole grains and legumes, with a limited amount of saturated fat. - Make physical activity part of your daily routine. Regular exercise can help prevent prediabetes and type 2 diabetes, and it can help those who already have diabetes to maintain better blood sugar control. Thirty minutes of moderate exercise - such as brisk walking - most days of the week is recommended. A combination of exercises - aerobic exercises, such as walking or dancing on most days, combined with resistance training, such as weightlifting or yoga twice a week - often helps control blood sugar more effectively than does either type of exercise alone. Lifestyle for type 1 and type 2 diabetes In addition, if you have type 1 or type 2 diabetes: - Identify yourself. Wear a tag or bracelet that says you have diabetes. Keep a glucagon kit nearby in case of a low blood sugar emergency - and make sure your friends and loved ones know how to use it. - Schedule a yearly physical and regular eye exams. Your regular diabetes checkups aren't meant to replace yearly physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications and screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma. - Keep your vaccinations up to date. High blood sugar can weaken your immune system. Get a flu shot every year, and your doctor may recommend the pneumonia vaccine, as well. The Centers for Disease Control and Prevention (CDC) also currently recommends hepatitis B vaccination if you haven't previously been vaccinated against hepatitis B and you're an adult ages 19 to 59 with type 1 or type 2 diabetes. The most recent CDC guidelines advise vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes. If you are age 60 or older, have diabetes, and haven't previously received the vaccine, talk to your doctor about whether it's right for you. - Pay attention to your feet. Wash your feet daily in lukewarm water. Dry them gently, especially between the toes. Moisturize with lotion, but not between the toes. Check your feet every day for blisters, cuts, sores, redness or swelling. Consult your doctor if you have a sore or other foot problem that doesn't heal promptly on its own. - Keep your blood pressure and cholesterol under control. Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Medication may be needed, too. - Take care of your teeth. Diabetes may leave you prone to more-serious gum infections. Brush and floss your teeth at least twice a day. And if you have type 1 or type 2 diabetes, schedule regular dental exams. Consult your dentist right away if your gums bleed or look red or swollen. - If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications. Smokers who have diabetes are more likely to die of cardiovascular disease than are nonsmokers who have diabetes, according to the American Diabetes Association. Talk to your doctor about ways to stop smoking or to stop using other types of tobacco. - If you drink alcohol, do so responsibly. Alcohol can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, do so only in moderation - one drink a day for women of all ages and men older than 65, and up to two drinks a day for men age 65 and younger - and always with food. Remember to include the carbohydrates from any alcohol you drink in your daily carbohydrate count. And check your blood sugar levels before going to bed. - Take stress seriously. The hormones your body may produce in response to prolonged stress may prevent insulin from working properly, which will raise your blood sugar and stress you even more. Set limits for yourself and prioritize your tasks. Learn relaxation techniques. And get plenty of sleep. Numerous substances have been shown to improve insulin sensitivity in some studies, while other studies fail to find any benefit for blood sugar control or in lowering A1C levels. Because of the conflicting findings, there aren't any alternative therapies that are currently recommended to help with blood sugar management. If you decide to try an alternative therapy, don't stop taking the medications that your doctor has prescribed. Be sure to discuss the use of any of these therapies with your doctor to make sure that they won't cause adverse reactions or interact with your current therapy. Additionally, there are no treatments - alternative or conventional - that can cure diabetes, so it's critical that people who are receiving insulin therapy for diabetes don't stop using insulin unless directed to do so by their physicians.",
+    "https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444"
+  ],
+  [
+    "Diabetes - resources: The following sites provide further information on diabetes: - American Diabetes Association -- www.diabetes.org - Juvenile Diabetes Research Foundation International -- www.jdrf.org - National Center for Chronic Disease Prevention and Health Promotion -- www.cdc.gov/diabetes - National Diabetes Education Program -- www.ndep.nih.gov - National Institute of Diabetes and Digestive and Kidney Diseases -- www.diabetes.niddk.nih.gov - National Library of Medicine MedlinePlus -- www.nlm.nih.gov/medlineplus/diabetes.html The following organizations have information on diabetes-related complications: Diabetic retinopathy resources: - National Eye Institute -- www.nei.nih.gov/health/diabetic/retinopathy - American Academy of Ophthalmology -- www.aao.org/eye-health/diseases/what-is-diabetic-retinopathy Diabetic neuropathy (nerve pain) resources: - American Chronic Pain Association -- theacpa.org - National Institute of Neurological Disorders and Stroke --\u00a0www.ninds.nih.gov/disorders/all-disorders/diabetic-neuropathy-information-page Kidney disease resources: - National Institute of Diabetes and Digestive and Kidney Diseases -- kidney.niddk.nih.gov - National Kidney Foundation -- www.kidney.org/atoz/atozTopic_Diabetes Updated by: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology and Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Editorial update 06/12/2017.",
+    "https://medlineplus.gov/ency/article/002179.htm"
+  ],
+  [
+    "Bupropion (Brand names): - Aplenzin\u00ae - Budeprion\u00ae SR\u00b6 - Budeprion\u00ae XL\u00b6 - Buproban\u00ae\u00b6 - Forfivo\u00ae XL - Wellbutrin\u00ae - Wellbutrin\u00ae SR - Wellbutrin\u00ae XL - Zyban\u00ae",
+    "https://medlineplus.gov/druginfo/meds/a695033.html"
+  ],
+  [
+    "Bupropion (Why is this medication prescribed?): Bupropion (Aplenzin, Wellbutrin, Wellbutrin SR, Wellbutrin XL) is used to treat depression. Bupropion (Aplenzin, Wellbutrin XL) is also used to treat seasonal affective disorder (SAD; episodes of depression that occur at the same time each year [usually in the fall and winter but rarely may occur in the spring or summer months]). Bupropion (Zyban) is used to help people stop smoking. Bupropion is in a class of medications called antidepressants. It works by increasing certain types of activity in the brain.",
+    "https://medlineplus.gov/druginfo/meds/a695033.html"
+  ],
+  [
+    "Bupropion (How should this medicine be used?): Bupropion comes as a tablet and a sustained-release or extended-release (long-acting) tablet to take by mouth. The regular tablet (Wellbutrin) is usually taken three times a day, with doses at least 6 hours apart, or four times a day, with doses at least 4 hours apart. The sustained-release tablet (Wellbutrin SR, Zyban) is usually taken twice a day, with doses at least 8 hours apart. The extended-release tablet (Aplenzin, Wellbutrin XL) is usually taken once daily in the morning; doses of the extended-release tablet should be taken at least 24 hours apart. When bupropion is used to treat seasonal affective disorder, it is usually taken once a day in the morning beginning in the early fall, continuing through the winter, and stopping in the early spring. Sometimes a lower dose of bupropion is taken for 2 weeks before the medication is stopped. Take bupropion with food if the medication upsets your stomach. If you have trouble falling asleep or staying asleep, do not take bupropion too close to bedtime. Take bupropion at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take bupropion exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Swallow the sustained-release and extended-release tablets whole; do not split, chew, or crush them. Your doctor will probably start you on a low dose of bupropion and gradually increase your dose. It may take 4 weeks or longer before you feel the full benefit of bupropion. Continue to take bupropion even if you feel well. Do not stop taking bupropion without talking to your doctor. Your doctor may decrease your dose gradually.",
+    "https://medlineplus.gov/druginfo/meds/a695033.html"
+  ],
+  [
+    "Cevimeline (What special precautions should I follow?): Before taking cevimeline, - tell your doctor and pharmacist if you are allergic to cevimeline, or any other medications. - tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: amiodarone (Pacerone, Cordarone); antifungal medications such as ketoconazole (Nizoral) and itraconazole (Sporanox); beta blockers such as acebutolol (Sectral), atenolol (Tenormin), betaxolol (Kerlone), bisoprolol (Zebeta, in Ziac), carvedilol (Coreg), labetalol (Trandate), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), pindolol, propranolol (Inderal), sotalol (Betapace), and timolol (Blocadren); bethanechol (Urecholine); bupropion (Wellbutrin, Wellbutrin XL, Wellbutrin SR, Zyban); calcium channel blockers such as diltiazem (Cardizem, Dilacor, Tiazac, others) and verapamil (Calan, Covera, Isoptin, Verelan); chlorpheniramine (Chlor-Trimeton, Aller-Chlor, Teldrin Allergy, others); cimetidine (Tagamet); clarithromycin (Biaxin); clomipramine (Anafranil); duloxetine (Cymbalta); erythromycin (E.E.S., Erythrocin, E-Mycin); fluoxetine (Prozac, Sarafem); fluvoxamine; haloperidol (Haldol); ipratropium (Atrovent); certain medications for HIV such as indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir); medications for Alzheimer's disease, glaucoma, irritable bowel syndrome, motion sickness, Myastenia Gravis, Parkinson's disease, ulcers, or urinary problems; methadone (Dolophine); nefazodone; paroxetine (Paxil, Paxil CR, Pexeva); quinidine; and troleandomycin. Many other medications may also interact with cevimeline, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. - tell your doctor what herbal products you are taking, especially St. John's wort. - tell your doctor if you have asthma, acute iritis (uveitis; swelling and irritation inside the eye), or glaucoma (an eye disease). Your doctor may tell you not to take cevimeline. - tell your doctor if you have or have ever had chest pain or a heart attack, chronic bronchitis, chronic obstructive pulmonary disease (COPD; a group of lung diseases that includes chronic bronchitis and emphysema), kidney stones, gallstones or heart disease. - tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking cevimeline, call your doctor. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking cevimeline. - you should know cevimeline may cause changes in vision, especially at night or when there is not enough light. Use caution when driving at night or performing hazardous activities in reduced lighting. - you should know that cevimeline may cause you to sweat a great deal, which can cause dehydration. Be sure to drink plenty of water and talk to your doctor about ways to prevent dehydration while taking this medication.",
+    "https://medlineplus.gov/druginfo/meds/a608025.html"
+  ],
+  [
+    "Bupropion: For people taking bupropion (Wellbutrin) for depression: A small number of children, teenagers, and young adults (up to 24 years of age) who took antidepressants ('mood elevators') such as bupropion during clinical studies became suicidal (thinking about harming or killing oneself or planning or trying to do so). Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. This risk should be considered and compared with the potential benefit in the treatment of depression, in deciding whether a child or teenager should take an antidepressant. Children younger than 18 years of age should not normally take bupropion, but in some cases, a doctor may decide that bupropion is the best medication to treat a child's condition. No matter what your age, before you take an antidepressant, you, your parent, or your caregiver should talk to your doctor about the risks and benefits of treating your condition with an antidepressant or with other treatments. You should also talk about the risks and benefits of not treating your condition. You should know that having depression or another mental illness greatly increases the risk that you will become suicidal, especially at the beginning of your treatment or any time that your dose is increased or decreased. This risk is higher if you or anyone in your family has or has ever had bipolar disorder or mania or has thought about or attempted suicide. Talk to your doctor about your condition, symptoms, and personal and family medical history. You and your doctor will decide what type of treatment is right for you. You should know that your mental health may change in unexpected ways when you take bupropion or other antidepressants even if you are an adult over age 24 or if you do not have a mental illness and you are taking bupropion to treat a different type of condition. You may become suicidal, especially at the beginning of your treatment and any time that your dose is increased or decreased. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own. For all patients taking bupropion: Your health care provider will want to see you often while you are taking bupropion, especially at the beginning of your treatment. Be sure to keep all appointments or office visits with your doctor. Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with bupropion and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You also can visit the Food and Drug Administration (FDA) website: http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm or the manufacturer's website to obtain the Medication Guide. Talk to your doctor about the risks and benefits of taking bupropion. Bupropion (Aplenzin, Wellbutrin, Wellbutrin SR, Wellbutrin XL) is used to treat depression. Bupropion (Aplenzin, Wellbutrin XL) is also used to treat seasonal affective disorder (SAD; episodes of depression that occur at the same time each year [usually in the fall and winter but rarely may occur in the spring or summer months]). Bupropion (Zyban) is used to help people stop smoking. Bupropion is in a class of medications called antidepressants. It works by increasing certain types of activity in the brain. Bupropion comes as a tablet and a sustained-release or extended-release (long-acting) tablet to take by mouth. The regular tablet (Wellbutrin) is usually taken three times a day, with doses at least 6 hours apart, or four times a day, with doses at least 4 hours apart. The sustained-release tablet (Wellbutrin SR, Zyban) is usually taken twice a day, with doses at least 8 hours apart. The extended-release tablet (Aplenzin, Wellbutrin XL) is usually taken once daily in the morning; doses of the extended-release tablet should be taken at least 24 hours apart. When bupropion is used to treat seasonal affective disorder, it is usually taken once a day in the morning beginning in the early fall, continuing through the winter, and stopping in the early spring. Sometimes a lower dose of bupropion is taken for 2 weeks before the medication is stopped. Take bupropion with food if the medication upsets your stomach. If you have trouble falling asleep or staying asleep, do not take bupropion too close to bedtime. Take bupropion at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take bupropion exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Swallow the sustained-release and extended-release tablets whole; do not split, chew, or crush them. Your doctor will probably start you on a low dose of bupropion and gradually increase your dose. It may take 4 weeks or longer before you feel the full benefit of bupropion. Continue to take bupropion even if you feel well. Do not stop taking bupropion without talking to your doctor. Your doctor may decrease your dose gradually. Bupropion is also sometimes used to treat episodes of depression in patients with bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods) and to treat attention deficit hyperactivity disorder (ADHD; more difficulty focusing, controlling actions, and remaining still or quiet than other people who are the same age). Talk to your doctor about the possible risks of using this medication for your condition. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Before taking bupropion, - tell your doctor and pharmacist if you are allergic to bupropion, any other medications, or any of the ingredients in bupropion tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients. - tell your doctor if you are taking a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate), or if you have stopped taking an MAO inhibitor within the past 14 days. Your doctor will probably tell you not to take bupropion. - do not take more than one product containing bupropion at a time. You could receive too much medication and experience severe side effects. - tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amantadine (Symmetrel); beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); cimetidine (Tagamet); clopidogrel (Plavix); cyclophosphamide (Cytoxan, Neosar); efavirenz (Sustiva, in Atripla); insulin or oral medications for diabetes; medications for irregular heartbeat such as flecainide (Tambocor) and propafenone (Rythmol); medications for mental illness such as haloperidol (Haldol), risperidone (Risperdal), and thioridazine (Mellaril); medications for seizures such as carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), and phenytoin (Dilantin); levodopa (Sinemet, Larodopa); lopinavir and ritonavir (Kaletra); nelfinavir (Viracept); nicotine patch; oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); orphenadrine (Norflex); other antidepressants such as citalopram (Celexa), desipramine (Norpramin), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), paroxetine (Paxil) and sertraline (Zoloft); ritonavir (Norvir); sedatives; sleeping pills; tamoxifen (Nolvadex, Soltamox); theophylline (Theobid, Theo-Dur, others); thiotepa; and ticlopidine (Ticlid). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor if you have or have ever had seizures, anorexia nervosa (an eating disorder) or bulimia (an eating disorder). Also tell your doctor if you drink large amounts of alcohol but expect to suddenly stop drinking or you take sedatives but expect to suddenly stop taking them. Your doctor will probably tell you not to take bupropion. - tell your doctor if you drink large amounts of alcohol, use street drugs, or overuse prescription medications and if you have ever had a heart attack; a head injury; a tumor in your brain or spine; high blood pressure; diabetes; or liver, kidney, or heart disease. - tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking bupropion, call your doctor. - you should know that bupropion may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. - talk to your doctor about the safe use of alcoholic beverages while you are taking bupropion. Alcohol can make the side effects from bupropion worse. - you should know that bupropion may cause an increase in your blood pressure. Your doctor may check your blood pressure before starting treatment and regularly while you are taking this medication, especially if you also are using nicotine replacement therapy. - you should know that bupropion may cause angle-closure glaucoma (a condition where the fluid is suddenly blocked and unable to flow out of the eye causing a quick, severe increase in eye pressure which may lead to a loss of vision). Talk to your doctor about having an eye examination before you start taking this medication. If you have nausea, eye pain, changes in vision, such as seeing colored rings around lights, and swelling or redness in or around the eye, call your doctor or get emergency medical treatment right away. - you should know that some people have reported symptoms such as changes in behavior, hostility, agitation, depressed mood, and suicidal thoughts (thinking about harming or killing oneself or planning or trying to do so) while taking bupropion to stop smoking. The role of bupropion in causing these mood changes is unclear since people who quit smoking with or without medication may experience changes in their mental health due to nicotine withdrawal. However, some of these symptoms occurred in people who were taking bupropion and continued to smoke. Some people had these symptoms when they began taking bupropion, and others developed them after several weeks of treatment or after stopping bupropion. These symptoms have occurred in people without a history of mental illness and have worsened in people who already had a mental illness. Tell your doctor if you have or have ever had depression, bipolar disorder (mood that changes from depressed to abnormally excited), schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions), or other mental illnesses. If you experience any of the following symptoms, stop taking bupropion (Zyban) and call your doctor immediately: suicidal thoughts or actions; new or worsening depression, anxiety, or panic attacks; agitation; restlessness; angry or violent behavior; acting dangerously; mania (frenzied, abnormally excited or irritated mood); abnormal thoughts or sensations; hallucinations (seeing things or hearing voices that do not exist); feeling that people are against you; feeling confused; or any other sudden or unusual changes in behavior. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own. Your doctor will monitor you closely until your symptoms get better. Unless your doctor tells you otherwise, continue your normal diet. Skip the missed dose and continue your regular dosing schedule. Always allow the full scheduled amount of time to pass between doses of bupropion. Do not take a double dose to make up for a missed one. Bupropion may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - drowsiness - anxiety - excitement - difficulty falling asleep or staying asleep - dry mouth - dizziness - headache - nausea - vomiting - stomach pain - uncontrollable shaking of a part of the body - loss of appetite - weight loss - constipation - excessive sweating - ringing in the ears - changes in your sense of taste - frequent urination - sore throat Some side effects can be serious. If you experience any of the following symptoms or those listed in the IMPORTANT WARNING or SPECIAL PRECAUTIONS sections, call your doctor immediately or get emergency medical treatment: - seizures - confusion - hallucinating (seeing things or hearing voices that do not exist) - irrational fears - muscle or joint pain - rapid, pounding, or irregular heartbeat If you experience any of the following symptoms, stop taking bupropion and call your doctor immediately or get emergency medical treatment: - fever - rash or blisters - itching - hives - swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs - hoarseness - difficulty breathing or swallowing - chest pain Bupropion may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light, excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of overdose may include the following: - seizure - hallucinating (seeing things or hearing voices that do not exist) - loss of consciousness - rapid or pounding heartbeat Keep all appointments with your doctor. Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking bupropion. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. If you are taking the extended-release tablet, you may notice something that looks like a tablet in your stool. This is just the empty tablet shell and does not mean that you did not get your complete dose of medication. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Aplenzin\u00ae - Budeprion\u00ae SR\u00b6 - Budeprion\u00ae XL\u00b6 - Buproban\u00ae\u00b6 - Forfivo\u00ae XL - Wellbutrin\u00ae - Wellbutrin\u00ae SR - Wellbutrin\u00ae XL - Zyban\u00ae",
+    "https://medlineplus.gov/druginfo/meds/a695033.html"
+  ],
+  [
+    "Low sex drive in women (Treatment): Most women benefit from a treatment approach aimed at the many causes behind this condition. Recommendations may include sex education, counseling, and sometimes medication and hormone therapy. Sex education and counseling Talking with a sex therapist or counselor skilled in addressing sexual concerns can help with low sex drive. Therapy often includes education about sexual response and techniques. Your therapist or counselor likely will provide recommendations for reading materials or couples' exercises. Couples counseling that addresses relationship issues may also help increase feelings of intimacy and desire. Medications Your doctor will want to review the medications you're already taking, to see if any of them tend to cause sexual side effects. For example, antidepressants such as paroxetine (Paxil) and fluoxetine (Prozac, Sarafem) may lower sex drive. Switching to bupropion (Wellbutrin SR, Wellbutrin XL) - a different type of antidepressant - usually improves sex drive and is sometimes prescribed for HSDD. Along with counseling, your doctor may prescribe a medication called flibanserin (Addyi) to boost your libido. It's the first Food and Drug Administration (FDA)-approved treatment for premenopausal women with HSDD. You take the pill once a day, before you go to bed. Side effects include low blood pressure, dizziness, nausea and fatigue. Drinking alcohol or taking fluconazole (Diflucan), a common medication to treat vaginal yeast infections, can make these side effects worse. Hormone therapy Dryness or shrinking of the vagina (vaginal atrophy) might make sex uncomfortable and, in turn, reduce your desire. Estrogen may help relieve vaginal atrophy symptoms. However, estrogen doesn't improve sexual functioning related to hypoactive sexual desire disorder. Estrogen is available in many forms, including pills, patches, sprays and gels. Smaller doses of estrogen are found in vaginal creams and a slow-releasing suppository or ring. Ask your doctor about the risks and benefits of each form. Male hormones, such as testosterone, also play an important role in female sexual function, even though testosterone occurs in much lower amounts in women. It's not approved by the FDA for sexual dysfunction in women, but sometimes it's prescribed off-label to help lift a lagging libido. However, the use of testosterone in women is controversial. Taking it can cause acne, excess body hair, and mood or personality changes.",
+    "https://www.mayoclinic.org/diseases-conditions/low-sex-drive-in-women/symptoms-causes/syc-20374554"
+  ],
+  [
+    "Nebivolol (What special precautions should I follow?): Before taking nebivolol, - tell your doctor and pharmacist if you are allergic to nebivolol, any other medications, or any of the ingredients in nebivolol tablets. Ask your pharmacist for a list of the ingredients. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Pacerone); beta blockers such as acebutolol (Sectral), atenolol (Tenormin, in Tenoretic), betaxolol, bisoprolol (Zebeta, in Ziac), carvedilol (Coreg), labetalol, metoprolol (Lopressor, Toprol XL), nadolol (Corgard, in Corzide), pindolol, propranolol (Inderal, InnoPran XL, in Inderide), sotalol (Betapace, Betapace AF, Sorine), timolol; bupropion (Aplenzin, Forfivo XL, Wellbutrin, Zyban); calcium channel blockers such as diltiazem (Cardizem, Dilacor, others) and verapamil (Calan, Covera, Isoptin, Verelan, in Tarka); chlorpheniramine (antihistamine in allergy and cold medications); cimetidine; clomipramine (Anafranil); clonidine (Catapres, Kapvay, in Clorpres); digoxin (Lanoxin); disopyramide (Norpace); duloxetine (Cymbalta); fluoxetine (Prozac, Sarafem, Selfemra, in Symbyax); haloperidol (Haldol); insulin; oral medications for diabetes; methadone (Dolophine, Methadose); paroxetine (Paxil); propafenone (Rythmol); quinidine; reserpine; ritonavir (Norvir, in Kaletra); and sildenafil (Revatio, Viagra). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor if you have a slow heart rate, heart or liver disease, or heart failure. Your doctor may tell you not to take nebivolol. - tell your doctor if you have or have ever had asthma or other lung diseases, diabetes, hyperthyroidism (an overactive thyroid gland), problems with blood circulation, kidney disease, severe allergies, or pheochromocytoma (a tumor that develops on a gland near the kidneys and may cause high blood pressure and fast heart rate). - tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking nebivolol, call your doctor. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking nebivolol. - you should know that nebivolol may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. - you should know that if you have allergic reactions to different substances, your reactions may be worse while you are using nebivolol, and your allergic reactions may not respond to the usual doses of injectable epinephrine.",
+    "https://medlineplus.gov/druginfo/meds/a608029.html"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Treatment): Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, tell your doctor - this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode. Light therapy In light therapy, also called phototherapy, you sit a few feet from a special light box so that you're exposed to bright light within the first hour of waking up each day. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood. Light therapy is one of the first line treatments for fall-onset SAD. It generally starts working in a few days to a few weeks and causes few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving SAD symptoms. Before you purchase a light box, talk with your doctor about the best one for you, and familiarize yourself with the variety of features and options so that you buy a high-quality product that's safe and effective. Also ask your doctor about how and when to use the light box. Medications Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe. An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants also may commonly be used to treat SAD. Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away. Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects. Psychotherapy Psychotherapy, also called talk therapy, is another option to treat SAD. A type of psychotherapy known as cognitive behavioral therapy can help you: - Identify and change negative thoughts and behaviors that may be making you feel worse - Learn healthy ways to cope with SAD, especially with reducing avoidance behavior and scheduling activities - Learn how to manage stress Mind-body connection Examples of mind-body techniques that some people may choose to try to help cope with SAD include: - Relaxation techniques such as yoga or tai chi - Meditation - Guided imagery - Music or art therapy",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Isavuconazonium (What special precautions should I follow?): Before taking isavuconazonium, - tell your doctor and pharmacist if you are allergic to isavuconazonium, fluconazole, itraconazole, ketoconazole, posaconazole, voriconazole, any other medications, or any of the ingredients in isavuconazonium capsules. Ask your pharmacist for a list of the ingredients. - tell your doctor if you are taking carbamazepine (Carbatrol, Tegretol), ketoconazole (Nizoral), phenobarbital, rifampin (Rifadin, Rifamate), ritonavir (Norvir, in Kaletra), or St. John's wort. Your doctor will probably tell you not to take isavuconazonium if you are taking one or more of these medications. - tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: atorvastatin (Lipitor), bupropion (Aplenzin, Forfivo XL, Wellbutrin, Zyban), cyclosporine (Gengraf, Neoral, Sandimmune), digoxin (Digitek, Lanoxicaps, Lanoxin), midazolam, mycophenolate mofetil (CellCept), sirolimus (Rapamune), or tacrolimus (Prograf). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with isavuconazonium, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. - tell your doctor if you or anyone in your family has or has ever had short QT syndrome (condition that increases the risk of irregular heartbeat, dizziness, fainting, or sudden death). Your doctor will probably tell you not to take isavuconazonium. - tell your doctor if you have or have ever had heart or liver problems. - tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking isavuconazonium, call your doctor.",
+    "https://medlineplus.gov/druginfo/meds/a615031.html"
+  ],
+  [
+    "Creating a family health history (How Will a Family History Help You and Your Family?): Share your family history with your provider and your child's provider. Your provider can use this information to help lower your risk for certain conditions or diseases. For example, your provider may recommend certain tests, such as: - Early screening tests if you are at a higher risk than the average person - Genetic tests before you get pregnant to see if you carry the gene for certain rare diseases Your provider also may suggest lifestyle changes to help reduce your risk. These may include: - Eating a healthy diet and getting regular exercise - Losing extra weight - Quitting smoking - Reducing how much alcohol you drink Having a family health history can also help protect your child's health: - You can help your child learn healthy diet and exercise habits. This can reduce the risk of diseases such as diabetes. - You and your child's provider can be alert to early signs of possible health problems that run in the family. This can help you and your provider take preventive action.",
+    "https://medlineplus.gov/ency/patientinstructions/000947.htm"
+  ],
+  [
+    "What are the treatments for Alcoholic liver disease?: LIFESTYLE CHANGES Some things you can do to help take care of your liver disease are: - Drink less alcohol. - Eat a healthy diet that is low in salt. - Get vaccinated for diseases such as influenza, hepatitis A and hepatitis B, and pneumococcal pneumonia. - Talk to your doctor about all medicines you take, including herbs and supplements and over-the-counter medicines. MEDICINES FROM YOUR DOCTOR - \"Water pills\" (diuretics) to get rid of fluid build-up - Vitamin K or blood products to prevent excess bleeding - Medicines for mental confusion - Antibiotics for infections OTHER TREATMENTS - Endoscopic treatments for enlarged veins in the throat (bleeding varices) - Removal of fluid from the abdomen (paracentesis) - Placement of a transjugular intrahepatic portosystemic shunt (TIPS) to repair blood flow in the liver When cirrhosis progresses to end-stage liver disease, a liver transplant may be needed.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000281.htm"
+  ],
+  [
+    "Creating a family health history: A family health history is a record of a family's health information. It includes your health information and that of your grandparents, aunts and uncles, parents, and siblings. Many health problems tend to run in families. Creating a family history can help you and your family be aware of possible health risks so you can take steps to reduce them. Many factors affect your health. These include your: - Genes - Diet and exercise habits - Environment Family members tend to share certain behaviors, genetic traits, and habits. Creating a family history can help you identify the specific risks that influence your health and your family's health. For example, having a family member with a condition such as diabetes may increase your risk of getting it. The risk is higher when: - More than one person in the family has the condition - A family member developed the condition 10 to 20 years earlier than most other people with the condition Serious diseases such as heart diseases, diabetes, cancer, and stroke are more likely to run in families. You can share this information with your health care provider who can suggest ways to reduce your risk. For a complete family medical history, you will need health information about your: - Parents - Grandparents - Aunts and Uncles - Cousins - Sisters and brothers You can ask for this information at family gatherings or reunions. You may need to explain: - Why you are gathering this information - How it will help you and others in your family You can even offer to share what you find with other family members. For a complete picture of each relative, find out: - Date of birth or approximate age - Where the person grew up and lived - Any health habits they are willing to share, such as smoking or drinking alcohol - Medical conditions, long-term (chronic) conditions such as asthma, and serious conditions such as cancer - Any history of mental illness - Age at which they developed the medical condition - Any learning problems or developmental disabilities - Birth defects - Problems with pregnancies or childbirth - The age and cause of death for relatives who are deceased - Which country/region your family originally came from (Ireland, Germany, Eastern Europe, Africa, and so on) Ask these same questions about any relatives who have died. Share your family history with your provider and your child's provider. Your provider can use this information to help lower your risk for certain conditions or diseases. For example, your provider may recommend certain tests, such as: - Early screening tests if you are at a higher risk than the average person - Genetic tests before you get pregnant to see if you carry the gene for certain rare diseases Your provider also may suggest lifestyle changes to help reduce your risk. These may include: - Eating a healthy diet and getting regular exercise - Losing extra weight - Quitting smoking - Reducing how much alcohol you drink Having a family health history can also help protect your child's health: - You can help your child learn healthy diet and exercise habits. This can reduce the risk of diseases such as diabetes. - You and your child's provider can be alert to early signs of possible health problems that run in the family. This can help you and your provider take preventive action. Everyone can benefit from a family history. Create your family history as soon as you can. It is especially useful when: - You are planning to have a baby - You already know that a certain condition runs in the family - You or your child develops signs of a disorder Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000947.htm"
+  ],
+  [
+    "Creating a family health history (When to Create Your Family History): Everyone can benefit from a family history. Create your family history as soon as you can. It is especially useful when: - You are planning to have a baby - You already know that a certain condition runs in the family - You or your child develops signs of a disorder",
+    "https://medlineplus.gov/ency/patientinstructions/000947.htm"
+  ],
+  [
+    "Creating a family health history (What Should Be Included in Your Family Health History?): For a complete family medical history, you will need health information about your: - Parents - Grandparents - Aunts and Uncles - Cousins - Sisters and brothers You can ask for this information at family gatherings or reunions. You may need to explain: - Why you are gathering this information - How it will help you and others in your family You can even offer to share what you find with other family members. For a complete picture of each relative, find out: - Date of birth or approximate age - Where the person grew up and lived - Any health habits they are willing to share, such as smoking or drinking alcohol - Medical conditions, long-term (chronic) conditions such as asthma, and serious conditions such as cancer - Any history of mental illness - Age at which they developed the medical condition - Any learning problems or developmental disabilities - Birth defects - Problems with pregnancies or childbirth - The age and cause of death for relatives who are deceased - Which country/region your family originally came from (Ireland, Germany, Eastern Europe, Africa, and so on) Ask these same questions about any relatives who have died.",
+    "https://medlineplus.gov/ency/patientinstructions/000947.htm"
+  ],
+  [
+    "Creating a family health history (What Is a Family History?): Many factors affect your health. These include your: - Genes - Diet and exercise habits - Environment Family members tend to share certain behaviors, genetic traits, and habits. Creating a family history can help you identify the specific risks that influence your health and your family's health. For example, having a family member with a condition such as diabetes may increase your risk of getting it. The risk is higher when: - More than one person in the family has the condition - A family member developed the condition 10 to 20 years earlier than most other people with the condition Serious diseases such as heart diseases, diabetes, cancer, and stroke are more likely to run in families. You can share this information with your health care provider who can suggest ways to reduce your risk.",
+    "https://medlineplus.gov/ency/patientinstructions/000947.htm"
+  ],
+  [
+    "Serum phenylalanine screening (How the Test is Performed): The test is usually done as part of routine screening tests before a newborn leaves the hospital. If the child is not born in a hospital, the test should be done in the first 48 to 72 hours of life. An area of the infant's skin, usually the heel, is cleaned with a germ killer and punctured with a sharp needle or a lancet. Three drops of blood are placed in 3 separate test circles on a piece of paper. Cotton or a bandage may be applied to the puncture site if it is still bleeding after the blood drops are taken. The test paper is taken to the laboratory, where it is mixed with a type of bacteria that needs phenylalanine to grow. Another substance that blocks phenylalanine from reacting with anything else is added. See also: Newborn screening tests",
+    "https://medlineplus.gov/ency/article/003362.htm"
+  ],
+  [
+    "Schistosomiasis (Diagnosis): Examination of stool and/or urine for ova is the primary method of diagnosis for schistosomiasis. The choice of sample depends on the suspected species, which may be determined by careful review of travel and residence history. The sensitivity of this testing can be limited by the intensity of infection. For best results, three samples should be collected on different days. [3]\u00a0 A blood sample can also be tested for evidence of infection. Blood tests are indicated for travelers or immigrants from endemic areas who have not been treated (or not treated appropriately) in the past. The most common tests detect antibodies to the adult worm. For accurate results, the blood sample tested should be collected at least 6 to 8 weeks after likely infection. Blood testing may not be appropriate for patients who have been repeatedly infected and treated in the past because antibodies can persist despite cure. In these patients, blood testing cannot distinguish between a past or current infection. A specific blood test has been developed for this population (which can detect an active infection based on the presence of\u00a0 schistosomal antigen), but this test is not commercially available in the United States and is currently being studied for its ability to detect mild infections.[3]",
+    "https://rarediseases.info.nih.gov/diseases/9687/schistosomiasis"
+  ],
+  [
+    "Serum phenylalanine screening (What Abnormal Results Mean): If the screening test results are abnormal, PKU is a possibility. Further testing will be done if the phenylalanine levels in your baby's blood are too high.",
+    "https://medlineplus.gov/ency/article/003362.htm"
+  ],
+  [
+    "Osteoporosis - overview (Treatment): Treatment for osteoporosis may involve: - Making lifestyle changes, such as changing your diet and exercise routine - Taking calcium and vitamin D supplements - Using medicines Medicines are used to strengthen bones when: - Osteoporosis has been diagnosed by a bone density study, whether or not you have a fracture and your fracture risk is high. - You have had a bone fracture and a bone density test shows that you have thin bones, but not osteoporosis. Medicines used to treat osteoporosis include: - Bisphosphonates (the main drugs used to prevent and treat osteoporosis in postmenopausal women) - Estrogen and estrogen receptor modulators - Teriparatide (a man-made form of a hormone your body makes that increases bone density) - Calcitonin (a man-made form of a hormone your body makes that increases bone density, used mainly to treat the sudden pain from a spine fracture) - Denusomab (lessens bone loss and increases bone density) Exercise plays a key role in preserving bone density in older adults. Some of the exercises recommended to reduce your chance of a fracture include: - Weight-bearing exercises such as walking, jogging, playing tennis, dancing - Free weights, weight machines, stretch bands - Balance exercises such as tai chi and yoga - Rowing machines Avoid any exercise that presents a risk of falling. Also, do not do high-impact exercises that can cause fractures in older adults. Follow these guidelines for getting enough calcium and vitamin D: - Adults under age 50 should have 1,000 mg of calcium and 400 to 800 International Units\u00a0(IU) of vitamin D a day. - Women ages 51 to 70 should have 1,200 mg of calcium and 400 to 800 IU of vitamin D a day. - Men ages 51 to 70 should have 1,000 mg of calcium and 400 to 800 IU of vitamin D a day. - Adults over age 70 should have 1,200 mg of calcium and 800 IU of vitamin D a day. - Your provider may recommend a calcium supplement. - Follow a diet that provides the proper amount of calcium and vitamin D. - Your provider may recommend higher doses of vitamin D if you have risk factors for osteoporosis or a low level of this vitamin. (Note: Some expert groups are not sure the benefits and safety of these amounts of vitamin D and calcium outweigh their risks. Be sure to discuss with your provider whether supplements are a good choice for you.) Stop unhealthy habits: - Quit smoking, if you smoke. - Limit your alcohol intake. Too much alcohol can damage your bones. This puts you at risk of falling and breaking a bone. It is important to prevent falls. These suggestions can help: - Do not take medicines\u00a0that make you drowsy and unsteady. If you must take them, be extra careful when you are up and about. For example, hold on to countertops or sturdy furniture to avoid falling. - Remove household hazards, such as throw rugs, to reduce the risk of falls. - Leave lights on at night so you can see better when walking around your house. - Install and use safety grab bars in the bathroom. - Install antislip flooring in bathtubs and showers. - Make sure your vision is good. Have your eyes checked once or twice a year by an eye doctor. - Wear shoes that fit well and have low heels. This includes slippers. Slippers that do not have heels can cause you to trip and fall. - Do not walk outdoors alone on icy days. Surgery to treat severe, disabling pain from spinal fractures due to osteoporosis include: - Kyphoplasty (a material is placed into a bone of your spine to restore the height of the vertebrae) - Spinal fusion (bones of your spine are joined together so they do not move against each other)",
+    "https://medlineplus.gov/ency/article/000360.htm"
+  ],
+  [
+    "What are the brand names of Calcium Carbonate?: - Alka-Mints - Calel-D - Calcid - Caltrate 600 - Chooz - Miralac - Os-Cal 500 - Rolaids - Titralac - Tums",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/meds/a601032.html"
+  ],
+  [
+    "Osteoporosis (Treatment): Treatment recommendations are often based on an estimate of your risk of breaking a bone in the next 10 years using information such as the bone density test. If the risk is not high, treatment might not include medication and might focus instead on modifying risk factors for bone loss and falls. For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include: - Alendronate (Fosamax) - Risedronate (Actonel, Atelvia) - Ibandronate (Boniva) - Zoledronic acid (Reclast) Side effects include nausea, abdominal pain and heartburn-like symptoms. These are less likely to occur if the medicine is taken properly. Intravenous forms of bisphosphonates don't cause stomach upset but can cause fever, headache and muscle aches for up to three days. And it may be easier to schedule a quarterly or yearly injection than to remember to take a weekly or monthly pill, but it can be more costly to do so. Using bisphosphonate therapy for more than five years has been linked to a very rare problem in which the middle of the thighbone cracks and might even break completely. Bisphosphonates also have the potential to affect the jawbone. Osteonecrosis of the jaw is a rare condition that can occur typically after a tooth extraction in which a section of jawbone fails to heal where the tooth was pulled. You should have a recent dental examination before starting bisphosphonates. Hormone-related therapy Estrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase the risk of blood clots, endometrial cancer, breast cancer and possibly heart disease. Therefore, estrogen is typically used for bone health in younger women or in women whose menopausal symptoms also require treatment. Raloxifene (Evista) mimics estrogen's beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen. Taking this drug may reduce the risk of some types of breast cancer. Hot flashes are a common side effect. Raloxifene also may increase your risk of blood clots. In men, osteoporosis may be linked with a gradual age-related decline in testosterone levels. Testosterone replacement therapy can help improve symptoms of low testosterone, but osteoporosis medications have been better studied in men to treat osteoporosis and thus are recommended alone or in addition to testosterone. Other osteoporosis medications If you can't tolerate the more common treatments for osteoporosis - or if they don't work well enough - your doctor might suggest trying: - Denosumab (Prolia). Compared with bisphosphonates, denosumab produces similar or better bone density results and reduces the chance of all types of fractures. Denosumab is delivered via a shot under the skin every six months. - Teriparatide (Forteo). This powerful drug is similar to parathyroid hormone and stimulates new bone growth. It's given by daily injection under the skin. After two years of treatment with teriparatide, another osteoporosis drug is taken to maintain the new bone growth.",
+    "https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968"
+  ],
+  [
+    "Juvenile osteoporosis (Summary): Juvenile osteoporosis is a condition of bone demineralization characterized by pain in the back and extremities, multiple fractures,\u00a0difficulty walking, and evidence of osteoporosis. [1] [2] Symptoms typically develop just before puberty. Osteoporosis is rare in children and adolescents. When it does occur, it is usually caused by an underlying medical disorder or by medications used to treat the disorder. This is called secondary osteoporosis. Sometimes, however, there is no identifiable cause of osteoporosis in a child. This is known as idiopathic osteoporosis. There is no established medical or surgical therapy for juvenile osteoporosis. In some cases, treatment is not necessary, as the condition resolves spontaneously. Early diagnosis may allow for preventive steps, including physical therapy , avoidance of weight-bearing activities, use of crutches and other supportive care. A well-balanced diet rich in calcium and vitamin D is also important. In severe, long-lasting cases, medications such as bisphosphonates may be used. In most cases, complete recovery of bone occurs. [2]",
+    "https://rarediseases.info.nih.gov/diseases/6760/juvenile-osteoporosis"
+  ],
+  [
+    "Osteoporosis (How is it treated?): Treatment for osteoporosis includes: - A balanced diet rich in calcium and vitamin D. - An exercise plan. - A healthy lifestyle. - Medicines to help prevent and treat the disease. Treatment for osteoporosis includes: - A balanced diet rich in calcium and vitamin D. - An exercise plan. - A healthy lifestyle. - Medicines to help prevent and treat the disease. Treatment for osteoporosis includes: - A balanced diet rich in calcium and vitamin D. - An exercise plan. - A healthy lifestyle. - Medicines to help prevent and treat the disease.",
+    "https://www.niams.nih.gov/health-topics/osteoporosis"
+  ],
+  [
+    "Osteoporosis: Osteoporosis is a disease of the bones that causes bones to become weak and break easily. Osteoporosis affects mostly older women, but prevention starts when you are younger. No matter your age, you can take steps to build bone mass and prevent bone loss. Broken bones from osteoporosis cause serious health problems and disability in older women. Osteoporosis is a disease of the bones. People with osteoporosis have bones that are weak and break easily. Osteoporosis is called a \"silent\" disease. You may have bone loss for many years without any symptoms until you break a bone. A broken bone can cause severe pain and disability. It can make it harder to do daily tasks on your own, such as walking. Bone loss is the amount of minerals, such as calcium, that your body absorbs (takes) from your bones. Bone loss can happen for several reasons. Some of the most common reasons include: Osteoporosis affects more women than men. Of the estimated 10 million Americans with osteoporosis, more than 8 million (or 80%) are women.1 Women are more likely to get osteoporosis because:2,3 Osteoporosis is most common in older women. In the United States, osteoporosis affects one in four women 65 or older.4 But younger women can get osteoporosis. And girls and women of all ages need to take steps to protect their bones. Yes. Your risk for osteoporosis is higher if you: You may not have any symptoms of osteoporosis until you break (fracture) a bone. A fracture can happen in any bone of the body. But fractures are most common in the hip, wrist, and spine (vertebrae). Vertebrae support your body, helping you to stand and sit up. See the picture. Osteoporosis in the vertebrae can cause serious problems for women. A fracture in this area can happen during day-to-day activities like climbing stairs, lifting objects, or bending forward when you have osteoporosis. Fractures in the vertebrae can cause it to collapse and bend forward. If this happens, you may get any or all of these symptoms: Osteoporosis is caused by bone loss. Most often, the reason for bone loss is very low levels of the hormone estrogen. Estrogen plays an important role in building and maintaining your bones. The most common cause of low estrogen levels is menopause. After menopause, your ovaries make very little estrogen. Also, your risk for developing osteoporosis is higher if you did not develop strong bones when you were young. Girls develop 90% of bone mass by age 18.14 If an eating disorder, poor eating, lack of physical activity, or another health problem prevents you from building bone mass early in life, you will have less bone mass to draw on later in life. Your doctor will do a bone density test to see how strong or weak your bones are. A common test is a central dual-energy x-ray absorptiometry (DXA). A DXA is a special type of x-ray of your bones. This test uses a very low amount of radiation. Your doctor may also use other screening tools to predict your risk of having low bone density or breaking a bone. Your doctor may suggest a bone density test for osteoporosis if:15 Screening for osteoporosis is covered by most insurance plans, including Medicare Part B. Depending on your insurance plan, you may be able to get screenings at no cost to you. If you have osteoporosis, your doctor may prescribe medicine to prevent more bone loss or build new bone mass. The most common types of medicine to prevent or treat osteoporosis include: Your doctor may also suggest getting more calcium, vitamin D, and physical activity. All medicines have risks. For example, menopausal hormone therapy may raise your risk of a blood clot, heart attack, stroke, breast cancer, or gallbladder disease. Talk to your doctor or nurse about the benefits and risks of all medicines. One of the best ways to prevent weak bones is to work on building strong ones. Building strong bones during childhood and the teen years is important to help prevent osteoporosis later. As you get older, your bones don't make new bone fast enough to keep up with the bone loss. And after menopause, bone loss happens even more quickly. But you can take steps to slow the natural bone loss with aging and to prevent your bones from becoming weak and brittle. Calcium is found in your bones and teeth. It helps build bones and keep them healthy. Your body also uses calcium to help your blood clot and your muscles contract. If you don't get enough calcium each day from the foods you eat, your body will take the calcium it needs from your bones, making your bones weak. You can get calcium through food or calcium supplements. How much calcium you need depends on your age:16 Pregnant or nursing women need the same amount of calcium as other women of the same age. You can get the calcium you need each day from food and/or calcium supplements. Calcium is found naturally in some foods:13 Calcium is sometimes added to certain foods, such as: When buying food with calcium, look at the Nutrition Facts label to see how much calcium is in the food. Food labels show the amount of calcium as a percentage of the Daily Value (written as %DV). Foods providing 20%DV or more are high sources of calcium, but foods with lower percentages (5% or more) are still good sources of calcium.16 See the example of calcium on a food label here. Learn how to read food labels on a package. If you have problems eating foods with dairy or don't like to eat them, try the following tips to make sure you get enough calcium: The answer depends on how much calcium you need each day and how much calcium you get from the foods you eat. It's best to get the calcium your body needs from food. But if you don't get enough calcium from the foods you eat, you may want to consider taking a calcium supplement. You can get calcium supplements at the grocery store or drug store. Talk with your doctor or nurse before taking calcium supplements to see which kind is best for you and how much you need to take. Vitamin D helps your body absorb calcium from the food you eat. Just eating foods with calcium is not enough. You also need to get enough vitamin D to help your body use the calcium it gets. Your skin makes vitamin D when it is exposed to sunlight. In general, you need 10 to 15 minutes of sunlight to the hands, arms, and face, two to three times a week to make enough vitamin D. The amount of time depends on how sensitive your skin is to light. It also depends on your use of sunscreen, your skin color, the season, the latitude (how far north or south) where you live, and the amount of pollution in the air. You can also get vitamin D from foods such as milk or from vitamin supplements. The vitamin D you get from food or supplements is measured in international units (IU). How much vitamin D you need each day depends on your age:17 Pregnant and breastfeeding women need the same amount of vitamin D (600 IU) as other women of the same age. Although it's hard to get enough vitamin D through food alone, foods with vitamin D include:13 Vitamin D is often added to certain foods, including: Regular physical activity of any type can help slow bone loss, improve muscle strength, and help your balance. But weight-bearing physical activity is especially important to build bone and help prevent bone loss. Weight-bearing physical activity is any activity in which your body works against gravity. Weight-bearing activities you can try include: Learn more about physical activity and how much you need in our Fitness and Nutrition section. Osteoporosis that is not treated can lead to serious bone breaks (fractures), especially in the hip and spine. One in three women is likely to have a fracture caused by osteoporosis in her lifetime.18 Fractures can happen after minor falls, stumbles, or bumps into furniture. Falls are the leading cause of injuries in older adults over age 65.19 Maybe. Your unborn baby needs calcium to help his or her bones grow. While in the womb, babies get calcium from what you eat (or the supplements you take). If you don't get enough calcium from food or supplements, your baby will use the calcium in your bones. You can lose some bone density during pregnancy, but any bone mass lost is usually restored after childbirth (or after breastfeeding). Also, during pregnancy, you absorb calcium from food and supplements (like prenatal vitamins) better than women who are not pregnant. Your body also makes more of the hormone estrogen, which protects bone. Yes, women often lose some bone density during breastfeeding. But this loss is temporary. Several studies have shown that when women lose bone mass during breastfeeding, they recover full bone density within six months after breastfeeding stops.20 For more information about osteoporosis, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:",
+    "https://www.womenshealth.gov/a-z-topics/osteoporosis"
+  ],
+  [
+    "Osteoporosis (Risk factors): A number of factors can increase the likelihood that you'll develop osteoporosis - including your age, race, lifestyle choices, and medical conditions and treatments. Some risk factors for osteoporosis are out of your control, including: - Your sex. Women are much more likely to develop osteoporosis than are men. - Age. The older you get, the greater your risk of osteoporosis. - Race. You're at greatest risk of osteoporosis if you're white or of Asian descent. - Family history. Having a parent or sibling with osteoporosis puts you at greater risk, especially if your mother or father experienced a hip fracture. - Body frame size. Men and women who have small body frames tend to have a higher risk because they may have less bone mass to draw from as they age. Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies. Examples include: - Sex hormones. Lowered sex hormone levels tend to weaken bone. The reduction of estrogen levels in women at menopause is one of the strongest risk factors for developing osteoporosis. Men experience a gradual reduction in testosterone levels as they age. Treatments for prostate cancer that reduce testosterone levels in men and treatments for breast cancer that reduce estrogen levels in women are likely to accelerate bone loss. - Thyroid problems. Too much thyroid hormone can cause bone loss. This can occur if your thyroid is overactive or if you take too much thyroid hormone medication to treat an underactive thyroid. - Other glands. Osteoporosis has also been associated with overactive parathyroid and adrenal glands. Osteoporosis is more likely to occur in people who have: - Low calcium intake. A lifelong lack of calcium plays a role in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss and an increased risk of fractures. - Eating disorders. Severely restricting food intake and being underweight weakens bone in both men and women. - Gastrointestinal surgery. Surgery to reduce the size of your stomach or to remove part of the intestine limits the amount of surface area available to absorb nutrients, including calcium. Steroids and other medications Long-term use of oral or injected corticosteroid medications, such as prednisone and cortisone, interferes with the bone-rebuilding process. Osteoporosis has also been associated with medications used to combat or prevent: - Seizures - Gastric reflux - Cancer - Transplant rejection The risk of osteoporosis is higher in people who have certain medical problems, including: - Celiac disease - Inflammatory bowel disease - Kidney or liver disease - Cancer - Lupus - Multiple myeloma - Rheumatoid arthritis Lifestyle choices Some bad habits can increase your risk of osteoporosis. Examples include: - Sedentary lifestyle. People who spend a lot of time sitting have a higher risk of osteoporosis than do those who are more active. Any weight-bearing exercise and activities that promote balance and good posture are beneficial for your bones, but walking, running, jumping, dancing and weightlifting seem particularly helpful. - Excessive alcohol consumption. Regular consumption of more than two alcoholic drinks a day increases your risk of osteoporosis. - Tobacco use. The exact role tobacco plays in osteoporosis isn't clearly understood, but it has been shown that tobacco use contributes to weak bones.",
+    "https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968"
+  ],
+  [
+    "Osteoporosis (What causes it?): Certain risk factors can cause bone loss and osteoporosis. Some of these things you cannot change and others you can. Risk factors you cannot change include: - Age. Your chances of getting osteoporosis increase as you get older. - Ethnicity. White and Asian women are more likely to get osteoporosis. African American and Hispanic women have a lower chance of getting the disease. - Family history. Osteoporosis tends to run in families. If a family member has osteoporosis or breaks a bone, there is a greater chance that you will too. - Gender. You have a greater chance of getting osteoporosis if you are a woman. Women have smaller bones than men and lose bone faster than men because of hormone changes that happen after menopause. Risk factors that you may be able to change include: - Alcohol. Too much alcohol can cause bone loss and broken bones. - Diet. Getting too little calcium and vitamin D can increase your chances of getting osteoporosis. - Hormones. Low estrogen levels due to missing menstrual periods or to menopause can cause osteoporosis in women. Low testosterone levels can bring on osteoporosis in men. - Medicines: Certain medicines can cause bone loss. - Physical activity. Not exercising and not being active for long periods of time can increase your chances of getting osteoporosis. Like muscles, bones become stronger, and stay stronger, with regular exercise. - Smoking. Cigarettes can keep your body from using the calcium in your diet. Also, women who smoke go through menopause earlier than those who don\u2019t smoke. - Body weight. Being too thin makes you more likely to get osteoporosis. Certain risk factors can cause bone loss and osteoporosis. Some of these things you cannot change and others you can. Risk factors you cannot change include: - Age. Your chances of getting osteoporosis increase as you get older. - Ethnicity. White and Asian women are more likely to get osteoporosis. African American and Hispanic women have a lower chance of getting the disease. - Family history. Osteoporosis tends to run in families. If a family member has osteoporosis or breaks a bone, there is a greater chance that you will too. - Gender. You have a greater chance of getting osteoporosis if you are a woman. Women have smaller bones than men and lose bone faster than men because of hormone changes that happen after menopause. Risk factors that you may be able to change include: - Alcohol. Too much alcohol can cause bone loss and broken bones. - Diet. Getting too little calcium and vitamin D can increase your chances of getting osteoporosis. - Hormones. Low estrogen levels due to missing menstrual periods or to menopause can cause osteoporosis in women. Low testosterone levels can bring on osteoporosis in men. - Medicines: Certain medicines can cause bone loss. - Physical activity. Not exercising and not being active for long periods of time can increase your chances of getting osteoporosis. Like muscles, bones become stronger, and stay stronger, with regular exercise. - Smoking. Cigarettes can keep your body from using the calcium in your diet. Also, women who smoke go through menopause earlier than those who don\u2019t smoke. - Body weight. Being too thin makes you more likely to get osteoporosis. Certain risk factors can cause bone loss and osteoporosis. Some of these things you cannot change and others you can. Risk factors you cannot change include: - Age. Your chances of getting osteoporosis increase as you get older. - Ethnicity. White and Asian women are more likely to get osteoporosis. African American and Hispanic women have a lower chance of getting the disease. - Family history. Osteoporosis tends to run in families. If a family member has osteoporosis or breaks a bone, there is a greater chance that you will too. - Gender. You have a greater chance of getting osteoporosis if you are a woman. Women have smaller bones than men and lose bone faster than men because of hormone changes that happen after menopause. Risk factors that you may be able to change include: - Alcohol. Too much alcohol can cause bone loss and broken bones. - Diet. Getting too little calcium and vitamin D can increase your chances of getting osteoporosis. - Hormones. Low estrogen levels due to missing menstrual periods or to menopause can cause osteoporosis in women. Low testosterone levels can bring on osteoporosis in men. - Medicines: Certain medicines can cause bone loss. - Physical activity. Not exercising and not being active for long periods of time can increase your chances of getting osteoporosis. Like muscles, bones become stronger, and stay stronger, with regular exercise. - Smoking. Cigarettes can keep your body from using the calcium in your diet. Also, women who smoke go through menopause earlier than those who don\u2019t smoke. - Body weight. Being too thin makes you more likely to get osteoporosis.",
+    "https://www.niams.nih.gov/health-topics/osteoporosis"
+  ],
+  [
+    "Laboratory Tests (Summary): Summary Laboratory tests check a sample of your blood, urine, or body tissues. A technician or your doctor analyzes the test samples to see if your results fall within the normal range. The tests use a range because what is normal differs from person to person. Many factors affect test results. These include - Your sex, age and race - What you eat and drink - Medicines you take - How well you followed pre-test instructions Your doctor may also compare your results to results from previous tests. Laboratory tests are often part of a routine checkup to look for changes in your health. They also help doctors diagnose medical conditions, plan or evaluate treatments, and monitor diseases.",
+    "#"
+  ],
+  [
+    "What are the genetic changes related to osteogenesis imperfecta?: Mutations in the COL1A1, COL1A2, CRTAP, and P3H1 genes cause osteogenesis imperfecta. Mutations in the COL1A1 and COL1A2 genes are responsible for more than 90 percent of all cases of osteogenesis imperfecta. These genes provide instructions for making proteins that are used to assemble type I collagen. This type of collagen is the most abundant protein in bone, skin, and other connective tissues that provide structure and strength to the body. Most of the mutations that cause osteogenesis imperfecta type I occur in the COL1A1 gene. These genetic changes reduce the amount of type I collagen produced in the body, which causes bones to be brittle and to fracture easily. The mutations responsible for most cases of osteogenesis imperfecta types II, III, and IV occur in either the COL1A1 or COL1A2 gene. These mutations typically alter the structure of type I collagen molecules. A defect in the structure of type I collagen weakens connective tissues, particularly bone, resulting in the characteristic features of osteogenesis imperfecta. Mutations in the CRTAP and P3H1 genes are responsible for rare, often severe cases of osteogenesis imperfecta. Cases caused by CRTAP mutations are usually classified as type VII; when P3H1 mutations underlie the condition, it is classified as type VIII. The proteins produced from these genes work together to process collagen into its mature form. Mutations in either gene disrupt the normal folding, assembly, and secretion of collagen molecules. These defects weaken connective tissues, leading to severe bone abnormalities and problems with growth. In cases of osteogenesis imperfecta without identified mutations in one of the genes described above, the cause of the disorder is unknown. These cases include osteogenesis imperfecta types V and VI. Researchers are working to identify additional genes that may be responsible for these conditions.",
+    "https://ghr.nlm.nih.gov/condition/osteogenesis-imperfecta"
+  ],
+  [
+    "VDRL test: The VDRL test is a screening test for syphilis. It measures substances (proteins), called antibodies, that your body may produce if you have come in contact with the bacteria that cause syphilis. The test is most often done using a blood sample. It can also be done using a sample of spinal fluid. This article discusses the blood test. A blood sample is needed. When the needle is inserted to draw blood, some people may feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or a slight bruise. This soon goes away. This test is used to screen for syphilis. The bacteria that cause syphilis is called Treponema pallidum. Your health care provider may order this test if you have signs and symptoms of a sexually transmitted illness (STI). Syphilis screening is a routine part of prenatal care during pregnancy. Several states also require screening for syphilis prior to obtaining a marriage license. This test is similar to the newer rapid plasma reagin (RPR) test. A negative test is normal. It means that no antibodies to syphilis have been seen in your blood sample. The screening test is most likely to be positive in the secondary and latent stages of syphilis. This test may give a false-negative result during early- and late-stage syphilis. This test must be confirmed with another blood test to make the diagnosis of syphilis. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results. A positive test result may mean you have syphilis. If the test is positive, the next step is to confirm the results with an FTA-ABS test, which is a more specific syphilis test. The VDRL test's ability to detect syphilis depends on the stage of the disease. The test's sensitivity to detect syphilis nears 100% during the middle stages; it is less sensitive during the earlier and later stages. Some conditions may cause a false-positive test, including: - HIV - Lyme disease - Certain types of pneumonia - Malaria - Systemic lupus erythematosus The body does not always produce antibodies specifically in response to the syphilis bacteria, so this test is not always accurate. Veins and arteries vary in size from one person to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others. Other risks associated with having blood drawn are slight, but may include: - Excessive bleeding - Fainting or feeling lightheaded - Hematoma (blood accumulating under the skin) - Infection (a slight risk any time the skin is broken) Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003515.htm"
+  ],
+  [
+    "VDRL test (Normal Results): A negative test is normal. It means that no antibodies to syphilis have been seen in your blood sample. The screening test is most likely to be positive in the secondary and latent stages of syphilis. This test may give a false-negative result during early- and late-stage syphilis. This test must be confirmed with another blood test to make the diagnosis of syphilis. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results.",
+    "https://medlineplus.gov/ency/article/003515.htm"
+  ],
+  [
+    "VDRL test (Why the Test is Performed): This test is used to screen for syphilis. The bacteria that cause syphilis is called Treponema pallidum. Your health care provider may order this test if you have signs and symptoms of a sexually transmitted illness (STI). Syphilis screening is a routine part of prenatal care during pregnancy. Several states also require screening for syphilis prior to obtaining a marriage license. This test is similar to the newer rapid plasma reagin (RPR) test.",
+    "https://medlineplus.gov/ency/article/003515.htm"
+  ],
+  [
+    "VDRL test (What Abnormal Results Mean): A positive test result may mean you have syphilis. If the test is positive, the next step is to confirm the results with an FTA-ABS test, which is a more specific syphilis test. The VDRL test's ability to detect syphilis depends on the stage of the disease. The test's sensitivity to detect syphilis nears 100% during the middle stages; it is less sensitive during the earlier and later stages. Some conditions may cause a false-positive test, including: - HIV - Lyme disease - Certain types of pneumonia - Malaria - Systemic lupus erythematosus The body does not always produce antibodies specifically in response to the syphilis bacteria, so this test is not always accurate.",
+    "https://medlineplus.gov/ency/article/003515.htm"
+  ],
+  [
+    "VDRL test (Risks): Veins and arteries vary in size from one person to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others. Other risks associated with having blood drawn are slight, but may include: - Excessive bleeding - Fainting or feeling lightheaded - Hematoma (blood accumulating under the skin) - Infection (a slight risk any time the skin is broken)",
+    "https://medlineplus.gov/ency/article/003515.htm"
+  ],
+  [
+    "VDRL test (How the Test will Feel): When the needle is inserted to draw blood, some people may feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or a slight bruise. This soon goes away.",
+    "https://medlineplus.gov/ency/article/003515.htm"
+  ],
+  [
+    "VDRL test (Review Date 9/10/2015): Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003515.htm"
+  ],
+  [
+    "Cervicitis: Cervicitis is swelling or inflamed tissue of the end of the uterus (cervix). Cervicitis is most often caused by an infection that is caught during sexual activity. Sexually transmitted infections (STIs) that can cause cervicitis include: - Chlamydia - Gonorrhea - Herpes virus (genital herpes) - Human papilloma virus (genital warts) - Trichomoniasis Other things that can cause cervicitis include: - A device inserted into the pelvic area such as a cervical cap, diaphragm, or pessary - Allergy to spermicides used for birth control - Allergy to latex in condoms - Exposure to a chemical Cervicitis is very common. It affects more than one half of all women at some point during their adult life. Risks include: - High-risk sexual behavior - History of STIs - Many sexual partners - Sex (intercourse) at an early age - Sexual partners who have engaged in high-risk sexual behavior or have had an STI Bacteria (such as staphylococcus and streptococcus) and too much growth of normal bacteria in the vagina (bacterial vaginosis) can also cause cervicitis. Symptoms include: - Abnormal vaginal bleeding that occurs after intercourse, after menopause, or between periods - Unusual vaginal discharge that does not go away: discharge may be gray, white or yellow in color - Painful sexual intercourse - Pain in the vagina - Pressure or heaviness in the pelvis Note: There may be no symptoms. Women who may be at risk for chlamydia should be tested for this infection, even if they do not have symptoms. A pelvic exam is done to look for: - Discharge from the cervix - Redness of the cervix - Swelling (inflammation) of the walls of the vagina Tests that may be done include: - Inspection of the discharge under a microscope (may show candidiasis, trichomoniasis, or bacterial vaginosis) - Pap test - Tests for gonorrhea or chlamydia Rarely, colposcopy and biopsy of the cervix is necessary. Antibiotics are used to treat chlamydia or gonorrhea. Drugs called antivirals may be used to treat herpes infections. Hormonal therapy (with estrogen or progesterone) may be used in women who have reached menopause. When these treatments have not worked or when cervicitis has been present for a long time, treatment may include: - Cryosurgery (freezing) - A small probe with an electric current running through it is used to burn or destroy the tissue - Laser therapy Most of the time, simple cervicitis usually heals with treatment if the cause is found and there is a treatment for that cause. Cervicitis may last for months to years. Cervicitis may lead to pain with intercourse (dyspareunia). Call your health care provider if you have symptoms of cervicitis. Things you can do to reduce your risk of developing cervicitis include: - Avoid irritants such as douches and deodorant tampons. - Make sure that any foreign objects you insert into your vagina (such as tampons) are properly placed. Be sure to follow instructions on how long to leave it inside, how often to change it, or how often to clean it. - Make sure your partner is free of any STI. You and your partner should not have sex with any other people. - Use a condom every time you have sex to lower your risk of getting an STI. Condoms are available for both men and women, but are most commonly worn by the man. A condom must be used properly every time. Updated by: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/001495.htm"
+  ],
+  [
+    "What are the treatments for Anemia of Inflammation and Chronic Disease?: Anemia of inflammation and chronic disease often is not treated separately from the condition with which it occurs. In general, health care providers focus on treating the underlying illness. If this treatment is successful, the anemia usually resolves. For example, antibiotics prescribed for infection and anti-inflammatory medications prescribed for rheumatoid arthritis or IBD can cause AI/ACD to disappear. However, AI/ACD is increasingly being viewed as a medical condition that merits direct treatment. For people with cancer or kidney disease who have low levels of EPO, a synthetic form of EPO may be prescribed. A health care provider usually injects EPO subcutaneouslyunder the skintwo or three times a week. A person may be taught how to inject the EPO at home. People on hemodialysis who cannot tolerate EPO shots may receive EPO intravenously during hemodialysis. If iron deficiency has a role in causing AI/ACD, a person may need iron supplements to raise hematocrit to a target level. Iron supplements can be taken by pill, subcutaneously, or intravenously during hemodialysis. People with kidney disease and AI/ACD may also be advised to take vitamin B12 and folic acid supplements. A person should talk with a health care provider before taking any supplements. More information is provided in the NIDDK health topic, Anemia in Kidney Disease and Dialysis.",
+    "http://www.niddk.nih.gov/health-information/health-topics/blood-diseases/anemia-inflammation-chronic-disease/Pages/fact-sheet.aspx"
+  ],
+  [
+    "Proctitis (Causes): There are many causes of proctitis. They can be grouped as follows: - Inflammatory bowel disease - Autoimmune disease - Harmful substances - Non-sexually transmitted infection - Sexually transmitted disease (STD) Proctitis caused by STD is common in people who have anal intercourse. STDs that can cause proctitis include gonorrhea, herpes, chlamydia, and lymphogranuloma venereum. Infections that are not sexually transmitted are less common than STD proctitis. One type of proctitis not from an STD is an infection in children that is caused by the same bacteria as strep throat. Autoimmune proctitis is linked to diseases such as ulcerative colitis or Crohn disease. If the inflammation is in the rectum only, it may come and go or move upward into the large intestine. Proctitis may also be caused by some medicines, radiotherapy or inserting harmful substances into the rectum. Risk factors include: - Autoimmune disorders, including inflammatory bowel disease - High-risk sexual practices, such as anal sex",
+    "https://medlineplus.gov/ency/article/001139.htm"
+  ],
+  [
+    "Prostatitis: Inflammation of the Prostate (Points to Remember): Prostatitis is a frequently painful condition that involves inflammation of the prostate and sometimes the areas around the prostate. Scientists have identified four types of prostatitis: chronic prostatitis/chronic pelvic pain syndrome acute bacterial prostatitis chronic bacterial prostatitis asymptomatic inflammatory prostatitis The prostate is a walnut-shaped gland that is part of the male reproductive system. The causes of prostatitis differ depending on the type. Prostatitis is the most common urinary tract problem for men younger than age 50 and the third most common urinary tract problem for men older than age 50. Each type of prostatitis has a range of symptoms that vary depending on the cause and may not be the same for every man. Many symptoms are similar to those of other conditions. The complications of prostatitis may include bacterial infection in the bloodstream prostatic abscess\u2014a pus-filled cavity in the prostate sexual dysfunction inflammation of reproductive organs near the prostate A health care provider diagnoses prostatitis based on a personal and family history a physical exam medical tests A health care provider may have to rule out other conditions that cause similar signs and symptoms before diagnosing prostatitis. Treatment depends on the type of prostatitis. Treatment for chronic prostatitis/chronic pelvic pain syndrome aims to decrease pain, discomfort, and inflammation. A urologist treats acute bacterial prostatitis with antibiotics. A urologist treats chronic bacterial prostatitis with antibiotics; however, treatment requires a longer course of therapy. Men cannot prevent prostatitis.Prostatitis is a frequently painful condition that involves inflammation of the prostate and sometimes the areas around the prostate.Scientists have identified four types of prostatitis: chronic prostatitis/chronic pelvic pain syndrome acute bacterial prostatitis chronic bacterial prostatitis asymptomatic inflammatory prostatitischronic prostatitis/chronic pelvic pain syndrome acute bacterial prostatitis chronic bacterial prostatitis asymptomatic inflammatory prostatitischronic prostatitis/chronic pelvic pain syndromeacute bacterial prostatitischronic bacterial prostatitisasymptomatic inflammatory prostatitisThe prostate is a walnut-shaped gland that is part of the male reproductive system.The causes of prostatitis differ depending on the type.Prostatitis is the most common urinary tract problem for men younger than age 50 and the third most common urinary tract problem for men older than age 50.Each type of prostatitis has a range of symptoms that vary depending on the cause and may not be the same for every man. Many symptoms are similar to those of other conditions.The complications of prostatitis may include bacterial infection in the bloodstream prostatic abscess\u2014a pus-filled cavity in the prostate sexual dysfunction inflammation of reproductive organs near the prostatebacterial infection in the bloodstream prostatic abscess\u2014a pus-filled cavity in the prostate sexual dysfunction inflammation of reproductive organs near the prostatebacterial infection in the bloodstreamprostatic abscess\u2014a pus-filled cavity in the prostatesexual dysfunctioninflammation of reproductive organs near the prostateA health care provider diagnoses prostatitis based on a personal and family history a physical exam medical testsa personal and family history a physical exam medical testsa personal and family historya physical exammedical testsA health care provider may have to rule out other conditions that cause similar signs and symptoms before diagnosing prostatitis.Treatment depends on the type of prostatitis.Treatment for chronic prostatitis/chronic pelvic pain syndrome aims to decrease pain, discomfort, and inflammation.A urologist treats acute bacterial prostatitis with antibiotics.A urologist treats chronic bacterial prostatitis with antibiotics; however, treatment requires a longer course of therapy.Men cannot prevent prostatitis.",
+    "https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostatitis-inflammation-prostate"
+  ],
+  [
+    "Diskitis: Diskitis is swelling (inflammation) and irritation of the space between the bones of the spine (intervertebral disk space). Diskitis is an uncommon condition. It is usually seen in children younger than 10 years and in adults around 50 years of age. Men are more affected than women. Diskitis can be caused by an infection from bacteria or a virus. It can also be caused by inflammation, such as from autoimmune diseases. Autoimmune diseases are conditions in which the immune system mistakenly attacks certain cells in the body. Disks in the neck and low back are most commonly affected. Symptoms may include any of the following: - Abdominal pain - Back pain - Difficulty getting up and standing - Increased curvature of the back - Irritability - Low-grade fever (102\u00b0F or 38.9\u00b0C) or lower - Sweating at night - Recent flu-like symptoms - Refusal to sit up, stand, or walk (younger child) - Stiffness in back The health care provider will perform a physical exam and ask about the symptoms. Tests that may be ordered include any of the following: - Bone scan - Complete blood count (CBC) - ESR\u00a0or\u00a0C-reactive protein to measure inflammation - MRI of the spine - X-ray of the spine The goal is to treat the cause of the inflammation or infection and reduce pain. Treatment may involve any of the following: - Antibiotics if the infection is caused by bacteria - Anti-inflammatory medicines if the cause is an autoimmune disease - Pain medicines such as NSAIDs - Bed rest or a brace to keep the back from moving - Surgery if other methods don't work Children with an infection should fully recover after treatment. In rare cases, chronic back pain persists. In cases of autoimmune disease, the outcome depends on the condition. These are often chronic illnesses. Complications may include: - Persistent back pain (rare) - Side effects of medicines Call your provider if your child has back pain that does not go away,\u00a0or problems with standing and walking that seem unusual for his or her age. Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000993.htm"
+  ],
+  [
+    "Cervicitis (Possible Complications): Cervicitis may last for months to years. Cervicitis may lead to pain with intercourse (dyspareunia).",
+    "https://medlineplus.gov/ency/article/001495.htm"
+  ],
+  [
+    "Cervicitis (When to Contact a Medical Professional): Call your health care provider if you have symptoms of cervicitis.",
+    "https://medlineplus.gov/ency/article/001495.htm"
+  ],
+  [
+    "Etiology: Etiology describes the cause or causes of a disease. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002356.htm"
+  ],
+  [
+    "Do you have information about Developmental milestones record - 4 months: Summary : Typical 4-month-old infants are expected to develop certain physical and mental skills. These skills are called milestones. Information : All children develop a little differently. If you are concerned about your child's development, talk to your child's health care provider. PHYSICAL AND MOTOR SKILLS The typical 4-month-old baby should: - Slow in weight gain to about 20 grams (almost two thirds of an ounce) per day - Weigh 2 times more than their birth weight - Have almost no head droop while in a sitting position - Be able to sit straight if propped up - Raise head 90 degrees when placed on stomach - Be able to roll from front to back - Hold and let go of an object - Play with a rattle when it's placed in their hands, but won't be able to pick it up if dropped - Be able to grasp a rattle with both hands - Be able to place objects in the mouth - Sleep 9 to 10 hours at night with 2 naps during the day (total of 14 to 16 hours per day) SENSORY AND COGNITIVE SKILLS A 4-month-old baby is expected to: - Have well-established close vision - Increase eye contact with parents and others - Have beginning hand-eye coordination - Be able to coo - Be able to laugh out loud - Anticipate feeding when able to see a bottle (if bottle-fed) - Begin to show memory - Demand attention by fussing - Recognize parent's voice or touch PLAY You can encourage development through play: - Place the baby in front of a mirror. - Provide bright-colored toys to hold. - Repeat sounds the infant makes. - Help the infant roll over. - Use an infant swing at the park if the baby has head control. - Play on the stomach (tummy time)",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/002007.htm"
+  ],
+  [
+    "Chromosome 20 trisomy (Summary): Chromosome 20 trisomy , (also called trisomy 20)\u00a0is a condition in which a fetus or individual has an extra full or partial copy of chromosome 20 in some or all\u00a0of of his/her cells .\u00a0An extra full copy of\u00a0chromosome 20 in all of a person's cells is\u00a0rare, and almost all fetuses with this do not survive past the first trimester of\u00a0pregnancy. [1] The presence of\u00a0an extra copy\u00a0of only part of chromosome 20 is called partial trisomy 20; and an extra copy of chromosome 20 in only some of a person's cells is called mosaic trisomy 20. Mosaic trisomy 20 is the most common type of chromosome 20 trisomy and is one of the more common chromosomal abnormalities found during prenatal diagnostic testing. Studies have shown that\u00a0the child\u00a0is normal in the\u00a0vast majority of prenatally diagnosed individuals. However, features that have been reported\u00a0include spinal abnormalities (including spinal stenosis, vertebral fusion, and kyphosis), hypotonia \u00a0(decreased muscle tone), lifelong constipation, sloped shoulders, and significant learning disabilities despite normal intelligence. [2] Trisomy 20\u00a0usually results from an error that occurs when an egg or sperm cell develops (before fertilization); mosaic trisomy 20\u00a0usually results from errors in cell division soon after fertilization. [3]",
+    "https://rarediseases.info.nih.gov/diseases/5332/chromosome-20-trisomy"
+  ],
+  [
+    "Trisomy 17 mosaicism: Trisomy 17 mosaicism is a chromosomal abnormality in which there are three copies of chromosome 17 in some cells of the body, rather than the usual two copies. Trisomy 17 mosaicism is one of the rarest trisomies in humans. It is often incorrectly called trisomy 17 (also referred to as full trisomy 17), which is when three copies of chromosome 17 are present in all cells of the body. Full trisomy 17 has never been reported in a living individual in the medical literature. [1] Few cases of trisomy 17 mosaicism have been described, most having been detected during pregnancy through a test called amniocentesis . [2] Only a few individuals have had a confirmed diagnosis of trisomy 17 mosaicism after birth. Because the proportion and location of cells with trisomy 17 differs from case to case, the presence and severity of signs and symptoms may vary significantly from person to person. While trisomy 17 mosaicism is rare, there are a few cases that have been reported in the medical literature as well as a few reviews. Most cases of trisomy 17 mosaicism reported in the medical literature that were detected during pregnancy via chorionic villus sampling\u00a0(CVS) or amniocentesis \u00a0have not been confirmed in the baby after birth. In those cases, the babies appeared to be in good health at birth and it is suspected that in those cases, trisomy 17 was confined to extra-embryonic ( placental) cells and tissues . [3] [4] Some cases of trisomy 17 mosaicism detected during pregnancy have been confirmed in the baby after birth. The symptoms reported include: developmental delays, body asymmetry, slow growth, and cerebellar hypoplasia. Again, signs and symptoms may vary in these individuals depending on which cells and how many cells contain an extra chromosome 17. [3] [4] Trisomy 17 mosaicism occurs due to a random event during the formation of the reproductive cells (egg and sperm) or after fertilization has taken place. An error in cell division (called nondisjunction ) may cause some eggs or sperm to have an abnormal number of chromosomes . If an egg or sperm with an extra chromosome 17 contributes to the genetic makeup of an embryo, the embryo will have an extra copy of chromosome 17 in each cell. As the embryo grows and divides, an attempt may be made to correct the mistake by eliminating one extra chromosome 17. In individuals with trisomy 17 mosaicism, this attempt may be partly successful, leaving some cells with an extra chromosome 17 and some cells with the extra chromosome deleted (the usual chromosome number). This correction process is called trisomy rescue. In other cases, the egg and sperm may have a normal number of chromosomes, but an error of cell division (nondisjunction) occurs when the fertilized egg is growing and dividing. If an error occurs during one of the divisions, it can cause some cells to have an abnormal number of chromosomes. In people affected by trisomy 17 mosaicism, some of the body's cells have the usual two copies of chromosome 17, and other cells have three copies of this chromosome (trisomy). The percentage of cells with trisomy 17 and which parts of the body are affected vary from person to person. This leads to variability in the range and severity of symptoms. MedlinePlus, a resource through the National Library of Medicine, offers general information on mosaicism.",
+    "https://rarediseases.info.nih.gov/diseases/5317/trisomy-17-mosaicism"
+  ],
+  [
+    "Trisomy 13: Trisomy 13 is a type of chromosome disorder characterized by having 3 copies of chromosome 13 in cells of the body, instead of the usual 2 copies. In some affected people, only a portion of cells contains the extra chromosome 13 (called mosaic trisomy 13), whereas other cells contain the normal chromosome pair. [1] [2] [3] Trisomy 13 causes severe intellectual disability and many physical abnormalities, such as congenital heart defects ; brain or spinal cord abnormalities; very small or poorly developed eyes (microphthalmia); extra fingers or toes; cleft lip with or without cleft palate; and weak muscle tone ( hypotonia ). Most cases are not inherited and result from a random error during the formation of eggs or sperm in healthy parents. [2] Due to various life-threatening medical problems, many infants with trisomy 13 do not survive past the first days or weeks of life. [2] Trisomy 13 is associated with severe intellectual disability and physical abnormalities in many parts of the body. People with this condition often have congenital heart defects , brain or spinal cord abnormalities, very small or poorly developed eyes (microphthalmia), extra fingers and/or toes ( polydactyly ), cleft lip or palate, and decreased muscle tone ( hypotonia ). [2] Many infants with trisomy 13 fail to grow and gain weight at the expected rate (failure to thrive); have severe feeding difficulties; and episodes in which there is temporary cessation of spontaneous breathing (apnea). [1] Other features or trisomy 13 may include: [3] Clenched hands (with outer fingers on top of the inner fingers) Close-set eyes Hernias: umbilical hernia, inguinal hernia A hole, split, or cleft in the iris of the eye (coloboma) Low-set ears Scalp defects such as missing skin Seizures Single palmar crease Skeletal (limb) abnormalities Small head ( microcephaly ) Small lower jaw ( micrognathia ) Undescended testicle (cryptorchidism) The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Abnormality of pelvic girdle bone morphology Very frequent Abnormality of the fontanelles or cranial sutures Very frequent Anophthalmia Very frequent Atrial septal defect Very frequent Bilateral single transverse palmar creases Very frequent Cognitive impairment Very frequent Cystic hygroma Very frequent Hydrops fetalis Very frequent Hypotelorism Very frequent Intellectual disability, severe Very frequent Intrauterine growth retardation Very frequent Low-set ears Very frequent Malar flattening Very frequent Median cleft lip Very frequent Microphthalmia Very frequent Muscular hypotonia Very frequent Neurological speech impairment Very frequent Patent ductus arteriosus Very frequent Postaxial hand polydactyly Very frequent Seizures Very frequent Severe global developmental delay Very frequent Ventricular septal defect Very frequent Abnormal lung lobation Frequent Abnormality of female internal genitalia Frequent Abnormality of the antihelix Frequent Abnormality of the dentition Frequent Abnormality of the eyelashes Frequent Abnormality of the helix Frequent Abnormality of the middle ear Frequent Abnormality of the retinal vasculature Frequent Abnormality of the ribs Frequent Abnormality of the ureter Frequent Abnormality of vision Frequent Aplasia/Hypoplasia of the iris Frequent Arnold-Chiari malformation Frequent Calvarial skull defect Frequent Capillary hemangiomas Frequent Cataract Frequent Cryptorchidism Frequent Deeply set eye Frequent Displacement of the external urethral meatus Frequent Hernia Frequent High, narrow palate Frequent Hydronephrosis Frequent Iris coloboma Frequent Kyphosis Frequent Long philtrum Frequent Multiple renal cysts Frequent Narrow chest Frequent Optic atrophy Frequent Preauricular pit Frequent Preauricular skin tag Frequent Scoliosis Frequent Sensorineural hearing impairment Frequent View complete list of signs and symptoms... Most cases of trisomy 13 are caused by random events during the formation of eggs or sperm in healthy parents (prior to conception). Trisomy 13 is typically due to having three full copies of chromosome 13 in each cell in the body, instead of the usual two copies. This is referred to as complete trisomy 13 or full trisomy 13. The extra genetic material present disrupts the normal course of development, causing the characteristic features of the disorder. Trisomy 13 can also occur when part of chromosome 13 becomes attached (translocated) to another chromosome during the formation of eggs or sperm, or very early in fetal development. This is referred to as translocation trisomy 13. People with this type of trisomy 13 have the normal two normal copies of chromosome 13, plus an extra copy of chromosome 13 that is attached to another chromosome. Translocation trisomy 13 can be inherited . Approximately 20% of cases of trisomy 13 are caused by translocation trisomy 13.\u00a0 In rare cases, only part of chromosome 13 is present in three copies in each cell (rather than the full chromosome); this is called partial trisomy 13. In other rare cases, a person has an extra copy of chromosome 13 in only some of the body's cells; this is called mosaic trisomy 13. The severity of mosaic trisomy 13 depends on the type and proportion of cells that have the extra chromosome. [4] [5] Most cases of trisomy 13 are not inherited and result from random events during the formation of eggs and sperm in healthy parents. An error in cell division called nondisjunction results in an egg or sperm cell with an abnormal number of chromosomes . For example, an egg or sperm cell may gain an extra copy of chromosome 13. If one of these contributes to the genetic makeup of a child, the child will have an extra chromosome 13 in each cell of the body. [4] For a woman who has never had a pregnancy or child with a trisomy, the risk to have a pregnancy with a chromosome abnormality would typically be her age-related risk - the risk increases with maternal age. For a woman who has had an affected pregnancy or child in the past, the recurrence risk is generally quoted as about 1% or the maternal age-related risk - whichever is higher at the time of pregnancy. On the other hand, translocation trisomy 13 can be inherited. An unaffected parent can have a rearrangement of genetic material between chromosome 13 and another chromosome. These rearrangements are called balanced translocations because there is no extra or missing genetic material from chromosome 13. A person with a balanced translocation involving chromosome 13 has an increased chance of passing extra material from chromosome 13 to his/her children. [4] People interested in learning about their personal risk to have a child with a chromosome abnormality should speak with their health care provider or a genetics professional. While most cases of trisomy 13 occur randomly, a few cases are due to the presence of a translocation involving chromosome 13 in a parent. Parents who are at risk to have a translocation due to their family history can have a blood test called a karyotype , which can determine if a translocation is present. Prenatal testing or screening (such as maternal blood screening, fetal ultrasound, chorionic villus sampling, or amniocentesis ) is also available to determine if a current pregnancy is at risk for, or is affected by, trisomy 13 or other chromosome disorders . People with a family history of trisomy 13 who are interested in learning about genetic screening or testing for themselves or family members are encouraged speak with a genetic counselor or other genetics professional. Treatment for trisomy 13 depends on the affected person's signs and symptoms, and is generally symptomatic and supportive. [3] Surgeries are generally withheld for the first few months of life because of the high mortality rate associated with trisomy 13. Parents and medical personnel must carefully weigh decisions about extraordinary life-prolonging measures against the severity of the neurological and physical defects that are present and the likelihood of post-surgical recovery or prolonged survival. [6] Trisomy 13 involves multiple abnormalities, many of which are life-threatening. More than 80% of children with trisomy 13 do not survive past the first month of life. For those that do survive, complications are common and may include: [3] Breathing difficulty or lack of breathing (apnea) Deafness Feeding problems Heart failure Seizures Vision problems People with trisomy 13 who survive infancy have severe intellectual disability and developmental delays, and are at increased risk for cancers .[6]",
+    "https://rarediseases.info.nih.gov/diseases/7341/trisomy-13"
+  ],
+  [
+    "Trisomy 17 mosaicism (Symptoms): While trisomy 17 mosaicism is rare, there are a few cases that have been reported in the medical literature as well as a few reviews. Most cases of trisomy 17 mosaicism reported in the medical literature that were detected during pregnancy via chorionic villus sampling\u00a0(CVS) or amniocentesis \u00a0have not been confirmed in the baby after birth. In those cases, the babies appeared to be in good health at birth and it is suspected that in those cases, trisomy 17 was confined to extra-embryonic ( placental) cells and tissues . [3] [4] Some cases of trisomy 17 mosaicism detected during pregnancy have been confirmed in the baby after birth. The symptoms reported include: developmental delays, body asymmetry, slow growth, and cerebellar hypoplasia. Again, signs and symptoms may vary in these individuals depending on which cells and how many cells contain an extra chromosome 17. [3] [4]",
+    "https://rarediseases.info.nih.gov/diseases/5317/trisomy-17-mosaicism"
+  ],
+  [
+    "Trisomy 2 mosaicism: Trisomy 2 mosaicism is a rare chromosome disorder characterized by having an extra copy of chromosome 2 (three copies in total) in a proportion of a person\u2019s cells . Many cases of trisomy 2 mosaicism result in miscarriage during pregnancy. In infants born with trisomy 2 mosaicism, signs and symptoms vary widely and may include any of various birth defects . [1] The severity and specific symptoms present depend on the level of mosaicism (the proportion of cells affected) and the location or type of affected cells in the body. Trisomy 2 mosaicism is not inherited . It is caused by a random error in cell division during early development of the embryo. When trisomy 2 mosaicism is detected during early pregnancy with\u00a0 chorionic villus sampling\u00a0( CVS ), the affected cells may be confined only to the placenta, and not present in the fetus.\u00a0 Amniocentesis \u00a0is typically recommended to confirm this, and monitoring is still warranted due to an increased risk for intrauterine growth restriction, low amniotic fluid level ( oligohydramnios), or other complications including stillbirth. [2] [3] The severity and specific symptoms associated with trisomy 2 mosaicism can vary considerably and depend on the level of mosaicism (proportion of affected cells ) and the location and type of cells affected. During pregnancy (prenatally), trisomy 2 mosaicism may be associated with various findings, such as: elevated maternal serum alpha-fetoprotein (MSAFP) abnormal results of other maternal serum screening tests ultrasound findings such as intrauterine growth restriction;\u00a0low amniotic fluid level (oligohydramnios);\u00a0 congenital heart defects ;\u00a0enlargement of fluid-filled structures in the brain (ventriculomegaly);\u00a0spina bifida;\u00a0and swelling of the kidneys (hydronephrosis)[3] Signs and symptoms that have been reported in live births with trisomy 2 mosaicism include: craniofacial abnormalities such as a flattened appearance of the middle part of the face (midface hypoplasia); absence of one or both eyes (anophthalmia) or abnormally small eyes (microphthalmia); cleft lip and palate; wide-set eyes (hypertelorism); and small head size ( microcephaly ) growth and motor delay intellectual disability congenital heart defects neural tube defects diaphragmatic hernia inguinal hernia radioulnar hypoplasia rocker-bottom feet (feet with a rounded bottom, resembling the bottom of a rocking chair) abnormal development of the lower end of the spine (caudal dysgenesis) portal fibrosis intestinal malrotation (twisting of the intestines) Hirschsprung disease hypomelanosis of Ito polydactyly deafness undescended testes face and body asymmetry clubfoot lack of sacrum[3][4] Because few cases have been reported in the literature and the level of mosaicism differs among affected fetuses and individuals, it is not possible to predict how a person may be affected by trisomy 2 mosaicism. The long-term outlook ( prognosis ) associated with trisomy 2 mosaicism is difficult to predict and depends on many factors. These factors may include the level of mosaicism (proportion of cells affected); the location and type of the cells affected (which cannot be predicted); the nature of abnormal ultrasound findings (if detected); and potential pregnancy-related or health-related complications that may arise before or after birth. A range of outcomes have been reported, including miscarriage, stillbirth, pregnancy termination after abnormal ultrasound findings or prenatal diagnosis , favorable pregnancy outcome, apparently healthy newborn, and any of many mild to severe birth defects . [3] [5] Few cases of trisomy 2 mosaicism have been reported in livebirths. [4] When trisomy 2 mosaicism is diagnosed (in a fetus or child), it can be difficult to estimate the true level of mosaicism because levels can differ depending on the nature of the sample tested. Different levels of mosaicism may be found in the same pregnancy using various lab techniques in samples obtained by chorionic villus sampling, amniocentesis (both uncultured and cultured cells), and cord blood sampling. [5] Likewise, different levels of mosaicism may be found in a liveborn when samples are obtained for urinary analysis, blood analysis, or tissue analysis. For example, a blood test can only determine the level of mosaicism in the blood cells. During pregnancy, because it is not possible to predict the outcome for all fetuses diagnosed with trisomy 2 mosaicism, health care professionals may recommend a variety of additional tests to obtain as much information as possible about how a fetus is developing. Tests that may be recommended may include analysis of other types of prenatal samples, more detailed ultrasound exams, fetal echocardiography to evaluate the fetal heart, and/or fetal MRI . Prognosis information in each individual case may be based on results of these tests and the outlook associated with specific findings.",
+    "https://rarediseases.info.nih.gov/diseases/5331/trisomy-2-mosaicism"
+  ],
+  [
+    "Trisomy 13 (Inheritance): Most cases of trisomy 13 are not inherited and result from random events during the formation of eggs and sperm in healthy parents. An error in cell division called nondisjunction results in an egg or sperm cell with an abnormal number of chromosomes . For example, an egg or sperm cell may gain an extra copy of chromosome 13. If one of these contributes to the genetic makeup of a child, the child will have an extra chromosome 13 in each cell of the body. [4] For a woman who has never had a pregnancy or child with a trisomy, the risk to have a pregnancy with a chromosome abnormality would typically be her age-related risk - the risk increases with maternal age. For a woman who has had an affected pregnancy or child in the past, the recurrence risk is generally quoted as about 1% or the maternal age-related risk - whichever is higher at the time of pregnancy. On the other hand, translocation trisomy 13 can be inherited. An unaffected parent can have a rearrangement of genetic material between chromosome 13 and another chromosome. These rearrangements are called balanced translocations because there is no extra or missing genetic material from chromosome 13. A person with a balanced translocation involving chromosome 13 has an increased chance of passing extra material from chromosome 13 to his/her children. [4] People interested in learning about their personal risk to have a child with a chromosome abnormality should speak with their health care provider or a genetics professional.",
+    "https://rarediseases.info.nih.gov/diseases/7341/trisomy-13"
+  ],
+  [
+    "How to Prevent High Blood Pressure (Summary): Summary About 1 in 3 adults in the U.S. has high blood pressure, or hypertension, but many don't realize it. High blood pressure usually has no warning signs, yet it can lead to life-threatening conditions like heart attack or stroke. The good news is that you can often prevent or treat high blood pressure. Early diagnosis and simple, healthy changes can keep high blood pressure from seriously damaging your health. What is blood pressure? Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is called diastolic pressure. Your blood pressure reading uses these two numbers. Usually the systolic number comes before or above the diastolic number. How do I know if my blood pressure is high? High blood pressure usually has no symptoms. So the only way to find out if you have high blood pressure is to get regular blood pressure checks from your health care provider. Your provider will use a gauge, a stethoscope or electronic sensor, and a blood pressure cuff. For most adults, blood pressure readings will be in one of four categories: Normal blood pressure means - Your systolic pressure is less than 120 AND - Your diastolic pressure is less than 80 Prehypertension means - Your systolic pressure is between 120-139 OR - Your diastolic pressure is between 80-89 Stage 1 high blood pressure means - Your systolic pressure is between 140-159 OR - Your diastolic pressure is between 90-99 Stage 2 high blood pressure means - Your systolic pressure is 160 or higher OR - Your diastolic pressure is 100 or higher For children and teens, the health care provider compares the blood pressure reading to what is normal for other kids who are the same age, height, and gender. People with diabetes or chronic kidney disease should keep their blood pressure below 130/80. Why do I need to worry about prehypertension and high blood pressure? Prehypertension means you're likely to end up with high blood pressure, unless you take steps to prevent it. When your blood pressure stays high over time, it causes the heart to pump harder and work overtime, possibly leading to serious health problems such as heart attack, stroke, heart failure, and kidney failure. What are the different types of high blood pressure? There are two main types of high blood pressure: primary and secondary high blood pressure. - Primary, or essential, high blood pressure is the most common type of high blood pressure. For most people who get this kind of blood pressure, it develops over time as you get older. - Secondary high blood pressure is caused by another medical condition or use of certain medicines. It usually gets better after you treat the cause or stop taking the medicines that are causing it. Who is at risk for high blood pressure? Anyone can develop high blood pressure, but there are certain factors that can increase your risk: - Age - Blood pressure tends to rise with age - Race/Ethnicity - High blood pressure is more common in African American adults - Weight - People who are overweight or obese are more likely to develop prehypertension or high blood pressure - Gender - Before age 55, men are more likely than women to develop high blood pressure. After age 55, women are more likely than men to develop it. - Lifestyle - Certain lifestyle habits can raise your risk for high blood pressure, such as eating too much sodium or not enough potassium, lack of exercise, drinking too much alcohol, and smoking. - Family history - A family history of high blood pressure raises the risk of developing prehypertension or high blood pressure How can I prevent high blood pressure? You can help prevent high blood pressure by having a healthy lifestyle. This means - Eating a healthy diet. To help manage your blood pressure, you should limit the amount of sodium (salt) that you eat, and increase the amount of potassium in your diet. It is also important to eat foods that are lower in fat, as well as plenty of fruits, vegetables, and whole grains. The DASH diet is an example of an eating plan that can help you to lower your blood pressure. - Getting regular exercise. Exercise can help you maintain a healthy weight and lower your blood pressure. You should try to get moderate-intensity aerobic exercise at least 2 and a half hours per week, or vigorous-intensity aerobic exercise for 1 hour and 15 minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats harder and you use more oxygen than usual. - Being at a healthy weight. Being overweight or obese increases your risk for high blood pressure. Maintaining a healthy weight can help you control high blood pressure and reduce your risk for other health problems. - Limiting alcohol. Drinking too much alcohol can raise your blood pressure. It also adds extra calories, which may cause weight gain. Men should have no more than two drinks per day, and women only one. - Not smoking. Cigarette smoking raises your blood pressure and puts you at higher risk for heart attack and stroke. If you do not smoke, do not start. If you do smoke, talk to your health care provider for help in finding the best way for you to quit. - Managing stress. Learning how to relax and manage stress can improve your emotional and physical health and lower high blood pressure. Stress management techniques include exercising, listening to music, focusing on something calm or peaceful, and meditating. If you already have high blood pressure, it is important to prevent it from getting worse or causing complications. You should get regular medical care and follow your prescribed treatment plan. Your plan will include healthy lifestyle habit recommendations and possibly medicines. NIH: National Heart, Lung, and Blood Institute",
+    "#"
+  ],
+  [
+    "High blood pressure (Some High Blood Pressure Risks You Can\u2019t Change): Anyone can get high blood pressure. But, some people have a greater chance of having it because of things they can't change. These are:- Age. The chance of having high blood pressure increases as you get older. - Gender. Before age 55, men have a greater chance of having high blood pressure. Women are more likely to have high blood pressure after menopause. - Family history. High blood pressure tends to run in some families. - Race. African Americans are at increased risk for high blood pressure.",
+    "https://www.nia.nih.gov/health/topics/high-blood-pressure"
+  ],
+  [
+    "What is High Blood Pressure?: Blood pressure rises as body weight increases. Losing even 10 pounds can lower blood pressure -- and it has the greatest effect for those who are overweight and already have hypertension. If you are overweight or obese, work with your health care provider to develop a plan to help you lower your weight and maintain a healthy weight. Aim to reduce your weight by 7 to 10 percent over six months, which can lower your risk for health problems. For example, if you are overweight at 200 pounds, try to lose 14 to 20 pounds over six months. After that, you may have to continue to lose weight to get to a healthy weight.",
+    "http://nihseniorhealth.gov/highbloodpressure/toc.html"
+  ],
+  [
+    "What is High Blood Pressure?: \"DASH\" stands for \"Dietary Approaches to Stop Hypertension.\" This is the name of a clinical study that tested the effects of nutrients in food on blood pressure. Study results indicated that you can reduce high blood pressure by following an eating plan that emphasizes fruits, vegetables, and fat-free or low-fat milk and milk products, and that is low in saturated fat, cholesterol, total fat, and added sugars. The DASH eating plan also includes whole grains, poultry, fish, and nuts, and has reduced amounts of red meats, sweets, added sugars, and beverages containing sugars. A second study, called \"DASH-Sodium,\" showed that eating less salt also lowered blood pressure in people following either the DASH eating plan or the typical American diet. But those following DASH, especially those with high blood pressure, benefited the most. For more information on using the DASH eating plan, see Your Guide to Lowering Your Blood Pressure with DASH.",
+    "http://nihseniorhealth.gov/highbloodpressure/toc.html"
+  ],
+  [
+    "Cataract removal: Cataract removal is surgery to remove a clouded lens (cataract) from the eye. Cataracts are removed to help you see better. The procedure almost always includes placing an artificial lens (IOL) in the eye. Cataract surgery is an outpatient procedure. This means you likely do not have to stay overnight at a hospital. The surgery is performed by an ophthalmologist. This is a medical doctor who specializes in eye diseases and eye surgery. Adults are usually awake for the procedure. Numbing medicine (local anesthesia) is given using eyedrops or a shot. This blocks pain. You will also get medicine to help you relax. Children usually receive general anesthesia. This makes them unconscious and unable to feel pain. The doctor uses a special microscope to view the eye. A small cut (incision) is made in the eye. The lens is removed in one of the following ways, depending on the type of cataract: - Phacoemulsification: With this procedure, the doctor uses a tool that produces sound waves to break up the cataract into small pieces. The pieces are then suctioned out. This procedure uses a very small incision. - Extracapsular extraction: The doctor uses a small tool to remove the cataract in mostly one piece. This procedure uses a larger incision. - Laser surgery: The doctor guides a machine that uses laser energy to make the incisions and soften the cataract. The rest of the surgery is much like phacoemulsification. Using the laser instead of a knife (scalpel) may speed recovery and be more accurate. After the cataract is removed, a manmade lens, called an intraocular lens (IOL), is usually placed into the eye to restore the focusing power of the lens (cataract). It helps improve your vision. The doctor may close the incision with very small stitches. Usually, a self-sealing (sutureless) method is used. If you have stitches, they may need to be removed later. The surgery lasts less than half an hour. Most times, just one eye is done. If you have cataracts in both eyes, your doctor may suggest waiting at least 1 to 2 weeks between each surgery. The normal lens of the eye is clear (transparent). As a cataract develops, the lens becomes cloudy. This blocks light from entering your eye. Without enough light, you cannot see as clearly. Cataracts are painless. They are most often seen in older adults. Sometimes, children are born with them. Cataract surgery is usually done if you cannot see well enough because of cataracts. Cataracts usually do not damage your eye, so you and your eye doctor can decide when surgery is right for you. In rare cases, the entire lens cannot be removed. If this happens, a procedure to remove all of the lens fragments will be done at a later time. Afterward, vision can still be improved. Very rare complications can include infection and bleeding. This can lead to permanent vision problems. Before surgery, you will have a complete eye exam and eye tests by the ophthalmologist. The doctor will use ultrasound or a laser scanning device to measure your eye. These tests help determine the best IOL for you. Usually, the doctor will try to choose an IOL that can allow you to see without glasses or contact lenses after surgery. Be sure you understand what your vision will be like after the IOL is implanted. Your doctor may prescribe eyedrops before the surgery. Follow instructions exactly\u00a0on how to use the drops. Before you go home, you may receive the following: - A patch to wear over your eye until the follow-up exam - Eyedrops to prevent infection, treat inflammation, and help with healing You will need to have someone drive you home after surgery. You will usually have a follow-up exam with your doctor the next day. If you had stitches, you will need to make an appointment to have them removed. Tips for recovering after cataract surgery: - Wear dark sunglasses outside after you remove the patch. - Wash your hands well before and after using eyedrops and touching your eye. Try not to get soap and water in your eye when you are bathing or showering for the first few days. - Light activities are best as you recover. Check with your doctor before doing any strenuous activity, resuming sexual activity, or driving. Recovery takes about 2 weeks. If you need new glasses or contact lenses, you can usually have them fitted at that time. Keep your follow-up visit with your doctor. Most people do well and recover quickly after cataract surgery. If a person has other eye problems, such as glaucoma or macular degeneration, the surgery may be more difficult or the outcome may not be as good. Updated by: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Editorial update 11/17/2016.",
+    "https://medlineplus.gov/ency/article/002957.htm"
+  ],
+  [
+    "What is Congenital cataract?: A congenital cataract is a clouding of the lens of the eye that is present at birth. The lens of the eye is normally clear. It focuses light that comes into the eye onto the retina.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/001615.htm"
+  ],
+  [
+    "Cataract removal (Why the Procedure is Performed): The normal lens of the eye is clear (transparent). As a cataract develops, the lens becomes cloudy. This blocks light from entering your eye. Without enough light, you cannot see as clearly. Cataracts are painless. They are most often seen in older adults. Sometimes, children are born with them. Cataract surgery is usually done if you cannot see well enough because of cataracts. Cataracts usually do not damage your eye, so you and your eye doctor can decide when surgery is right for you.",
+    "https://medlineplus.gov/ency/article/002957.htm"
+  ],
+  [
+    "Cataract - adult (Treatment): For early cataract, the eye doctor may recommend the following: - Change in eyeglass prescription - Better lighting - Magnifying lenses - Sunglasses As vision gets worse, you may need to make changes around the home to avoid falls and injuries. The only treatment for a cataract is surgery to remove it.\u00a0If a cataract is not making it hard for you to see, surgery is usually not necessary. Cataracts usually do not harm the eye, so you can have surgery when you and your eye doctor decide it is right for you. Surgery is usually recommended when you cannot do normal activities such as driving, reading, or looking at computer or video screens, even with glasses. Some people may have other eye problems, such as diabetic retinopathy, that cannot be treated without first having cataract surgery.",
+    "https://medlineplus.gov/ency/article/001001.htm"
+  ],
+  [
+    "Cataract removal (Outlook (Prognosis)): Most people do well and recover quickly after cataract surgery. If a person has other eye problems, such as glaucoma or macular degeneration, the surgery may be more difficult or the outcome may not be as good.",
+    "https://medlineplus.gov/ency/article/002957.htm"
+  ],
+  [
+    "Congenital cataract (Treatment): If congenital cataracts are mild and do not affect vision, they may not need to be treated, especially if they are in both eyes. Moderate to severe cataracts that affect vision, or a cataract that is in only 1 eye, will need to be treated with cataract removal surgery. In most (noncongenital) cataract surgeries, an artificial intraocular lens (IOL) is inserted into the eye. The use of IOLs in infants is controversial. Without an IOL, the infant will need to wear a contact lens. Patching to force the child to use the weaker eye is often needed to prevent amblyopia. The infant may also need to be treated for the inherited disorder that is causing the cataracts.",
+    "https://medlineplus.gov/ency/article/001615.htm"
+  ],
+  [
+    "Cerulean cataract (Treatment): No treatment is known to prevent cerulean cataracts , and there is currently no cure for the condition.\u00a0Frequent eye\u00a0evaluations and eventual\u00a0cataract surgery are typically required to prevent amblyopia (vision loss) as the opacities progress. [2] The symptoms of early cataracts may be improved with new eyeglasses, brighter lighting, anti-glare sunglasses, or magnifying lenses. However, if these measures do not help, surgery is often\u00a0the only effective treatment. Surgery involves removing the cloudy lens and replacing it with an artificial lens. Surgery is often considered when vision loss regularly interferes with everyday activities, such as driving, reading, or watching TV. [3]",
+    "https://rarediseases.info.nih.gov/diseases/9508/cerulean-cataract"
+  ],
+  [
+    "Cataract removal (Before the Procedure): Before surgery, you will have a complete eye exam and eye tests by the ophthalmologist. The doctor will use ultrasound or a laser scanning device to measure your eye. These tests help determine the best IOL for you. Usually, the doctor will try to choose an IOL that can allow you to see without glasses or contact lenses after surgery. Be sure you understand what your vision will be like after the IOL is implanted. Your doctor may prescribe eyedrops before the surgery. Follow instructions exactly\u00a0on how to use the drops.",
+    "https://medlineplus.gov/ency/article/002957.htm"
+  ],
+  [
+    "Gastrointestinal perforation: Perforation is a hole that develops through the wall of a body organ. This problem may occur in the esophagus, stomach, small intestine, large intestine, rectum, or gallbladder. Perforation of an organ can be caused by a variety of factors. These include: - Appendicitis - Cancer - Crohn disease - Diverticulitis - Gallbladder disease - Peptic ulcer disease - Ulcerative colitis - Bowel blockage - Chemotherapy agents It may also be caused by surgery in the abdomen or procedures such as colonoscopy. Perforation of the intestine or other organs causes the contents to leak into the abdomen. This causes a severe infection called peritonitis. Symptoms may include: - Severe abdominal pain - Chills - Fever - Nausea - Vomiting X-rays of the chest or abdomen may show air in the abdominal cavity. This is called free air. It is a sign of a tear. A CT scan of the abdomen often shows where the hole is located. The white blood cell count is often higher than normal. Treatment most often involves emergency surgery to repair the hole. - Sometimes, a small part of the intestine must be removed. One end of the intestine may be brought out through an opening (stoma) made in the abdominal wall. This is called a colostomy or ileostomy. - A drain from the abdomen or other organ may also be needed. In rare cases, people can be treated with antibiotics alone if the perforation has closed. This can be confirmed by a physical exam, blood tests, CT scan, and x-rays. Surgery is successful most of the time. However, the outcome will depend on how severe the perforation is, and for how long it was present before treatment. The presence of other illnesses can also affect how well a person will do after treatment. Even with surgery, infection is the most common complication of the condition. Infections can be either inside the abdomen (abdominal abscess or peritonitis), or throughout the whole body. Body-wide infection is called sepsis.\u00a0Sepsis can be very serious and can lead to death. Call your\u00a0health care provider\u00a0if you have: - Blood in your stool - Changes in bowel habits - Fever - Nausea - Severe abdominal pain - Vomiting People will often have a few days of pain before the intestinal perforation occurs. If you have pain in the abdomen, see your provider right away. Treatment is much simpler and safer when it is started before the perforation occurs. Updated by: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000235.htm"
+  ],
+  [
+    "What are the side effects or risks of Nicotine Oral Inhalation?: Nicotine oral inhalation may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - irritation in the mouth and throat - cough - runny nose - taste changes - pain of the jaw, neck, or back - tooth problems - sinus pressure and pain - headache - pain, burning, or tingling in the hands or feet - gas Some side effects can be serious. If you experience the following symptom, call your doctor immediately: - rapid heart rate Nicotine inhalation may cause other side effects. Call your doctor if you have any unusual problems while using this medication.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/meds/a606021.html"
+  ],
+  [
+    "Diarrhea (How does digestion work?): Digestion works by moving food through the GI tract. Digestion begins in the mouth with chewing and ends in the small intestine. As food passes through the GI tract, it mixes with digestive juices, causing large molecules of food to break down into smaller molecules. The body then absorbs these smaller molecules through the walls of the small intestine into the bloodstream, which delivers them to the rest of the body. Waste products of digestion pass through the large intestine and out of the body as a solid matter called stool.Table 1 shows the parts of the digestive process performed by each digestive organ, including movement of food, type of digestive juice used, and food particles broken down by that organ.",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea"
+  ],
+  [
+    "Diarrhea (Why is digestion important?): Digestion is important for breaking down food into nutrients, which the body uses for energy, growth, and cell repair. Food and drink must be changed into smaller molecules of nutrients before the blood absorbs them and carries them to cells throughout the body. The body breaks down nutrients from food and drink into carbohydrates, protein, fats, and vitamins.Carbohydrates. Carbohydrates are the sugars, starches, and fiber found in many foods. Carbohydrates are called simple or complex, depending on their chemical structure. Simple carbohydrates include sugars found naturally in foods such as fruits, vegetables, milk, and milk products, as well as sugars added during food processing. Complex carbohydrates are starches and fiber found in whole-grain breads and cereals, starchy vegetables, and legumes. The Dietary Guidelines for Americans, 2010, recommends that 45 to 65 percent of total daily calories come from carbohydrates.1Protein. Foods such as meat, eggs, and beans consist of large molecules of protein that the body digests into smaller molecules called amino acids. The body absorbs amino acids through the small intestine into the blood, which then carries them throughout the body. The Dietary Guidelines for Americans, 2010, recommends that 10 to 35 percent of total daily calories come from protein.1Fats. Fat molecules are a rich source of energy for the body and help the body absorb vitamins. Oils, such as corn, canola, olive, safflower, soybean, and sunflower, are examples of healthy fats. Butter, shortening, and snack foods are examples of less healthy fats. During digestion, the body breaks down fat molecules into fatty acids and glycerol. The Dietary Guidelines for Americans, 2010, recommends that 20 to 35 percent of total daily calories come from fat.1Vitamins. Scientists classify vitamins by the fluid in which they dissolve. Water-soluble vitamins include all the B vitamins and vitamin C. Fat-soluble vitamins include vitamins A, D, E, and K. Each vitamin has a different role in the body\u2019s growth and health. The body stores fat-soluble vitamins in the liver and fatty tissues, whereas the body does not easily store water-soluble vitamins and flushes out the extra in the urine. Read more about vitamins on the Office of Dietary Supplements website at www.ods.od.nih.gov.1",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea"
+  ],
+  [
+    "Gastrointestinal perforation (Summary): Perforation is a hole that develops through the wall of a body organ. This problem may occur in the esophagus, stomach, small intestine, large intestine, rectum, or gallbladder.",
+    "https://medlineplus.gov/ency/article/000235.htm"
+  ],
+  [
+    "Gastrointestinal perforation (Exams and Tests): X-rays of the chest or abdomen may show air in the abdominal cavity. This is called free air. It is a sign of a tear. A CT scan of the abdomen often shows where the hole is located. The white blood cell count is often higher than normal.",
+    "https://medlineplus.gov/ency/article/000235.htm"
+  ],
+  [
+    "Gastrointestinal perforation (Treatment): Treatment most often involves emergency surgery to repair the hole. - Sometimes, a small part of the intestine must be removed. One end of the intestine may be brought out through an opening (stoma) made in the abdominal wall. This is called a colostomy or ileostomy. - A drain from the abdomen or other organ may also be needed. In rare cases, people can be treated with antibiotics alone if the perforation has closed. This can be confirmed by a physical exam, blood tests, CT scan, and x-rays.",
+    "https://medlineplus.gov/ency/article/000235.htm"
+  ],
+  [
+    "Fibromyalgia: Fibromyalgia, or fibromyalgia syndrome, is a condition that causes aches and pain all over the body. People with fibromyalgia often experience other symptoms, such as extreme tiredness or sleeping, mood, or memory problems. Fibromyalgia affects more women than men. The pain, extreme tiredness, and lack of sleep that fibromyalgia causes can affect your ability to work or do daily activities. Treatment can help relieve pain and help prevent flare-ups of symptoms. Fibromyalgia is also called fibromyalgia syndrome. A syndrome is a group of symptoms that happen together. People with fibromyalgia experience aches and pain all over the body, fatigue (extreme tiredness that does not get better with sleep or rest), and problems sleeping. Fibromyalgia may be caused by a problem in the brain with nerves and pain signals. In other words, in people with fibromyalgia, the brain misunderstands everyday pain and other sensory experiences, making the person more sensitive to pressure, temperature (hot or cold), bright lights, and noise compared to people who do not have fibromyalgia. Fibromyalgia has been compared to arthritis. Like arthritis, fibromyalgia causes pain and fatigue. But, unlike arthritis, fibromyalgia does not cause redness and swelling, or damage to your joints. Fibromyalgia affects as many as 4 million Americans 18 and older.1 The average age range at which fibromyalgia is diagnosed is 35 to 45 years old, but most people have had symptoms, including chronic pain, that started much earlier in life. Fibromyalgia is more common in women than in men.1,2 Maybe. Fibromyalgia is more common in people who:1 Chronic (long-term), widespread pain is the most common symptom of fibromyalgia. You may feel the pain all over your body. Or, you may feel it more in the muscles you use most often, like in your back or legs. The pain may feel like a deep muscle ache, or it may throb or burn. Your pain may also be worse in the morning. Other symptoms of fibromyalgia include:3,4,5 Women with fibromyalgia often have more morning fatigue, pain all over the body, and IBS symptoms than men with fibromyalgia have.8 Fibromyalgia symptoms can happen without warning. But certain events may trigger flare-ups, including: Researchers are not sure exactly what causes fibromyalgia. Genetics may play a role. Studies also show that the brains of people with fibromyalgia may not process pain in the same way as people who do not have fibromyalgia. Lower levels of certain brain neurotransmitters, such as serotonin or norepinephrine, may cause you to be more sensitive to pain and have a more severe reaction to pain. Imaging studies of the brain show that people with fibromyalgia feel pain when people without fibromyalgia do not.10 Some medicines prescribed to treat fibromyalgia try to bring the levels of those neurotransmitters back into balance. Your doctor or nurse will ask about your symptoms and your medical history. There is no lab test for fibromyalgia. Instead, your doctor will make a diagnosis based upon two criteria: You may have to see several doctors before getting a diagnosis. One reason for this may be that pain and fatigue, the main symptoms of fibromyalgia, also are symptoms of many other conditions, such as myalgic encephalomyelitis/chronic fatigue syndrome, rheumatoid arthritis, and lupus. Doctors try to figure out if fibromyalgia or another health problem is causing your symptoms. Treatment for fibromyalgia may include: Your doctor or nurse may also suggest taking steps at home to relieve your symptoms. You can take the following steps at home to help relieve your symptoms: Maybe. Fibromyalgia is a chronic disease that is often a lifelong condition. But fibromyalgia is not a progressive disease, meaning it will not get worse over time. It also does not cause damage to your joints, muscles, or organs. Taking steps to treat fibromyalgia can help relieve your symptoms. Many women with fibromyalgia have no problems getting pregnant, and some women report that their symptoms get better during pregnancy. But, for some women, fibromyalgia can cause problems during pregnancy. Your symptoms may flare or get worse, especially in the first few months of pregnancy. Also, some normal pregnancy complaints, such as fatigue, stress, and mood swings caused by changing hormones, may be worse for women with fibromyalgia. Talk to your doctor about any medicines you take to treat fibromyalgia, as they may cause other health problems for you or your unborn baby. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia are similar in many ways. A person can have fibromyalgia and ME/CFS. Both ME/CFS and fibromyalgia have pain and fatigue as symptoms. But the main symptom of fibromyalgia is pain, and the main symptom of ME/CFS is extreme tiredness that does not get better with sleep and rest, also called fatigue. Usually. Most people with fibromyalgia continue to work, but you may have to make changes to do so. You can cut down the number of hours you work, switch to a less demanding job, or adapt a current job. If you face challenges at work, an occupational therapist can help you design a more comfortable workstation or find more efficient and less painful ways to do your job. A number of federal laws protect your rights. However, if you cannot work because of your fibromyalgia, you may qualify for disability benefits through your employer or the Social Security Administration. For more information about fibromyalgia, call the OWH Helpline at 800-994-9662 or contact the following organizations:",
+    "https://www.womenshealth.gov/a-z-topics/fibromyalgia"
+  ],
+  [
+    "How to diagnose Fibromyalgia?: To be diagnosed with fibromyalgia, you must have had at least 3 months of widespread pain with one or more of the following: - Ongoing problems with sleep - Fatigue - Thinking or memory problems It is no longer necessary to find tender points during the exam to make a diagnosis. Results from blood and urine tests are normal most of the time. However, these tests may be done to rule out other conditions with similar symptoms.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000427.htm"
+  ],
+  [
+    "Fibromyalgia (What are the symptoms of fibromyalgia?): Chronic (long-term), widespread pain is the most common symptom of fibromyalgia. You may feel the pain all over your body. Or, you may feel it more in the muscles you use most often, like in your back or legs. The pain may feel like a deep muscle ache, or it may throb or burn. Your pain may also be worse in the morning. Other symptoms of fibromyalgia include:3,4,5 Women with fibromyalgia often have more morning fatigue, pain all over the body, and IBS symptoms than men with fibromyalgia have.8",
+    "https://www.womenshealth.gov/a-z-topics/fibromyalgia"
+  ],
+  [
+    "Fibromyalgia (Who gets fibromyalgia?): Fibromyalgia affects as many as 4 million Americans 18 and older.1 The average age range at which fibromyalgia is diagnosed is 35 to 45 years old, but most people have had symptoms, including chronic pain, that started much earlier in life. Fibromyalgia is more common in women than in men.1,2",
+    "https://www.womenshealth.gov/a-z-topics/fibromyalgia"
+  ],
+  [
+    "Fibromyalgia (What is it? Points To Remember About Fibromyalgia): - Fibromyalgia is a long-lasting or chronic disorder that causes muscle pain and fatigue (feeling tired). - The symptoms of fibromyalgia are pain and tenderness throughout your body. - You can treat your fibromyalgia with medicines, lifestyle changes, and complementary therapies. Fibromyalgia is a long-lasting or chronic disorder that causes muscle pain and fatigue (feeling tired). If you have fibromyalgia, you have pain and tenderness throughout your body. Sometime you may have two or more chronic pain conditions at the same time, such as: - Chronic fatigue syndrome. - Endometriosis. - Inflammatory bowel disease. - Interstitial cystitis. - Temporomandibular joint dysfunction (TMJ). - Vulvodynia. - Fibromyalgia is a long-lasting or chronic disorder that causes muscle pain and fatigue (feeling tired). - The symptoms of fibromyalgia are pain and tenderness throughout your body. - You can treat your fibromyalgia with medicines, lifestyle changes, and complementary therapies. - Fibromyalgia is a long-lasting or chronic disorder that causes muscle pain and fatigue (feeling tired). - The symptoms of fibromyalgia are pain and tenderness throughout your body. - You can treat your fibromyalgia with medicines, lifestyle changes, and complementary therapies. Fibromyalgia is a long-lasting or chronic disorder that causes muscle pain and fatigue (feeling tired). If you have fibromyalgia, you have pain and tenderness throughout your body. Sometime you may have two or more chronic pain conditions at the same time, such as: - Chronic fatigue syndrome. - Endometriosis. - Inflammatory bowel disease. - Interstitial cystitis. - Temporomandibular joint dysfunction (TMJ). - Vulvodynia.",
+    "https://www.niams.nih.gov/health-topics/fibromyalgia"
+  ],
+  [
+    "Fibromyalgia (Symptoms): Symptoms of fibromyalgia include: - Widespread pain. The pain associated with fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist. - Fatigue. People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea. - Cognitive difficulties. A symptom commonly referred to as \"fibro fog\" impairs the ability to focus, pay attention and concentrate on mental tasks. Fibromyalgia often co-exists with other painful conditions, such as: - Irritable bowel syndrome - Migraine and other types of headaches - Interstitial cystitis or painful bladder syndrome - Temporomandibular joint disorders",
+    "https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780"
+  ],
+  [
+    "Fibromyalgia (Is there a test for it?): Currently there aren\u2019t any laboratory tests to diagnose fibromyalgia. You may see many doctors before receiving the diagnosis. This can happen because the main symptoms of fibromyalgia, pain and fatigue, are similar to many other conditions. Doctors often have to rule out other causes of these symptoms before making a diagnosis of fibromyalgia. Doctors use guidelines to help diagnose fibromyalgia, which can include: - A history of widespread pain lasting more than 3 months. - Physical symptoms including fatigue, waking unrefreshed, and cognitive (memory or thought) problems. - The number of areas throughout the body in which you had pain in the past week. Currently there aren\u2019t any laboratory tests to diagnose fibromyalgia. You may see many doctors before receiving the diagnosis. This can happen because the main symptoms of fibromyalgia, pain and fatigue, are similar to many other conditions. Doctors often have to rule out other causes of these symptoms before making a diagnosis of fibromyalgia. Doctors use guidelines to help diagnose fibromyalgia, which can include: - A history of widespread pain lasting more than 3 months. - Physical symptoms including fatigue, waking unrefreshed, and cognitive (memory or thought) problems. - The number of areas throughout the body in which you had pain in the past week. Currently there aren\u2019t any laboratory tests to diagnose fibromyalgia. You may see many doctors before receiving the diagnosis. This can happen because the main symptoms of fibromyalgia, pain and fatigue, are similar to many other conditions. Doctors often have to rule out other causes of these symptoms before making a diagnosis of fibromyalgia. Doctors use guidelines to help diagnose fibromyalgia, which can include: - A history of widespread pain lasting more than 3 months. - Physical symptoms including fatigue, waking unrefreshed, and cognitive (memory or thought) problems. - The number of areas throughout the body in which you had pain in the past week.",
+    "https://www.niams.nih.gov/health-topics/fibromyalgia"
+  ],
+  [
+    "Fibromyalgia (What causes it?): Doctors don\u2019t know the exact cause of fibromyalgia. Researchers continue to study fibromyalgia and think the following events may contribute to the cause of the disorder: - Stressful or traumatic events, such as car accidents. - Repetitive injuries. - Illness. - Certain diseases. Sometimes, fibromyalgia can develop on its own. Fibromyalgia tends to run in families and some scientists think that a gene or genes could make you more likely to develop fibromyalgia. The genes could make you react strongly to things that other people would not find painful. Doctors don\u2019t know the exact cause of fibromyalgia. Researchers continue to study fibromyalgia and think the following events may contribute to the cause of the disorder: - Stressful or traumatic events, such as car accidents. - Repetitive injuries. - Illness. - Certain diseases. Sometimes, fibromyalgia can develop on its own. Fibromyalgia tends to run in families and some scientists think that a gene or genes could make you more likely to develop fibromyalgia. The genes could make you react strongly to things that other people would not find painful. Doctors don\u2019t know the exact cause of fibromyalgia. Researchers continue to study fibromyalgia and think the following events may contribute to the cause of the disorder: - Stressful or traumatic events, such as car accidents. - Repetitive injuries. - Illness. - Certain diseases. Sometimes, fibromyalgia can develop on its own. Fibromyalgia tends to run in families and some scientists think that a gene or genes could make you more likely to develop fibromyalgia. The genes could make you react strongly to things that other people would not find painful.",
+    "https://www.niams.nih.gov/health-topics/fibromyalgia"
+  ],
+  [
+    "BRCA1 hereditary breast and ovarian cancer syndrome: BRCA1 hereditary breast and ovarian cancer syndrome (BRCA1 HBOC) is an inherited condition that is characterized by an increased risk for a variety of different cancers. Women with this condition have a 57-60% risk of developing breast cancer, a 40-59% risk of developing ovarian cancer and an 83% risk of developing contralateral breast cancer by age 70. Men have a 1% lifetime risk of breast cancer and an increased risk for prostate cancer . BRCA1 HBOC may also be associated with an elevated risk for cancers of the cervix, uterus, pancreas, esophagus, stomach, fallopian tube, and primary peritoneum; however, these risks are not well defined. [1] [2] This condition is caused by changes ( mutations ) in the BRCA1 gene and is inherited in an autosomal dominant manner. [3] Management may include high risk cancer screening , chemoprevention\u00a0and/or prophylactic surgeries. [1] [4] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Abnormality of the fallopian tube Very frequent Ovarian neoplasm Very frequent Primary peritoneal carcinoma Very frequent Breast carcinoma Frequent Melanoma Occasional Neoplasm of the pancreas Occasional Prostate cancer Occasional Autosomal dominant inheritance - Multifactorial inheritance - Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. The resources below provide information about treatment options for this condition. If you have questions about which treatment is right for you, talk to your healthcare professional. Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information National Library of Medicine Drug Information Portal The following diseases are related to BRCA1 hereditary breast and ovarian cancer syndrome. If you have a question about any of these diseases, you can contact GARD. Familial breast cancer",
+    "https://rarediseases.info.nih.gov/diseases/12351/brca1-hereditary-breast-and-ovarian-cancer-syndrome"
+  ],
+  [
+    "Do you have information about Giving an insulin injection: Summary : To give an insulin injection, you need to fill the right syringe with the right amount of medicine, decide where to give the injection, and know how to give the injection. Getting Ready : - Your health care provider will teach you all of these steps, watch you practice, and answer your questions. You may take notes to remember the details. - Know the name and dose of each medicine to give. The type of insulin should match the type of syringe: U-100 or U-500. Because U-500 syringes may be difficult to find, your health care provider may give you instructions for using U-500 insulin with U-100 syringes. - Some types of insulin can be mixed with each other in one syringe, but not all. Consult with your provider or pharmacist about this. - Always use the same brands and types of supplies. DO NOT use expired insulin. - Insulin should be given at room temperature. If you had it in the refrigerator or cooler bag, take it out 30 minutes before the injection. Once you have started using a vial of insulin, it can be kept at room temperature for a month. - Gather your supplies: insulin, needles, syringes, alcohol wipes, and a container for used needles and syringes. Filling the Syringe - One Type of Insulin : - Wash your hands with soap and water. Dry them well. - Check the insulin bottle label. Make sure it is the right insulin. Make sure it is not expired. - The insulin should not have any clumps on the sides of the bottle. If it does, throw it out and get another bottle. - Intermediate-acting insulin is cloudy, and must be rolled between your hands to mix it. DO NOT shake the bottle. This can make the insulin clump. - Clear insulin does not need to be mixed. - If the insulin vial has a plastic cover, take it off. Wipe the top of the bottle with an alcohol wipe. Let it dry. DO NOT blow on it. - Know the dose of insulin you want. Take the cap off the needle, being careful not to touch the needle to keep it sterile. Pull back the plunger of the syringe to put as much air in the syringe as the dose of medicine you want. - Put the needle into and through the rubber top of the insulin bottle. Push the plunger so the air goes into the bottle. - Keep the needle in the bottle and turn the bottle upside down. - With the tip of the needle in the liquid, pull back on the plunger to get the right dose of insulin into the syringe. - Check the syringe for air bubbles. If there are bubbles, hold both the bottle and syringe in one hand, and tap the syringe with your other hand. The bubbles will float to the top. Push the bubbles back into the insulin bottle, then pull back to get the right dose. - When there are no bubbles, take the syringe out of the bottle. Put the syringe down carefully so the needle does not touch anything. Filling the Syringe - Two Types of Insulin : - Never mix two types of insulin in one syringe unless you are told to do this. You will also be told which insulin to draw up first. Always do it in that order. - Your doctor will tell you how much of each insulin you will need. Add these two numbers together. This is the amount of insulin you should have in the syringe before injecting it. - Wash your hands with soap and water. Dry them well. - Check the insulin bottle label. Make sure it is the right insulin. - The insulin should not have any clumps on the sides of the bottle. If it does, throw it out and get another bottle. - Intermediate-acting insulin is cloudy, and must be rolled between your hands to mix it. DO NOT shake the bottle. This can make the insulin clump. - Clear insulin does not need to be mixed. - If the vial has a plastic cover, take it off. Wipe the top of the bottle with an alcohol wipe. Let it dry. DO NOT blow on it. - Know the dose of each insulin you want. Take the cap off the needle, being careful not to touch the needle to keep it sterile. Pull back the plunger of the syringe to put as much air in the syringe as the dose of the longer-acting insulin. - Put the needle into the rubber top of that insulin bottle. Push the plunger so the air goes into the bottle. Remove the needle from the bottle. - Put the air in the short-acting insulin bottle the same way as the previous two steps above. - Keep the needle in the short-acting bottle and turn the bottle upside down. - With the tip of the needle in the liquid, pull back on the plunger to get the right dose of insulin into the syringe. - Check the syringe for air bubbles. If there are bubbles, hold both the bottle and syringe in one hand, and tap the syringe with your other hand. The bubbles will float to the top. Push the bubbles back into the insulin bottle, then pull back to get the right dose. - When there are no bubbles, take the syringe out of the bottle. Look at it again to make sure you have the right dose. - Put the needle into the rubber top of the longer-acting insulin bottle. - Turn the bottle upside down. With the tip of the needle in the liquid, slowly pull back on the plunger to exactly the right dose of long-acting insulin. DO NOT draw extra insulin in the syringe, since you should not push the mixed insulin back into the bottle. - Check the syringe for air bubbles. If there are bubbles, hold both the bottle and syringe in one hand, and tap the syringe with your other hand. The bubbles will float to the top. Remove the needle from the bottle before you push out the air. - Make sure you have the right total dose of insulin. Put the syringe down carefully so the needle does not touch anything. Giving the Injection : Choose where to give the injection. Keep a chart of places you have used, so you do not put the insulin in the same place all the time. Ask your doctor for a chart. - Keep your shots 1 inch away from scars and 2 inches away from your navel. - DO NOT put a shot in a spot that is bruised, swollen, or tender. The site you choose for the injection should be clean and dry. If your skin is visibly dirty, clean it with soap and water. DO NOT use an alcohol wipe on your injection site. The insulin needs to go into the fat layer under the skin. - Pinch the skin and put the needle in at a 45 angle. - If your tissues are thick enough, you may be able to inject straight up and down (90 angle). Check with your health care provider before doing this. - Push the needle all the way into the skin. Let go of the pinched skin. Inject the insulin slowly and steadily until it is all in. - Leave the syringe in place for 5 seconds after injecting. Pull the needle out at the same angle it went in. Put the syringe down. There is no need to recap it. If insulin tends to leak from your injection site, press the injection site for a few seconds after the injection. If this happens often, check with your health care provider. Place the needle and syringe in a safe hard container. Close the container, and keep it safely away from children and animals. Never reuse needles or syringes. Storing Your Insulin and Supplies : Ask your pharmacist how to store your insulin so it does not go bad.",
+    "https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000660.htm"
+  ],
+  [
+    "Pancreatic cancer: Pancreatic cancer is cancer that starts in the pancreas. The pancreas is a large organ behind the stomach. It makes and releases enzymes into the intestines that help the body digest and absorb food, especially fats. The pancreas also makes and releases insulin and glucagon. These are hormones that help the body control blood sugar levels. There are different types of pancreatic cancers. The type depends on the cell the cancer develops in. Examples include: - Adenocarcinoma, the most common type of pancreatic cancer - Other more rare types include glucagonoma, insulinoma, islet cell tumor, VIPoma The exact cause of pancreatic cancer is unknown. It is more common in persons who: - Are obese - Have a diet high in fat and low in fruits and vegetables - Have diabetes - Have long-term exposure to certain chemicals - Have long-term inflammation of the pancreas (chronic pancreatitis) - Smoke Pancreatic cancer is slightly more common in women than in men. The risk increases with age. Family history of the disease also slightly increases the chance of developing this cancer. A tumor (cancer) in the pancreas may grow without any symptoms at first. This means the cancer is often advanced when it is first found. Symptoms of pancreatic cancer include: - Diarrhea - Dark urine and clay-colored stools - Fatigue and weakness - Sudden increase in blood sugar level (diabetes) - Jaundice (a yellow color in the skin, mucous membranes, or white part of the eyes) and itching of the skin - Loss of appetite and weight loss - Nausea and vomiting - Pain or discomfort in the upper part of the belly or abdomen The doctor will perform a physical exam and ask about your symptoms. During the exam, the doctor may feel a lump (mass) in your abdomen. Blood tests that may be ordered include: - Complete blood count (CBC) - Liver function tests - Serum bilirubin Imaging tests that may be ordered include: - CT scan of the abdomen - Endoscopic retrograde cholangiopancreatography (ERCP) - Endoscopic ultrasound - MRI of the abdomen Diagnosis of pancreatic cancer (and what type) is made by a pancreatic biopsy. If tests confirm you have pancreatic cancer, more tests will be done to see how far the cancer has spread within and outside the pancreas. This is called staging. Staging helps guide treatment and gives you an idea of what to expect. Treatment for adenocarcinoma depends on the stage of the tumor. Surgery may be done if the tumor has not spread or has spread very little. Along with surgery, chemotherapy or radiation therapy or both may be used before or after surgery. A small number of people can be cured with this treatment approach. When the tumor has not spread out of the pancreas but cannot be surgically removed, chemotherapy and radiation therapy together may be recommended. When the tumor has spread (metastasized) to other organs such as the liver, chemotherapy alone is usually used. With advanced cancer, the goal of treatment is to manage pain and other symptoms. For example, if the tube that carries bile is blocked by the pancreatic tumor, a procedure to place a tiny metal tube (stent) may be done to open the blockage. This can help relieve loss of appetite, jaundice, and itching of the skin. You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone. Some people with pancreatic cancer that can be surgically removed are cured. But in most people, the tumor has spread and cannot be completely removed at the time of diagnosis. Chemotherapy and radiation are often given after surgery to increase the cure rate (this is called adjuvant therapy). For pancreatic cancer that cannot be removed completely with surgery or cancer that has spread beyond the pancreas, a cure is not possible. In this case, chemotherapy is given to improve and extend one's life. Call for an appointment with your health care provider if you have: - Abdominal pain that does not go away - Back pain - Loss of appetite - Unexplained fatigue or weight loss - Other symptoms of this disorder Preventive measures include: - If you smoke, now is the time to quit. - Keep a diet high in fruits, vegetables, and whole grains. - Exercise regularly to stay at a healthy weight. Updated by: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000236.htm"
+  ],
+  [
+    "Lung cancer (Exams and Tests): Lung cancer is often found when an x-ray or CT scan is done for another reason. If lung cancer is suspected, the doctor will perform a physical exam and ask about your medical history. You will be asked if you smoke. If so, you'll be asked how much you smoke and for how long you have smoked. You will also be asked about other things that may have put you at risk of lung cancer, such as exposure to certain chemicals. When listening to the chest with a stethoscope, the doctor may hear fluid around the lungs. This may suggest cancer. Tests that may be done to diagnose lung cancer or see if it has spread include: - Bone scan - Chest x-ray - Complete blood count (CBC) - CT scan of the chest - MRI of the chest - Positron emission tomography (PET) scan - Sputum test to look for cancer cells - Thoracentesis (sampling of fluid buildup around the lung) In most cases, a piece of tissue is removed from your lungs for examination under a microscope. This is called a biopsy. There are several ways to do this: - Bronchoscopy combined with biopsy - CT-scan-directed needle biopsy - Endoscopic esophageal ultrasound (EUS) with biopsy - Mediastinoscopy with biopsy - Open lung biopsy - Pleural biopsy If the biopsy shows cancer, more imaging tests are done to find out the stage of the cancer. Stage means how big the tumor is and how far it has spread. Staging helps guide treatment and follow-up and gives you an idea of what to expect.",
+    "https://medlineplus.gov/ency/article/007270.htm"
+  ],
+  [
+    "How to tell your child that you have cancer (Common Fears): There are some common fears that many children have when they learn about cancer. Since your child may not tell you about these fears, it is a good idea to bring them up yourself. - Your child is to blame. It is common for children to think that something they did caused a parent's cancer. Let your child know that no one in your family did anything to cause the cancer. - Cancer is contagious. Many children worry that cancer can spread like the flu, and other people in your family will catch it. Make sure to let your child know that you cannot \"catch\" cancer from someone else, and they will not get cancer by touching or kissing you. - Everyone dies from cancer. You can explain that cancer is a serious illness, but modern treatments have helped millions of people survive cancer. If your child knows someone who has died of cancer, let them know that there are many kinds of cancer and everyone's cancer is different. Just because Uncle Mike died of his cancer, it does not mean that you will too. You may need to repeat these points to your child many times during your treatment.",
+    "https://medlineplus.gov/ency/patientinstructions/000934.htm"
+  ],
+  [
+    "Intestinal Cancer (Summary): Summary Your small intestine is part of your digestive system. It is a long tube that connects your stomach to your large intestine. Intestinal cancer is rare, but eating a high-fat diet or having Crohn's disease, celiac disease, or a history of colonic polyps can increase your risk. Possible signs of small intestine cancer include - Abdominal pain - Weight loss for no reason - Blood in the stool - A lump in the abdomen Imaging tests that create pictures of the small intestine and the area around it can help diagnose intestinal cancer and show whether it has spread. Surgery is the most common treatment. Additional options include chemotherapy, radiation therapy, or a combination. NIH: National Cancer Institute",
+    "#"
+  ],
+  [
+    "Esophageal cancer: Esophageal cancer is cancer that starts in the esophagus. This is the tube that moves food from the mouth to the stomach. Esophageal cancer is not common in the United States. It occurs most often in men over 50 years old. There are two main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. These two types look different from each other under the microscope. Squamous cell esophageal cancer is linked to smoking and drinking too much alcohol. Adenocarcinoma is the more common type of esophageal cancer. Having Barrett esophagus increases the risk of this type of cancer. Acid reflux disease (gastroesophageal reflux disease, or GERD) can develop into Barrett esophagus. Other risk factors include smoking, being male, or being obese. Symptoms may include any of the following: - Backward movement of food through the esophagus and possibly mouth (regurgitation) - Chest pain not related to eating - Difficulty swallowing solids or liquids - Heartburn - Vomiting blood - Weight loss Tests used to help diagnose esophageal cancer may include: - Barium swallow - Chest MRI or thoracic CT (usually used to help determine the stage of the disease) - Endoscopic ultrasound (also sometimes used to determine the stage of disease) - Esophagogastroduodenoscopy (EGD) and biopsy - PET scan (sometimes useful for determining the stage of disease, and whether surgery is possible) Stool testing may show small amounts of blood in the stool. Upper endoscopy (EGD) will be used to obtain a tissue sample from the esophagus to diagnose cancer. When the cancer is only in the esophagus and has not spread, surgery will be done. The cancer and part, or all, of the esophagus is removed. The surgery may be done using: - Open surgery, during which one or two larger incisions are made. - Minimally invasive surgery, during which a 2 to 4 small incisions are made in the belly. A laparoscope with a tiny camera is inserted into the belly through one of the incisions. Radiation therapy may also be used instead of surgery in some cases when the cancer has not spread outside the esophagus. Either chemotherapy, radiation, or both may be used to shrink the tumor and make surgery easier to perform. If the person is too ill to have major surgery or the cancer has spread to other organs, chemotherapy or radiation may be used to help reduce symptoms. This is called palliative therapy. In such cases, the disease is usually not curable. Beside a change in diet, other treatments that may be used to help the patient swallow include: - Dilating (widening) the esophagus using an endoscope. Sometimes a stent is placed to keep the esophagus open. - A feeding tube into the stomach. - Photodynamic therapy, in which a special drug is injected into the tumor and is then exposed to light. The light activates the medicine that attacks the tumor. You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone When the cancer has not spread outside the esophagus, surgery may improve the chance of survival. When the cancer has spread to other areas of the body, a cure is generally not possible. Treatment is directed toward relieving symptoms. Complications may include: - Pneumonia - Severe weight loss from not eating enough Call your health care provider if you have difficulty swallowing with no known cause and it does not get better. Also call if you have other symptoms of esophageal cancer. To reduce your risk of cancer of the esophagus: - DO NOT smoke - Limit or DO NOT drink alcoholic beverages - Get checked by your doctor if you have severe GERD - Get regular checkups if you have Barrett esophagus Updated by: Subodh K. Lal, MD, gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000283.htm"
+  ],
+  [
+    "Vulva cancer (Outlook (Prognosis)): Most women with vulvar cancer who are diagnosed and treated at an early stage do well. But a woman's outcome depends on: - The size of the tumor - The type of vulvar cancer - Whether the cancer has spread The cancer commonly comes back at or near the site of the original tumor.",
+    "https://medlineplus.gov/ency/article/000902.htm"
+  ],
+  [
+    "Colon cancer (Exams and Tests): Through screening tests, colon cancer can be detected before symptoms develop. This is when the cancer is most curable. Your doctor will perform a physical exam and press on your belly area. The physical exam rarely shows any problems, although the doctor may feel a lump (mass) in the abdomen. A rectal exam may reveal a mass in people with rectal cancer, but not colon cancer. A fecal occult blood test (FOBT) may detect small amounts of blood in the stool. This may suggest colon cancer. A sigmoidoscopy, or more likely, a colonoscopy, will be done to evaluate the cause of blood in your stool. Only a full colonoscopy can see the entire colon. This is the best screening test for colon cancer. Blood tests may be done for those diagnosed with colorectal cancer, including: - Complete blood count (CBC) to check for anemia - Liver function tests If you are diagnosed with colorectal cancer, more tests will be done to see if the cancer has spread. This is called staging. CT or MRI scans of the abdomen, pelvic area, or chest may be used to stage the cancer. Sometimes, PET scans are also used. Stages of colon cancer are: - Stage 0: Very early cancer on the innermost layer of the intestine - Stage I: Cancer is in the inner layers of the colon - Stage II: Cancer has spread through the muscle wall of the colon - Stage III: Cancer has spread to the lymph nodes - Stage IV: Cancer has spread to other organs outside the colon Blood tests to detect tumor markers, such as carcinoembryonic antigen (CEA) may help the doctor follow you during and after treatment.",
+    "https://medlineplus.gov/ency/article/000262.htm"
+  ],
+  [
+    "Plantar fasciitis: Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia). Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move more, the pain normally decreases, but it might return after long periods of standing or after rising from sitting. Plantar fasciitis is more common in runners. In addition, people who are overweight and those who wear shoes with inadequate support have an increased risk of plantar fasciitis. Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or rising from sitting. The pain is usually worse after exercise, not during it. Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension and stress on that bowstring become too great, small tears can arise in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed, though in many cases of plantar fasciitis, the cause isn't clear. Though plantar fasciitis can arise without an obvious cause, factors that can increase your risk of developing plantar fasciitis include: - Age. Plantar fasciitis is most common between the ages of 40 and 60. - Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue - such as long-distance running, ballistic jumping activities, ballet dancing and aerobic dance - can contribute to an earlier onset of plantar fasciitis. - Foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can affect the way weight is distributed when you're standing and put added stress on the plantar fascia. - Obesity. Excess pounds put extra stress on your plantar fascia. - Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia. The diagnosis is made based on the medical history and physical examination. During the exam, your doctor will check for areas of tenderness in your foot. Where your pain is situated can help determine its cause. Imaging tests Usually no tests are necessary. Your doctor might suggest an X-ray or magnetic resonance imaging (MRI) to make sure your pain isn't being caused by another problem, such as a stress fracture or a pinched nerve. Sometimes an X-ray shows a spur of bone projecting forward from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain. Most people who have plantar fasciitis recover with conservative treatments, including resting, icing the painful area and stretching, in several months. Medications Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) can ease the pain and inflammation associated with plantar fasciitis. Therapies Stretching and strengthening exercises or use of specialized devices may provide symptom relief. These include: - Physical therapy. A physical therapist can instruct you in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist might also teach you to apply athletic taping to support the bottom of your foot. - Night splints. Your physical therapist or doctor might recommend that you wear a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and facilitates stretching. - Orthotics. Your doctor might prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly. Surgical or other procedures When more-conservative measures aren't working after several months, your doctor might recommend: - Injections. Injecting a type of steroid medication into the tender area can provide temporary pain relief. Multiple injections aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture. More recently, platelet-rich plasma has been used, under ultrasound guidance, to provide pain relief with less risk of tissue rupture. - Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It's usually used for chronic plantar fasciitis that hasn't responded to more-conservative treatments. This procedure might cause bruising, swelling, pain, numbness or tingling. Some studies show promising results, but it hasn't been shown to be consistently effective. - Tenex procedure. This minimally invasive procedure removes the scar tissue of plantar fasciitis without surgery. - Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot. To reduce the pain of plantar fasciitis, try these self-care tips: - Maintain a healthy weight. Lose weight if you're overweight or obese to minimize stress on your plantar fascia. - Choose supportive shoes. Avoid high heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency. Don't go barefoot, especially on hard surfaces. - Don't wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet. If you're a runner, buy new shoes after about 400 to 500 miles of use. - Change your sport. Try a low-impact sport, such as swimming or bicycling, instead of walking or jogging. - Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 to 20 minutes three or four times a day or after activity. Or try ice massage. Freeze a water-filled paper cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massage can help reduce pain and inflammation. - Stretch your arches. Simple home exercises can stretch your plantar fascia, Achilles tendon and calf muscles.",
+    "https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846"
+  ],
+  [
+    "What are the treatments for Plantar fasciitis?: Your health care provider will often recommend these steps first: - Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation - Heel and foot stretching exercises - Night splints to wear while sleeping to stretch the foot - Resting as much as possible for at least a week - Wearing shoes with good support and cushions Other steps to relieve pain include: - Apply ice to the painful area. Do this at least twice a day for 10 - 15 minutes, more often in the first couple of days. - Try wearing a heel cup, felt pads in the heel area, or shoe inserts. - Use night splints to stretch the injured fascia and allow it to heal. If these treatments do not work, your health care provider may recommend: - Wearing a boot cast, which looks like a ski boot, for 3 - 6 weeks. It can be removed for bathing. - Custom-made shoe inserts (orthotics) - Steroid shots or injections into the heel Sometimes, foot surgery is needed.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/007021.htm"
+  ],
+  [
+    "Plantar fasciitis: The plantar fascia is the thick tissue on the bottom of the foot. It connects the heel bone to the toes and creates the arch of the foot. When this tissue becomes swollen or inflamed, it is called plantar fasciitis. Swelling occurs when the thick band of tissue on the bottom of the foot (fascia) is overstretched or overused. This can be painful and make walking more difficult. You are more likely to get plantar fasciitis if you: - Have foot arch problems (both flat feet and high arches) - Run long distances, downhill or on uneven surfaces - Are obese or gain weight suddenly - Have a tight Achilles tendon (the tendon connecting the calf muscles to the heel) - Wear shoes with poor arch support or soft soles - Change your activities Plantar fasciitis is seen in both men and women. It is one of the most common orthopedic foot complaints. Plantar fasciitis was commonly thought to be caused by a heel spur. However, research has found that this is not the case. On x-ray, heel spurs are seen in people with and without plantar fasciitis. The most common symptom is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn. The pain is often worse: - In the morning when you take your first steps - After standing or sitting for awhile - When climbing stairs - After intense activity - Walking, running, and jumping sports The pain may develop slowly over time, or come on suddenly after intense activity. The health care provider will perform a physical exam. This may show: - Pain on the bottom of your foot. - Pain along the sole of the foot. - Flat feet or high arches. - Mild foot swelling or redness. - Stiffness or tightness of the arch in the bottom of your foot. X-rays may be taken to rule out other problems. Your provider will often recommend these steps first: - Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation. Heel and foot stretching exercises - Night splints to wear while sleeping to stretch the foot - Resting as much as possible for at least a week - Wearing shoes with good support and cushions You can also apply ice to the painful area. Do this at least twice a day for 10 to 15 minutes, more often in the first couple of days. If these treatments do not work, your provider may recommend: - Wearing a boot cast, which looks like a ski boot, for 3 to 6 weeks. It can be removed for bathing. - Custom-made shoe inserts (orthotics) - Steroid shots or injections into the heel Sometimes, foot surgery is needed. Nonsurgical treatments almost always improve the pain. Treatment can last from several months to 2 years before symptoms get better. Most people feel better with 6 to 18 months. Some people need surgery to relieve the pain. Contact your provider if you have symptoms of plantar fasciitis. Making sure your ankle, Achilles tendon, and calf muscles are flexible can help prevent plantar fasciitis. Stretch your plantar fascia in the morning before you get out of bed. Doing activities in moderation can also help. Updated by: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007021.htm"
+  ],
+  [
+    "Plantar fasciitis (Risk factors): Though plantar fasciitis can arise without an obvious cause, factors that can increase your risk of developing plantar fasciitis include: - Age. Plantar fasciitis is most common between the ages of 40 and 60. - Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue - such as long-distance running, ballistic jumping activities, ballet dancing and aerobic dance - can contribute to an earlier onset of plantar fasciitis. - Foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can affect the way weight is distributed when you're standing and put added stress on the plantar fascia. - Obesity. Excess pounds put extra stress on your plantar fascia. - Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.",
+    "https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846"
+  ],
+  [
+    "Plantar fasciitis (Prevention): Making sure your ankle, Achilles tendon, and calf muscles are flexible can help prevent plantar fasciitis. Stretch your plantar fascia in the morning before you get out of bed. Doing activities in moderation can also help.",
+    "https://medlineplus.gov/ency/article/007021.htm"
+  ],
+  [
+    "Plantar fasciitis (When to Contact a Medical Professional): Contact your provider if you have symptoms of plantar fasciitis.",
+    "https://medlineplus.gov/ency/article/007021.htm"
+  ],
+  [
+    "Plantar fasciitis (Treatment): Most people who have plantar fasciitis recover with conservative treatments, including resting, icing the painful area and stretching, in several months. Medications Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) can ease the pain and inflammation associated with plantar fasciitis. Therapies Stretching and strengthening exercises or use of specialized devices may provide symptom relief. These include: - Physical therapy. A physical therapist can instruct you in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist might also teach you to apply athletic taping to support the bottom of your foot. - Night splints. Your physical therapist or doctor might recommend that you wear a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and facilitates stretching. - Orthotics. Your doctor might prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly. Surgical or other procedures When more-conservative measures aren't working after several months, your doctor might recommend: - Injections. Injecting a type of steroid medication into the tender area can provide temporary pain relief. Multiple injections aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture. More recently, platelet-rich plasma has been used, under ultrasound guidance, to provide pain relief with less risk of tissue rupture. - Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It's usually used for chronic plantar fasciitis that hasn't responded to more-conservative treatments. This procedure might cause bruising, swelling, pain, numbness or tingling. Some studies show promising results, but it hasn't been shown to be consistently effective. - Tenex procedure. This minimally invasive procedure removes the scar tissue of plantar fasciitis without surgery. - Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.",
+    "https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846"
+  ],
+  [
+    "Plantar fasciitis (Causes): Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension and stress on that bowstring become too great, small tears can arise in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed, though in many cases of plantar fasciitis, the cause isn't clear.",
+    "https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846"
+  ],
+  [
+    "Upper GI and small bowel series (Considerations): The upper GI series should be done after other x-ray procedures. This is because the barium that remains in the body may block details in other imaging tests.",
+    "https://medlineplus.gov/ency/article/003816.htm"
+  ],
+  [
+    "What is Liver Cancer?: Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. Primary liver cancer starts in the liver. Metastatic liver cancer starts somewhere else and spreads to your liver. Risk factors for primary liver cancer include - Having hepatitis B or C - Heavy alcohol use - Having cirrhosis, or scarring of the liver - Having hemochromatosis, an iron storage disease - Obesity and diabetes Symptoms can include a lump or pain on the right side of your abdomen and yellowing of the skin. However, you may not have symptoms until the cancer is advanced. This makes it harder to treat. Doctors use tests that examine the liver and the blood to diagnose liver cancer. Treatment options include surgery, radiation, chemotherapy, or liver transplantation. NIH: National Cancer Institute",
+    "https://www.nlm.nih.gov/medlineplus/livercancer.html"
+  ],
+  [
+    "Upper GI and small bowel series (Summary): An upper GI and small bowel series is a set of x-rays taken to examine the esophagus, stomach, and small intestine. Barium enema is a related test that examines the large intestine.",
+    "https://medlineplus.gov/ency/article/003816.htm"
+  ],
+  [
+    "Upper GI and small bowel series (How the Test is Performed): An upper GI and small bowel series is done in a health care office or hospital radiology department. You may get an injection of a medicine that slows muscle movement in the small intestine. This makes it easier to see the structures of your organs on the x-rays. Before the x-rays are taken, you must drink 16 to 20 ounces (480 to 600 milliliters) of a milkshake-like drink. The drink contains a substance called barium, which shows up well on x-rays. An x-ray method called fluoroscopy tracks how the barium moves through your esophagus, stomach, and small intestine. Pictures are taken while you sit or stand in different positions. The test most often takes around 3 hours but can take as long as 6 hours to complete. A GI series may include this test or a barium enema.",
+    "https://medlineplus.gov/ency/article/003816.htm"
+  ],
+  [
+    "Gastrointestinal bleeding: Gastrointestinal (GI) bleeding refers to any bleeding that starts in the gastrointestinal tract. Bleeding may come from any site along the GI tract, but is often divided into: - Upper GI bleeding: The upper GI tract includes the esophagus (the tube from the mouth to the stomach), stomach, and first part of the small intestine. - Lower GI bleeding: The lower GI tract includes much of the small intestine, large intestine or bowels, rectum, and anus. The amount of GI bleeding may be so small that it can only be detected on a lab test such as the fecal occult blood test. Other signs of GI bleeding include: - Dark, tarry stools - Larger amounts of blood passed from the rectum - Small amounts of blood in the toilet bowl, on toilet paper, or in streaks on stool (feces) - Vomiting blood Massive bleeding from the GI tract can be dangerous. However, even very small amounts of bleeding that occur over a long period of time can lead to problems such as anemia or low blood counts. Once a bleeding site is found, many therapies are available to stop the bleeding or treat the cause. GI bleeding may be due to conditions that are not serious, including: - Anal fissure - Hemorrhoids GI bleeding may also be a sign of more serious diseases and conditions. These may include cancers of the GI tract such as: - Cancer of the colon - Cancer of the small intestine - Cancer of the stomach - Intestinal polyps (a pre-cancerous condition) Other causes of GI bleeding may include: - Abnormal blood vessels in the lining of the intestines (also called angiodysplasia) - Bleeding diverticulum, or diverticulosis - Crohn disease or ulcerative colitis - Esophageal varices - Esophagitis - Gastric (stomach) ulcer - Intussusception (bowel telescoped on itself) - Mallory-Weiss tear - Meckel diverticulum - Radiation injury to the bowel There are home stool tests for microscopic blood that may be recommended for people with anemia or for colon cancer screening. Call your health care provider if: - You have black, tarry stools (this may be a sign of GI bleeding) - You have blood in your stool - You vomit blood or you vomit material that looks like coffee grounds Your provider may discover GI bleeding during an exam at your office visit. GI bleeding can be an emergency condition that requires immediate medical care. Treatment may involve: - Blood transfusions. - Fluids and medicines through a vein. - Esophagogastroduodenoscopy (EGD). A thin tube with a camera on the end is passed through your mouth into your esophagus, stomach, and small intestine. - A tube is placed through your mouth into the stomach to drain the stomach contents (gastric lavage). Once your condition is stable, you will have a physical exam and a detailed exam of your abdomen. You will also be asked questions about your symptoms, including: - When did you first notice symptoms? - Did you have black, tarry stools or red blood in the stools? - Have you vomited blood? - Did you vomit material that looks like coffee grounds? - Do you have a history of peptic or duodenal ulcers? - Have you ever had symptoms like this before? - What other symptoms do you have? Tests that may be done include: - Abdominal CT scan - Abdominal MRI scan - Abdominal x-ray - Angiography - Bleeding scan (tagged red blood cell scan) - Blood clotting tests - Capsule endoscopy (camera pill that is swallowed to look at the small intestine) - Colonoscopy - Complete blood count (CBC), clotting tests, platelet count, and other laboratory tests - Enteroscopy - Sigmoidoscopy Updated by: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003133.htm"
+  ],
+  [
+    "Liver cancer (Diagnosis): Diagnosing liver cancer Tests and procedures used to diagnose liver cancer include: - Blood tests. Blood tests may reveal liver function abnormalities. - Imaging tests. Your doctor may recommend imaging tests, such as an ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI). - Removing a sample of liver tissue for testing. Your doctor may recommend removing a piece of liver tissue for laboratory testing in order to make a definitive diagnosis of liver cancer. During a liver biopsy, your doctor inserts a thin needle through your skin and into your liver to obtain a tissue sample. In the lab, doctors examine the tissue under a microscope to look for cancer cells. Liver biopsy carries a risk of bleeding, bruising and infection. Determining the extent of the liver cancer Once liver cancer is diagnosed, your doctor will work to determine the extent (stage) of the cancer. Staging tests help determine the size and location of cancer and whether it has spread. Imaging tests used to stage liver cancer include CTs, MRIs and bone scans. There are different methods of staging liver cancer. One method uses Roman numerals I through IV, and another uses letters A through D. Your doctor uses your cancer's stage to determine your treatment options and your prognosis. Stage IV and stage D indicate the most advanced liver cancer with the worst prognosis.",
+    "https://www.mayoclinic.org/diseases-conditions/hepatocellular-carcinoma/cdc-20354552"
+  ],
+  [
+    "Upper GI and small bowel series (What Abnormal Results Mean): Abnormal results in the esophagus may indicate the following problems: - Achalasia - Diverticula - Esophageal cancer - Esophageal narrowing (stricture) - benign - Hiatal hernia - Ulcers Abnormal results in the stomach may indicate the following problems: - Gastric cancer - Gastric ulcer - benign - Gastritis - Polyps (a tumor that is usually noncancerous and grows on the mucus membrane) - Pyloric stenosis (narrowing) Abnormal results in the small intestine may indicate the following problems: - Malabsorption syndrome - Swelling and irritation of the small intestines - Tumors - Ulcers The test may also be done for the following conditons: - Annular pancreas - Duodenal ulcer - Gastroesophageal reflux disease - Gastroparesis - Intestinal obstruction - Lower esophageal ring - Primary or idiopathic intestinal pseudo-obstruction",
+    "https://medlineplus.gov/ency/article/003816.htm"
+  ],
+  [
+    "Upper GI and small bowel series (Risks): You are exposed to a low level of radiation during this test, which carries a very small risk of cancer. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most experts feel that the risk is low compared with the benefits. Pregnant women should not have this test in most cases. Children are more sensitive to the risks of x-rays. Barium may cause constipation. Talk to your provider if the barium has not passed through your system by 2 or 3 days after the exam.",
+    "https://medlineplus.gov/ency/article/003816.htm"
+  ],
+  [
+    "Heart attack - what to ask your doctor (Summary): A heart attack occurs when blood flow to a part of your heart is blocked for a period of time and a part of the heart muscle is damaged. It is also called a myocardial infarction (MI). Watch this video about: Coronary artery disease Angina is pain or pressure in the chest. It occurs when your heart muscle is not getting enough blood or oxygen. You may feel angina in your neck or jaw. Sometimes you may notice that you are short of breath. Below are some questions you may want to ask your health care provider to help you take care of yourself after a heart attack.",
+    "https://medlineplus.gov/ency/patientinstructions/000231.htm"
+  ],
+  [
+    "How to diagnose Heart Attack?: Your doctor will diagnose a heart attack based on your signs and symptoms, your medical and family histories, and test results. Diagnostic Tests EKG (Electrocardiogram) An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart. An EKG can show signs of heart damage due to coronary heart disease (CHD) and signs of a previous or current heart attack. Blood Tests During a heart attack, heart muscle cells die and release proteins into the bloodstream. Blood tests can measure the amount of these proteins in the bloodstream. Higher than normal levels of these proteins suggest a heart attack. Commonly used blood tests include troponin tests, CK or CKMB tests, and serum myoglobin tests. Blood tests often are repeated to check for changes over time. Coronary Angiography Coronary angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the insides of your coronary arteries. This test often is done during a heart attack to help find blockages in the coronary arteries. To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-e-ter-ih-ZA-shun). A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through the coronary arteries. The dye lets your doctor study the flow of blood through the heart and blood vessels. If your doctor finds a blockage, he or she may recommend a procedure calledpercutaneous (per-ku-TA-ne-us) coronary intervention (PCI), sometimes referred to ascoronary angioplasty(AN-jee-oh-plas-tee). This procedure can help restore blood flow through a blocked artery. Sometimes a small mesh tube called a stent is placed in the artery to help prevent blockages after the procedure.",
+    "http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack"
+  ],
+  [
+    "Heart Attack (Life After): Many people survive heart attacks and live active, full lives. If you get help quickly, treatment can limit damage to your heart muscle. Less heart damage improves your chances for a better quality of life after a heart attack. Medical Followup After a heart attack, you'll need treatment for coronary heart disease (CHD). This will help prevent another heart attack. Your doctor may recommend: Lifestyle changes, such as following a healthy diet, being physically active, maintaining a healthy weight, and quitting smoking. Medicines to control chest pain or discomfort, high blood cholesterol, high blood pressure, and your heart's workload.\u00a0Some of these medicines can help you prevent another heart attack. Anticlotting medicines, such as aspirin, that your doctor may prescribe to help you prevent another heart attack. A cardiac rehabilitation program If you find it hard to get your medicines or or complete your cardiac rehabilitation program, talk with your doctor. Don't stop the medicines or program because it\u00a0can help you prevent another heart attack. Returning to Normal Activities After a heart attack, most people who don't have chest pain or discomfort or other problems can safely return to most of their normal activities within a few weeks. Most can begin walking right away. Sexual activity also can begin within a few weeks for most patients. Talk with your doctor about a safe schedule for returning to your normal routine. If allowed by State law, driving usually can begin within a week for most patients who don't have chest pain or discomfort or other disabling problems. Each State has rules about driving a motor vehicle following a serious illness. People who have complications shouldn't drive until their symptoms have been stable for a few weeks. Anxiety and Depression After a Heart Attack After a heart attack, many people worry about having another heart attack. Sometimes they feel depressed and have trouble adjusting to new lifestyle changes. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life. Joining a patient support group may help you adjust to life after a heart attack. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center. Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you. Risk of a Repeat Heart Attack Once you've had a heart attack, you're at higher risk for another one. Knowing the difference between angina and a heart attack is important. Angina is chest pain that occurs in people who have CHD. The pain from angina usually occurs after physical exertion and goes away in a few minutes when you rest or take medicine as directed. The pain from a heart attack usually is more severe than the pain from angina. Heart attack pain doesn't go away when you rest or take medicine. If you don't know whether your chest pain is angina or a heart attack, call 9\u20131\u20131. The symptoms of a second heart attack may not be the same as those of a first heart attack. Don't take a chance if you're in doubt. Always call 9\u20131\u20131 right away if you or someone else has heart attack symptoms. Unfortunately, most heart attack victims wait 2 hours or more after their symptoms start before they seek medical help. This delay can result in lasting heart damage or death.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack"
+  ],
+  [
+    "How to diagnose Heart Attack?: If You Have Symptoms, Call 9-1-1 Diagnosis and treatment of a heart attack can begin when emergency personnel arrive after you call 9-1-1. Do not put off calling 9-1-1 because you are not sure that you are having a heart attack. Call within 5 minutes of the start of symptoms. At the hospital emergency room, doctors will work fast to find out if you are having or have had a heart attack. They will consider your symptoms, medical and family history, and test results. Initial tests will be quickly followed by treatment if you are having a heart attack. Diagnostic Tests - an electrocardiogram - blood tests - nuclear heart scan - cardiac catheterization - and coronary angiography. an electrocardiogram blood tests nuclear heart scan cardiac catheterization and coronary angiography. The electrocardiogram, also known as ECG or EKG, is used to measure the rate and regularity of your heartbeat. Blood tests are also used in diagnosing a heart attack. When cells in the heart die, they release enzymes into the blood. They are called markers or biomarkers. Measuring the amount of these markers in the blood can show how much damage was done to your heart. Doctors often repeat these tests to check for changes. The nuclear heart scan uses radioactive tracers to outline the heart chambers and major blood vessels leading to and from the heart. A nuclear heart scan shows any damage to your heart muscle as well as how well blood flows to and from the heart. In cardiac catheterization, a thin, flexible tube is passed through an artery in your groin or arm to reach the coronary arteries. This test allows your doctor to - determine blood pressure and flow in the heart's chambers - collect blood samples from the heart, and - examine the arteries of the heart by x-ray. determine blood pressure and flow in the heart's chambers collect blood samples from the heart, and examine the arteries of the heart by x-ray. Coronary angiography is usually done with the cardiac catheterization. A dye that can be seen on an x-ray is injected through the catheter into the coronary arteries. It shows where there are blockages and how severe they are.",
+    "http://nihseniorhealth.gov/heartattack/toc.html"
+  ],
+  [
+    "Heart Attack (Signs and Symptoms): Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. In one study, for example, one-third of the patients who had heart attacks had no chest pain. These patients were more likely to be older, female, or diabetic. The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one. It is important for you to know the most common symptoms of a heart attack and also remember these facts: Heart attacks can start slowly and cause only mild pain or discomfort. Symptoms can be mild or more intense and sudden. Symptoms also may come and go over several hours. People who have high blood sugar (diabetes) may have no symptoms or very mild ones. The most common symptom, in both men and women, is chest pain or discomfort. Women are somewhat more likely to have shortness of breath, nausea and vomiting, unusual tiredness (sometimes for days), and pain in the back, shoulders, and jaw. Some people don't have symptoms at all. Heart attacks that occur without any symptoms or with very mild symptoms are called silent heart attacks. Most Common Symptoms The most common warning symptoms of a heart attack for both men and women are: Chest pain or discomfort.\u00a0Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion. The feeling can be mild or severe. Upper body discomfort.\u00a0You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button). Shortness of breath.\u00a0This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity. The symptoms of angina (an-JI-nuh or AN-juh-nuh) can be similar to the symptoms of a heart attack. Angina is chest pain that occurs in people who have coronary heart disease, usually when they're active. Angina pain usually lasts for only a few minutes and goes away with rest. Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack. All chest pain should be checked by a doctor. Other Common Signs and Symptoms Pay attention to these other possible symptoms of a heart attack: Breaking out in a cold sweat Feeling unusually tired for no reason, sometimes for days (especially if you are a woman) Nausea (feeling sick to the stomach) and vomiting Light-headedness or sudden dizziness Any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual) Not everyone having a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. However, some people may have a pattern of symptoms that recur. The more signs and symptoms you have, the more likely it is that you're having a heart attack. Quick Action Can Save Your Life: Call 9\u20131\u20131\u00a0 The signs and symptoms of a heart attack can develop suddenly. However, they also can develop slowly\u2014sometimes within hours, days, or weeks of a heart attack. Any time you think you might be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9\u20131\u20131 for emergency medical care, even if you are not sure whether you're having a heart attack. Here's why: Acting fast can save your life. An ambulance is the best and safest way to get to the hospital. Emergency medical services (EMS) personnel can check how you are doing and start life-saving medicines and other treatments right away. People who arrive by ambulance often receive faster treatment at the hospital.\u00a0 The 9\u20131\u20131 operator or EMS technician can give you advice. You might be told to crush or chew an aspirin if you're not allergic, unless there is a medical reason for you not to take one. Aspirin taken during a heart attack can limit the damage to your heart and save your life. Every minute matters. Never delay calling 9\u20131\u20131 to take aspirin or do anything else you think might help.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack"
+  ],
+  [
+    "How to diagnose Heart Attack?: Several tests are used to diagnose a heart attack. - An electrocardiogram, also called an EKG, measures the rate and regularity of your heartbeat. - Blood tests identify and measure markers in the blood that can show how much damage was done to your heart. These tests are often repeated at specific time periods to check for changes. - A nuclear heart scan uses radioactive tracers to show damage to heart chambers and major blood vessels. - Cardiac catheterization involves passing a thin flexible tube through an artery in your groin or arm to look at your coronary arteries. It allows your doctor to examine the blood flow in your heart's chambers. - Cardiac angiography is usually performed along with cardiac catheterization, using a dye injected through the cardiac catheter. The dye allows the doctor to see where there may be blockages in the coronary arteries. An electrocardiogram, also called an EKG, measures the rate and regularity of your heartbeat. Blood tests identify and measure markers in the blood that can show how much damage was done to your heart. These tests are often repeated at specific time periods to check for changes. A nuclear heart scan uses radioactive tracers to show damage to heart chambers and major blood vessels. Cardiac catheterization involves passing a thin flexible tube through an artery in your groin or arm to look at your coronary arteries. It allows your doctor to examine the blood flow in your heart's chambers. Cardiac angiography is usually performed along with cardiac catheterization, using a dye injected through the cardiac catheter. The dye allows the doctor to see where there may be blockages in the coronary arteries.",
+    "http://nihseniorhealth.gov/heartattack/toc.html"
+  ],
+  [
+    "Heart attack: A heart attack occurs when the flow of blood to the heart is blocked, most often by a build-up of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries). The interrupted blood flow can damage or destroy part of the heart muscle. A heart attack, also called a myocardial infarction, can be fatal, but treatment has improved dramatically over the years. It's crucial to call 911 or emergency medical help if you think you might be having a heart attack. Common heart attack signs and symptoms include: - Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back - Nausea, indigestion, heartburn or abdominal pain - Shortness of breath - Cold sweat - Fatigue - Lightheadedness or sudden dizziness Heart attack symptoms vary Not all people who have heart attacks have the same symptoms or have the same severity of symptoms. Some people have mild pain; others have more severe pain. Some people have no symptoms, while for others, the first sign may be sudden cardiac arrest. However, the more signs and symptoms you have, the greater the likelihood you're having a heart attack. Some heart attacks strike suddenly, but many people have warning signs and symptoms hours, days or weeks in advance. The earliest warning may be recurrent chest pain (angina) that's triggered by exertion and relieved by rest. Angina is caused by a temporary decrease in blood flow to the heart. A heart attack differs from a condition in which your heart suddenly stops (sudden cardiac arrest, which occurs when an electrical disturbance disrupts your heart's pumping action and causes blood to stop flowing to the rest of your body). A heart attack can cause cardiac arrest, but it's not the only cause. When to see a doctor Act immediately. Some people wait too long because they don't recognize the important signs and symptoms. Take these steps: - Call for emergency medical help. If you suspect you're having a heart attack, don't hesitate. Immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only if there are no other options. Because your condition can worsen, driving yourself puts you and others at risk. - Take nitroglycerin, if prescribed to you by a doctor. Take it as instructed while awaiting emergency help. - Take aspirin, if recommended. Taking aspirin during a heart attack could reduce heart damage by helping to keep your blood from clotting. Aspirin can interact with other medications, however, so don't take an aspirin unless your doctor or emergency medical personnel recommend it. Don't delay calling 911 to take an aspirin. Call for emergency help first. What to do if you see someone having a heart attack If you encounter someone who is unconscious, first call for emergency medical help. Then begin CPR to keep blood flowing. Push hard and fast on the person's chest in a fairly rapid rhythm - about 100 to 120 compressions a minute. It's not necessary to check the person's airway or deliver rescue breaths unless you've been trained in CPR. A heart attack occurs when one or more of your coronary arteries become blocked. Over time, a coronary artery can narrow from the buildup of various substances, including cholesterol (atherosclerosis). This condition, known as coronary artery disease, causes most heart attacks. During a heart attack, one of these plaques can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If large enough, the clot can completely block the flow of blood through the coronary artery. Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Use of tobacco and of illicit drugs, such as cocaine, can cause a life-threatening spasm. A heart attack can also occur due to a tear in the heart artery (spontaneous coronary artery dissection). Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body. You can improve or eliminate many of these risk factors to reduce your chances of having a first or subsequent heart attack. Heart attack risk factors include: - Age. Men age 45 or older and women age 55 or older are more likely to have a heart attack than are younger men and women. - Tobacco. Smoking and long-term exposure to secondhand smoke increase the risk of a heart attack. - High blood pressure. Over time, high blood pressure can damage arteries that feed your heart by accelerating atherosclerosis. High blood pressure that occurs with obesity, smoking, high cholesterol or diabetes increases your risk even more. - High blood cholesterol or triglyceride levels. A high level of low-density lipoprotein (LDL) cholesterol (the \"bad\" cholesterol) is most likely to narrow arteries. A high level of triglycerides, a type of blood fat related to your diet, also ups your risk of heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol (the \"good\" cholesterol) lowers your risk of heart attack. - Diabetes. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, a form of sugar. Having diabetes - not producing enough insulin or not responding to insulin properly - causes your body's blood sugar levels to rise. Diabetes, especially uncontrolled, increases your risk of a heart attack. - Family history of heart attack. If your siblings, parents or grandparents have had early heart attacks (by age 55 for male relatives and by age 65 for female relatives), you may be at increased risk. - Lack of physical activity. An inactive lifestyle contributes to high blood cholesterol levels and obesity. People who get regular aerobic exercise have better cardiovascular fitness, which decreases their overall risk of heart attack. Exercise is also beneficial in lowering high blood pressure. - Obesity. Obesity is associated with high blood cholesterol levels, high triglyceride levels, high blood pressure and diabetes. Losing just 10 percent of your body weight can lower this risk, however. - Stress. You may respond to stress in ways that can increase your risk of a heart attack. - Illegal drug use. Using stimulant drugs, such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack. - A history of preeclampsia. This condition causes high blood pressure during pregnancy and increases the lifetime risk of heart disease. - A history of an autoimmune condition, such as rheumatoid arthritis or lupus. Conditions such as rheumatoid arthritis, lupus and other autoimmune conditions can increase your risk of having a heart attack. Complications are often related to the damage done to your heart during an attack. Damage can lead to: - Abnormal heart rhythms (arrhythmias). Electrical \"short circuits\" can develop, resulting in abnormal heart rhythms, some of which can be serious, even fatal. - Heart failure. An attack may damage so much heart tissue that the remaining heart muscle can't adequately pump blood out of your heart. Heart failure may be temporary, or it can be a chronic condition resulting from extensive and permanent damage to your heart. - Heart rupture. Areas of heart muscle weakened by a heart attack can rupture, leaving a hole in part of the heart. This rupture is often fatal. - Valve problems. Heart valves damaged during a heart attack may develop severe leakage problems. Ideally, your doctor should screen you during regular physical exams for risk factors that can lead to a heart attack. If you're in an emergency setting for symptoms of a heart attack, you'll be asked to describe your symptoms and have your blood pressure, pulse and temperature checked. You'll be hooked up to a heart monitor and will almost immediately have tests to see if you're having a heart attack. Tests will help check if your signs and symptoms, such as chest pain, indicate a heart attack or another condition. These tests include: - Electrocardiogram (ECG). This first test done to diagnose a heart attack records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as waves displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress. - Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Emergency room doctors will take samples of your blood to test for the presence of these enzymes. Additional tests If you've had a heart attack or one is occurring, doctors will take immediate steps to treat your condition. You may also undergo these additional tests: - Chest X-ray. An X-ray image of your chest allows your doctor to check the size of your heart and its blood vessels and to look for fluid in your lungs. - Echocardiogram. During this test, sound waves directed at your heart from a wandlike device (transducer) held on your chest bounce off your heart and are processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged by a heart attack and isn't pumping normally or at peak capacity. - Coronary catheterization (angiogram). A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg or groin, to the arteries in your heart. The dye makes the arteries visible on X-ray, revealing areas of blockage. - Exercise stress test. In the days or weeks after your heart attack, you may also undergo a stress test. Stress tests measure how your heart and blood vessels respond to exertion. You may walk on a treadmill or pedal a stationary bike while attached to an ECG machine. Or you may receive a drug intravenously that stimulates your heart similar to exercise. Your doctor may also order a nuclear stress test, which is similar to an exercise stress test, but uses an injected dye and special imaging techniques to produce detailed images of your heart while you're exercising. These tests can help determine your long-term treatment. - Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). These tests can be used to diagnose heart problems, including the extent of damage from heart attacks. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. In a cardiac MRI, you lie on a table inside a long tubelike machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. The signals create images of your heart. Heart attack treatment at a hospital With each passing minute after a heart attack, more heart tissue loses oxygen and deteriorates or dies. The main way to prevent heart damage is to restore blood flow quickly. Medications Medications given to treat a heart attack include: - Aspirin. The 911 operator may instruct you to take aspirin, or emergency medical personnel may give you aspirin immediately. Aspirin reduces blood clotting, thus helping maintain blood flow through a narrowed artery. - Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you'll survive and with less heart damage. - Antiplatelet agents. Emergency room doctors may give you other drugs to help prevent new clots and keep existing clots from getting larger. These include medications, such as clopidogrel (Plavix) and others, called platelet aggregation inhibitors. - Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood less \"sticky\" and less likely to form clots. Heparin is given intravenously or by an injection under your skin. - Pain relievers. You may receive a pain reliever, such as morphine, to ease your discomfort. - Nitroglycerin. This medication, used to treat chest pain (angina), can help improve blood flow to the heart by widening (dilating) the blood vessels. - Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure, making your heart's job easier. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks. - ACE inhibitors. These drugs lower blood pressure and reduce stress on the heart. Surgical and other procedures In addition to medications, you may undergo one of the following procedures to treat your heart attack: - Coronary angioplasty and stenting. Doctors insert a long, thin tube (catheter) that's passed through an artery, usually in your leg or groin, to a blocked artery in your heart. If you've had a heart attack, this procedure is often done immediately after a cardiac catheterization, a procedure used to locate blockages. This catheter is equipped with a special balloon that, once in position, is briefly inflated to open a blocked coronary artery. A metal mesh stent may be inserted into the artery to keep it open long term, restoring blood flow to the heart. Depending on your condition, your doctor may opt to place a stent coated with a slow-releasing medication to help keep your artery open. - Coronary artery bypass surgery. In some cases, doctors may perform emergency bypass surgery at the time of a heart attack. If possible, your doctor may suggest that you have bypass surgery after your heart has had time - about three to seven days - to recover from your heart attack. Bypass surgery involves sewing veins or arteries in place beyond a blocked or narrowed coronary artery, allowing blood flow to the heart to bypass the narrowed section. Once blood flow to your heart is restored and your condition is stable, you're likely to remain in the hospital for several days. Your lifestyle affects your heart health. The following steps can help you not only prevent but also recover from a heart attack: - Avoid smoke. The most important thing you can do to improve your heart's health is to not smoke. Also, avoid being around secondhand smoke. If you need to quit, ask your doctor for help. - Control your blood pressure and cholesterol levels. If one or both of these is high, your doctor can prescribe changes to your diet and medications. Ask your doctor how often you need to have your blood pressure and cholesterol levels monitored. - Get regular medical checkups. Some of the major risk factors for heart attack - high blood cholesterol, high blood pressure and diabetes - cause no symptoms early on. Your doctor can perform tests to check for these conditions and help you manage them, if necessary. - Exercise regularly. Regular exercise helps improve heart muscle function after a heart attack and helps prevent a heart attack by helping you to control your weight, diabetes, cholesterol and blood pressure. Exercise needn't be vigorous. Walking 30 minutes a day, five days a week can improve your health. - Maintain a healthy weight. Excess weight strains your heart and can contribute to high cholesterol, high blood pressure and diabetes. - Eat a heart-healthy diet. Saturated fat, trans fats and cholesterol in your diet can narrow arteries to your heart, and too much salt can raise blood pressure. Eat a heart-healthy diet that includes lean proteins, such as fish and beans, plenty of fruits and vegetables and whole grains. - Manage diabetes. High blood sugar is damaging to your heart. Regular exercise, eating well and losing weight all help to keep blood sugar levels at more-desirable levels. Many people also need medication to manage their diabetes. - Control stress. Reduce stress in your day-to-day activities. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events in your life. - If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and men older than age 65, and up to two drinks a day for men age 65 and younger.",
+    "https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106"
+  ],
+  [
+    "Heart attack (Risk factors): Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body. You can improve or eliminate many of these risk factors to reduce your chances of having a first or subsequent heart attack. Heart attack risk factors include: - Age. Men age 45 or older and women age 55 or older are more likely to have a heart attack than are younger men and women. - Tobacco. Smoking and long-term exposure to secondhand smoke increase the risk of a heart attack. - High blood pressure. Over time, high blood pressure can damage arteries that feed your heart by accelerating atherosclerosis. High blood pressure that occurs with obesity, smoking, high cholesterol or diabetes increases your risk even more. - High blood cholesterol or triglyceride levels. A high level of low-density lipoprotein (LDL) cholesterol (the \"bad\" cholesterol) is most likely to narrow arteries. A high level of triglycerides, a type of blood fat related to your diet, also ups your risk of heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol (the \"good\" cholesterol) lowers your risk of heart attack. - Diabetes. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, a form of sugar. Having diabetes - not producing enough insulin or not responding to insulin properly - causes your body's blood sugar levels to rise. Diabetes, especially uncontrolled, increases your risk of a heart attack. - Family history of heart attack. If your siblings, parents or grandparents have had early heart attacks (by age 55 for male relatives and by age 65 for female relatives), you may be at increased risk. - Lack of physical activity. An inactive lifestyle contributes to high blood cholesterol levels and obesity. People who get regular aerobic exercise have better cardiovascular fitness, which decreases their overall risk of heart attack. Exercise is also beneficial in lowering high blood pressure. - Obesity. Obesity is associated with high blood cholesterol levels, high triglyceride levels, high blood pressure and diabetes. Losing just 10 percent of your body weight can lower this risk, however. - Stress. You may respond to stress in ways that can increase your risk of a heart attack. - Illegal drug use. Using stimulant drugs, such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack. - A history of preeclampsia. This condition causes high blood pressure during pregnancy and increases the lifetime risk of heart disease. - A history of an autoimmune condition, such as rheumatoid arthritis or lupus. Conditions such as rheumatoid arthritis, lupus and other autoimmune conditions can increase your risk of having a heart attack.",
+    "https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106"
+  ],
+  [
+    "Heart attack (Causes): A heart attack occurs when one or more of your coronary arteries become blocked. Over time, a coronary artery can narrow from the buildup of various substances, including cholesterol (atherosclerosis). This condition, known as coronary artery disease, causes most heart attacks. During a heart attack, one of these plaques can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If large enough, the clot can completely block the flow of blood through the coronary artery. Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Use of tobacco and of illicit drugs, such as cocaine, can cause a life-threatening spasm. A heart attack can also occur due to a tear in the heart artery (spontaneous coronary artery dissection).",
+    "https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106"
+  ],
+  [
+    "Syncope: Syncope is a medical term used to describe a temporary loss of consciousness due to the sudden decline of blood flow to the brain. Syncope is commonly called fainting or \u201cpassing out.\u201d If an individual is about to faint, he or she will feel dizzy, lightheaded, or nauseous and their field of vision may \u201cwhite out\u201d or \u201cblack out.\u201d\u00a0 The skin may be cold and clammy. \u00a0The person drops to the floor as he or she loses consciousness.\u00a0 After fainting, an individual may be unconscious for a minute or two, but will revive and slowly return to normal.\u00a0 Syncope can occur in otherwise healthy people and affects all age groups, but occurs more often in the elderly.\u00a0 There are several types of syncope.\u00a0\u00a0Vasovagal\u00a0syncope usually has an easily identified triggering event such as emotional stress, trauma, pain, the sight of blood, or prolonged standing.\u00a0\u00a0Carotid sinus\u00a0syncope happens because of constriction of the carotid artery in the neck and can occur after turning the head, while shaving, or when wearing a tight collar.\u00a0\u00a0Situational\u00a0syncope happens during urination, defecation, coughing, or as a result of gastrointestinal stimulation.\u00a0 Syncope can also be a symptom of heart disease or abnormalities that create an uneven heart rate or rhythm that temporarily affect blood volume and its distribution in the body.\u00a0 Syncope isn\u2019t normally a primary sign of a neurological disorder, but it may indicate an increased risk for neurologic disorders such as Parkinson\u2019s disease, postural orthostatic tachycardia syndrome (POTS), diabetic neuropathy, and other types of neuropathy.\u00a0 Certain classes of drugs are associated with an increased risk of syncope, including diuretics, calcium antagonists, ACE inhibitors, nitrates, antipsychotics, antihistamines, levodopa, narcotics, and alcohol. The immediate treatment for an individual who has fainted involves checking first to see if their airway is open and they are breathing.\u00a0 The person should remain lying down for at least 10-15 minutes, preferably in a cool and quiet space.\u00a0 If this isn\u2019t possible, have the individual sit forward and lower their head below their shoulders and between their knees.\u00a0 Ice or cold water in a cup is refreshing.\u00a0 For individuals who have problems with chronic fainting spells, therapy should focus on recognizing the triggers and learning techniques to keep from fainting.\u00a0 \u00a0At the appearance of warning signs such as lightheadedness, nausea, or cold and clammy skin, counter-pressure maneuvers that involve gripping fingers into a fist, tensing the arms, and crossing the legs or squeezing the thighs together can be used to ward off a fainting spell.\u00a0 If fainting spells occur often without a triggering event, syncope may be a sign of an underlying heart disease. Syncope is a dramatic event and can be life-threatening if not treated properly. Generally, however, people recover completely within minutes to hours. \u00a0If syncope is symptomatic of an underlying condition, then the prognosis will reflect the course of the disorder.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Fainting-Information-Page"
+  ],
+  [
+    "What is Ischemic Stroke?: A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Ischemic stroke is the most common type. It is usually caused by a blood clot that blocks or plugs a blood vessel in the brain. This keeps blood from flowing to the brain. Within minutes, brain cells begin to die. Another cause is stenosis, or narrowing of the artery. This can happen because of atherosclerosis, a disease in which plaque builds up inside your arteries. Transient ischemic attacks (TIAs) occur when the blood supply to the brain is interrupted briefly. Having a TIA can mean you are at risk for having a more serious stroke. Symptoms of stroke are - Sudden numbness or weakness of the face, arm or leg (especially on one side of the body) - Sudden confusion, trouble speaking or understanding speech - Sudden trouble seeing in one or both eyes - Sudden trouble walking, dizziness, loss of balance or coordination - Sudden severe headache with no known cause It is important to treat strokes as quickly as possible. Blood thinners may be used to stop a stroke while it is happening by quickly dissolving the blood clot. Post-stroke rehabilitation can help people overcome disabilities caused by stroke damage. NIH: National Institute of Neurological Disorders and Stroke",
+    "https://www.nlm.nih.gov/medlineplus/ischemicstroke.html"
+  ],
+  [
+    "Vasovagal syncope: Vasovagal syncope (vay-zoh-VAY-gul SING-kuh-pee) occurs when you faint because your body overreacts to certain triggers, such as the sight of blood or extreme emotional distress. It may also be called neurocardiogenic syncope. The vasovagal syncope trigger causes your heart rate and blood pressure to drop suddenly. That leads to reduced blood flow to your brain, causing you to briefly lose consciousness. Vasovagal syncope is usually harmless and requires no treatment. But it's possible you may injure yourself during a vasovagal syncope episode. Your doctor may recommend tests to rule out more serious causes of fainting, such as heart disorders. Before you faint due to vasovagal syncope, you may experience some of the following: - Pale skin - Lightheadedness - Tunnel vision - your field of vision narrows so that you see only what's in front of you - Nausea - Feeling warm - A cold, clammy sweat - Yawning - Blurred vision During a vasovagal syncope episode, bystanders may notice: - Jerky, abnormal movements - A slow, weak pulse - Dilated pupils Recovery after a vasovagal episode generally begins in less than a minute. However, if you stand up too soon after fainting - within about 15 to 30 minutes - you're at risk of fainting again. When to see a doctor Fainting can be a sign of a more serious condition, such as a heart or brain disorder. You may want to consult your doctor after a fainting spell, especially if you never had one before. Vasovagal syncope occurs when the part of your nervous system that regulates heart rate and blood pressure malfunctions in response to a trigger, such as the sight of blood. Your heart rate slows, and the blood vessels in your legs widen (dilate.) This allows blood to pool in your legs, which lowers your blood pressure. Combined, the drop in blood pressure and slowed heart rate quickly reduce blood flow to your brain, and you faint. Sometimes there is no classical vasovagal syncope trigger, but common triggers include: - Standing for long periods of time - Heat exposure - Seeing blood - Having blood drawn - Fear of bodily injury - Straining, such as to have a bowel movement Diagnosing vasovagal syncope often involves ruling out other possible causes of your fainting - particularly heart-related problems. These tests may include: - Electrocardiogram. This test records the electrical signals your heart produces. It can detect irregular heart rhythms and other cardiac problems. You may need to wear a portable monitor for at least a day or as long as a month. - Echocardiogram. This test uses ultrasound imaging to view the heart and look for conditions, such as valve problems, that can cause fainting. - Exercise stress test. This test studies heart rhythms during exercise. It's usually conducted while you walk or jog on a treadmill. - Blood tests. Your doctor may look for conditions, such as anemia, that can cause or contribute to fainting spells. Tilt table test If no heart problems appear to cause your fainting, your doctor may suggest you undergo a tilt table test. For a tilt table test: - You lie flat on your back on a table. - The table changes position, tilting you upward at various angles. - A technician monitors your heart rhythms and blood pressure to see if the postural changes affect them. In most cases of vasovagal syncope, treatment is unnecessary. Your doctor may help you identify your fainting triggers and discuss ways you might avoid them. However, if you experience vasovagal syncope often enough to interfere with your quality of life, your doctor may suggest trying one or more of the following remedies. Medications A drug called fludrocortisone acetate that's normally used to treat low blood pressure may be helpful in preventing vasovagal syncope. Selective serotonin inhibitors may also be used. Therapies Your doctor may recommend ways to decrease the pooling of blood in your legs. These may include foot exercises, wearing compression stockings or tensing your leg muscles when standing. You may need to increase salt in your diet if you don't usually have high blood pressure. Avoid prolonged standing - especially in hot, crowded places - and drink plenty of fluids. Surgery Very rarely, inserting an electrical pacemaker to regulate the heartbeat may help some people with vasovagal syncope who haven't been helped by other treatments.",
+    "https://www.mayoclinic.org/diseases-conditions/vasovagal-syncope/symptoms-causes/syc-20350527"
+  ],
+  [
+    "Stroke (What Is a Stroke?): A stroke happens when something changes how blood flows through the brain. Blood brings oxygen and nutrients to brain cells. If blood can't flow to a part of the brain, cells that do not receive enough oxygen suffer and eventually die. If brain cells are without oxygen for only a short time, they can sometimes get better. But brain cells that have died can't be brought back to life. So, someone who has had a stroke may have trouble speaking, thinking, or walking.There are two major types of stroke. The most common kind, ischemic, is caused by a blood clot or the narrowing of a blood vessel (an artery) leading to the brain. This keeps blood from flowing into other parts of the brain and keeps needed oxygen and nutrients from reaching brain cells. Blockages that cause ischemic strokes stem from three conditions:- Formation of a clot within a blood vessel of the brain or neck, called thrombosis - Movement of a clot from another part of the body, such as from the heart to the neck or brain, called an embolism - Severe narrowing of an artery (stenosis) in or leading to the brain, due to fatty deposits lining the blood vessel wallsIn the second major kind of stroke, hemorrhagic, a broken blood vessel causes bleeding in the brain. This break in the vessel also stops oxygen and nutrients from reaching brain cells.Sometimes the symptoms of a stroke last only a few minutes and then go away. That could be a transient ischemic attack (TIA), also called a mini-stroke. A TIA is a medical emergency. You should get medical help right away. If a TIA is not treated quickly, it could be followed within hours or days by a major disabling stroke.",
+    "https://www.nia.nih.gov/health/topics/stroke"
+  ],
+  [
+    "Stroke: A stroke occurs if the flow of oxygen-rich blood to a portion of the brain is blocked. Without oxygen, brain cells start to die after a few minutes. Sudden bleeding in the brain also can cause a stroke if it damages brain cells. If brain cells die or are damaged because of a stroke, symptoms occur in the parts of the body that these brain cells control. Examples of stroke symptoms include sudden weakness; paralysis or numbness of the face, arms, or legs (paralysis is an inability to move); trouble speaking or understanding speech; and trouble seeing. A stroke is a serious medical condition that requires emergency care. A stroke can cause lasting brain damage, long-term disability, or even death. If you think you or someone else is having a stroke, call 9\u20131\u20131 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts. Overview The two main types of stroke are ischemic (is-KE-mik) and hemorrhagic (hem-ah-RAJ-ik). Ischemic is the more common type of stroke. An ischemic stroke occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes. A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures (breaks open). The pressure from the leaked blood damages brain cells. High blood pressure and aneurysms (AN-u-risms) are examples of conditions that can cause hemorrhagic strokes. (Aneurysms are balloon-like bulges in an artery that can stretch and burst.) Another condition that\u2019s similar to a stroke is a transient ischemic attack, also called a TIA or \u201cmini-stroke.\u201d A TIA occurs if blood flow to a portion of the brain is blocked only for a short time. Thus, damage to the brain cells isn\u2019t permanent (lasting). Like ischemic strokes, TIAs often are caused by blood clots. Although TIAs are not full-blown strokes, they greatly increase the risk of having a stroke. If you have a TIA, it\u2019s important for your doctor to find the cause so you can take steps to prevent a stroke. Both strokes and TIAs require emergency care. Outlook Stroke is a leading cause of death in the United States. Many factors can raise your risk of having a stroke. Talk with your doctor about how you can control these risk factors and help prevent a stroke. If you have a stroke, prompt treatment can reduce damage to your brain and help you avoid lasting disabilities. Prompt treatment also may help prevent another stroke. Researchers continue to study the causes and risk factors for stroke. They\u2019re also finding new and better treatments and new ways to help the brain repair itself after a stroke. Ischemic Stroke An ischemic stroke occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes. The two types of ischemic stroke are thrombotic (throm-BOT-ik) and embolic (em-BOL-ik). In a thrombotic stroke, a blood clot (thrombus) forms in an artery that supplies blood to the brain. In an embolic stroke, a blood clot or other substance (such as plaque, a fatty material) travels through the bloodstream to an artery in the brain. (A blood clot or piece of plaque that travels through the bloodstream is called an embolus.) With both types of ischemic stroke, the blood clot or plaque blocks the flow of oxygen-rich blood to a portion of the brain. Ischemic Stroke Hemorrhagic Stroke A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures (breaks open). The pressure from the leaked blood damages brain cells. The two types of hemorrhagic stroke are intracerebral (in-trah-SER-e-bral) and subarachnoid (sub-ah-RAK-noyd). In an intracerebral hemorrhage, a blood vessel inside the brain leaks blood or ruptures. In a subarachnoid hemorrhage, a blood vessel on the surface of the brain leaks blood or ruptures. When this happens, bleeding occurs between the inner and middle layers of the membranes that cover the brain. In both types of hemorrhagic stroke, the leaked blood causes swelling of the brain and increased pressure in the skull. The swelling and pressure damage cells and tissues in the brain. Hemorrhagic Stroke Brain attack Cerebrovascular accident (CVA) Hemorrhagic stroke (includes intracerebral hemorrhage and subarachnoid hemorrhage) Ischemic stroke (includes thrombotic stroke and embolic stroke) A transient ischemic attack sometimes is called a TIA or mini-stroke. A TIA has the same symptoms as a stroke, and it increases your risk of having a stroke. Ischemic Stroke and Transient Ischemic Attack An ischemic stroke or transient ischemic attack (TIA) occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Many medical conditions can increase the risk of ischemic stroke or TIA. For example, atherosclerosis (ath-er-o-skler-O-sis) is a disease in which a fatty substance called plaque builds up on the inner walls of the arteries. Plaque hardens and narrows the arteries, which limits the flow of blood to tissues and organs (such as the heart and brain). Plaque in an artery can crack or rupture (break open). Blood platelets (PLATE-lets), which are disc-shaped cell fragments, stick to the site of the plaque injury and clump together to form blood clots. These clots can partly or fully block an artery. Plaque can build up in any artery in the body, including arteries in the heart, brain, and neck. The two main arteries on each side of the neck are called the carotid (ka-ROT-id) arteries. These arteries supply oxygen-rich blood to the brain, face, scalp, and neck. When plaque builds up in the carotid arteries, the condition is called carotid artery disease. Carotid artery disease causes many of the ischemic strokes and TIAs that occur in the United States. An embolic stroke (a type of ischemic stroke) or TIA also can occur if a blood clot or piece of plaque breaks away from the wall of an artery. The clot or plaque can travel through the bloodstream and get stuck in one of the brain\u2019s arteries. This stops blood flow through the artery and damages brain cells. Heart conditions and blood disorders also can cause blood clots that can lead to a stroke or TIA. For example, atrial fibrillation (A-tre-al fi-bri-LA-shun), or AF, is a common cause of embolic stroke. In AF, the upper chambers of the heart contract in a very fast and irregular way. As a result, some blood pools in the heart. The pooling increases the risk of blood clots forming in the heart chambers. An ischemic stroke or TIA also can occur because of lesions caused by atherosclerosis. These lesions may form in the small arteries of the brain, and they can block blood flow to the brain. Hemorrhagic Stroke Sudden bleeding in the brain can cause a hemorrhagic stroke. The bleeding causes swelling of the brain and increased pressure in the skull. The swelling and pressure damage brain cells and tissues. Examples of conditions that can cause a hemorrhagic stroke include high blood pressure, aneurysms, and arteriovenous (ar-TEER-e-o-VE-nus) malformations (AVMs). \"Blood pressure\" is the force of blood pushing against the walls of the arteries as the heart pumps blood. If blood pressure rises and stays high over time, it can damage the body in many ways. Aneurysms are balloon-like bulges in an artery that can stretch and burst. AVMs are tangles of faulty arteries and veins that can rupture within the brain. High blood pressure can increase the risk of hemorrhagic stroke in people who have aneurysms or AVMs. Certain traits, conditions, and habits can raise your risk of having a stroke or transient ischemic attack (TIA). These traits, conditions, and habits are known as risk factors. The more risk factors you have, the more likely you are to have a stroke. You can treat or control some risk factors, such as high blood pressure and smoking. Other risk factors, such as age and gender, you can\u2019t control. The major risk factors for stroke include: High blood pressure. High blood pressure is the main risk factor for stroke. Blood pressure is considered high if it stays at or above 140/90 millimeters of mercury (mmHg) over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher. Diabetes. Diabetes is a disease in which the blood sugar level is high because the body doesn\u2019t make enough insulin or doesn\u2019t use its insulin properly. Insulin is a hormone that helps move blood sugar into cells where it\u2019s used for energy. Heart diseases.\u00a0Coronary heart disease,\u00a0cardiomyopathy,\u00a0heart failure, and\u00a0atrial fibrillation\u00a0can cause blood clots that can lead to a stroke. Smoking. Smoking can damage blood vessels and raise blood pressure. Smoking also may reduce the amount of oxygen that reaches your body\u2019s tissues. Exposure to secondhand smoke also can damage the blood vessels. Age and gender. Your risk of stroke increases as you get older. At younger ages, men are more likely than women to have strokes. However, women are more likely to die from strokes. Women who take birth control pills also are at slightly higher risk of stroke. Race and ethnicity. Strokes occur more often in African American, Alaska Native, and American Indian adults than in white, Hispanic, or Asian American adults. Personal or family history of stroke or TIA. If you\u2019ve had a stroke, you\u2019re at higher risk for another one. Your risk of having a repeat stroke is the highest right after a stroke. A TIA also increases your risk of having a stroke, as does having a family history of stroke. Brain\u00a0aneurysms\u00a0or arteriovenous malformations (AVMs). Aneurysms are balloon-like bulges in an artery that can stretch and burst. AVMs are tangles of faulty arteries and veins that can rupture (break open) within the brain. AVMs may be present at birth, but often aren\u2019t diagnosed until they rupture. Other risk factors for stroke, many of which of you can control, include: Alcohol and illegal drug use, including cocaine, amphetamines, and other drugs Certain medical conditions, such as sickle cell disease, vasculitis (inflammation of the blood vessels), and bleeding disorders Lack of physical activity Overweight and Obesity Stress and depression Unhealthy cholesterol levels Unhealthy diet Use of nonsteroidal anti-inflammatory drugs (NSAIDs), but not aspirin, may increase the risk of heart attack or stroke, particularly in patients who have had a heart attack or cardiac bypass surgery. The risk may increase the longer NSAIDs are used. Common NSAIDs include ibuprofen and naproxen. Following a heart-healthy lifestyle can lower the risk of stroke. Some people also may need to take medicines to lower their risk. Sometimes strokes can occur in people who don\u2019t have any known risk factors. The signs and symptoms of a stroke often develop quickly. However, they can develop over hours or even days. The type of symptoms depends on the type of stroke and the area of the brain that\u2019s affected. How long symptoms last and how severe they are vary among different people. Signs and symptoms of a stroke may include: Sudden weakness Paralysis (an inability to move) or numbness of the face, arms, or legs, especially on one side of the body Confusion Trouble speaking or understanding speech Trouble seeing in one or both eyes Problems breathing Dizziness, trouble walking, loss of balance or coordination, and unexplained falls Loss of consciousness Sudden and severe headache A transient ischemic attack (TIA) has the same signs and symptoms as a stroke. However, TIA symptoms usually last less than 1\u20132 hours (although they may last up to 24 hours). A TIA may occur only once in a person\u2019s lifetime or more often. At first, it may not be possible to tell whether someone is having a TIA or stroke. All stroke-like symptoms require medical care. If you think you or someone else is having a TIA or stroke, call 9\u20131\u20131 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts. Stroke Complications After you\u2019ve had a stroke, you may develop other complications, such as: Blood clots and muscle weakness. Being immobile (unable to move around) for a long time can raise your risk of developing blood clots in the deep veins of the legs. Being immobile also can lead to muscle weakness and decreased muscle flexibility. Problems swallowing and pneumonia. If a stroke affects the muscles used for swallowing, you may have a hard time eating or drinking. You also may be at risk of inhaling food or drink into your lungs. If this happens, you may develop pneumonia. Loss of bladder control. Some strokes affect the muscles used to urinate. You may need a urinary catheter (a tube placed into the bladder) until you can urinate on your own. Use of these catheters can lead to urinary tract infections. Loss of bowel control or constipation also may occur after a stroke. Your doctor will diagnose a stroke based on your signs and symptoms, your medical history, a physical exam, and test results. Your doctor will want to find out the type of stroke you\u2019ve had, its cause, the part of the brain that's affected, and whether you have bleeding in the brain. If your doctor thinks you\u2019ve had a transient ischemic attack (TIA), he or she will look for its cause to help prevent a future stroke. Medical History and Physical Exam Your doctor will ask you or a family member about your risk factors for stroke. Examples of risk factors include high blood pressure, smoking, heart disease, and a personal or family history of stroke. Your doctor also will ask about your signs and symptoms and when they began. During the physical exam, your doctor will check your mental alertness and your coordination and balance. He or she will check for numbness or weakness in your face, arms, and legs; confusion; and trouble speaking and seeing clearly. Your doctor will look for signs of carotid artery disease, a common cause of ischemic stroke. He or she will listen to your carotid arteries with a stethoscope. A whooshing sound called a bruit (broo-E) may suggest changed or reduced blood flow due to plaque buildup in the carotid arteries. Diagnostic Tests and Procedures Your doctor may recommend one or more of the following tests to diagnose a stroke or TIA. Brain Computed Tomography A brain computed tomography (to-MOG-rah-fee) scan, or brain CT scan, is a painless test that uses x rays to take clear, detailed pictures of your brain. This test often is done right after a stroke is suspected. A brain CT scan can show bleeding in the brain or damage to the brain cells from a stroke. The test also can show other brain conditions that may be causing your symptoms. Magnetic Resonance Imaging Magnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of the organs and structures in your body. This test can detect changes in brain tissue and damage to brain cells from a stroke. An MRI may be used instead of, or in addition to, a CT scan to diagnose a stroke. Computed Tomography Arteriogram and Magnetic Resonance Arteriogram A CT arteriogram (CTA) and magnetic resonance arteriogram (MRA) can show the large blood vessels in the brain. These tests may give your doctor more information about the site of a blood clot and the flow of blood through your brain. Carotid Ultrasound Carotid ultrasound is a painless and harmless test that uses sound waves to create pictures of the insides of your carotid arteries. These arteries supply oxygen-rich blood to your brain. Carotid ultrasound shows whether plaque has narrowed or blocked your carotid arteries. Your carotid ultrasound test may include a Doppler ultrasound. Doppler ultrasound is a special test that shows the speed and direction of blood moving through your blood vessels. Carotid Angiography Carotid angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the insides of your carotid arteries. For this test, a small tube called a catheter is put into an artery, usually in the groin (upper thigh). The tube is then moved up into one of your carotid arteries. Your doctor will inject a substance (called contrast dye) into the carotid artery. The dye helps make the artery visible on x-ray pictures. Heart Tests EKG (Electrocardiogram) An EKG is a simple, painless test that records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart. An EKG can help detect heart problems that may have led to a stroke. For example, the test can help diagnose atrial fibrillation or a previous heart attack. Echocardiography Echocardiography (EK-o-kar-de-OG-ra-fee), or echo, is a painless test that uses sound waves to create pictures of your heart. The test gives information about the size and shape of your heart and how well your heart's chambers and valves are working. Echo can detect possible blood clots inside the heart and problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to all parts of your body. Blood Tests Your doctor also may use blood tests to help diagnose a stroke. A blood glucose test measures the amount of glucose (sugar) in your blood. Low blood glucose levels may cause symptoms similar to those of a stroke. A platelet count measures the number of platelets in your blood. Blood platelets are cell fragments that help your blood clot. Abnormal platelet levels may be a sign of a bleeding disorder (not enough clotting) or a thrombotic disorder (too much clotting). Your doctor also may recommend blood tests to measure how long it takes for your blood to clot. Two tests that may be used are called PT and PTT tests. These tests show whether your blood is clotting normally. Treatment for a stroke depends on whether it is ischemic or hemorrhagic. Treatment for a transient ischemic attack (TIA) depends on its cause, how much time has passed since symptoms began, and whether you have other medical conditions. Strokes and TIAs are medical emergencies. If you have stroke symptoms, call 9\u20131\u20131 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin lifesaving treatment on the way to the emergency room. During a stroke, every minute counts. Once you receive immediate treatment, your doctor will try to treat your stroke risk factors and prevent complications by recommending heart-healthy lifestyle changes. Treating an Ischemic Stroke or Transient Ischemic Attack An ischemic stroke or TIA occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Often, blood clots cause the blockages that lead to ischemic strokes and TIAs. Treatment for an ischemic stroke or TIA may include medicines and medical procedures. Medicines If you have a stroke caused by a blood clot, you may be given a clot-dissolving, or clot-busting, medication called tissue plasminogen activator (tPA). A doctor will inject tPA into a vein in your arm. This type of medication must be given within 4\u00a0hours of symptom onset. Ideally, it should be given as soon as possible. The sooner treatment begins, the better your chances of recovery. Thus, it\u2019s important to know the signs and symptoms of a stroke and to call 9\u20131\u20131 right away for emergency care. If you can\u2019t have tPA for medical reasons, your doctor may give you antiplatelet medicine that helps stop platelets from clumping together to form blood clots or anticoagulant medicine (blood thinner) that keeps existing blood clots from getting larger. Two common medicines are aspirin and clopidogrel. Medical Procedures If you have carotid artery disease, your doctor may recommend a carotid endarterectomy or carotid artery\u00a0angioplasty. Both procedures open blocked carotid arteries. Researchers are testing other treatments for ischemic stroke, such as intra-arterial thrombolysis and mechanical clot removal in cerebral ischemia (MERCI). In intra-arterial thrombolysis, a long flexible tube called a catheter is put into your groin (upper thigh) and threaded to the tiny arteries of the brain. Your doctor can deliver medicine through this catheter to break up a blood clot in the brain. MERCI is a device that can remove blood clots from an artery. During the procedure, a catheter is threaded through a carotid artery to the affected artery in the brain. The device is then used to pull the blood clot out through the catheter. Treating a Hemorrhagic Stroke A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures. The first steps in treating a hemorrhagic stroke are to find the cause of bleeding in the brain and then control it. Unlike ischemic strokes, hemorrhagic strokes aren\u2019t treated with antiplatelet medicines and blood thinners because these medicines can make bleeding worse. If you\u2019re taking antiplatelet medicines or blood thinners and have a hemorrhagic stroke, you\u2019ll be taken off the medicine. If high blood pressure is the cause of bleeding in the brain, your doctor may prescribe medicines to lower your blood pressure. This can help prevent further bleeding. Surgery also may be needed to treat a hemorrhagic stroke. The types of surgery used include aneurysm clipping, coil embolization, and arteriovenous malformation (AVM) repair. Aneurysm Clipping and Coil Embolization If an aneurysm (a balloon-like bulge in an artery) is the cause of a stroke, your doctor may recommend aneurysm clipping or coil embolization. Aneurysm clipping is done to block off the aneurysm from the blood vessels in the brain. This surgery helps prevent further leaking of blood from the aneurysm. It also can help prevent the aneurysm from bursting again.\u00a0During the procedure, a surgeon will make an incision (cut) in the brain and place a tiny clamp at the base of the aneurysm. You\u2019ll be given medicine to make you sleep during the surgery. After the surgery, you\u2019ll need to stay in the hospital\u2019s intensive care unit for a few days. Coil embolization is a less complex procedure for treating an aneurysm. The surgeon will insert a tube called a catheter into an artery in the groin. He or she will thread the tube to the site of the aneurysm.\u00a0Then, a tiny coil will be pushed through the tube and into the aneurysm. The coil will cause a blood clot to form, which will block blood flow through the aneurysm and prevent it from bursting\u00a0again.\u00a0Coil embolization is done in a hospital. You\u2019ll be given medicine to make you sleep during the\u00a0surgery. Arteriovenous Malformation Repair If an AVM is the cause of a stroke, your doctor may recommend an AVM repair. (An AVM is a tangle of faulty arteries and veins that can rupture within the brain.) AVM repair helps prevent further bleeding in the brain. Doctors use several methods to repair AVMs. These methods include: Injecting a substance into the blood vessels of the AVM to block blood flow Surgery to remove the AVM Using radiation to shrink the blood vessels of the AVM Treating Stroke Risk Factors After initial treatment for a stroke or TIA, your doctor will treat your risk factors. He or she may recommend heart-healthy lifestyle changes to help control your risk factors. Heart-healthy lifestyle changes may include: Heart-healthy eating Aiming for a healthy weight Managing stress Physical activity Quitting smoking If heart-healthy lifestyle changes aren\u2019t enough, you may need medicine to control your risk factors. \u00a0 Taking action to control your risk factors can help prevent or delay a stroke. If you\u2019ve already had a stroke.\u00a0Talk to your doctor about whether you may benefit from aspirin\u00a0primary prevention, or using aspirin to help prevent your first stroke. The following heart-healthy lifestyle changes can help prevent your first stroke and help prevent you from having another one. Be physically active. Physical activity can improve your fitness level and health. Talk with your doctor about what types and amounts of activity are safe for you. Don\u2019t smoke, or if you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk of stroke. Talk with your doctor about programs and products that can help you quit. Also, secondhand smoke can damage the blood\u00a0vessels. Aim for a healthy weight. If you\u2019re overweight or obese, work with your doctor to create a reasonable weight loss plan. Controlling your weight helps you control risk factors for stroke. Make heart-healthy eating choices. Heart-healthy eating can help lower your risk or prevent a stroke. Manage stress. Use techniques to lower your stress levels. If you or someone in your family has had a stroke, be sure to tell your doctor. By knowing your family history of stroke, you may be able to lower your risk factors and prevent or delay a stroke. If you\u2019ve had a transient ischemic attack (TIA), don\u2019t ignore it. TIAs are warnings, and it\u2019s important for your doctor to find the cause of the TIA so you can take steps to prevent a stroke. \u00a0 The time it takes to recover from a stroke varies\u2014it can take weeks, months, or even years. Some people recover fully, while others have long-term or lifelong disabilities. Ongoing care, rehabilitation, and emotional support can help you recover and may even help prevent another stroke. If you\u2019ve had a stroke, you\u2019re at risk of having another one. Know the warning signs and what to do if a stroke or transient ischemic attack (TIA) occurs. Call 9\u20131\u20131 as soon as symptoms start. Do not drive to the hospital or let someone else drive you. By calling an ambulance, medical personnel can begin lifesaving treatment on the way to the emergency room. During a stroke, every minute counts. Ongoing Care Heart-Healthy Lifestyle Changes Heart-healthy lifestyle changes can help you recover from a stroke and may help prevent another one. Examples of these changes include heart-healthy eating, aiming for a healthy weight, managing stress, physical activity, and quitting smoking. Medicines Your doctor also may prescribe medicines to help you recover from a stroke or control your stroke risk factors. Take all of your medicines as your doctor prescribes. Don\u2019t cut back on the dosage unless your doctor tells you to do so. If you have side effects or other problems related to your medicines, talk with your doctor. Medicines called anticoagulants or blood thinners, which prevent blood clots or keep existing blood clots from getting larger, are the main treatment for people who have known carotid artery disease, which can lead to a stroke. Two common medicines are aspirin and clopidogrel. You\u2019ll likely need routine blood tests to check how well these medicines are working. The most common side effect of blood thinners is bleeding. This happens if the medicine thins your blood too much. This side effect can be life-threatening. Bleeding can occur inside your body cavities (internal bleeding) or from the surface of your skin (external bleeding). Know the warning signs of bleeding so you can get help right away. They include: Blood in your urine, bright red blood in your stools, or black tarry stools Bright red vomit or vomit that looks like coffee grounds Increased menstrual flow Pain in your abdomen or severe pain in your head Unexplained bleeding from the gums and nose Unexplained bruising or tiny red or purple dots on the skin A lot of bleeding after a fall or injury or easy bruising or bleeding also may mean that your blood is too thin. Call your doctor right away if you have any of these signs. If you have severe bleeding, call 9\u20131\u20131. Your doctor also may discuss beginning statin treatment. Doctors recommend statin medications for many people because they help lower or control blood cholesterol levels and decrease the chance for heart attack and stroke. Doctors usually prescribe statins for people who have: Diabetes Heart disease or have had a stroke High LDL cholesterol levels You should still follow a heart-healthy lifestyle, even if you take medicines to control your risk factors for stroke. Take all medicines regularly, as your doctor prescribes. Don\u2019t change the amount of your medicine or skip a dose unless your doctor tells you to. Talk with your doctor about how often you should schedule follow-up visits or tests. These visits and tests can help your doctor monitor your stroke risk factors and adjust your treatment as\u00a0needed. Rehabilitation After a stroke, you may need rehabilitation (rehab) to help you recover. Rehab may include working with speech, physical, and occupational therapists. Language, Speech, and Memory You may have trouble communicating after a stroke. You may not be able to find the right words, put complete sentences together, or put words together in a way that makes sense. You also may have problems with your memory and thinking clearly. These problems can be very frustrating. Speech and language therapists can help you learn ways to communicate again and improve your memory. Muscle and Nerve Problems A stroke may affect only one side of the body or part of one side. It can cause paralysis (an inability to move) or muscle weakness, which can put you at risk for falling. Physical and occupational therapists can help you strengthen and stretch your muscles. They also can help you relearn how to do daily activities, such as dressing, eating, and bathing. Bladder and Bowel Problems A stroke can affect the muscles and nerves that control the bladder and bowels. You may feel like you have to urinate often, even if your bladder isn\u2019t full. You may not be able to get to the bathroom in time. Medicines and a bladder or bowel specialist can help with these problems. Swallowing and Eating Problems You may have trouble swallowing after a stroke. Signs of this problem are coughing or choking during eating or coughing up food after eating. A speech therapist can help you with these issues. He or she may suggest changes to your diet, such as eating pur\u00e9ed (finely chopped) foods or drinking thick liquids. Mental Health Care and Support After a stroke, you may have changes in your behavior or judgment. For example, your mood may change quickly. Because of these and other changes, you may feel scared, anxious, and depressed. Recovering from a stroke can be slow and frustrating. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you\u2019re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life. Joining a patient support group may help you adjust to life after a stroke. You can see how other people have coped with having strokes. Talk with your doctor about local support groups, or check with an area medical center. Support from family and friends also can help relieve fear and anxiety. Let your loved ones know how you feel and what they can do to help you.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/stroke"
+  ],
+  [
+    "Stroke: A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications. The good news is that strokes can be treated and prevented, and many fewer Americans die of stroke now than in the past. Watch for these signs and symptoms if you think you or someone else may be having a stroke. Pay attention to when the signs and symptoms begin. The length of time they have been present can affect your treatment options: - Trouble with speaking and understanding. You may experience confusion. You may slur your words or have difficulty understanding speech. - Paralysis or numbness of the face, arm or leg. You may develop sudden numbness, weakness or paralysis in your face, arm or leg. This often happens just on one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Also, one side of your mouth may droop when you try to smile. - Trouble with seeing in one or both eyes. You may suddenly have blurred or blackened vision in one or both eyes, or you may see double. - Headache. A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate you're having a stroke. - Trouble with walking. You may stumble or experience sudden dizziness, loss of balance or loss of coordination. When to see a doctor Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear. Think \"FAST\" and do the following: - Face. Ask the person to smile. Does one side of the face droop? - Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise up? - Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or strange? - Time. If you observe any of these signs, call 911 immediately. Call 911 or your local emergency number right away. Don't wait to see if symptoms stop. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability. If you're with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance. A stroke may be caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may experience only a temporary disruption of blood flow to the brain (transient ischemic attack, or TIA) that doesn't cause permanent damage. Ischemic stroke About 80 percent of strokes are ischemic strokes. Ischemic strokes occur when the arteries to your brain become narrowed or blocked, causing severely reduced blood flow (ischemia). The most common ischemic strokes include: - Thrombotic stroke. A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot may be caused by fatty deposits (plaque) that build up in arteries and cause reduced blood flow (atherosclerosis) or other artery conditions. - Embolic stroke. An embolic stroke occurs when a blood clot or other debris forms away from your brain - commonly in your heart - and is swept through your bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus. Hemorrhagic stroke Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels. These include: - Uncontrolled high blood pressure (hypertension) - Overtreatment with anticoagulants (blood thinners) - Weak spots in your blood vessel walls (aneurysms) A less common cause of hemorrhage is the rupture of an abnormal tangle of thin-walled blood vessels (arteriovenous malformation). Types of hemorrhagic stroke include: - Intracerebral hemorrhage. In an intracerebral hemorrhage, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging brain cells. Brain cells beyond the leak are deprived of blood and are also damaged. High blood pressure, trauma, vascular malformations, use of blood-thinning medications and other conditions may cause an intracerebral hemorrhage. - Subarachnoid hemorrhage. In a subarachnoid hemorrhage, an artery on or near the surface of your brain bursts and spills into the space between the surface of your brain and your skull. This bleeding is often signaled by a sudden, severe headache. A subarachnoid hemorrhage is commonly caused by the bursting of a small sack-shaped or berry-shaped aneurysm. After the hemorrhage, the blood vessels in your brain may widen and narrow erratically (vasospasm), causing brain cell damage by further limiting blood flow. Transient ischemic attack (TIA) A transient ischemic attack (TIA) - sometimes known as a ministroke - is a temporary period of symptoms similar to those you'd have in a stroke. A temporary decrease in blood supply to part of your brain causes TIAs, which may last as little as five minutes. Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of your nervous system - but there is no permanent tissue damage and no lasting symptoms. Seek emergency care even if your symptoms seem to clear up. Having a TIA puts you at greater risk of having a full-blown stroke, causing permanent damage later. If you've had a TIA, it means there's likely a partially blocked or narrowed artery leading to your brain or a clot source in the heart. It's not possible to tell if you're having a stroke or a TIA based only on your symptoms. Even when symptoms last for under an hour, there is still a risk of permanent tissue damage. Many factors can increase your stroke risk. Some factors can also increase your chances of having a heart attack. Potentially treatable stroke risk factors include: Lifestyle risk factors - Being overweight or obese - Physical inactivity - Heavy or binge drinking - Use of illicit drugs such as cocaine and methamphetamines Medical risk factors - Blood pressure readings higher than 120/80 millimeters of mercury (mm Hg) - Cigarette smoking or exposure to secondhand smoke - High cholesterol - Diabetes - Obstructive sleep apnea - Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm - Personal or family history of stroke, heart attack or transient ischemic attack. Other factors associated with a higher risk of stroke include: - Age -People age 55 or older have a higher risk of stroke than do younger people. - Race - African-Americans have a higher risk of stroke than do people of other races. - Sex - Men have a higher risk of stroke than women. Women are usually older when they have strokes, and they're more likely to die of strokes than are men. - Hormones - use of birth control pills or hormone therapies that include estrogen, as well as increased estrogen levels from pregnancy and childbirth. A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected. Complications may include: - Paralysis or loss of muscle movement. You may become paralyzed on one side of your body, or lose control of certain muscles, such as those on one side of your face or one arm. Physical therapy may help you return to activities affected by paralysis, such as walking, eating and dressing. - Difficulty talking or swallowing. A stroke might affect control of the muscles in your mouth and throat, making it difficult for you to talk clearly (dysarthria), swallow (dysphagia) or eat. You also may have difficulty with language (aphasia), including speaking or understanding speech, reading, or writing. Therapy with a speech-language pathologist might help. - Memory loss or thinking difficulties. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, making judgments, reasoning and understanding concepts. - Emotional problems. People who have had strokes may have more difficulty controlling their emotions, or they may develop depression. - Pain. Pain, numbness or other strange sensations may occur in the parts of the body affected by stroke. For example, if a stroke causes you to lose feeling in your left arm, you may develop an uncomfortable tingling sensation in that arm. People also may be sensitive to temperature changes, especially extreme cold, after a stroke. This complication is known as central stroke pain or central pain syndrome. This condition generally develops several weeks after a stroke, and it may improve over time. But because the pain is caused by a problem in your brain, rather than a physical injury, there are few treatments. - Changes in behavior and self-care ability. People who have had strokes may become more withdrawn and less social or more impulsive. They may need help with grooming and daily chores. As with any brain injury, the success of treating these complications varies from person to person. To determine the most appropriate treatment for your stroke, your emergency team needs to evaluate the type of stroke you're having and the areas of your brain affected by the stroke. They also need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction. Your doctor may use several tests to determine your risk of stroke, including: - Physical examination. Your doctor will ask you or a family member what symptoms you've been having, when they started and what you were doing when they began. Your doctor then will evaluate whether these symptoms are still present. Your doctor will want to know what medications you take and whether you have experienced any head injuries. You'll be asked about your personal and family history of heart disease, transient ischemic attack and stroke. Your doctor will check your blood pressure and use a stethoscope to listen to your heart and to listen for a whooshing sound (bruit) over your neck (carotid) arteries, which may indicate atherosclerosis. Your doctor may also use an ophthalmoscope to check for signs of tiny cholesterol crystals or clots in the blood vessels at the back of your eyes. - Blood tests. You may have several blood tests, which tell your care team how fast your blood clots, whether your blood sugar is abnormally high or low, whether critical blood chemicals are out of balance, or whether you may have an infection. Managing your blood's clotting time and levels of sugar and other key chemicals will be part of your stroke care. - Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show a hemorrhage, tumor, stroke and other conditions. Doctors may inject a dye into your bloodstream to view your blood vessels in your neck and brain in greater detail (computerized tomography angiography). There are different types of CT scans that your doctor may use depending on your situation. - Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography, or magnetic resonance venography). - Carotid ultrasound. In this test, sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries. - Cerebral angiogram. In this test, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck. - Echocardiogram. An echocardiogram uses sound waves to create detailed images of your heart. An echocardiogram can find a source of clots in your heart that may have traveled from your heart to your brain and caused your stroke. You may have a transesophageal echocardiogram. In this test, your doctor inserts a flexible tube with a small device (transducer) attached into your throat and down into the tube that connects the back of your mouth to your stomach (esophagus). Because your esophagus is directly behind your heart, a transesophageal echocardiogram can create clear, detailed ultrasound images of your heart and any blood clots. Emergency treatment for stroke depends on whether you're having an ischemic stroke blocking an artery - the most common kind - or a hemorrhagic stroke that involves bleeding into the brain. Ischemic stroke To treat an ischemic stroke, doctors must quickly restore blood flow to your brain. Emergency treatment with medications. Therapy with clot-busting drugs must start within 4.5 hours if they are given into the vein - and the sooner, the better. Quick treatment not only improves your chances of survival but also may reduce complications. You may be given: - Intravenous injection of tissue plasminogen activator (tPA). This injection of recombinant tissue plasminogen activator (tPA), also called alteplase, is considered the gold standard treatment for ischemic stroke. An injection of tPA is usually given through a vein in the arm. This potent clot-busting drug ideally is given within three hours. In some instances, tPA can be given up to 4.5 hours after stroke symptoms begin. This drug restores blood flow by dissolving the blood clot causing your stroke, and it may help people who have had strokes recover more fully. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if tPA is appropriate for you. Emergency endovascular procedures. Doctors sometimes treat ischemic strokes with procedures performed directly inside the blocked blood vessel. These procedures must be performed as soon as possible, depending on features of the blood clot: - Medications delivered directly to the brain. Doctors may insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver tPA directly into the area where the stroke is occurring. This is called intra-arterial thrombolysis. The time window for this treatment is somewhat longer than for intravenous tPA, but is still limited. - Removing the clot with a stent retriever. Doctors may use a catheter to maneuver a device into the blocked blood vessel in your brain and trap and remove the clot. This procedure is particularly beneficial for people with large clots that can't be completely dissolved with tPA, though this procedure is often performed in combination with intravenous tPA. Several large and recent studies suggest that, depending on the location of the clot and other factors, endovascular therapy might be the most effective treatment. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after ischemic stroke. Other procedures. To decrease your risk of having another stroke or transient ischemic attack, your doctor may recommend a procedure to open up an artery that's narrowed by plaque. Doctors sometimes recommend the following procedures to prevent a stroke. Options will vary depending on your situation: - Carotid endarterectomy. In a carotid endarterectomy, a surgeon removes plaques from arteries that run along each side of your neck to your brain (carotid arteries). In this procedure, your surgeon makes an incision along the front of your neck, opens your carotid artery and removes plaque that blocks the carotid artery. Your surgeon then repairs the artery with stitches or a patch made from a vein or artificial material (graft). The procedure may reduce your risk of ischemic stroke. However, a carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions. - Angioplasty and stents. In an angioplasty, a surgeon usually accesses your carotid arteries through an artery in your groin. Here, your surgeon can gently and safely navigate to the carotid arteries in your neck. A balloon is then inflated to expand the narrowed artery. Then a stent can be inserted to support the opened artery. Hemorrhagic stroke Emergency treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing pressure in your brain. You might also need surgery to help reduce future risk. Emergency measures. If you take warfarin (Coumadin, Jantoven) or anti-platelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners' effects. You may also be given drugs to lower pressure in your brain (intracranial pressure), lower your blood pressure, prevent vasospasm or prevent seizures. Once the bleeding in your brain stops, treatment usually involves supportive medical care while your body absorbs the blood. Healing is similar to what happens while a bad bruise goes away. If the area of bleeding is large, your doctor may perform surgery to remove the blood and relieve pressure on your brain. Surgical blood vessel repair. Surgery may be used to repair blood vessel abnormalities associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if an aneurysm or arteriovenous malformation (AVM) or other type of vascular malformation caused your hemorrhagic stroke: - Surgical clipping. A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This clamp can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged. - Coiling (endovascular embolization). A surgeon inserts a catheter into an artery in your groin and guides it to your brain using X-ray imaging. Tiny detachable coils are guided into the aneurysm (aneurysm coiling). The coils fill the aneurysm, which blocks blood flow into the aneurysm and causes the blood to clot. - Surgical AVM removal. Surgeons may remove a smaller AVM if it's located in an accessible area of your brain, to eliminate the risk of rupture and lower the risk of hemorrhagic stroke. However, it's not always possible to remove an AVM if its removal would cause too large a reduction in brain function, or if it's large or located deep within your brain. - Stereotactic radiosurgery. Using multiple beams of highly focused radiation, stereotactic radiosurgery is an advanced minimally invasive treatment used to repair vascular malformations. Stroke recovery and rehabilitation After emergency treatment, stroke care focuses on helping you recover as much function as possible and return to independent living. The impact of your stroke depends on the area of the brain involved and the amount of tissue damaged. If your stroke affected the right side of your brain, your movement and sensation on the left side of your body may be affected. If your stroke damaged the brain tissue on the left side of your brain, your movement and sensation on the right side of your body may be affected. Brain damage to the left side of your brain may cause speech and language disorders. In addition, if you've had a stroke, you may have problems with breathing, swallowing, balancing and vision. Most stroke survivors receive treatment in a rehabilitation program. Your doctor will recommend the most rigorous therapy program you can handle based on your age, overall health and degree of disability from your stroke. Your doctor will take into consideration your lifestyle, interests and priorities, and the availability of family members or other caregivers. Your rehabilitation program may begin before you leave the hospital. After discharge, you might continue your program in a rehabilitation unit of the same hospital, another rehabilitation unit or skilled nursing facility, an outpatient unit, or your home. Every person's stroke recovery is different. Depending on your condition, your treatment team may include: - Doctor trained in brain conditions (neurologist) - Rehabilitation doctor (physiatrist) - Nurse - Dietitian - Physical therapist - Occupational therapist - Recreational therapist - Speech pathologist - Social worker - Case manager - Psychologist or psychiatrist - Chaplain One way to evaluate the care of patients diagnosed with stroke is to look at the percentage of patients receiving the timely and effective care measures that are appropriate. The goal is 100 percent. The graph below displays the percentage of eligible Mayo Clinic patients diagnosed with stroke receiving all of the appropriate care measures. Timely and effective care Carotid Endarterectomy Mortality Rate See related graph. Carotid Stenting Mortality Rate See related graph. Comprehensive Stroke Measure See related graph. Comprehensive Stroke - Post Thrombolysis Revascularization Rate See related graph. Comprehensive Stroke - Timeliness of IV t-PA Therapy See related graph. For additional information and data visit Medicare Hospital Compare. For additional information about quality at Mayo Clinic visit Quality Measures.",
+    "https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113"
+  ],
+  [
+    "Stroke: Stroke is a leading cause of disability and death in the United States. Strokes leave many people with long-term physical and cognitive difficulties; rehabilitation after stroke is an important goal. The NICHD is one of many federal agencies and NIH Institutes working to understand stroke and how to improve methods of post-stroke rehabilitation. What is stroke? A stroke occurs when a blocked vessel or artery prevents blood from getting to part of the brain, or when a vessel or artery bursts and spills blood into the brain. The blood supplies the brain with the oxygen and nutrients it needs to work properly. When part of the brain cannot get the blood it needs, it becomes damaged or dies. The sudden flooding of blood into the brain also can cause damage or death to the brain cells (neurons). There are two types of stroke: - Ischemic stroke Ischemic (pronounced ih-SKEE-mik) stroke happens when an artery carrying blood to the brain becomes blocked and cannot supply enough blood to the brain. Usually a blood clot causes the blockage. Sometimes the blockage occurs when an artery becomes too narrow for enough blood to pass through it. This narrowing is called stenosis (sti-NOH-sis). Stenosis is caused by a buildup of plaque (plak)\u2014a mixture of fatty substances, including cholesterol\u2014that forms on the inner walls of the artery. - Hemorrhagic stroke Hemorrhagic (prounounced hem-uh-RAJ-ik) stroke occurs when an artery bursts and spills blood into part of the brain. In a healthy brain, the blood remains in the arteries and does not come into contact with neurons. When blood bursts into the brain during a hemorrhagic stroke, the normal flow of blood to the brain is upset, and the blood interferes with the normal chemical balance that neurons need to function. Transient Ischemic Attack Sometimes called a mini-stroke, a transient ischemic attack (TIA) starts with the same symptoms of a full stroke but does not progress and cause the damage of a full stroke. A TIA is a warning that a person is at risk for a more serious stroke in the future. What are common symptoms? \u00bb Stroke symptoms come on suddenly and include: - Numbness or weakness of the face, arm, or leg, especially on one side of the body - Confusion, trouble talking, or trouble understanding what others are saying - Dizziness, trouble walking, or loss of balance or coordination - Trouble seeing in one or both eyes - Sudden severe headache with no known cause If you believe you or someone you know is having any of these symptoms, do not wait. Call 911 immediately. A person suffering a stroke must receive medications as soon as possible at a hospital to prevent or minimize brain damage. The symptoms of a transient ischemic attack (TIA) are similar to those of a more serious stroke, but unlike a serious stroke, a TIA usually lasts only a few minutes and goes away within an hour. However, it is impossible to tell the difference between the symptoms of a TIA and a more serious stroke. You should not wait to see if the symptoms go away. Assume that all stroke symptoms signal an emergency. The National Institute of Neurological Disorders and Stroke (NINDS) provides detailed information about stroke and stroke symptoms at http://www.ninds.nih.gov/disorders/stroke/stroke.htm. \u00ab Condition Information How many people are affected/at risk? \u00bb Each year, about 795,000 people in the United States have strokes, and of these incidents, 137,000 of the people die. About 610,000 of these cases are first strokes, and 185,000 people who survive a stroke will have another stroke within 5 years. Ischemic strokes make up about 87% of all strokes. Hemorrhagic strokes make up the remaining 13%. Stroke is a leading cause of death and disability in the United States. People of all ages and backgrounds can have a stroke. However, some demographic factors put certain people at higher risk of stroke or death from stroke. These include: - Race/ethnicity. African Americans have almost two times the risk of white people of having a first stroke. Hispanic Americans and American Indian/Alaska Natives are at greater risk than whites are for having a stroke but are at less risk than African Americans. African Americans and Hispanics are more likely than whites to die after having a stroke. - Age. Stroke risk increases with age. Three-quarters of strokes occur in people ages 65 and older. - Geography. The highest U.S. death rates from stroke occur in the southeastern United States. - Gender. Men are more likely than women to have a stroke. Certain lifestyle factors and conditions also increase the risk for stroke. The most important of these include: - High blood pressure - Diabetes - Heart disease (such as atrial fibrillation) - Previous stroke or transient ischemic attack - Cigarette smoking Additional risk factors include: - Physical inactivity - Overweight or obesity - High cholesterol - Sickle cell disease - Drinking too much alcohol - Family history of stroke - Drug abuse - Genetic conditions, such as blood-clotting or vascular disorders (for example, Factor V Leiden or CADASIL) - Certain medications (such as hormonal birth control pills) - Being pregnant - Menopause Lesser risk factors include: - Head and neck injuries - Recent viral or bacterial infections Amplification of risk occurs when a person has more than one of the risk factors listed above. This means that the combined risk of two or more risk factors is greater than simply adding their effects. \u00ab What are common symptoms? What causes it? \u00bb Ischemic Stroke Ischemic stroke is caused by a blockage in an artery carrying blood to the brain. The blocked artery cuts off the blood supply to part of the brain. Usually a blood clot causes the blockage. Sometimes the blockage occurs when an artery becomes too narrow for enough blood to pass through it. This narrowing is called stenosis (pronounced sti-NOH-sis). Stenosis is caused by a buildup of blood clots and plaque\u2014a mixture of fatty substances, including cholesterol\u2014on the inner walls of the artery. Problems with blood clotting become more frequent as people age. Certain medications, such as hormonal birth control pills, also can increase the risk of blood clots. Stenosis is caused most commonly by a blood vessel disease called atherosclerosis (pronounced ath-uh-roh-skluh-ROH-sis). In atherosclerosis, plaque builds up on the inner walls of arteries. This causes the artery walls to become thick, hard, and less flexible, and decreases blood flow. The presence of plaque also leads to the formation of blood clots. Eating foods high in saturated fat and cholesterol can make the amount of cholesterol in the body too high. Having high cholesterol can lead to its buildup in plaque in the artery walls. High blood pressure also contributes to atherosclerosis. Hemorrhagic Stroke Hemorrhagic stroke is caused by a burst artery that spills blood into part of the brain. In a healthy brain, the blood remains in the arteries and does not come into contact with neurons. When blood bursts into the brain during a hemorrhagic stroke, the normal flow of blood to the brain is upset, and the blood interferes with the normal chemical balance that neurons need to function. High blood pressure can weaken artery walls and make them more likely to break or burst. Poor blood clotting also can increase the risk of bleeding in a hemorrhagic stroke. Poor blood clotting may be caused by blood disorders or medications that decrease clotting. Another cause of hemorrhagic stroke is abnormalities in the structure of blood vessels that form during brain development. \u00ab How many people are affected/at risk? What are the outcomes and treatments? \u00bb Recovery from a stroke may take months or years. Many people who have had a stroke never fully recover. A person who has had a stroke may have the following temporary or permanent symptoms: - Inability to move on one side of the body - Weakness on one side of the body - Problems with thinking, awareness, attention, learning, judgment, and memory - Problems understanding or forming speech - Problems with controlling or expressing emotions - Numbness or strange sensations - Pain in the hands and feet that worsens with movement and temperature changes - Depression Types of Treatment for Stroke Stroke treatment includes: - Emergency treatment - Preventing another stroke - Rehabilitation Emergency Treatment When a person is able to get to the hospital within a few hours of having a stroke, health care providers will treat a stroke with medications, surgery, or both, depending on the type of stroke. Medication for Ischemic Stroke - Thrombolytic (pronounced throm-buh-LIT-ik) agents These medications are used to treat an ongoing ischemic stroke caused by a blocked artery. They stop the stroke by dissolving the blood clot that has blocked blood flow to the brain. - Blood-thinning medications These drugs include antiplatelet (pronounced anti-PLEYT-lit) drugs and anticoagulants (pronounced anti-koh-AG-yuh-luhnts) and work to prevent blood clotting that causes ischemic stroke. Surgery In the case of ischemic stroke, a surgeon can clear out the clogged artery to allow blood to resume flowing to the affected part of the brain. Surgery can also repair structural abnormalities in arteries in the case of hemorrhagic stroke. [top] Preventing Another Stroke A patient who has had a stroke may continue taking blood-thinning medications, referred to as blood thinners, to prevent another stroke. Surgery performed to treat a stroke may also help to prevent another stroke. Health care providers will also advise stroke survivors to make lifestyle changes, such as eating a healthy diet, exercising, and treating related medical conditions. For more information on preventing stroke, see the Other FAQs within the Stroke topic. [top] Rehabilitation Stroke is the leading cause of serious adult disability in the United States. Several types of therapies can help a stroke survivor regain some or all of the functions damaged by the stroke. These therapies include: - Physical therapy A physical therapist uses training and exercises to help a patient relearn physical activities such as walking, sitting, standing, and lying down. A special type of physical therapy called constraint-induced movement therapy (CIMT) can improve the use of a weakened or paralyzed arm. CIMT involves training and exercise for the affected arm while the unaffected arm is restrained by a special mitt. - Occupational therapy Occupational therapy involves exercise and training to help a patient relearn daily activities such as eating, drinking, dressing, bathing, cooking, reading, writing, and using a toilet. - Speech therapy Speech therapy helps patients relearn language and speaking, including swallowing. - Psychological therapy Stroke survivors may suffer from depression, anxiety, frustration, and anger. Talk therapy, medications, or both can treat these symptoms. [top] \u00ab What causes it? Other FAQs \u00bb Can stroke be prevented? Making healthy choices and managing medical conditions can diminish your risk of stroke. These include: - Eating a healthy diet, which includes plenty of fruits and vegetables and foods low in saturated fat, cholesterol, and sodium - Maintaining a healthy weight - Staying physically active - Not smoking - Limiting alcohol use - Checking your cholesterol - Monitoring your blood pressure - Managing diabetes - Taking medication to treat high cholesterol, high blood pressure, or diabetes - Talking to your health care provider regularly about preventing or treating the medical conditions that lead to heart disease or increase your risk of stroke \u00ab What are the outcomes and treatments?",
+    "https://www.nichd.nih.gov/health/topics/stroke"
+  ],
+  [
+    "Chronic progressive external ophthalmoplegia (Treatment): Ptosis caused by\u00a0chronic progressive external ophthalmoplegia (CPEO)\u00a0can be corrected by surgery, or by using glasses that have a \u201cptosis crutch\u201d to lift the upper eyelids. [4] Strabismus surgery can be helpful in carefully selected patients if diplopia (double vision) occurs. [5] Some individuals with\u00a0a\u00a0deficiency of coenzyme Q10 have CPEO as an associated abnormality. Coenzyme Q10 is important for\u00a0normal mitochondrial function. In individuals with this deficiency, supplemental coenzyme Q10 has been found to improve general neurologic function and exercise tolerance.\u00a0However, coenzyme Q10 has not been shown to\u00a0improve the ophthalmoplegia or ptosis in\u00a0people who have isolated CPEO. [1] Management Guidelines GeneReviews provides a current, expert-authored, peer-reviewed, full-text article on mitochondrial disorders , including CPEO. GeneReview articles describe the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions.",
+    "https://rarediseases.info.nih.gov/diseases/4503/chronic-progressive-external-ophthalmoplegia"
+  ],
+  [
+    "HIBCH deficiency (Treatment): Treatment of HIBCH deficiency involves frequent carbohydrate-rich meals, along with coenzyme Q10, vitamin C, and vitamin E supplementation. [5] People with HIBCH deficiency may also benefit from a low-valine diet with carnitine and N-acetyl-cysteine supplementation. [5] Prompt, supportive, treatment during periods of physical stress and viral illness is vital. This may involve frequent infusions of bicarbonate, plus additional supports as required. [5] We strongly recommend that these and other treatment options be carefully reviewed with a healthcare provider.",
+    "https://rarediseases.info.nih.gov/diseases/13202/hibch-deficiency"
+  ],
+  [
+    "Myoclonic epilepsy with ragged red fibers (Treatment): While there is no cure for MERRF, there are various medications and therapies that can be helpful in managing symptoms. This includes:\u00a0Antiseizure medications,\u00a0 levetiracetam\u00a0for myoclonus,\u00a0 physical therapy , and aerobic exercise. Standard medication is used to treat cardiac symptoms.\u00a0 Daily use of Coenzyme Q10 and L-carnitine have been of some benefit to individuals. Other supplements that might be utilized include creatinine and lipoic acid. [1] Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions.",
+    "https://rarediseases.info.nih.gov/diseases/7144/myoclonic-epilepsy-with-ragged-red-fibers"
+  ],
+  [
+    "Leber hereditary optic neuropathy (Treatment): Currently, there is no cure for this disease but there are several ongoing studies aiming to find an effective treatment. Management of affected individuals is usually supportive, with provision of visual aids. [2] High-dose oral idebenone may be considered as a treatment option, especially for individuals with LHON with relatively recent disease onset. Some\u00a0studies have reported a benefit from using idebenone with quinone analogues, such as ubiquinone (Coenzyme Q10) and with vitamin C and vitamin B12. [2] In an open-label study of five individuals with acute LHON treated within 90 days of disease onset, the antioxidant \u03b1-tocotrienol-quinone (EPI-743), a vitamin E derivative, showed good results. [2] Those with established LHON mitochondrial DNA mutations are advised not to smoke and to limit their alcohol intake. People with Leber hereditary optic neuropathy may also\u00a0find it helpful to speak with other affected individuals and to seek extra psychosocial or counseling support. [2] Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions.",
+    "https://rarediseases.info.nih.gov/diseases/6870/leber-hereditary-optic-neuropathy"
+  ],
+  [
+    "Leigh syndrome (Treatment): Treatment of Leigh syndrome is directed toward the specific symptoms present in each person. [6] Supportive care for Leigh syndrome includes treatment of acidosis, seizures , dystonia , and cardiomyopathy ,\u00a0and attention to nutritional status. [4] [3] Because anesthesia can potentially aggravate respiratory symptoms and bring on respiratory failure, careful consideration should be given to its use and close monitoring prior to, during, and after its use. [4] [3] Progression and new symptoms should be monitored regularly (typically every 6-12 months). Evaluations with a neurologist , ophthalmologist , audiologist , and cardiologist are recommended. [4] [3] Specific treatment is possible for the three nuclear gene -encoded Leigh-like syndromes (milder conditions with similar features). These include biotin-thiamine-responsive basal ganglia disease (BTBGD), biotinidase deficiency, and coenzyme Q10 deficiency caused by mutation of PDSS2. [4] Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. Mitochondrial DNA-Associated Leigh Syndrome Nuclear Gene-Encoded Leigh Syndrome",
+    "https://rarediseases.info.nih.gov/diseases/6877/leigh-syndrome"
+  ],
+  [
+    "Duchenne muscular dystrophy (Treatment): There is no known cure for Duchenne muscular dystrophy. Treatment aims to control symptoms to improve quality of life. Steroid drugs can slow the loss of muscle strength. They may be started when the child is diagnosed or when muscle strength begins to decline. Other treatments may include: - Albuterol, a drug used for people with asthma - Amino acids - Carnitine - Coenzyme Q10 - Creatine - Fish oil - Green tea extracts - Vitamin E However, the effects of these treatments have not been proven. Stem cells and gene therapy may be used in the future. The use of steroids and the lack of physical activity can lead to excessive weight gain. Activity is encouraged. Inactivity (such as bedrest) can make the muscle disease worse. Physical therapy may help to maintain muscle strength and function. Speech therapy is often needed. Other treatments may include: - Assisted ventilation (used during the day or night) - Drugs to help heart function, such as angiotensin converting enzyme inhibitors, beta blockers, and diuretics - Orthopedic appliances (such as braces and wheelchairs) to improve mobility - Proton pump inhibitors (for people with gastroesophageal reflux) Several new treatments are being studied in trials.",
+    "https://medlineplus.gov/ency/article/000705.htm"
+  ],
+  [
+    "Kearns-Sayre syndrome (Treatment): Treatment for Kearns-Sayre syndrome \u00a0is generally symptomatic and supportive. [2] Management options include placement of cardiac pacemakers in individuals with cardiac conduction blocks, eyelid slings for severe ptosis , cochlear implants and hearing aids for neurosensory hearing loss , hormone replacement for endocrinopathies, dilation of the upper esophageal sphincter to alleviate cricopharyngeal achalasia, folinic acid supplementation in individuals with Kearns-Sayre syndrome\u00a0with low\u00a0cerebral spinal fluid\u00a0folic acid, administration of coenzyme Q10 and L-carnitine, physical and occupational therapy, and treatment of depression. Antioxidants may ameliorate damage from reactive oxygen species; percutaneous endoscopic gastrostomy may improve nutritional intake and prevent aspiration pneumonia in individuals with severe dysphagia . Surveillance includes EKG and echocardiogram every six to 12 months and yearly audiometry and endocrinologic evaluation. [1] Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions.",
+    "https://rarediseases.info.nih.gov/diseases/6817/kearns-sayre-syndrome"
+  ],
+  [
+    "Essential thrombocythemia (Treatment): Long-term, different medications are used to decrease the platelet count to avoid complications. The most common medications used include: hydroxyurea, interferon-alpha, or anagrelide. In people who are at a high risk for clotting ( thrombosis), aspirin at a low dose (81 to 100 mg per day) decreases clotting episodes.\u00a0 Many people do not need any treatment, but they must be followed closely by their provider. [1] Management Guidelines The NORD Physician Guide for Essential thrombocythemia was developed as a free service of the National Organization for Rare Disorders (NORD) and it's medical advisors. \u00a0The guides provide a resource for clinicians about specific rare disorders to facilitate diagnosis and treatment of their patients with this condition.\u00a0 FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information",
+    "https://rarediseases.info.nih.gov/diseases/6594/essential-thrombocythemia"
+  ],
+  [
+    "Cerebrotendinous xanthomatosis (Treatment): Cerebrotendinous xanthomatosis may be treated with chenodeoxycholic acid (CDCA), which has been shown to normalize levels of cholestonal and improve neurologic symptoms. Inhibitors of HMG-CoA reductase may be used\u00a0alone or in combination with CDCA. They\u00a0are also effective in decreasing cholestanol concentration and improving clinical symptoms, however\u00a0these treatments can lead to muscle damage. Coenzyme Q10 may improve muscle weakness, and cataract surgery may also be required. [1] Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions.",
+    "https://rarediseases.info.nih.gov/diseases/5622/cerebrotendinous-xanthomatosis"
+  ],
+  [
+    "Essential thrombocythemia (Treatment): If you have life-threatening complications, you may have a treatment called platelet pheresis. It quickly reduces platelets in the blood. Long-term, medicines are used to decrease the platelet count to avoid complications. The most common medicines used include hydroxyurea, interferon-alpha, or anagrelide. In some people with a JAK2 mutation, specific inhibitors of the JAK2 protein may be used. In people who are at a high risk of clotting, aspirin at a low dose (81 to 100 mg per day) may decrease\u00a0clotting episodes. Many people do not need any treatment, but they must be followed closely by their provider.",
+    "https://medlineplus.gov/ency/article/000543.htm"
+  ],
+  [
+    "Autoimmune hepatitis (Treatment): Some people with mild forms of\u00a0autoimmune hepatitis\u00a0may not need to take medication. Doctors assess each patient individually to determine whether those with mild autoimmune hepatitis should undergo treatment. [1] Treatment works best when autoimmune hepatitis is diagnosed early. With proper treatment, autoimmune hepatitis can usually be controlled. In fact, studies show that sustained response to treatment stops the disease from getting worse and may reverse some of the damage. [1] The primary treatment is medicine to suppress, or slow down, an overactive immune system . [1]\u00a0 Prednisone or other corticosteroids help reduce the inflammation. [1] [2] Azathioprine and mercaptopurine are drugs used to treat other autoimmune disorders, which have shown to help patients with autoimmune hepatitis as well. [2] In about seven out of 10 people, the disease goes into remission within 3 years of starting treatment. Remission occurs when symptoms disappear and lab tests show improvement in liver function. Some people can eventually stop treatment, although many will see the disease return. People who stop treatment must carefully monitor their condition and promptly report any new symptoms to their doctor. Treatment with low doses of prednisone or azathioprine may be necessary on and off for years, if not for life. [1] People who do not respond to standard immune therapy or who have severe side effects may benefit from other immunosuppressive agents such as mycophenylate mofetil, cyclosporine, or tacrolimus. People who progress to end-stage liver disease\u2014also called liver failure\u2014or cirrhosis may need a liver transplant. Transplantation has a 1-year survival rate of 90 percent and a 5-year survival rate of 70 to 80 percent. [1]",
+    "https://rarediseases.info.nih.gov/diseases/5871/autoimmune-hepatitis"
+  ],
+  [
+    "What are the treatments for Autoimmune disorders?: The goals of treatment are to: - Reduce symptoms - Control the autoimmune process - Maintain the body's ability to fight disease Treatments will depend on your disease and symptoms. Types of treatments include: - Supplements to replace a substance that the body lacks, such as thyroid hormone, vitamin B12, or insulin, due to the autoimmune disease - Blood transfusions if blood is affected - Physical therapy to help with movement if the bones, joints, or muscles are affected Many people take medicines to reduce the immune system's abnormal response. These are often called immunosuppressive medicines. Examples include corticosteroids (such as prednisone) and nonsteroid drugs such as azathioprine, cyclophosphamide, mycophenolate, sirolimus, or tacrolimus. Targeted drugs called tumor necrosis factor (TFN) blockers can be used for some diseases.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000816.htm"
+  ],
+  [
+    "Autoimmune autonomic ganglionopathy (Treatment): Since autoimmune autonomic ganglionopathy is so rare, no standard treatments have been established. [1] [2] [3] Experts familiar with this condition often use plasma exchange or total plasmapheresis, intravenous immunoglobulin (IVIG), IV corticosteroids , or immunosuppressive drugs, such as Rituxan to treat the symptoms of the disease. [2] A therapeutic trial for autoimmune autonomic ganglionopathy is currently being conducted by the Autonomic Disorders Consortium. [1]",
+    "https://rarediseases.info.nih.gov/diseases/11917/autoimmune-autonomic-ganglionopathy"
+  ],
+  [
+    "Autoimmune diseases (How can I manage my life now that I have an autoimmune disease?): Although most autoimmune diseases don't go away, you can treat your symptoms and learn to manage your disease, so you can enjoy life! Women with autoimmune diseases lead full, active lives. Your life goals should not have to change. It is important, though, to see a doctor who specializes in these types of diseases, follow your treatment plan, and adopt a healthy lifestyle.",
+    "https://www.womenshealth.gov/a-z-topics/autoimmune-diseases"
+  ],
+  [
+    "Insulin autoimmune syndrome (Treatment): The treatment of insulin autoimmune syndrome is similar to treatments for other conditions that cause low blood sugar . This includes eating smaller meals more frequently in order to maintain a more consistent blood sugar level and continuous monitoring of blood sugar. Additional treatment options can include treatment with steroids and a procedure called plasmaphoresis which removes the blood from the body, separates the insulin antibodies in the blood stream, and replaces the blood without the antibodies. Any damage to the pancreas may also require treatment. [7] [8]",
+    "https://rarediseases.info.nih.gov/diseases/10808/insulin-autoimmune-syndrome"
+  ],
+  [
+    "Autoimmune diseases (Are there medicines to treat autoimmune diseases?): There are many types of medicines used to treat autoimmune diseases. The type of medicine you need depends on which disease you have, how severe it is, and your symptoms. Treatment can do the following: New treatments for autoimmune diseases are being studied all the time.",
+    "https://www.womenshealth.gov/a-z-topics/autoimmune-diseases"
+  ],
+  [
+    "Autoimmune hepatitis (Treatment): You may need prednisone or other corticosteroid medicines to help reduce the inflammation. Azathioprine and 6-mercaptopurine are drugs used to treat other autoimmune disorders. They have been shown to help people with autoimmune hepatitis, as well. Some people may need a liver transplant.",
+    "https://medlineplus.gov/ency/article/000245.htm"
+  ],
+  [
+    "Autoimmune pancreatitis (Treatment): - Biliary stenting. Before starting medication, sometimes doctors will insert a tube to drain the biliary ducts (biliary stenting) in people with symptoms of obstructive jaundice. Often, though, jaundice improves with steroid treatment alone. Sometimes drainage is recommended if the diagnosis is uncertain. - Steroids. Symptoms of autoimmune pancreatitis often improve after a short course of prednisolone or prednisone. Many people respond quickly, even dramatically. Sometimes people get better without any treatment. - Immunosuppressants and immunomodulators. About 30 to 50 percent of the time, AIP returns, requiring additional treatment, sometimes long term. To help reduce the serious side effects associated with extended steroid use, doctors often add drugs that suppress or modify the immune system, sometimes called steroid-sparing medications, to the treatment. You may be able to stop taking steroids altogether Immunosuppressants and immunomodulators include mercaptopurine (Purinethol, Purixan), azathioprine (Imuran, Azasan) and rituximab (Rituxan). In general, they have been used in small sample groups and long-term benefits are still being studied. - Treatment for pancreatic insufficiency. If you have insufficient pancreatic enzymes, you may need supplementary enzymes. If you need supplements, your doctor will prescribe pancreatic enzymes (Creon, Viokace, Pancreaze, Zenpep, Pertzye). The over-the-counter versions of these drugs are not regulated by the Food and Drug Administration. - Treatment for diabetes. If you have diabetes, you will need appropriate treatment. - Monitoring of other organ involvement. Type 1 AIP often is associated with other organ involvement, including enlarged lymph nodes and salivary glands, scarring of the bile ducts, liver inflammation, and kidney disease. Although these signs may lessen or disappear completely with steroid therapy, your doctor will continue to monitor you.",
+    "https://www.mayoclinic.org/diseases-conditions/autoimmune-pancreatitis/symptoms-causes/syc-20369800"
+  ],
+  [
+    "Autoimmune diseases (What types of doctors treat autoimmune diseases?): Juggling your health care needs among many doctors and specialists can be hard. But specialists, along with your main doctor, may be helpful in managing some symptoms of your autoimmune disease. If you see a specialist, make sure you have a supportive main doctor to help you. Often, your family doctor may help you coordinate care if you need to see one or more specialists. Here are some specialists who treat autoimmune diseases:",
+    "https://www.womenshealth.gov/a-z-topics/autoimmune-diseases"
+  ],
+  [
+    "Autoimmune atrophic gastritis (Treatment): The treatment of autoimmune atrophic gastritis is generally focused on preventing or treating\u00a0 vitamin B 12\u00a0and iron deficiencies. If pernicious anemia is already present at the time of diagnosis, vitamin B 12\u00a0shots (injections) may be recommended. Since dietary and oral iron supplements do not usually improve iron levels, alternative iron therapy approaches may include receiving periodic intravenous (IV) iron (iron infusion) to increase iron stores or a daily dose of oral ferrous glycine sulfate to meet daily iron requirements. People with autoimmune atrophic gastritis should have their levels of B 12 and iron monitored for the rest of their life. [1] [2] [3] In some cases, periodic endoscopy may also be recommended due to the increased risk of certain types of cancer . [1] [2] [3]",
+    "https://rarediseases.info.nih.gov/diseases/10310/autoimmune-atrophic-gastritis"
+  ],
+  [
+    "Etiology: Etiology describes the cause or causes of a disease. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002356.htm"
+  ],
+  [
+    "Venlafaxine (Brand names): - Effexor\u00ae\u00b6 - Effexor\u00ae XR\u00b6",
+    "https://medlineplus.gov/druginfo/meds/a694020.html"
+  ],
+  [
+    "Erectile Dysfunction (ED) (Definition and Facts): Erectile dysfunction (ED) is a condition in which you are unable to get or keep an erection firm enough for satisfactory sexual intercourse. ED can be a short-term or long-term problem. You have ED when youcan get an erection sometimes, but not every time you want to have sex can get an erection, but it does not last long enough for fulfilling or satisfactory sex are unable to get an erection at any timeHealth care professionals, such as primary care providers and urologists, often can treat ED. Although ED is very common, it is not a normal part of aging. Talk with a health care professional if you have any ED symptoms. ED could be a sign of a more serious health problem.You may find it embarrassing and difficult to talk with a health care professional about ED. However, remember that a healthy sex life can improve your quality of life and is part of a healthy life overall. Health care professionals, especially urologists, are trained to speak to people about many kinds of sexual problems.",
+    "https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction"
+  ],
+  [
+    "Erection problems - aftercare (Lifestyle): For many men, lifestyle changes can help with ED. For example, alcohol and illegal drugs may make you feel more relaxed. But they can cause ED or make it worse. Avoid illegal drugs, and consider limiting the amount of alcohol you drink. Smoking and smokeless tobacco can cause narrowing of blood vessels all over the body, including those that supply blood to the penis. Talk to your provider about quitting. Other lifestyle tips include: - Get plenty of rest and take time to relax. - Exercise and eat healthy foods to maintain good circulation. - Use safe sex practices. Reducing your worry about STDs may help prevent negative emotions that can affect your erection. - Talk with your provider and review your daily prescription medicine list. Many prescription medicines can cause or worsen ED.",
+    "https://medlineplus.gov/ency/patientinstructions/000396.htm"
+  ],
+  [
+    "Erection problems - aftercare: You have seen your health care provider for erection problems. You may be unable to get an erection at all. Or you may prematurely lose the erection during intercourse. If the condition persists, the medical term for this problem is erectile dysfunction (ED). Erection problems are common in adult men. In fact, almost all men have a problem getting or maintaining an erection at times. For many men, lifestyle changes can help with ED. For example, alcohol and illegal drugs may make you feel more relaxed. But they can cause ED or make it worse. Avoid illegal drugs, and consider limiting the amount of alcohol you drink. Smoking and smokeless tobacco can cause narrowing of blood vessels all over the body, including those that supply blood to the penis. Talk to your provider about quitting. Other lifestyle tips include: - Get plenty of rest and take time to relax. - Exercise and eat healthy foods to maintain good circulation. - Use safe sex practices. Reducing your worry about STDs may help prevent negative emotions that can affect your erection. - Talk with your provider and review your daily prescription medicine list. Many prescription medicines can cause or worsen ED. Having ED can make you feel bad about yourself. This can make it even more difficult to seek treatment and enjoy sexual activity. ED can be a troubling issue for couples, because it can be difficult for you or your partner to discuss the problem with each other. Couples who do not openly talk to each other are more likely to have problems with sexual intimacy. Likewise, men who have trouble talking about their feelings may be unable to share their sexual concerns with their partners. If you have trouble communicating, counseling can be very helpful for you and your partner. Finding a way for both of you to express your feelings and desires, and then work on the issues together, can make a big difference. Sildenafil (Viagra), vardenafil (Levitra, Staxyn), and tadalafil (Cialis) are medicines prescribed for ED. They cause erections only when you are sexually aroused. - The effect is most often seen within 15 to 45 minutes. The effects of these drugs may last for several hours. Tadalafil (Cialis) may last for up to 36 hours. - Sildenafil (Viagra) should be taken on an empty stomach. (Levitra) and tadalafil (Cialis) may be taken with or without food. - These drugs should not be used more than once a day. - Common side effects of these medicines include flushing, upset stomach, headache, nasal congestion, back pain, and dizziness. If you have heart disease, talk with your provider before using these medicines. Men who take nitrates for heart disease should not take ED medications. Many herbs and dietary supplements are marketed to help sexual performance or desire. None of these remedies have been proven effective for treating ED. Talk to your provider to see if any of these treatments is right for you. Call your health care provider right away or go to an emergency room if any ED medicine gives you an erection that lasts more than 4 hours. If this problem is not treated, you may suffer lasting damage to your penis. To end an erection you may try to repeat climax and apply a cold pack to your genitalia (wrap the pack in a cloth first). Never go to sleep with an erection. Updated by: Jennifer Sobol, DO, Urologist with the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000396.htm"
+  ],
+  [
+    "Erectile Dysfunction (Summary): Summary Erectile dysfunction (ED) is a common type of male sexual dysfunction. It is when a man has trouble getting or keeping an erection. ED becomes more common as you get older. But it's not a natural part of aging. Some people have trouble speaking with their doctors about sex. But if you have ED, you should tell your doctor. ED can be a sign of health problems. It may mean your blood vessels are clogged. It may mean you have nerve damage from diabetes. If you don't see your doctor, these problems will go untreated. Your doctor can offer several new treatments for ED. For many men, the answer is as simple as taking a pill. Getting more exercise, losing weight, or stopping smoking may also help. NIH: National Institute of Diabetes and Digestive and Kidney Diseases",
+    "#"
+  ],
+  [
+    "Erectile Dysfunction (ED) (Treatment): You can work with a health care professional to treat an underlying cause of your erectile dysfunction (ED). Choosing an ED treatment is a personal decision. However, you also may benefit from talking with your partner about which treatment is best for you as a couple.Your health care professional may suggest that you make lifestyle changes to help reduce or improve ED. You canquit smoking limit or stop drinking alcohol increase physical activity and maintain a healthy body weight stop illegal drug useYou can seek help from a health professional if you have trouble making these changes on your own.Talk with your doctor about going to a counselor if psychological or emotional issues are affecting your ED. A counselor can teach you how to lower your anxiety or stress related to sex. Your counselor may suggest that you bring your partner to counseling sessions to learn how to support you. As you work on relieving your anxiety or stress, a doctor can focus on treating the physical causes of ED.",
+    "https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction"
+  ],
+  [
+    "Prescription drug abuse (Risk factors): Many people fear that they may become addicted to medications prescribed for medical conditions, such as painkillers prescribed after surgery. However, people who take potentially addictive drugs as prescribed don't often abuse them or become addicted. Risk factors for prescription drug abuse include: - Past or present addictions to other substances, including alcohol and tobacco - Family history of substance abuse problems - Younger age, especially the teens or early 20s - Certain pre-existing psychiatric conditions - Exposure to peer pressure or a social environment where there's drug use - Easier access to prescription drugs, such as having prescription medications in the home medicine cabinet - Lack of knowledge about prescription drugs and their potential harm Older adults and prescription drug abuse Prescription drug abuse in older adults is a growing problem, especially when they combine drugs with alcohol. Having multiple health problems and taking multiple drugs can put seniors at risk of misusing drugs or becoming addicted.",
+    "https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/symptoms-causes/syc-20376813"
+  ],
+  [
+    "How to prevent What I need to know about Erectile Dysfunction?: You can prevent many of the causes of ED by making healthy lifestyle choices. Following a healthy diet may help prevent ED. Quitting smoking and getting physical activity are also important ways to prevent ED. Physical activity increases blood flow throughout your body, including your penis. Talk with your doctor before starting new activities. If you have not been active, start slow, with easier activities such as walking at a normal pace or gardening. Then you can work up to harder activities such as walking briskly or swimming. Try to aim for at least 30 minutes of activity most days of the week.",
+    "http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/erectile-dysfunction/Pages/ez.aspx"
+  ],
+  [
+    "Prescription Drug Abuse (Summary): Summary If you take a medicine in a way that is different from what the doctor prescribed, it is called prescription drug abuse. It could be - Taking a medicine that was prescribed for someone else - Taking a larger dose than you are supposed to - Taking the medicine in a different way than you are supposed to. This might be crushing tablets and then snorting or injecting them. - Using the medicine for another purpose, such as getting high Abusing some prescription drugs can lead to addiction. These include opioids, sedatives, tranquilizers, and stimulants. Every medicine has some risk of side effects. Doctors take this into account when prescribing medicines. People who abuse these drugs may not understand the risks. The medicines may not be safe for them, especially at higher doses or when taken with other medicines. NIH: National Institute on Drug Abuse",
+    "#"
+  ],
+  [
+    "Prescription drug abuse (Diagnosis): Doctors generally base a diagnosis of prescription drug abuse on medical history and answers to other questions. In some cases, certain signs and symptoms also provide clues. Blood or urine tests can detect many types of drugs. These tests can also help track the progress of a person who's getting treatment.",
+    "https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/symptoms-causes/syc-20376813"
+  ],
+  [
+    "Prescription drug abuse (Symptoms): Signs and symptoms of prescription drug abuse depend on the specific drug. Because of their mind-altering properties, the most commonly abused prescription drugs are: - Opioids, such as oxycodone (Oxycontin, Roxicodone) and those containing hydrocodone (Vicodin, Lortab, Norco), used to treat pain - Anti-anxiety medications and sedatives, such as alprazolam (Xanax) and diazepam (Valium), and hypnotics, such as zolpidem (Ambien), used to treat anxiety and sleep disorders - Stimulants, such as methylphenidate (Ritalin, Concerta, others), dextroamphetamine and amphetamine (Adderall XR) and dextroamphetamine (Dexedrine), used to treat attention-deficit/hyperactivity disorder (ADHD) and certain sleep disorder Other signs include: - Stealing, forging or selling prescriptions - Taking higher doses than prescribed - Excessive mood swings or hostility - Increase or decrease in sleep - Poor decision-making - Appearing to be high, unusually energetic or revved up, or sedated - Continually \"losing\" prescriptions, so more prescriptions must be written - Seeking prescriptions from more than one doctor When to see a doctor Talk with your doctor if you think you may have a problem with prescription drug use. You may feel embarrassed to talk about it - but remember that medical professionals are trained to help you, not judge you. It's easier to tackle the problem early before it becomes an addiction and leads to more-serious problems.",
+    "https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/symptoms-causes/syc-20376813"
+  ],
+  [
+    "Medicare Prescription Drug Coverage (Summary): Summary Part D is the name of Medicare's prescription drug coverage. It's insurance that helps people pay for prescription drugs. It is available to everyone who has Medicare. It provides protection if you pay high drug costs or have unexpected prescription drug bills. It doesn't cover all costs. You have to pay part of the cost of prescription drugs. Most people also have to pay an additional monthly cost. Private companies provide Medicare prescription drug coverage. You choose the drug plan you like best. Whether or not you should sign up depends on how good your current coverage is. You need to sign up as soon as you are eligible for Medicare. Otherwise, there may be additional charges. Centers for Medicare and Medicaid Services",
+    "#"
+  ],
+  [
+    "General anesthesia: General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery. After you receive these medicines, you will not be aware of what is happening around you. Most times, a doctor called an anesthesiologist will give you the anesthesia. Sometimes, a certified and registered nurse anesthetist will take care of you. The medicine is given into your vein. You may be asked to breathe in (inhale) a special gas through a mask. Once you are asleep, the doctor may insert a tube into your windpipe (trachea) to help you breathe and protect your lungs. You will be watched very closely while you are asleep. Your blood pressure, pulse, and breathing will be monitored. The health care provider taking care of you can change how deeply asleep you are during the surgery. You will not move, feel any pain, or have any memory of the procedure because of this medicine. General anesthesia is a safe way to stay asleep and pain-free during procedures that would: - Be too painful - Take a long time - Affect your ability to breathe - Make you uncomfortable - Cause too much anxiety You may also be able to have conscious sedation for your procedure. Sometimes, though, it is not enough to make you comfortable. Children may need general anesthesia for a medical or dental procedure to handle any pain or anxiety they may feel. General anesthesia is usually safe for healthy people. You may have a higher risk of problems with general anesthesia if you: - Abuse alcohol or medicines - Have allergies or a family history of being allergic to medicines - Have heart, lung, or kidney problems - Smoke Ask your doctor about these complications: - Death (rare) - Harm to your vocal cords - Heart attack - Lung infection - Mental confusion (temporary) - Stroke - Trauma to the teeth or tongue - Waking during anesthesia (rare) - Allergy to the drugs - Malignant hyperthermia (fast rise in body temperature and severe muscle contractions) Tell your provider: - If you could be pregnant - What medicines you are taking, even drugs or herbs you bought without a prescription During the days before the surgery: - An anesthesiologist will take a complete medical history to determine the type and amount of the anesthesia you need. This includes asking you about any allergies, health conditions, medicines, and history of anesthesia. - Several days to a week before surgery, you may be asked to stop taking blood thinning drugs, such as aspirin, ibuprofen (Advil, Motrin), and warfarin (Coumadin, Jantoven). - Ask your provider which drugs you should still take on the day of your surgery. - Always try to stop smoking. Your doctor can help. On the day of your surgery: - You will likely be asked not to drink or eat anything after midnight the night before the surgery. This is to prevent you from vomiting while you are under the effect of the anesthesia. Vomiting can cause food in the stomach to be inhaled into the lungs. This can lead to breathing problems. - Take the drugs that your provider told you to take with a small sip of water. - Arrive at the hospital on time. You will wake up tired and groggy in the recovery or operating room. You may also feel sick to your stomach, and have a dry mouth, sore throat, or feel cold or restless until the effect of the anesthesia wears off. Your nurse will monitor these side effects, which will wear off, but it may take a few hours. Sometimes, nausea and vomiting can be treated with other medicines. Follow your surgeon's instructions while you recover and care for your surgical wound. General anesthesia is generally safe because of modern equipment, medicines, and safety standards. Most people recover completely and do not have any complications. Updated by: Mary C. Mancini, MD, PhD, Department of Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007410.htm"
+  ],
+  [
+    "What is Aortic stenosis?: The aorta is the main artery that carries blood out of the heart to the rest of the body. Blood flows out of the heart and into the aorta through the aortic valve. In aortic stenosis, the aortic valve does not open fully. This decreases blood flow from the heart.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000178.htm"
+  ],
+  [
+    "General paresis: General paresis is a problem with mental function due to damage to the brain from untreated syphilis. General paresis is one form of neurosyphilis. It usually occurs in people who have had untreated syphilis for many years. Syphilis is bacterial infection that is most often spread through sexual or nonsexual contact. Today, neurosyphilis is very rare. With neurosyphilis, the syphilis bacteria attack the brain and nervous system. General paresis often begins about 10 to 30 years after the syphilis infection. Syphilis infection can damage many different nerves of the brain. With general paresis, symptoms are usually those of dementia and may include: - Memory problems - Language problems, such as saying or writing words incorrectly - Decreased mental function, such as problems thinking and with judgment - Mood changes - Personality changes, such as delusions, hallucinations, irritability, inappropriate behavior The doctor will perform a physical exam and ask about your medical history. During the exam, the doctor may check your nervous system function. Mental function tests will also be done. Tests that may be ordered to detect syphilis in the body include: - CSF-VDRL - FTA-ABS Tests of the nervous system may include: - Head CT scan and MRI - Nerve conduction tests The goals of treatment are to cure the infection and slow the disorder from getting worse. The doctor will prescribe penicillin or other antibiotics to treat the infection. Treatment will likely continue until the infection has completely cleared. Treating the infection will reduce new nerve damage. But it will not cure damage that has already occurred. Treatment of symptoms is needed for existing nervous system damage. Without treatment, a person can become disabled. People with late syphilis infections are more likely to get other infections and diseases. Complications of this condition include: - Inability to communicate or interact with others - Injury due to seizures or falls - Inability to care for yourself Call your health care provider if you know you have been exposed to syphilis or another sexually transmitted infection in the past, and have not been treated. Call your provider if you have nervous system problems (such as trouble thinking), especially if you know you have been infected with syphilis. Go to the emergency room or call the local emergency number (such as 911) if you have seizures. Treating primary syphilis and secondary syphilis infections will prevent general paresis. Practicing safer sex, such as limiting partners and using protection, may reduce the risk of getting infected with syphilis. Avoid direct skin contact with people who have secondary syphilis. Updated by: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000748.htm"
+  ],
+  [
+    "Aortic valve stenosis: Aortic valve stenosis (AVS) is a condition characterized by narrowing of the heart's aortic valve opening. This narrowing prevents the valve from opening fully, which obstructs blood flow from the heart into the aorta, and onward to the rest of the body. [1] AVS can range from mild to severe. Signs and symptoms typically develop when the narrowing of the opening is severe and may include chest pain (angina) or tightness; shortness of breath or fatigue (especially during exertion); feeling faint or fainting; heart palpitations; and heart murmur. [1] [2] Individuals with less severe congenital AVS (present at birth) may not develop symptoms until adulthood. Individuals with severe cases may faint without warning. [2] The condition can eventually lead to heart failure. AVS can have several causes including abnormal development before birth (such as having 1 or 2 valve leaflets instead of 3); calcium build-up on the valve in adulthood; and rheumatic fever. Treatment may include medications to ease the symptoms, but surgery to repair or replace the valve is the only way to eliminate the condition. [1] Aortic valve stenosis can be congenital (present at birth) or can develop later in life. When the condition is congenital, it is typically due to abnormal development of the aortic valve - either it forms abnormally narrow, or it is made up of one flap or leaflet (called a unicuspid valve, which is very rare) or two leaflets (bicuspid valve) instead of the usual three. Having a bicuspid valve can run in families. A bicuspid valve may not cause any problems until adulthood, when the valve begins to narrow or leak. In most cases, the exact underlying cause of congenital aortic valve stenosis is unknown. [1] Aortic valve stenosis can also be caused by the buildup of calcium deposits on the heart valve with increasing age. This cause is most common in people older than 65. Rheumatic fever can also cause the condition because it may result in scar tissue forming on the valve, causing the leaflets to stiffen and fuse. Rheumatic fever can also cause a rough surface on the valve, which can lead to accumulation of calcium deposits later in life. [1]",
+    "https://rarediseases.info.nih.gov/diseases/5830/aortic-valve-stenosis"
+  ],
+  [
+    "Aortic valve stenosis: Aortic valve stenosis - or aortic stenosis - occurs when the heart's aortic valve narrows. This narrowing prevents the valve from opening fully, which reduces or blocks blood flow from your heart into the main artery to your body (aorta) and onward to the rest of your body. When the blood flow through the aortic valve is reduced or blocked, your heart needs to work harder to pump blood to your body. Eventually, this extra work limits the amount of blood it can pump, and this can cause symptoms as well as possibly weaken your heart muscle. Your treatment depends on the severity of your condition. You may need surgery to repair or replace the valve. Left untreated, aortic valve stenosis can lead to serious heart problems. Aortic valve disease care at Mayo Clinic Aortic valve stenosis ranges from mild to severe. Aortic valve stenosis signs and symptoms generally develop when narrowing of the valve is severe. Some people with aortic valve stenosis may not experience symptoms for many years. Signs and symptoms of aortic valve stenosis may include: - Abnormal heart sound (heart murmur) heard through a stethoscope - Chest pain (angina) or tightness with activity - Feeling faint or dizzy or fainting with activity - Shortness of breath, especially when you have been active - Fatigue, especially during times of increased activity - Heart palpitations - sensations of a rapid, fluttering heartbeat - Not eating enough (mainly in children with aortic valve stenosis) - Not gaining enough weight (mainly in children with aortic valve stenosis) The heart-weakening effects of aortic valve stenosis may lead to heart failure. Heart failure signs and symptoms include fatigue, shortness of breath, and swollen ankles and feet. When to see a doctor If you have a heart murmur, your doctor may recommend that you visit a cardiologist. If you develop any symptoms that may suggest aortic valve stenosis, see your doctor. Your heart has four valves that keep blood flowing in the correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps (cusps or leaflets) that open and close once during each heartbeat. Sometimes, the valves don't open or close properly, disrupting the blood flow through your heart and potentially impairing the ability to pump blood to your body. In aortic valve stenosis, the aortic valve between the lower left heart chamber (left ventricle) and the main artery that delivers blood from the heart to the body (aorta) is narrowed (stenosis). When the aortic valve is narrowed, the left ventricle has to work harder to pump a sufficient amount of blood into the aorta and onward to the rest of your body. This can cause the left ventricle to thicken and enlarge. Eventually the extra work of the heart can weaken the left ventricle and your heart overall, and it can ultimately lead to heart failure and other problems. Aortic valve stenosis can occur due to many causes, including: - Congenital heart defect. The aortic valve consists of three tightly fitting, triangular-shaped flaps of tissue called cusps. Some children are born with an aortic valve that has only two (bicuspid) cusps instead of three. People may also be born with one (unicuspid) or four (quadricuspid) cusps, but these are rare. This defect may not cause any problems until adulthood, at which time the valve may begin to narrow or leak and may need to be repaired or replaced. Having a congenitally abnormal aortic valve requires regular evaluation by a doctor to watch for signs of valve problems. In most cases, doctors don't know why a heart valve fails to develop properly, so it isn't something you could have prevented. - Calcium buildup on the valve. With age, heart valves may accumulate deposits of calcium (aortic valve calcification). Calcium is a mineral found in your blood. As blood repeatedly flows over the aortic valve, deposits of calcium can build up on the valve's cusps. These calcium deposits aren't linked to taking calcium tablets or drinking calcium-fortified drinks. These deposits may never cause any problems. However, in some people - particularly those with a congenitally abnormal aortic valve, such as a bicuspid aortic valve - calcium deposits result in stiffening of the cusps of the valve. This stiffening narrows the aortic valve and can occur at a younger age. However, aortic valve stenosis that is related to increasing age and the buildup of calcium deposits on the aortic valve is most common in older people. It usually doesn't cause symptoms until ages 70 or 80. - Rheumatic fever. A complication of strep throat infection, rheumatic fever may result in scar tissue forming on the aortic valve. Scar tissue alone can narrow the aortic valve and lead to aortic valve stenosis. Scar tissue can also create a rough surface on which calcium deposits can collect, contributing to aortic valve stenosis later in life. Rheumatic fever may damage more than one heart valve, and in more than one way. A damaged heart valve may not open fully or close fully - or both. While rheumatic fever is rare in the United States, some older adults had rheumatic fever as children. Risk factors of aortic valve stenosis include: - Older age - Certain heart conditions present at birth (congenital heart disease) such as a bicuspid aortic valve - History of infections that can affect the heart - Having cardiovascular risk factors, such as diabetes, high cholesterol and high blood pressure - Chronic kidney disease - History of radiation therapy to the chest Aortic valve stenosis can cause complications, including: - Heart failure - Stroke - Blood clots - Bleeding - Heart rhythm abnormalities (arrhythmias) - Infections that affect the heart, such as endocarditis - Death To diagnose aortic valve stenosis, your doctor may review your signs and symptoms, discuss your medical history, and conduct a physical examination. Your doctor may listen to your heart with a stethoscope to determine if you have a heart murmur that may indicate an aortic valve condition. A doctor trained in heart disease (cardiologist) may evaluate you. Your doctor may order several tests to diagnose your condition and determine the cause and severity of your condition. Tests may include: - Echocardiogram. This test uses sound waves to produce video images of your heart in motion. During this test, specialists hold a wandlike device (transducer) on your chest. Doctors may use this test to evaluate your heart chambers, the aortic valve and the blood flow through your heart. A doctor generally uses this test to diagnose your condition if he or she suspects you have a heart valve condition. This test can help doctors closely look at the condition of the aortic valve, and the cause and severity of your condition. It can also help doctors determine if you have additional heart valve conditions. Doctors may conduct another type of echocardiogram called a transesophageal echocardiogram to get a closer look at the aortic valve. In this test, a small transducer attached to the end of a tube is inserted down the tube leading from your mouth to your stomach (esophagus). - Electrocardiogram (ECG). In this test, wires (electrodes) attached to pads on your skin measure the electrical activity of your heart. An ECG can detect enlarged chambers of your heart, heart disease and abnormal heart rhythms. - Chest X-ray. A chest X-ray can help your doctor determine whether your heart is enlarged, which can occur in aortic valve stenosis. It can also show whether you have an enlarged blood vessel (aorta) leading from your heart or any calcium buildup on your aortic valve. A chest X-ray can also help doctors determine the condition of your lungs. - Exercise tests or stress tests. Exercise tests help doctors see whether you have signs and symptoms of aortic valve disease during physical activity, and these tests can help determine the severity of your condition. If you are unable to exercise, medications that have similar effects as exercise on your heart may be used. - Cardiac computerized tomography (CT) scan. A cardiac CT scan uses a series of X-rays to create detailed images of your heart and heart valves. Doctors may use this test to measure the size of your aorta and look at your aortic valve more closely. - Cardiac MRI. A cardiac MRI uses magnetic fields and radio waves to create detailed images of your heart. This test may be used to determine the severity of your condition and evaluate the size of your aorta. - Cardiac catheterization. This test isn't often used to diagnose aortic valve disease, but it may be used if other tests aren't able to diagnose the condition or to determine its severity. In this procedure, your doctor threads a thin tube (catheter) through a blood vessel in your arm or groin and guides it to an artery in your heart. Doctors may inject a dye through the catheter, which helps your arteries become visible on an X-ray (coronary angiogram). This provides your doctor with a detailed picture of your heart arteries and how your heart functions. It can also measure the pressure inside your heart chambers. Treatment for aortic valve stenosis depends on the severity of your condition, whether you're experiencing signs and symptoms, and if your condition is getting worse. If your symptoms are mild or you aren't experiencing symptoms, your doctor may monitor your condition with regular follow-up appointments. Your doctor may recommend you make healthy lifestyle changes and take medications to treat symptoms or reduce the risk of complications. You may eventually need surgery to repair or replace the diseased aortic valve. In some cases, your doctor may recommend surgery even if you aren't experiencing symptoms. If you're having another heart surgery, doctors may perform aortic valve surgery at the same time. Surgery to repair or replace an aortic valve is usually performed through a cut (incision) in the chest. Less invasive approaches may be available, and your doctor will evaluate you to determine if you're a candidate for these procedures. If you have aortic valve stenosis, consider being evaluated and treated at a medical center with a multidisciplinary team of cardiologists and other doctors and medical staff trained and experienced in evaluating and treating heart valve disease. This team can work closely with you to determine the most appropriate treatment for your condition. Surgery options include: Aortic valve repair Surgeons rarely repair an aortic valve to treat aortic valve stenosis, and generally aortic valve stenosis requires aortic valve replacement. To repair an aortic valve, surgeons may separate valve flaps (cusps) that have fused. Balloon valvuloplasty Doctors may conduct a procedure using a long, thin tube (catheter) to repair a valve with a narrowed opening (aortic valve stenosis). In this procedure, called balloon valvuloplasty, a doctor inserts a catheter with a balloon on the tip into an artery in your arm or groin and guides it to the aortic valve. The doctor performing the procedure then inflates the balloon, which expands the opening of the valve. The balloon is then deflated, and the catheter and balloon are removed. The procedure can treat aortic valve stenosis in infants and children. However, the valve tends to narrow again in adults who've had the procedure, so it's usually only performed in adults who are too ill for surgery or who are waiting for a valve replacement, as they typically need additional procedures to treat the narrowed valve over time. Aortic valve replacement Aortic valve replacement is often needed to treat aortic valve stenosis. In aortic valve replacement, your surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve). Biological tissue valves degenerate over time and may eventually need to be replaced. People with mechanical valves will need to take blood-thinning medications for life to prevent blood clots. Your doctor will discuss with you the benefits and risks of each type of valve and discuss which valve may be appropriate for you. Doctors may perform a less invasive procedure called transcatheter aortic valve replacement (TAVR) to replace a narrowed aortic valve. TAVR may be an option for people who are considered to be at intermediate or high risk of complications from surgical aortic valve replacement. In TAVR, doctors insert a catheter in your leg or chest and guide it to your heart. A replacement valve is then inserted through the catheter and guided to your heart. A balloon may expand the valve, or some valves can self-expand. When the valve is implanted, doctors remove the catheter from your blood vessel. Doctors may also conduct a catheter procedure to insert a replacement valve into a failing biological tissue valve that is no longer working properly. Other catheter procedures to repair or replace aortic valves continue to be researched. You'll have regular follow-up appointments with your doctor to monitor your condition. You'll need to continue taking all your medications as prescribed. Your doctor may suggest you incorporate several heart-healthy lifestyle changes into your life, including: - Eating a heart-healthy diet. Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish, and whole grains. Avoid saturated and trans fat, and excess salt and sugar. - Maintaining a healthy weight. Aim to keep a healthy weight. If you're overweight or obese, your doctor may recommend that you lose weight. - Getting regular physical activity. Aim to include about 30 minutes of physical activity, such as brisk walks, into your daily fitness routine. - Managing stress. Find ways to help manage your stress, such as through relaxation activities, meditation, physical activity, and spending time with family and friends. - Avoiding tobacco. If you smoke, quit. Ask your doctor about resources to help you quit smoking. Joining a support group may be helpful. For women with aortic valve stenosis, it's important to talk with your doctor before you become pregnant. Your doctor can discuss with you which medications you can safely take, and whether you may need a procedure to treat your valve condition prior to pregnancy. You'll likely require close monitoring by your doctor during pregnancy. Doctors may recommend that women with severe valve stenosis avoid pregnancy to avoid the risk of complications.",
+    "https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-20353139"
+  ],
+  [
+    "Supravalvular aortic stenosis: Supravalvular aortic stenosis (SVAS) is a type of heart defect that develops before birth. It is characterized by a narrowing (stenosis) of the section of the aorta just above the valve that connects the aorta to the heart (aortic valve). The severity of SVAS varies from person to person; some individuals may die in infancy while others never experience symptoms. If symptoms develop, they may include shortness of breath, chest pain, murmur, and/or eventual heart failure. Some affected individuals also have defects in other blood vessels, such as the pulmonary artery. SVAS can be caused by mutations in the ELN gene and be inherited in an autosomal dominant manner, although some individuals that inherit the mutated gene never develop features of the condition (called reduced penetrance ). SVAS can also be associated with Williams syndrome. Treatment may include surgery to repair the condition in severe cases. [1] [2] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Supravalvular aortic stenosis Very frequent Autosomal dominant inheritance - Peripheral arterial stenosis - Pulmonary artery stenosis - Pulmonic stenosis - Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. Orphanet lists international laboratories offering diagnostic testing for this condition.",
+    "https://rarediseases.info.nih.gov/diseases/743/supravalvular-aortic-stenosis"
+  ],
+  [
+    "Malaise: Malaise is a general feeling of discomfort, illness, or lack of well-being. Malaise is a symptom that can occur with almost any health condition. It may start slowly or quickly, depending on the type of disease. Fatigue (feeling tired) occurs with malaise in many diseases. You can have a feeling of not having enough energy to do your usual activities. The following lists give examples of the diseases, conditions, and medicines that can cause malaise. SHORT-TERM (ACUTE) INFECTIOUS DISEASE - Acute bronchitis or pneumonia - Acute viral syndrome - Infectious mononucleosis (EBV) - Influenza - Lyme disease LONG-TERM (CHRONIC) INFECTIOUS DISEASE - AIDS - Chronic active hepatitis - Disease caused by parasites - Tuberculosis HEART AND LUNG (CARDIOPULMONARY) DISEASE - Congestive heart failure - COPD ORGAN FAILURE - Acute or chronic kidney disease - Acute or chronic liver disease CONNECTIVE TISSUE DISEASE - Rheumatoid arthritis - Sarcoidosis - Systemic lupus erythematosus ENDOCRINE or METABOLIC DISEASE - Adrenal gland dysfunction - Diabetes - Pituitary gland dysfunction (rare) - Thyroid disease CANCER - Leukemia - Lymphoma (cancer that starts in the lymph system) - Solid tumor cancers, such as colon cancer BLOOD DISORDERS - Severe anemia PSYCHIATRIC - Depression - Dysthymia MEDICINES - Anticonvulsant (antiseizure) medicines - Antihistamines - Beta blockers (medicines used to treat heart disease or high blood pressure) - Psychiatric medicines - Treatments involving several medicines Call your health care provider right away if you have severe malaise. Call your health care provider if: - You have other symptoms with the malaise - Malaise lasts longer than one week, with or without other symptoms Your health care provider will perform a physical exam and ask questions such as: - How long has this feeling lasted (weeks or months)? - What other symptoms do you have? - Is the malaise constant or episodic (comes and goes)? - Can you complete your daily activities? If not, what limits you? - Have you traveled recently? - What medicines are you on? - What are your other medical problems? - Do you use alcohol or other drugs? You may have tests to confirm the diagnosis if your provider thinks the problem may be due to an illness. These may include blood tests, x-rays, or other diagnostic tests. Your provider will recommend treatment if needed based on your exam and tests. Updated by: Linda J. Vorvick, MD, medical director and director of didactic curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003089.htm"
+  ],
+  [
+    "Home health care (General): When caring for an aging friend or relative from afar, it can be hard to know when your help is needed. Sometimes, your relative will ask for help. Or, the sudden start of a severe illness will make it clear that assistance is needed. But, when you live far away, some detective work might be necessary to uncover possible signs that support or help is needed.A phone call is not always the best way to tell whether or not an older person needs help handling daily activities. The person may not want to worry you or may be embarrassed to admit that he or she cannot handle certain daily activities.With the person's permission, you could contact people who see the person regularly-neighbors, friends, doctors, or local relatives, for example-and ask them to call you with any concerns. You might also ask if you can check in with them periodically. When you visit, look around for possible trouble areas-it's easier to disguise problems during a short phone call than during a longer visit. Make a list of trouble spots you want to check on-then, if you can't fix everything during your visit, see if you can arrange for someone else to finish up.In addition to safety issues and the overall condition of the home, try to determine the older person's mood and general health status. Sometimes people confuse depression in older people with normal aging. A depressed older person might brighten up for a phone call or short visit, but it's harder to hide serious mood problems during an extended visit.Read more about long-distance caregiving.",
+    "https://www.nia.nih.gov/health/topics/home-health-care"
+  ],
+  [
+    "Etiology: Etiology describes the cause or causes of a disease. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002356.htm"
+  ],
+  [
+    "white sponge nevus (Frequency): The exact prevalence of white sponge nevus is unknown, but it is estimated to affect less than 1 in 200,000 individuals worldwide.",
+    "https://ghr.nlm.nih.gov/condition/white-sponge-nevus"
+  ],
+  [
+    "APRT gene: The APRT gene provides instructions for making an enzyme called adenine phosphoribosyltransferase (APRT). This enzyme is produced in all cells and is part of the purine salvage pathway, which recycles a group of DNA building blocks (nucleotides) called purines to make other molecules. The APRT enzyme helps to recycle the purine adenine to make a molecule called adenosine monophosphate (AMP). This conversion occurs when AMP is needed as a source of energy for cells. At least 40 mutations in the APRT gene have been found to cause adenine phosphoribosyltransferase (APRT) deficiency, a condition that affects the kidneys and urinary tract. Most of these mutations change single protein building blocks (amino acids) in the APRT enzyme. The mutations that cause APRT deficiency are categorized into two groups known as the APRT*J allele and the APRT*Q0 allele. The APRT*J allele consists of one mutation that replaces the amino acid methionine with the amino acid threonine at position 136 in the APRT enzyme (written as Met136Thr or M136T). This mutation reduces the function of the enzyme. The M136T mutation occurs almost exclusively in Japanese individuals with the condition; most affected individuals have this mutation on both copies of the APRT gene in each cell. The APRT*Q0 allele consists of all other APRT gene mutations. The most common of these mutations (written IVS4+2insT) alters the genetic instructions used to make the enzyme, resulting in an abnormally short, nonfunctional enzyme. This mutation is estimated to occur in 40 percent of affected Europeans. APRT gene mutations lead to a lack of functional enzyme that prevents the conversion of adenine to AMP. As a result, adenine is converted to another molecule called 2,8-dihydroxyadenine (2,8-DHA). 2,8-DHA crystallizes in urine, forming stones in the kidneys and urinary tract. As a result, kidney function can decline, which may lead to end-stage renal disease (ESRD), a life-threatening failure of kidney function. At least 40 mutations in the APRT gene have been found to cause adenine phosphoribosyltransferase (APRT) deficiency, a condition that affects the kidneys and urinary tract. Most of these mutations change single protein building blocks (amino acids) in the APRT enzyme. The mutations that cause APRT deficiency are categorized into two groups known as the APRT*J allele and the APRT*Q0 allele. The APRT*J allele consists of one mutation that replaces the amino acid methionine with the amino acid threonine at position 136 in the APRT enzyme (written as Met136Thr or M136T). This mutation reduces the function of the enzyme. The M136T mutation occurs almost exclusively in Japanese individuals with the condition; most affected individuals have this mutation on both copies of the APRT gene in each cell. The APRT*Q0 allele consists of all other APRT gene mutations. The most common of these mutations (written IVS4+2insT) alters the genetic instructions used to make the enzyme, resulting in an abnormally short, nonfunctional enzyme. This mutation is estimated to occur in 40 percent of affected Europeans. APRT gene mutations lead to a lack of functional enzyme that prevents the conversion of adenine to AMP. As a result, adenine is converted to another molecule called 2,8-dihydroxyadenine (2,8-DHA). 2,8-DHA crystallizes in urine, forming stones in the kidneys and urinary tract. As a result, kidney function can decline, which may lead to end-stage renal disease (ESRD), a life-threatening failure of kidney function. Boll\u00e9e G, Dollinger C, Boutaud L, Guillemot D, Bensman A, Harambat J, Deteix P, Daudon M, Knebelmann B, Ceballos-Picot I. Phenotype and genotype characterization of adenine phosphoribosyltransferase deficiency. J Am Soc Nephrol. 2010 Apr;21(4):679-88. doi: 10.1681/ASN.2009080808. Epub 2010 Feb 11.",
+    "https://ghr.nlm.nih.gov/gene/APRT"
+  ],
+  [
+    "What should I know about storage and disposal of Glimepiride?: Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.",
+    "https://www.nlm.nih.gov/medlineplus/druginfo/meds/a696016.html"
+  ],
+  [
+    "Glimepiride: Glimepiride is used along with diet and exercise, and sometimes with other medications, to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood). Glimepiride lowers blood sugar by causing the pancreas to produce insulin (a natural substance that is needed to break down sugar in the body) and helping the body use insulin efficiently. This medication will only help lower blood sugar in people whose bodies produce insulin naturally. Glimepiride is not used to treat type 1 diabetes (condition in which the body does not produce insulin and, therefore, cannot control the amount of sugar in the blood) or diabetic ketoacidosis (a serious condition that may occur if high blood sugar is not treated). Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes. Glimepiride comes as a tablet to take by mouth. It is usually taken once a day with breakfast or the first main meal of the day. To help you remember to take glimepiride, take it at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take glimepiride exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor will probably start you on a low dose of glimepiride and gradually increase your dose if needed. After you have taken glimepiride for some time, glimepiride may not control your blood sugar as well as it did at the beginning of your treatment. Your doctor may adjust the dose of your medication as needed so that the medication will work best for you. Be sure to tell your doctor how you are feeling and if your blood sugar test results have been higher or lower than normal at any time during your treatment. Glimepiride helps control blood sugar but does not cure diabetes. Continue to take glimepiride even if you feel well. Do not stop taking glimepiride without talking to your doctor. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information. Before taking glimepiride, - tell your doctor and pharmacist if you are allergic to glimepiride, any other medications, or any of the ingredients in glimepiride. Ask your pharmacist for a list of the ingredients. - tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention anticoagulants ('blood thinners') such as warfarin (Coumadin); aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); chloramphenicol; clarithromycin (Biaxin); disopyramide (Norpace); diuretics ('water pills'); fluconazole (Diflucan); fluoxetine (Prozac, Sarafem); hormone replacement therapy and hormonal contraceptives (birth control pills, patches, rings, implants, and injections); insulin or other medications to treat high blood sugar or diabetes; isoniazid (INH); MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate); medications for asthma and colds; medications for mental illness and nausea; miconazole (Monistat); niacin; oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); phenytoin (Dilantin); probenecid (Benemid); quinolone and fluoroquinolone antibiotics such as cinoxacin (Cinobac), ciprofloxacin (Cipro), enoxacin (Penetrex), gatifloxacin (Tequin), levofloxacin (Levaquin), lomefloxacin (Maxaquin), moxifloxacin (Avelox), nalidixic acid (NegGram), norfloxacin (Noroxin), ofloxacin (Floxin), sparfloxacin (Zagam), trovafloxacin and alatrofloxacin combination (Trovan); rifampin (Rifadin); salicylate pain relievers such as choline magnesium trisalicylate, choline salicylate (Arthropan), diflunisal (Dolobid), magnesium salicylate (Doan's, others), and salsalate (Argesic, Disalcid, Salgesic); sulfa antibiotics such as co-trimoxazole (Bactrim, Septra); sulfasalazine (Azulfidine); and thyroid medications. Also be sure to tell your doctor or pharmacist if you stop taking any medications while taking glimepiride. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. - tell your doctor if you have or have ever had G6PD deficiency (an inherited condition causing premature destruction of red blood cells or hemolytic anemia); if you have hormone disorders involving the adrenal , pituitary, or thyroid gland; or if you have heart, kidney, or liver disease. - tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking glimepiride, call your doctor. - if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking glimepiride. - ask your doctor about the safe use of alcoholic beverages while you are taking glimepiride. Alcohol can make the side effects from glimepiride worse. Consuming alcohol while taking glimepiride also may cause symptoms such as flushing (reddening of the face), headache, nausea, vomiting, chest pain, weakness, blurred vision, mental confusion, sweating, choking, breathing difficulty, and anxiety. - plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Glimepiride may make your skin sensitive to sunlight. - ask your doctor what to do if you get sick, develop an infection or fever, experience unusual stress, or are injured. These conditions can affect your blood sugar and the amount of glimepiride you may need. Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. It is important to eat a healthy diet, exercise regularly, and lose weight if necessary. Before you start to take glimepiride, ask you doctor what you should do if you forget to take a dose. Write these directions down so that you can refer to them later. As a general rule, take the missed dose as soon as you remember it. If it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. This medication may cause changes in your blood sugar. You should know the symptoms of low and high blood sugar and what to do if you have these symptoms. Glimepiride may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: - dizziness - nausea Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately: - yellowing of the skin or eyes - light-colored stools - dark urine - pain in the upper right part of the stomach - unusual bruising or bleeding - diarrhea - fever - sore throat Glimepiride may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). In one study, people who took a medication similar to glimepiride to treat their diabetes were more likely to die of heart problems than people who were treated with insulin and diet changes. Talk to your doctor about the risks of taking glimepiride. Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location \u2013 one that is up and away and out of their sight and reach. http://www.upandaway.org In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911. Symptoms of overdose may include hypoglycemia symptoms as well as the following: - seizures - loss of consciousness Keep all appointments with your doctor and the laboratory. Your fasting blood sugar levels and glycosylated hemoglobin (HbA1c) should be checked regularly to determine your response to glimepiride. Your doctor may order other lab tests to check your response to glimepiride. Your doctor will also tell you how to check your response to this medication by measuring your blood sugar levels at home. Follow these instructions carefully. You should always wear a diabetic identification bracelet to be sure you get proper treatment in an emergency. Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. - Amaryl\u00ae - Avandaryl\u00ae (containing Glimepiride, Rosiglitazone) - Duetact\u00ae (containing Glimepiride, Pioglitazone)",
+    "https://medlineplus.gov/druginfo/meds/a696016.html"
+  ],
+  [
+    "Free sialic acid storage disease: The following summary is from Orphanet, a European reference portal for information on rare diseases and orphan drugs. Orpha Number: 834 Disease definition Free sialic acid storage disease (free SASD), is a group of lysosomal storage diseases characterized by a spectrum of clinical manifestations including neurological and developmental disorders with severity ranging from the milder phenotype , Salla disease (SD), to the most severe phenotype, infantile free sialic acid storage disease (ISSD). Visit the Orphanet disease page for more resources. The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Abnormal pyramidal signs Very frequent Abnormality of the foot Very frequent Aplasia/Hypoplasia of the abdominal wall musculature Very frequent Ataxia Very frequent Gait disturbance Very frequent Intellectual disability Very frequent Muscular hypotonia Very frequent Nystagmus Very frequent Spasticity Very frequent Abnormal facial shape Frequent Abnormality of skin pigmentation Frequent Abnormality of the upper limb Frequent Ascites Frequent Athetosis Frequent Dysarthria Frequent Failure to thrive in infancy Frequent Hydrops fetalis Frequent Iris hypopigmentation Frequent Oculomotor apraxia Frequent Recurrent respiratory infections Frequent Reduced bone mineral density Frequent Seizures Frequent Skeletal dysplasia Frequent Skin ulcer Frequent Hepatomegaly Occasional Nephrotic syndrome Occasional Proteinuria Occasional Splenomegaly Occasional View complete list of signs and symptoms... The resources below provide information about treatment options for this condition. If you have questions about which treatment is right for you, talk to your healthcare professional. Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. The following diseases are related to Free sialic acid storage disease. If you have a question about any of these diseases, you can contact GARD. Infantile free sialic acid storage disease Intermediate severe Salla disease Salla disease",
+    "https://rarediseases.info.nih.gov/diseases/10870/free-sialic-acid-storage-disease"
+  ],
+  [
+    "Platelet storage pool deficiency: Platelet storage pool deficiency refers to a group of conditions that are caused by problems with the platelet granules. Platelet granules are tiny storage sacs found within the platelets which release various substances to help stop bleeding. Platelet storage pool deficiencies occur when platelet granules are absent, reduced in number, or unable to empty their contents into the bloodstream. The signs and symptoms include frequent nosebleeds; abnormally heavy or prolonged\u00a0 menstruation; easy bruising; recurrent anemia ; and abnormal bleeding after surgery, dental work or childbirth. [1] Platelet storage pool deficiencies may be genetic or acquired (non-genetic). They can also be part of an inherited genetic\u00a0 syndrome such as Hermansky-Pudlak syndrome, Chediak-Higashi syndrome, thrombocytopenia-absent radius (TAR) syndrome, and Wiskott-Aldrich syndrome. Treatment is symptomatic. [2] [1] [3] The signs and symptoms of platelet storage pool deficiency vary but may include: [1] [3] [4] Frequent nosebleeds Abnormally heavy or prolonged menstruation Easy bruising Recurrent anemia Abnormal bleeding after surgery, dental work or childbirth The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Acute leukemia - Autosomal dominant inheritance - Decreased mean platelet volume - Myelodysplasia - Prolonged bleeding time - Platelet storage pool deficiency\u00a0refers to\u00a0a group of conditions that are caused by problems with the platelet\u00a0granules. Platelet granules\u00a0are\u00a0tiny storage sacs found within the platelets which\u00a0release various\u00a0substances\u00a0to\u00a0help stop bleeding. Some platelet storage pool deficiencies are\u00a0due\u00a0to reduced or absent granules or\u00a0granule contents. Others occur\u00a0if the platelets are unable to empty the contents of the platelet granules into the bloodstream.[3]\u00a0 Platelet storage pool deficiencies can be\u00a0genetic or acquired (non-genetic). The four major\u00a0genetic forms\u00a0include dense body deficiency, gray platelet syndrome, Factor V Quebec, and mixed alpha-granule/dense body deficiency. Platelet storage pool deficiency\u00a0is also a feature of several\u00a0 inherited conditions\u00a0such as\u00a0Hermansky-Pudlak syndrome, Chediak-Higashi syndrome, thrombocytopenia-absent radius (TAR) syndrome, and Wiskott-Aldrich syndrome.[3][4] Causes of acquired platelet storage pool deficiencies\u00a0include:[3] Systemic lupus erythematosus Cardiovascular bypass Hairy-cell leukemia Platelet storage pool deficiency refers to a group of conditions that can be acquired (non- inherited ) or inherited. Hereditary forms of the condition\u00a0may be inherited in an autosomal dominant , autosomal recessive , or X-linked manner. [4] In autosomal dominant conditions, one changed ( mutated ) copy of the responsible gene in each cell is enough to cause signs or symptoms of the condition. When a person with an autosomal dominant condition has children, each child has a 50% (1 in 2) risk to inherit the mutated copy of the gene from the affected parent. When a condition is inherited in an autosomal recessive manner, a person must have a change in both copies of the responsible gene in each cell. The parents of an affected person usually each carry one mutated copy of the gene and are referred to as carriers . Carriers typically do not show signs or symptoms of the condition. When two carriers of an autosomal recessive condition have children, each child has a 25% (1 in 4) risk to have the condition, a 50% (1 in 2) risk to be a carrier like each of the parents, and a 25% chance to not have the condition and not be a carrier. A condition is considered X-linked if the mutated gene that causes the condition is located on the X chromosome , one of the two sex chromosomes (the Y chromosome is the other sex chromosome ). Women have two X chromosomes and men have an X and a Y chromosome. X-linked conditions can be X-linked dominant or X-linked recessive . The inheritance is X-linked dominant if one copy of the altered gene in each cell is sufficient to cause the condition. Women with an X-linked dominant condition have a 50% chance of passing the condition on to a son or a daughter with each pregnancy. Men with an X-linked dominant condition will pass the condition on to all of their daughters and none of their sons. The inheritance is X-linked recessive if a gene on the X chromosome causes the condition in men with one gene mutation (they have only one X chromosome) and in females with two gene mutations (they have two X chromosomes). A woman with an X-linked condition will pass the mutation on to all of her sons and daughters. This means that all of her sons will have the condition and all of her daughters will be carriers. A man with an X-linked recessive condition will pass the mutation to all of his daughters (carriers) and none of his sons. A diagnosis of platelet storage pool deficiency is often suspected based on the presence of characteristic signs and symptoms. Specialized laboratory tests can then be ordered to confirm the diagnosis. This testing may include: [5] [4] Bleeding time studies Platelet aggregation studies Peripheral blood smear Flow cytometry (detects a reduction in certain types of granules in affected platelets) Treatment for platelet storage pool deficiency is symptomatic. For example, people who have severe episodes of bleeding may require platelet transfusions or antifibrinolytic medications, particularly during periods of high risk such as during surgical procedures or after an injury. Transfusions are generally used with caution as the potential risks often outweigh the benefits when bleeding is not life-threatening. [1] [3] People with a platelet storage pool deficiency should avoid antiplatelet drugs such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDS). [1] [3]",
+    "https://rarediseases.info.nih.gov/diseases/5034/platelet-storage-pool-deficiency"
+  ],
+  [
+    "Lipid Storage Diseases: Lipid storage diseases are a group of inherited metabolic disorders in which harmful amounts of fatty materials (lipids) accumulate in various tissues and cells in the body.\u00a0 Lipids are important parts of the membranes found within and between each cell and in the myelin sheath that coats and protects the nerves. \u00a0Over time, this excessive storage of fats can cause permanent cellular and tissue damage, particularly in the brain, peripheral nervous system, liver, spleen, and bone marrow.\u00a0 Lipid storage diseases are inherited from one or both parents who carry a defective gene. \u00a0 Symptoms may appear early in life or develop in the teen or even adult years.\u00a0 Neurological complications of the lipid storage diseases may include lack of muscle coordination, brain degeneration, seizures, loss of muscle tone, learning problems, spasticity, feeding and swallowing difficulties, slurred speech, hypersensitivity to touch,\u00a0pain in the arms and legs, and clouding of the cornea.\u00a0 Currently there is no specific treatment available for most of the lipid storage dThe prognosis for a lipid storage disorder is determined by the type of disease, the age of onset, and the severity of symptoms.\u00a0 Children treated for some forms of Gaucher disease may live well into adulthood, while children with Niemann-Pick disease often die at a young age from infection or progressive neurological loss.\u00a0 Children with Fabry disease often die prematurely of complications from heart disease, renal failure, or stroke.\u00a0 Most children with Farber\u2019s disease die by age 2, usually from lung disease.\u00a0 Children with Tay-Sachs and Sandhoff diseases often die at an early age from recurring or respiratory infection. The prognosis for a lipid storage disorder is determined by the type of disease, the age of onset, and the severity of symptoms.\u00a0 Children treated for some forms of Gaucher disease may live well into adulthood, while children with Niemann-Pick disease often die at a young age from infection or progressive neurological loss.\u00a0 Children with Fabry disease often die prematurely of complications from heart disease, renal failure, or stroke.\u00a0 Most children with Farber\u2019s disease die by age 2, usually from lung disease.\u00a0 Children with Tay-Sachs and Sandhoff diseases often die at an early age from recurring or respiratory infection.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Lipid-Storage-Diseases-Information-Page"
+  ],
+  [
+    "PRKAG2 gene: The PRKAG2 gene provides instructions for making one part (the gamma-2 subunit) of a larger enzyme called AMP-activated protein kinase (AMPK). This enzyme helps sense and respond to energy demands within cells. It is active in many different tissues, including heart (cardiac) muscle and muscles used for movement (skeletal muscles). AMP-activated protein kinase is likely involved in the development of the heart before birth, although its role in this process is unknown. AMP-activated protein kinase regulates chemical pathways involving the cell's main energy source, a molecule called adenosine triphosphate (ATP). The breakdown of ATP releases energy to drive many types of chemical reactions. AMP-activated protein kinase is activated during times of cellular stress (such as low oxygen levels or muscle exercise), when ATP is broken down rapidly to produce energy. If ATP levels become too low, the enzyme restores the balance of energy by limiting chemical reactions that require ATP and stimulating pathways that generate ATP. Studies suggest that AMP-activated protein kinase may play a role in controlling the activity of other genes, although many of these genes have not been identified. The enzyme may also regulate the activity of certain ion channels in the heart. These channels, which transport positively charged atoms (ions) into and out of heart muscle cells, play critical roles in maintaining the heart's normal rhythm. At least seven mutations that cause Wolff-Parkinson-White syndrome have been identified in the PRKAG2 gene. Some people with these mutations also have features of hypertrophic cardiomyopathy, a form of heart disease that enlarges and weakens the heart (cardiac) muscle. Researchers are uncertain how PRKAG2 mutations lead to the development of these heart conditions. Research suggests that these mutations alter the activity of AMP-activated protein kinase in the heart, disrupting the enzyme's ability to respond to changes in cellular energy demands. It is unclear, however, whether the genetic changes overactivate the enzyme or reduce its activity. Studies indicate that changes in AMP-activated protein kinase activity allow a complex sugar called glycogen to build up abnormally within cardiac muscle cells. The accumulation of this substance enlarges these cells, which may lead to hypertrophic cardiomyopathy. Researchers continue to investigate whether an abnormal buildup of glycogen in the heart is also responsible for the problems with electrical signaling that are characteristic of Wolff-Parkinson-White syndrome. Other studies have found that altered AMP-activated protein kinase activity is related to changes in the regulation of certain ion channels in the heart. These changes may help explain the increased risk of abnormal heart rhythms (arrhythmias) in people with Wolff-Parkinson-White syndrome. At least seven mutations that cause Wolff-Parkinson-White syndrome have been identified in the PRKAG2 gene. Some people with these mutations also have features of hypertrophic cardiomyopathy, a form of heart disease that enlarges and weakens the heart (cardiac) muscle. Researchers are uncertain how PRKAG2 mutations lead to the development of these heart conditions. Research suggests that these mutations alter the activity of AMP-activated protein kinase in the heart, disrupting the enzyme's ability to respond to changes in cellular energy demands. It is unclear, however, whether the genetic changes overactivate the enzyme or reduce its activity. Studies indicate that changes in AMP-activated protein kinase activity allow a complex sugar called glycogen to build up abnormally within cardiac muscle cells. The accumulation of this substance enlarges these cells, which may lead to hypertrophic cardiomyopathy. Researchers continue to investigate whether an abnormal buildup of glycogen in the heart is also responsible for the problems with electrical signaling that are characteristic of Wolff-Parkinson-White syndrome. Other studies have found that altered AMP-activated protein kinase activity is related to changes in the regulation of certain ion channels in the heart. These changes may help explain the increased risk of abnormal heart rhythms (arrhythmias) in people with Wolff-Parkinson-White syndrome. Several mutations in the PRKAG2 gene have been found in people with other heart conditions. For example, a specific mutation in this gene is responsible for a very severe form of heart disease called lethal congenital glycogen storage disease of the heart. People with this mutation are born with extremely enlarged hearts (cardiomegaly) and abnormal electrical signaling within the heart. These abnormalities lead to respiratory distress and heart failure early in life. The mutation responsible for this condition changes a single protein building block (amino acid) in the gamma-2 subunit of AMP-activated protein kinase. Specifically, this mutation replaces the amino acid arginine with the amino acid glutamine at position 531 (written as Arg531Gln or R531Q). Studies suggest that this severe disorder may be related to the abnormal buildup of glycogen within cardiac muscle cells. Other mutations in the PRKAG2 gene have been associated with disorders affecting both cardiac and skeletal muscle. These mutations change single amino acids in the gamma-2 subunit of AMP-activated protein kinase. Individuals with these genetic changes typically experience muscle pain and stiffness, particularly following exercise, in addition to hypertrophic cardiomyopathy and abnormal electrical signaling within the heart. It is not known why the effects of some PRKAG2 mutations appear to be confined to the heart, while other mutations cause signs and symptoms affecting both cardiac and skeletal muscles. Ahmad F, Arad M, Musi N, He H, Wolf C, Branco D, Perez-Atayde AR, Stapleton D, Bali D, Xing Y, Tian R, Goodyear LJ, Berul CI, Ingwall JS, Seidman CE, Seidman JG. Increased alpha2 subunit-associated AMPK activity and PRKAG2 cardiomyopathy. Circulation. 2005 Nov 15;112(20):3140-8. Epub 2005 Nov 7.",
+    "https://ghr.nlm.nih.gov/gene/PRKAG2"
+  ],
+  [
+    "adenosine monophosphate deaminase deficiency: Adenosine monophosphate (AMP) deaminase deficiency is a condition that can affect the muscles used for movement (skeletal muscles). In many affected individuals, AMP deaminase deficiency does not cause any symptoms. People who do experience symptoms typically have fatigue, muscle pain (myalgia), or cramps after exercise or prolonged physical activity (exercise intolerance). Following strenuous activity, they often get tired more quickly and stay tired longer than would normally be expected. In rare cases, affected individuals have more severe symptoms including severe muscle weakness, low muscle tone (hypotonia), and muscle wasting (atrophy), but it is unclear whether these symptoms are due solely to AMP deaminase deficiency or additional health conditions. Exercise intolerance associated with AMP deaminase deficiency usually becomes apparent in childhood or early adulthood. AMP deaminase deficiency is one of the most common inherited muscle disorders in white populations, affecting 1 in 50 to 100 people. The prevalence is lower in African Americans, affecting an estimated 1 in 40,000 people, and the condition is even less common in the Japanese population. AMP deaminase deficiency is caused by mutations in the AMPD1 gene, which provides instructions for producing an enzyme called AMP deaminase. This enzyme is found in skeletal muscles, where it plays a role in producing energy. Skeletal muscle cells need energy to function and move the body. Mutations in the AMPD1 gene often result in an AMP deaminase enzyme that cannot function and as a result, energy production in skeletal muscle cells is decreased. Skeletal muscles are particularly sensitive to decreases in energy during periods of exercise or increased activity when energy demands increase. The lack of AMP deaminase activity can result in fatigue, muscle weakness or pain, or other muscle problems in some people with AMP deaminase deficiency. It is not known why some people with this condition do not experience symptoms. Researchers speculate that additional factors, both genetic and environmental, may determine whether a person develops the signs and symptoms of AMP deaminase deficiency. This condition is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition. Fischer H, Esbj\u00f6rnsson M, Sabina RL, Str\u00f6mberg A, Peyrard-Janvid M, Norman B. AMP deaminase deficiency is associated with lower sprint cycling performance in healthy subjects. J Appl Physiol (1985). 2007 Jul;103(1):315-22. Epub 2007 Apr 26.",
+    "https://ghr.nlm.nih.gov/condition/adenosine-monophosphate-deaminase-deficiency"
+  ],
+  [
+    "sialic acid storage disease: Sialic acid storage disease is an inherited disorder that primarily affects the nervous system. People with sialic acid storage disease have signs and symptoms that may vary widely in severity. This disorder is generally classified into one of three forms: infantile free sialic acid storage disease, Salla disease, and intermediate severe Salla disease. Infantile free sialic acid storage disease (ISSD) is the most severe form of this disorder. Babies with this condition have severe developmental delay, weak muscle tone (hypotonia), and failure to gain weight and grow at the expected rate (failure to thrive). They may have unusual facial features that are often described as \"coarse,\" seizures, bone malformations, an enlarged liver and spleen (hepatosplenomegaly), and an enlarged heart (cardiomegaly). The abdomen may be swollen due to the enlarged organs and an abnormal buildup of fluid in the abdominal cavity (ascites). Affected infants may have a condition called hydrops fetalis in which excess fluid accumulates in the body before birth. Children with this severe form of the condition usually live only into early childhood. Salla disease is a less severe form of sialic acid storage disease. Babies with Salla disease usually begin exhibiting hypotonia during the first year of life and go on to experience progressive neurological problems. Signs and symptoms of Salla disease include intellectual disability and developmental delay, seizures, problems with movement and balance (ataxia), abnormal tensing of the muscles (spasticity), and involuntary slow, sinuous movements of the limbs (athetosis). Individuals with Salla disease usually survive into adulthood. People with intermediate severe Salla disease have signs and symptoms that fall between those of ISSD and Salla disease in severity. Sialic acid storage disease is a very rare disorder. ISSD has been identified in only a few dozen infants worldwide. Salla disease occurs mainly in Finland and Sweden and has been reported in approximately 150 people. A few individuals have been identified as having intermediate severe Salla disease. Mutations in the SLC17A5 gene cause all forms of sialic acid storage disease. This gene provides instructions for producing a protein called sialin that is located mainly on the membranes of lysosomes, compartments in the cell that digest and recycle materials. Sialin moves a molecule called free sialic acid, which is produced when certain proteins and fats are broken down, out of the lysosomes to other parts of the cell. Free sialic acid means that the sialic acid is not attached (bound) to other molecules. Researchers believe that sialin may also have other functions in brain cells, in addition to those associated with the lysosomes, but these additional functions are not well understood. Approximately 20 mutations that cause sialic acid storage disease have been identified in the SLC17A5 gene. Some of these mutations result in sialin that does not function normally; others prevent sialin from being produced. In a few cases, sialin is produced but not routed properly to the lysosomal membrane. SLC17A5 gene mutations that reduce or eliminate sialin activity result in a buildup of free sialic acid in the lysosomes. It is not known how this buildup, or the disruption of other possible functions of sialin in the brain, causes the specific signs and symptoms of sialic acid storage disease. This condition is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition. Adams D, Gahl WA. Free Sialic Acid Storage Disorders. 2003 Jun 13 [updated 2013 Jun 6]. In: Pagon RA, Adam MP, Ardinger HH, Wallace SE, Amemiya A, Bean LJH, Bird TD, Ledbetter N, Mefford HC, Smith RJH, Stephens K, editors. GeneReviews\u00ae [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2017. Available from http://www.ncbi.nlm.nih.gov/books/NBK1470/",
+    "https://ghr.nlm.nih.gov/condition/sialic-acid-storage-disease"
+  ],
+  [
+    "AMPD1 gene: The AMPD1 gene provides instructions for producing an enzyme called adenosine monophosphate (AMP) deaminase. This enzyme is found in the muscles used for movement (skeletal muscles), where it plays a role in producing energy. Specifically, during physical activity, this enzyme converts a molecule called adenosine monophosphate (AMP) to a molecule called inosine monophosphate (IMP) as part of a process called the purine nucleotide cycle. This cycle reuses molecules called purines, which are a group of building blocks of DNA (nucleotides), its chemical cousin RNA, and molecules such as AMP that serve as energy sources in the cell. As part of the purine nucleotide cycle, AMP deaminase converts AMP to IMP, and as the cycle continues, molecules are produced that the muscle cells can use for energy. Skeletal muscle cells need energy to function and move the body. At least nine mutations in the AMPD1 gene have been found to cause AMP deaminase deficiency. This condition is characterized by skeletal muscle pain or weakness after exercise or prolonged physical activity (exercise intolerance). Most cases are caused by a mutation that results in a premature stop signal in the instructions for making AMP deaminase (written as Gly12Ter or Q12X). The resulting enzyme is abnormally short and nonfunctional and cannot participate in the purine nucleotide cycle. As a result, the process stalls and energy production in skeletal muscle cells is decreased. Skeletal muscles are particularly sensitive to decreases in energy during periods of exercise or increased activity when energy demands increase. The lack of AMP deaminase as a source of energy production can result in fatigue and muscle weakness or pain in some people with AMP deaminase deficiency. It is not known why some people with this condition do not experience symptoms. Researchers speculate that additional factors, both genetic and environmental, may determine whether a person develops the signs and symptoms of AMP deaminase deficiency. At least nine mutations in the AMPD1 gene have been found to cause AMP deaminase deficiency. This condition is characterized by skeletal muscle pain or weakness after exercise or prolonged physical activity (exercise intolerance). Most cases are caused by a mutation that results in a premature stop signal in the instructions for making AMP deaminase (written as Gly12Ter or Q12X). The resulting enzyme is abnormally short and nonfunctional and cannot participate in the purine nucleotide cycle. As a result, the process stalls and energy production in skeletal muscle cells is decreased. Skeletal muscles are particularly sensitive to decreases in energy during periods of exercise or increased activity when energy demands increase. The lack of AMP deaminase as a source of energy production can result in fatigue and muscle weakness or pain in some people with AMP deaminase deficiency. It is not known why some people with this condition do not experience symptoms. Researchers speculate that additional factors, both genetic and environmental, may determine whether a person develops the signs and symptoms of AMP deaminase deficiency. Hancock CR, Brault JJ, Terjung RL. Protecting the cellular energy state during contractions: role of AMP deaminase. J Physiol Pharmacol. 2006 Nov;57 Suppl 10:17-29. Review.",
+    "https://ghr.nlm.nih.gov/gene/AMPD1"
+  ],
+  [
+    "Your baby and the flu: The flu is an easily spread disease. Children under age 2 have a higher risk of developing complications if they get the flu. The information in this article has been put together to help you protect children under age 2 from the flu. This is not a substitute for medical advice from your health care provider. If you think your baby may have the flu, you should contact a health care provider right away. FLU SYMPTOMS IN INFANTS AND TODDLERS The flu is an infection of the nose, throat, and (sometimes) lungs. Call your baby\u2019s health care provider if you notice any of the following signs: - Acting tired and cranky much of the time and not feeding well - Cough - Diarrhea and vomiting - Has a fever or feels feverish (if no thermometer available) - Runny nose HOW IS THE FLU TREATED IN BABIES? Children younger than 2 years old will often need to be treated with medicine that fights off the flu virus. This is called antiviral medicine. The medicine works best if started within 48 hours after symptoms begin, if possible. Oseltamivir (Tamiflu) in liquid form will likely be used. Although this drug is not approved for use in children younger than 1 year of age, serious side effects are quite rare. After talking about the risk of side effects against the possible complications of the flu in your baby, you and your health care provider may decide to use this medicine to treat the flu. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever in children. Sometimes, your health care provider will tell you to use both types of medicine. Always check with your health care provider before giving any cold medicines to your infant or toddler. SHOULD MY BABY GET THE FLU VACCINE? All infants 6 months or older should get the flu vaccine, even if they have had a flu-like illness. The flu vaccine is not approved for children under 6 months old. - Your child will need a second flu vaccine around 4 weeks after receiving the vaccine for the first time. - There are two types of flu vaccine. One is given as a shot, and the other is sprayed into your child's nose. The flu shot contains killed (inactive) viruses. It is not possible to get the flu from this type of vaccine. The flu shot is approved for people age 6 months and older. A nasal spray-type flu vaccine uses a live, weakened virus instead of a dead one like the flu shot. It is approved for healthy children over 2 years. Anyone who lives with or has close contact with a child younger than 6 months old should also have a flu shot. WILL THE VACCINE HARM MY BABY? You or your baby can NOT get the flu from either vaccine. Some children may get a low-grade fever for a day or two after the shot. If more severe symptoms develop or they last for more than 2 days, you should call your health care provider. Some parents are afraid the vaccine could hurt their baby. But children under 2 years of age are more likely to get a severe case of the flu. It is hard to predict how ill your child may get from flu because children often have a mild illness at first. They may become sick very fast. A small amount of mercury (called thimerosal) is a common preservative in multidose vaccines. Despite concerns, thimerosal-containing vaccines have NOT been shown to cause autism, ADHD, or any other medical problems. However, all of the routine vaccines are also available without added thimerosal. Ask your health care provider if they offer this type of vaccine. HOW CAN I PREVENT MY BABY FROM GETTING THE FLU? Anyone who has flu symptoms should not care for a newborn or infant, including feeding. If a person with symptoms must care for the child, the caretaker should use a face mask and wash their hands well. Everyone who comes in close contact with your baby should do the following: - Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue away after using it. - Wash your hands often with soap and water for 15\u00a0to 20 seconds, especially after you cough or sneeze. You may also use alcohol-based hand cleaners. If your baby is\u00a0younger than 6 months old and has close contact with someone with the flu, inform your health care provider. IF I HAVE FLU SYMPTOMS, CAN I BREASTFEED MY BABY? If a mother is not ill with the flu, breastfeeding is encouraged. If you are sick, you may need to express your milk for use in bottle feedings given by a healthy person. It is unlikely a newborn can catch flu from drinking your breast milk when you are sick. Breast milk is considered safe if you are taking antivirals. WHEN SHOULD I CALL THE DOCTOR? Talk to your child's health care provider or go to the emergency room if: - Your child does not act alert or more comfortable when the fever goes down. - Fever and flu symptoms come back after they have gone away. - The child does not have tears when crying. - The child's diapers are not wet, or the child has not urinated for the last 8 hours. Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007444.htm"
+  ],
+  [
+    "What is Flu?: The flu is an infection of the nose, throat, and lungs. It spreads easily. This article discusses influenza types A and B. Another type of the flu is the swine flu (H1N1).",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000080.htm"
+  ],
+  [
+    "Swine flu (H1N1 flu): Technically, the term \"swine flu\" refers to influenza in pigs. Occasionally, pigs transmit influenza viruses to people, mainly to hog farmers and veterinarians. Less often, someone infected with swine flu passes the infection to others. The human respiratory infection caused by a particular influenza virus H1N1 strain - popularly known as swine flu - was first recognized in spring 2009. A few months after the first swine flu cases were reported, rates of confirmed H1N1-related illness were increasing in much of the world. As a result, the World Health Organization declared the infection a global pandemic. The pandemic was declared over in August 2010. Currently, H1N1 is still circulating in humans as a seasonal flu virus and protection against this strain was included in the seasonal flu vaccine for 2015-16. Another strain, H3N2 emerged in humans in 2011. H1N1 flu signs and symptoms in humans are similar to those of other flu strains: - Fever (but not always) - Cough - Sore throat - Runny or stuffy nose - Watery, red eyes - Body aches - Headache - Fatigue - Diarrhea - Nausea and vomiting H1N1 flu symptoms develop about one to three days after you're exposed to the virus. When to see a doctor It's not necessary to see a doctor if you're generally healthy and develop flu signs and symptoms, such as fever, cough and body aches. Call your doctor, however, if you have flu symptoms and you're pregnant or you have a chronic disease, such as asthma, emphysema, diabetes or a heart condition, because you have a higher risk of complications from the flu. Influenza viruses infect the cells lining your nose, throat and lungs. The virus enters your body when you inhale contaminated droplets or transfer live virus from a contaminated surface to your eyes, nose or mouth. You can't catch swine flu from eating pork. If you've traveled to an area where many people are affected by swine flu (H1N1 flu), you may have been exposed to the virus, particularly if you spent time in large crowds. Swine farmers and veterinarians have the highest risk of true swine flu because of their exposure to pigs. Influenza complications include: - Worsening of chronic conditions, such as heart disease and asthma - Pneumonia - Neurological signs and symptoms, ranging from confusion to seizures - Respiratory failure Most cases of flu, including H1N1 flu, require only symptom relief. If you have a chronic respiratory disease, your doctor may prescribe additional medications to help relieve your symptoms. The antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) are sometimes prescribed within the first day or two of symptoms to reduce the severity of your symptoms, and possibly the risk of complications. But, flu viruses can develop resistance to these drugs. To make development of resistance less likely and maintain supplies of these drugs for those who need them most, antivirals are reserved for people at high risk of complications. High-risk groups are those who: - Are in a hospital, nursing home or other long-term care facility - Are younger than 5 years of age, particularly children younger than 2 years - Are 65 years and older - Are pregnant or within two weeks of delivery, including women who have had pregnancy loss - Are younger than 19 years of age and are receiving long-term aspirin therapy, because of an increased risk of developing Reye's syndrome, a rare but potentially fatal disease that can occur when using aspirin during a viral illness - Are morbidly obese, defined as having a body mass index above 40 - Have certain chronic medical conditions, including asthma, emphysema, heart disease, diabetes, neuromuscular disease, or kidney, liver or blood disease - Are immunosuppressed due to certain medications or HIV - Are American Indians or Native Alaskans",
+    "https://www.mayoclinic.org/diseases-conditions/swine-flu/symptoms-causes/syc-20378103"
+  ],
+  [
+    "What is Flu?: Flu is a respiratory infection caused by a number of viruses. The viruses pass through the air and enter your body through your nose or mouth. Between 5% and 20% of people in the U.S. get the flu each year. The flu can be serious or even deadly for elderly people, newborn babies, and people with certain chronic illnesses. Symptoms of the flu come on suddenly and are worse than those of the common cold. They may include - Body or muscle aches - Chills - Cough - Fever - Headache - Sore throat Is it a cold or the flu? Colds rarely cause a fever or headaches. Flu almost never causes an upset stomach. And \"stomach flu\" isn't really flu at all, but gastroenteritis. Most people with the flu recover on their own without medical care. People with mild cases of the flu should stay home and avoid contact with others, except to get medical care. If you get the flu, your health care provider may prescribe medicine to help your body fight the infection and lessen symptoms. The main way to keep from getting the flu is to get a yearly flu vaccine. Good hygiene, including hand washing, can also help. NIH: National Institute of Allergy and Infectious Diseases",
+    "https://www.nlm.nih.gov/medlineplus/flu.html"
+  ],
+  [
+    "Flu (Flu and Pneumonia): These diseases spread quickly from one person to another, and people with Alzheimer's are more likely to get them. Make sure that the person gets a flu shot each year and a pneumonia shot once after age 65. Some older people need to get more than one pneumonia vaccine. The shots lower the chances that the person will get the flu or pneumonia. For more information on pneumonia, visit the Centers for Disease Control and Prevention (CDC). For more information on the flu, visit the CDC or the National Institute of Allergy and Infectious Diseases.Flu and pneumonia may cause:- Fever (Not everyone with pneumonia has a fever.) - Chills - Aches and pains - Vomiting - Coughing - Trouble breathing",
+    "https://www.nia.nih.gov/health/topics/flu"
+  ],
+  [
+    "Pregnancy and the flu: During pregnancy, it is harder for a woman's immune system to fight infections. This makes a pregnant woman more likely to get the flu and other diseases. Pregnant women are more likely than other nonpregnant women their age to become very ill if they get the flu. If you are pregnant, you need to take special steps to stay healthy during the flu season. This article gives you information about the flu and pregnancy. It is not a substitute for medical advice from your health care provider. If you think you have the flu, you should contact your health care provider\u2019s office immediately. WHAT ARE THE SYMPTOMS OF FLU DURING PREGNANCY? Flu symptoms are the same for everyone and include: - Cough - Sore throat - Runny nose - Fever of 100\u00b0F (37.8\u00b0C) or\u00a0higher Other symptoms may include body aches, headache, fatigue, vomiting, and diarrhea. SHOULD I GET THE FLU VACCINE IF I AM PREGNANT? If you are pregnant or thinking about becoming pregnant, you should get the flu vaccine. The Centers for Disease Control and Prevention (CDC) considers pregnant women at a higher risk for getting the flu and developing flu-related complications. Pregnant women who get the flu\u00a0vaccine get sick less often. They are also very unlikely to get a bad case of the flu that can harm them or their baby. Getting a mild case of the flu is often not harmful to mother or child. However, the flu\u00a0vaccine can prevent the rare, severe cases of the flu that can harm mother and baby. Flu vaccines are available at most health care provider offices and health clinics. There are two types of flu vaccines: the flu shot and a nose-spray vaccine. - The flu shot is recommended for pregnant women. It contains killed (inactive) viruses. You cannot get the flu from this vaccine. - The nasal spray-type flu vaccine is not approved for pregnant women. It is\u00a0OK for a pregnant woman to be around somebody who has received the nasal flu vaccine. WILL THE VACCINE HARM MY BABY? A small amount of mercury (called thimerosal) is a common preservative in multidose vaccines. Despite concerns, vaccines that contain this substance have NOT been shown to cause autism or attention deficit hyperactivity disorder. If you have concerns about mercury, ask your health care provider about a preservative-free vaccine. All routine vaccines are also available without added thimerosal. The CDC says pregnant women may get flu\u00a0vaccines either with or without thimerosal. WHAT ABOUT SIDE EFFECTS OF THE VACCINE? Common side effects of the flu\u00a0vaccine are mild, but can include: - Redness or tenderness where the\u00a0shot was given - Headache - Muscle aches - Fever - Nausea and vomiting If side effects occur, they most often begin soon after the shot. They may last as long as 1\u00a0to 2 days. If you have side effects that last longer than 2 days, you should call your doctor. HOW DO I TREAT THE FLU IF I'M PREGNANT? Experts recommend treating pregnant women with flu-like illness as soon as possible after they develop symptoms. - Testing is not needed for most people. Health care providers should not wait for results of testing before treating pregnant women. - It is best to start antiviral medications within the first 48 hours of developing symptoms, but\u00a0antivirals can also be used after this time period. A 75-mg capsule of oseltamivir (Tamiflu) twice per day for 5 days is the recommended first choice antiviral. WILL ANTIVIRAL MEDICATIONS HARM MY BABY? You may be worried about the medicines harming your baby. However, it is important to realize there are severe risks if you do not get treatment: - In past flu outbreaks, pregnant women who were otherwise healthy were more likely than those who were not pregnant to become very sick or even die. - This does not mean that all pregnant women will have a severe infection, but it is hard to predict who will become very ill. Women who become more ill with the\u00a0flu will have mild symptoms at first. - Pregnant women can become very sick very fast, even if the symptoms are not bad at first. - Women who develop a high fever or pneumonia are at higher risk for early labor or delivery and other harm. DO I NEED AN ANTIVIRAL DRUG IF I HAVE BEEN AROUND SOMEONE WITH THE FLU? You are more likely to get the flu if you have close contact with someone who already has it. Close contact means: - Eating or drinking with the same utensils - Caring for children who are sick with the flu - Being near the droplets or secretions from someone who sneezes, coughs, or has a runny nose If you have been around someone who has the flu, ask your health care provider if you need an antiviral drug. WHAT TYPES OF COLD MEDICINE CAN I TAKE FOR THE FLU IF I'M PREGNANT? Many cold medicines contain more than one type of medicine. Some may be safer than others, but none are proven 100% safe. In general, it is best to avoid cold medicines, if possible, especially during the first 3\u00a0to\u00a04 months of pregnancy. To be safe, talk to your health care provider before taking any cold medicines while you are pregnant. WHAT ELSE CAN I DO TO PROTECT MYSELF AND MY BABY FROM THE FLU? There are many things you can do to help protect yourself and your unborn child from the\u00a0flu. - You should avoid sharing food, utensils, or cups with others. - Avoid touching your eyes, nose, and throat. - Carry hand sanitizer with you, and use it often during the day. Updated by: Daniel N. Sacks MD, FACOG, obstetrics and gynecology in private practice, West Palm Beach, FL. Review Provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007443.htm"
+  ],
+  [
+    "Flu: In addition to the symptoms of Alzheimer's disease, a person with Alzheimer's may have other medical problems over time, as all older adults do. These problems can cause more confusion and behavior changes. The person may not be able to tell you what is wrong. As a caregiver, you need to watch for signs of illness and tell the doctor about what you see. Here are some common medical problems to watch for. In addition to the symptoms of Alzheimer's disease, a person with Alzheimer's may have other medical problems over time, as all older adults do. These problems can cause more confusion and behavior changes. The person may not be able to tell you what is wrong. As a caregiver, you need to watch for signs of illness and tell the doctor about what you see. Here are some common medical problems to watch for. Having a fever means that the person's temperature is 2 degrees or more above his or her normal temperature.A fever may be a sign of:- Infection, caused by germs - Dehydration, caused by a lack of fluids - Heat stroke - Constipation (discussed later in this section)Don't use a glass thermometer because the person might bite down on the glass. Use a digital thermometer, which you can buy at a grocery store or drugstore. Call the doctor right away if the person with Alzheimer's disease has a fever. These diseases spread quickly from one person to another, and people with Alzheimer's are more likely to get them. Make sure that the person gets a flu shot each year and a pneumonia shot once after age 65. Some older people need to get more than one pneumonia vaccine. The shots lower the chances that the person will get the flu or pneumonia. For more information on pneumonia, visit the Centers for Disease Control and Prevention (CDC). For more information on the flu, visit the CDC or the National Institute of Allergy and Infectious Diseases.Flu and pneumonia may cause:- Fever (Not everyone with pneumonia has a fever.) - Chills - Aches and pains - Vomiting - Coughing - Trouble breathing As Alzheimer's disease gets worse, the person may have trouble walking and keeping his or her balance. He or she also may have changes in depth perception, which is the ability to understand distances. For example, someone with Alzheimer's may try to step down when walking from a carpeted to a tile floor. This puts him or her at risk for falls.To reduce the chance of a fall:- Clean up clutter. - Remove throw rugs. - Use chairs with arms. - Put grab bars in the bathroom. - Use good lighting. - Make sure the person wears sturdy shoes with good traction. Our bodies must have a certain amount of water to work well. If a person is sick or doesn't drink enough fluid, he or she may become dehydrated.Signs of dehydration to look for include:- Dry mouth - Dizziness - Hallucinations (Don't forget that hallucinations may be caused by Alzheimer's itself.) - Rapid heart rateBe aware of how much fluid the person is drinking. This is even more important during hot weather or in homes without air conditioning. Also, look for signs of dehydration during the winter months when heat in your home can create a lot of dry air. People can have constipation-trouble having a bowel movement-when they:- Change what they eat - Take certain medicines, including Namenda - Get less exercise than usual - Drink less fluid than usualTry to get the person to drink at least 6 glasses of liquid a day.Besides water, other good sources of liquid include:- Juice, especially prune juice - Gelatin, such as Jell-O - Soup - Milk or melted ice cream - Decaffeinated coffee and tea - Liquid cereal, such as Cream of WheatHave the person eat foods high in fiber. Foods like dried apricots, raisins, or prunes; some dry cereals; or soybeans might help ease constipation.If possible, make sure that the person gets some exercise each day, such as walking. Call the doctor if you notice a change in the person's bowel habits. Some medicines, including Alzheimer's medications, may cause diarrhea-loose bowel movements. Certain medical problems also may cause diarrhea. Make sure the person takes in lots of fluids when he or she has diarrhea. Also, be sure to let the doctor know about this problem. Incontinence means a person can't control his or her bladder and/or bowels. This may happen at any stage of Alzheimer's disease, but it is more often a problem in the later stages. Signs of this problem are leaking urine, problems emptying the bladder, and soiled underwear and bed sheets. Be sure to let the doctor know if this happens. He or she may be able to treat the cause of the problem.Here are some examples of things that can be treated:- Urinary tract infection - Enlarged prostate gland - Too little fluid in the body (dehydration) - Diabetes that isn't being treated - Taking too many water pills - Drinking too much caffeine - Taking medicines that make it hard to hold urineWhen you talk to the doctor, be ready to answer the following questions:- What medicines is the person taking? - Does the person leak urine when he or she laughs, coughs, or lifts something? - Does the person urinate often? - Can the person get to the bathroom in time? - Is the person urinating in places other than the bathroom? - Is the person soiling his or her clothes or bed sheets each night? - Do these problems happen each day or once in a while?Here are some ways you can deal with incontinence:- Remind the person to go to the bathroom every 2 to 3 hours. - Show him or her the way to the bathroom, or take him or her. - Make sure that the person wears loose, comfortable clothing that is easy to remove. - Limit fluids after 6 p.m. if problems happen at night. Do not give the person fluids with caffeine, such as coffee or tea. - Give the person fresh fruit before bedtime instead of fluids if he or she is thirsty. - Mark the bathroom door with a big sign that reads \"Toilet\" or \"Bathroom.\" - Use a stable toilet seat that is at a good height. Using a colorful toilet seat may help the person identify the toilet. You can buy raised toilet seats at medical supply stores. - Help the person when he or she needs to use a public bathroom. This may mean going into the stall with the person or using a family or private bathroom.Accidents happen. Be understanding when they occur. Stay calm and reassure the person if he or she is upset.Incontinence supplies, such as adult disposable briefs or underwear, bed protectors, and waterproof mattress covers, may be helpful. You can buy these items at drugstores and medical supply stores. A drainable pouch may be useful for the person who can't control his or her bowel movements. Talk to a nurse about how to use this product.Some people find it helpful to keep a record of how much food and fluid the person takes in and how often he or she goes to the bathroom. You can use this information to make a schedule of when he or she needs to go to the bathroom. As Alzheimer's disease gets worse, people need help taking care of their teeth or dentures.Check the person's mouth for any problems such as:- Sores - Decayed teeth - Food \"pocketed\" in the cheek or on the roof of the mouth - LumpsBe sure to take the person for dental checkups. Some people need medicine to calm them before they can see the dentist.Watch for Signs the Person Is in Pain Always remember that the person with Alzheimer's may not be able to tell you when he or she is in pain. Watch the person's face to see if it looks like he or she is in pain or feeling ill. Also, notice sudden changes in behavior such as increased yelling or striking out. If you are unsure what to do, call the doctor for help. People with Alzheimer's can have the same medical problems as many older adults. Research suggests that some of these medical problems may be related to Alzheimer's disease.For example, some heart and blood circulation problems, stroke, and diabetes are more common in people who have Alzheimer's than in the general population. Diseases caused by infections also are common. It's important that the person with Alzheimer's gets regular medical care. Make sure the person sees a health professional on a regular basis. This is the best thing you can do to help prevent medical problems.Here are some tips to help you get ready for a visit to the doctor's office:- Make an appointment during the person's best time of day and when the office is not very crowded. - Let the office staff know before the visit about the person's Alzheimer's disease. Ask them for help to make the visit go smoothly. - Don't tell the person with Alzheimer's about the visit until the day of the visit or even right before it is time to go if visiting the doctor makes the person nervous. Be positive and matter of fact. - Take something he or she likes to eat or drink and any materials or activities the person enjoys.For more information on preparing for hospital and emergency room visits, read Going to the Hospital: Tips for Dementia Caregivers.Read about this topic in Spanish. Lea sobre este tema en espanol.",
+    "https://www.nia.nih.gov/health/topics/flu"
+  ],
+  [
+    "Influenza (flu): Influenza is a viral infection that attacks your respiratory system - your nose, throat and lungs. Influenza, commonly called the flu, is not the same as stomach \"flu\" viruses that cause diarrhea and vomiting. For most people, influenza resolves on its own. But sometimes, influenza and its complications can be deadly. People at higher risk of developing flu complications include: - Young children under 5, and especially those under 2 years - Adults older than 65 - Residents of nursing homes and other long-term care facilities - Pregnant women and women up to two weeks postpartum - People with weakened immune systems - People who have chronic illnesses, such as asthma, heart disease, kidney disease and diabetes - People who are very obese, with a body mass index (BMI) of 40 or higher Your best defense against influenza is to receive an annual vaccination. Initially, the flu may seem like a common cold with a runny nose, sneezing and sore throat. But colds usually develop slowly, whereas the flu tends to come on suddenly. And although a cold can be a nuisance, you usually feel much worse with the flu. Common signs and symptoms of the flu include: - Fever over 100.4 F (38 C) - Aching muscles, especially in your back, arms and legs - Chills and sweats - Headache - Dry, persistent cough - Fatigue and weakness - Nasal congestion - Sore throat When to see a doctor Most people who get the flu can treat themselves at home and often don't need to see a doctor. If you have flu symptoms and are at risk of complications, see your doctor right away. Taking antiviral drugs within the first 48 hours after you first notice symptoms may reduce the length of your illness and help prevent more-serious problems. Flu viruses travel through the air in droplets when someone with the infection coughs, sneezes or talks. You can inhale the droplets directly, or you can pick up the germs from an object - such as a telephone or computer keyboard - and then transfer them to your eyes, nose or mouth. People with the virus are likely contagious from the day or so before symptoms first appear until about five days after symptoms begin, though sometimes people are contagious for as long as 10 days after symptoms appear. Children and people with weakened immune systems may be contagious for a slightly longer time. Influenza viruses are constantly changing, with new strains appearing regularly. If you've had influenza in the past, your body has already made antibodies to fight that particular strain of the virus. If future influenza viruses are similar to those you've encountered before, either by having the disease or by vaccination, those antibodies may prevent infection or lessen its severity. But antibodies against flu viruses you've encountered in the past can't protect you from new influenza subtypes that can be very different immunologically from what you had before. Factors that may increase your risk of developing influenza or its complications include: - Age. Seasonal influenza tends to target young children and older adults. - Living or working conditions. People who live or work in facilities along with many other residents, such as nursing homes or military barracks, are more likely to develop influenza. - Weakened immune system. Cancer treatments, anti-rejection drugs, corticosteroids and HIV/AIDS can weaken your immune system. This can make it easier for you to catch influenza and may also increase your risk of developing complications. - Chronic illnesses. Chronic conditions, such as asthma, diabetes or heart problems, may increase your risk of influenza complications. - Pregnancy. Pregnant women are more likely to develop influenza complications, particularly in the second and third trimesters. Women who are two weeks postpartum are also more likely to develop influenza-related complications. - Obesity. People with a BMI of 40 or more have an increased risk of complications from the flu. If you're young and healthy, seasonal influenza usually isn't serious. Although you may feel miserable while you have it, the flu usually goes away in a week or two with no lasting effects. But high-risk children and adults may develop complications such as: - Pneumonia - Bronchitis - Asthma flare-ups - Heart problems - Ear infections Pneumonia is the most serious complication. For older adults and people with a chronic illness, pneumonia can be deadly. Your doctor will conduct a physical exam, look for signs and symptoms of influenza, and possibly order a test that detects influenza viruses. The most commonly used test is called a rapid influenza diagnostics test, which looks for substances (antigens) on a swab sample from the back of the nose or throat. These tests can provide results in 30 minutes or less. However, results vary greatly and are not always accurate. Your doctor may diagnose you with influenza based on symptoms, despite having a negative test result. More-sensitive flu tests are available in some specialized hospitals and labs. Usually, you'll need nothing more than bed rest and plenty of fluids to treat the flu. But in some cases, your doctor may prescribe an antiviral medication, such as oseltamivir (Tamiflu) or zanamivir (Relenza). If taken soon after you notice symptoms, these drugs may shorten your illness by a day or so and help prevent serious complications. Oseltamivir is an oral medication. Zanamivir is inhaled through a device similar to an asthma inhaler and shouldn't be used by anyone with respiratory problems, such as asthma and lung disease. Antiviral medication side effects may include nausea and vomiting. These side effects may be lessened if the drug is taken with food. Oseltamivir has also been associated with delirium and self-harm behaviors in teenagers. Some researchers recommend further study on both of these drugs because of uncertainty about their effects beyond a slight reduction in the time of illness. Some studies have suggested that these medications can also help reduce the severity of complications. The Centers for Disease Control and Prevention still recommends their use for some people. An additional concern is that some strains of influenza have become resistant to oseltamivir, amantadine and rimantadine (Flumadine), which are older antiviral drugs.",
+    "https://www.mayoclinic.org/diseases-conditions/flu/symptoms-causes/syc-20351719"
+  ],
+  [
+    "College students and the flu: Every year, the flu spreads across college campuses nationwide. Close living quarters, shared restrooms, and a lot of social activities make a college student more likely to catch the flu. This article will give you information about the flu and college students. This is not a substitute for medical advice from your health care provider. WHAT ARE THE SYMPTOMS OF THE FLU? A college student with the flu will most often have a fever of 100\u00b0F (37.8\u00b0C) or higher, and a sore throat or a cough. Other symptoms may include: - Chills - Headache - Sore muscles - Runny nose - Fatigue - Diarrhea and vomiting Most people with milder symptoms should feel better within 3 to 4 days and do not need to see a health care provider. Avoid contact with other people and drink plenty of fluids if you are having flu symptoms. HOW DO I TREAT MY SYMPTOMS? Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever. Check with your health care provider before taking acetaminophen or ibuprofen if you have liver disease. - Take acetaminophen every 4\u00a0to 6 hours as directed. - Take ibuprofen every 6\u00a0to 8 hours as directed. - Do NOT use aspirin. A fever does not need to come all the way down to normal. Most people will feel better if their temperature drops by one degree. Over-the-counter cold medicines may relieve some symptoms. Throat lozenges or sprays that contain an anesthetic will help with a sore throat. Check your student health center's web site for more information. WHAT ABOUT ANTIVIRAL MEDICINES? Most people with milder symptoms feel better within 3 to 4 days and do not need to take antiviral medicines. Ask your health care provider if antiviral medicine is right for you. If you have any of the medical conditions below, you may be at risk for a more severe case of the flu: - Lung disease (including asthma) - Heart conditions (except high blood pressure) - Kidney, liver, nerve, and muscle conditions - Blood disorders (including sickle cell disease) - Diabetes and other metabolic disorders - A weakened immune system due to diseases (such as AIDS), radiation therapy, or certain medications, including chemotherapy and corticosteroids - Other long-term (chronic) medical problems Antiviral medicines such as oseltamivir (Tamiflu) and zanamivir (Relenza) are used to treat some people who have the flu. These drugs work better if you start taking them within 2 days of your first symptoms. WHEN CAN I RETURN TO SCHOOL? You should be able to return to school when you're feeling well and have not had a fever for 24 hours (without taking acetaminophen, ibuprofen, or other medicines to lower your fever). SHOULD I GET THE FLU VACCINE? People should get the vaccine even if they've had a flu-like illness already. The Centers for Disease Control and Prevention (CDC) recommends that everyone 6 months and older should receive the flu vaccine. Receiving the flu vaccine will help protect you from getting the flu. WHERE CAN I GET A FLU VACCINE? Flu vaccines are often available at local health centers, health care provider's offices, and pharmacies. Ask your student health center, health care provider, pharmacy, or your place of work if they offer the flu vaccine. HOW DO I AVOID CATCHING OR SPREADING FLU? - Stay in your apartment, dorm room, or home for at least 24 hours after your fever goes away. Wear a mask if you leave your room. - Do NOT share food, utensils, cups, or bottles. - Cover your mouth with a tissue when coughing and throw it away after use. - Cough into your sleeve if a tissue is not available. - Carry alcohol-based hand sanitizer with you. Use it often during the day and always after touching your face. - Do NOT touch your eyes, nose, and mouth. WHEN SHOULD I SEE A DOCTOR? Most college students do not need to see a health care provider when they have mild flu symptoms. This is because most college-age people are not at risk for a severe case. If you feel you should see a health care provider, call the office first and tell them your symptoms. This helps the staff prepare for your visit, so that you do not spread germs to other people there. If you have an increased risk of flu complications, contact your health care provider. Risk factors include: - Chronic lung problems (including asthma or COPD) - Heart problems (except high blood pressure) - Kidney disease or failure (long-term) - Liver disease (long-term) - Brain or nervous system disorder - Blood disorders (including sickle cell disease) - Diabetes and other metabolic disorders - Weak immune system (such as people with AIDS, cancer, or an organ transplant; receiving chemotherapy or radiation therapy; or taking corticosteroid pills every day) You may also want to talk to your health care provider if you are around others who may be at risk for a severe case of the flu, including people who: - Live with or care for a child 6 months old or younger - Work in a health care setting and have direct contact with patients - Live with or care for someone with a chronic medical problem who has not been vaccinated for the flu Call your health care provider right away or go to the emergency room if you have: - Difficulty breathing, or shortness of breath - Chest pain or abdominal pain - Sudden dizziness - Confusion, or problems reasoning - Severe vomiting, or vomiting that does not go away - Flu-like symptoms improve, but then return with a fever and worse cough Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007446.htm"
+  ],
+  [
+    "H1N1 influenza (Swine flu): The H1N1 virus (swine flu) is an infection of the nose, throat, and lungs. It is caused by the H1N1 influenza virus. Earlier forms of the H1N1 virus were found in pigs (swine). Over time, the virus changed (mutated) and infected humans. H1N1 is a new virus first detected in humans in 2009. It spread quickly around the world. The H1N1 virus is one of the three viruses included in the regular (seasonal) flu vaccine. You cannot get H1N1 flu virus from eating pork or any other food, drinking water, swimming in pools, or using hot tubs or saunas. Any flu virus can spread from person to person when: - Someone with the flu coughs or sneezes into air that others breathe in. - Someone touches a doorknob, desk, computer, or counter with the flu virus on it and then touches their mouth, eyes, or nose. - Someone touches mucus while taking care of a child or adult who is ill with the flu. Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007421.htm"
+  ],
+  [
+    "Your baby and the flu (Information): FLU SYMPTOMS IN INFANTS AND TODDLERS The flu is an infection of the nose, throat, and (sometimes) lungs. Call your baby\u2019s health care provider if you notice any of the following signs: - Acting tired and cranky much of the time and not feeding well - Cough - Diarrhea and vomiting - Has a fever or feels feverish (if no thermometer available) - Runny nose HOW IS THE FLU TREATED IN BABIES? Children younger than 2 years old will often need to be treated with medicine that fights off the flu virus. This is called antiviral medicine. The medicine works best if started within 48 hours after symptoms begin, if possible. Oseltamivir (Tamiflu) in liquid form will likely be used. Although this drug is not approved for use in children younger than 1 year of age, serious side effects are quite rare. After talking about the risk of side effects against the possible complications of the flu in your baby, you and your health care provider may decide to use this medicine to treat the flu. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever in children. Sometimes, your health care provider will tell you to use both types of medicine. Always check with your health care provider before giving any cold medicines to your infant or toddler. SHOULD MY BABY GET THE FLU VACCINE? All infants 6 months or older should get the flu vaccine, even if they have had a flu-like illness. The flu vaccine is not approved for children under 6 months old. - Your child will need a second flu vaccine around 4 weeks after receiving the vaccine for the first time. - There are two types of flu vaccine. One is given as a shot, and the other is sprayed into your child's nose. The flu shot contains killed (inactive) viruses. It is not possible to get the flu from this type of vaccine. The flu shot is approved for people age 6 months and older. A nasal spray-type flu vaccine uses a live, weakened virus instead of a dead one like the flu shot. It is approved for healthy children over 2 years. Anyone who lives with or has close contact with a child younger than 6 months old should also have a flu shot. WILL THE VACCINE HARM MY BABY? You or your baby can NOT get the flu from either vaccine. Some children may get a low-grade fever for a day or two after the shot. If more severe symptoms develop or they last for more than 2 days, you should call your health care provider. Some parents are afraid the vaccine could hurt their baby. But children under 2 years of age are more likely to get a severe case of the flu. It is hard to predict how ill your child may get from flu because children often have a mild illness at first. They may become sick very fast. A small amount of mercury (called thimerosal) is a common preservative in multidose vaccines. Despite concerns, thimerosal-containing vaccines have NOT been shown to cause autism, ADHD, or any other medical problems. However, all of the routine vaccines are also available without added thimerosal. Ask your health care provider if they offer this type of vaccine. HOW CAN I PREVENT MY BABY FROM GETTING THE FLU? Anyone who has flu symptoms should not care for a newborn or infant, including feeding. If a person with symptoms must care for the child, the caretaker should use a face mask and wash their hands well. Everyone who comes in close contact with your baby should do the following: - Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue away after using it. - Wash your hands often with soap and water for 15\u00a0to 20 seconds, especially after you cough or sneeze. You may also use alcohol-based hand cleaners. If your baby is\u00a0younger than 6 months old and has close contact with someone with the flu, inform your health care provider. IF I HAVE FLU SYMPTOMS, CAN I BREASTFEED MY BABY? If a mother is not ill with the flu, breastfeeding is encouraged. If you are sick, you may need to express your milk for use in bottle feedings given by a healthy person. It is unlikely a newborn can catch flu from drinking your breast milk when you are sick. Breast milk is considered safe if you are taking antivirals. WHEN SHOULD I CALL THE DOCTOR? Talk to your child's health care provider or go to the emergency room if: - Your child does not act alert or more comfortable when the fever goes down. - Fever and flu symptoms come back after they have gone away. - The child does not have tears when crying. - The child's diapers are not wet, or the child has not urinated for the last 8 hours.",
+    "https://medlineplus.gov/ency/article/007444.htm"
+  ],
+  [
+    "What causes Flu?: The flu is caused by an influenza virus. Most people get the flu when they breathe in tiny airborne droplets from the coughs or sneezes of someone who has the flu. You can also catch the flu if you touch something with the virus on it, and then touch your mouth, nose, or eyes. People often confuse colds and flu. They are different, but you might have some of the same symptoms. Most people get a cold several times a year. On the contrary, people get the flu only once every few years. Sometimes, you can get a virus that makes you throw up or have diarrhea. Some people call this the \"stomach flu.\" This is a misleading name because this virus is not the actual flu. The flu mostly affects your nose, throat, and lungs.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000080.htm"
+  ],
+  [
+    "Your baby and the flu: The flu is an easily spread disease. Children under age 2 have a higher risk of developing complications if they get the flu. The information in this article has been put together to help you protect children under age 2 from the flu. This is not a substitute for medical advice from your health care provider. If you think your baby may have the flu, you should contact a health care provider right away. FLU SYMPTOMS IN INFANTS AND TODDLERS The flu is an infection of the nose, throat, and (sometimes) lungs. Call your baby\u2019s health care provider if you notice any of the following signs: - Acting tired and cranky much of the time and not feeding well - Cough - Diarrhea and vomiting - Has a fever or feels feverish (if no thermometer available) - Runny nose HOW IS THE FLU TREATED IN BABIES? Children younger than 2 years old will often need to be treated with medicine that fights off the flu virus. This is called antiviral medicine. The medicine works best if started within 48 hours after symptoms begin, if possible. Oseltamivir (Tamiflu) in liquid form will likely be used. Although this drug is not approved for use in children younger than 1 year of age, serious side effects are quite rare. After talking about the risk of side effects against the possible complications of the flu in your baby, you and your health care provider may decide to use this medicine to treat the flu. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever in children. Sometimes, your health care provider will tell you to use both types of medicine. Always check with your health care provider before giving any cold medicines to your infant or toddler. SHOULD MY BABY GET THE FLU VACCINE? All infants 6 months or older should get the flu vaccine, even if they have had a flu-like illness. The flu vaccine is not approved for children under 6 months old. - Your child will need a second flu vaccine around 4 weeks after receiving the vaccine for the first time. - There are two types of flu vaccine. One is given as a shot, and the other is sprayed into your child's nose. The flu shot contains killed (inactive) viruses. It is not possible to get the flu from this type of vaccine. The flu shot is approved for people age 6 months and older. A nasal spray-type flu vaccine uses a live, weakened virus instead of a dead one like the flu shot. It is approved for healthy children over 2 years. Anyone who lives with or has close contact with a child younger than 6 months old should also have a flu shot. WILL THE VACCINE HARM MY BABY? You or your baby can NOT get the flu from either vaccine. Some children may get a low-grade fever for a day or two after the shot. If more severe symptoms develop or they last for more than 2 days, you should call your health care provider. Some parents are afraid the vaccine could hurt their baby. But children under 2 years of age are more likely to get a severe case of the flu. It is hard to predict how ill your child may get from flu because children often have a mild illness at first. They may become sick very fast. A small amount of mercury (called thimerosal) is a common preservative in multidose vaccines. Despite concerns, thimerosal-containing vaccines have NOT been shown to cause autism, ADHD, or any other medical problems. However, all of the routine vaccines are also available without added thimerosal. Ask your health care provider if they offer this type of vaccine. HOW CAN I PREVENT MY BABY FROM GETTING THE FLU? Anyone who has flu symptoms should not care for a newborn or infant, including feeding. If a person with symptoms must care for the child, the caretaker should use a face mask and wash their hands well. Everyone who comes in close contact with your baby should do the following: - Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue away after using it. - Wash your hands often with soap and water for 15\u00a0to 20 seconds, especially after you cough or sneeze. You may also use alcohol-based hand cleaners. If your baby is\u00a0younger than 6 months old and has close contact with someone with the flu, inform your health care provider. IF I HAVE FLU SYMPTOMS, CAN I BREASTFEED MY BABY? If a mother is not ill with the flu, breastfeeding is encouraged. If you are sick, you may need to express your milk for use in bottle feedings given by a healthy person. It is unlikely a newborn can catch flu from drinking your breast milk when you are sick. Breast milk is considered safe if you are taking antivirals. WHEN SHOULD I CALL THE DOCTOR? Talk to your child's health care provider or go to the emergency room if: - Your child does not act alert or more comfortable when the fever goes down. - Fever and flu symptoms come back after they have gone away. - The child does not have tears when crying. - The child's diapers are not wet, or the child has not urinated for the last 8 hours. Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007444.htm"
+  ],
+  [
+    "H1N1 Flu (Swine Flu) (Summary): Summary Swine flu is an infection caused by a virus. It's named for a virus that pigs can get. People do not normally get swine flu, but human infections can and do happen. In 2009 a strain of swine flu called H1N1 infected many people around the world. The virus is contagious and can spread from human to human. Symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. There are antiviral medicines you can take to prevent or treat swine flu. There is a vaccine available to protect against swine flu. You can help prevent the spread of germs that cause respiratory illnesses like influenza by - Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. - Washing your hands often with soap and water, especially after you cough or sneeze. You can also use alcohol-based hand cleaners. - Avoiding touching your eyes, nose or mouth. Germs spread this way. - Trying to avoid close contact with sick people. - Staying home from work or school if you are sick. Centers for Disease Control and Prevention",
+    "#"
+  ],
+  [
+    "Flu Shot (Summary): Summary Flu is a respiratory infection caused by a number of viruses. Most people with the flu get better on their own. But it can be serious. It can cause complications and sometimes even death. Getting the flu vaccine every year is the best way to lower your chance of getting the flu and spreading it to others. The flu vaccine causes antibodies to develop in your body about two weeks after you get it. These antibodies provide protection against infection with the viruses that are in the vaccine. There are different types of flu shots, including some especially for people 65 and older. Ask your health care provider which one is right for you. Everyone 6 months of age and older should get a flu vaccine every season. People with egg allergies should check with their doctors before getting a vaccine. Other exceptions are people who have - Had reactions to flu shots before - Guillain-Barre Syndrome - A fever Centers for Disease Control and Prevention",
+    "#"
+  ],
+  [
+    "Swine flu (H1N1 flu) (Symptoms): H1N1 flu signs and symptoms in humans are similar to those of other flu strains: - Fever (but not always) - Cough - Sore throat - Runny or stuffy nose - Watery, red eyes - Body aches - Headache - Fatigue - Diarrhea - Nausea and vomiting H1N1 flu symptoms develop about one to three days after you're exposed to the virus. When to see a doctor It's not necessary to see a doctor if you're generally healthy and develop flu signs and symptoms, such as fever, cough and body aches. Call your doctor, however, if you have flu symptoms and you're pregnant or you have a chronic disease, such as asthma, emphysema, diabetes or a heart condition, because you have a higher risk of complications from the flu.",
+    "https://www.mayoclinic.org/diseases-conditions/swine-flu/symptoms-causes/syc-20378103"
+  ],
+  [
+    "Swine flu (H1N1 flu): Technically, the term \"swine flu\" refers to influenza in pigs. Occasionally, pigs transmit influenza viruses to people, mainly to hog farmers and veterinarians. Less often, someone infected with swine flu passes the infection to others. The human respiratory infection caused by a particular influenza virus H1N1 strain - popularly known as swine flu - was first recognized in spring 2009. A few months after the first swine flu cases were reported, rates of confirmed H1N1-related illness were increasing in much of the world. As a result, the World Health Organization declared the infection a global pandemic. The pandemic was declared over in August 2010. Currently, H1N1 is still circulating in humans as a seasonal flu virus and protection against this strain was included in the seasonal flu vaccine for 2015-16. Another strain, H3N2 emerged in humans in 2011. H1N1 flu signs and symptoms in humans are similar to those of other flu strains: - Fever (but not always) - Cough - Sore throat - Runny or stuffy nose - Watery, red eyes - Body aches - Headache - Fatigue - Diarrhea - Nausea and vomiting H1N1 flu symptoms develop about one to three days after you're exposed to the virus. When to see a doctor It's not necessary to see a doctor if you're generally healthy and develop flu signs and symptoms, such as fever, cough and body aches. Call your doctor, however, if you have flu symptoms and you're pregnant or you have a chronic disease, such as asthma, emphysema, diabetes or a heart condition, because you have a higher risk of complications from the flu. Influenza viruses infect the cells lining your nose, throat and lungs. The virus enters your body when you inhale contaminated droplets or transfer live virus from a contaminated surface to your eyes, nose or mouth. You can't catch swine flu from eating pork. If you've traveled to an area where many people are affected by swine flu (H1N1 flu), you may have been exposed to the virus, particularly if you spent time in large crowds. Swine farmers and veterinarians have the highest risk of true swine flu because of their exposure to pigs. Influenza complications include: - Worsening of chronic conditions, such as heart disease and asthma - Pneumonia - Neurological signs and symptoms, ranging from confusion to seizures - Respiratory failure Most cases of flu, including H1N1 flu, require only symptom relief. If you have a chronic respiratory disease, your doctor may prescribe additional medications to help relieve your symptoms. The antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) are sometimes prescribed within the first day or two of symptoms to reduce the severity of your symptoms, and possibly the risk of complications. But, flu viruses can develop resistance to these drugs. To make development of resistance less likely and maintain supplies of these drugs for those who need them most, antivirals are reserved for people at high risk of complications. High-risk groups are those who: - Are in a hospital, nursing home or other long-term care facility - Are younger than 5 years of age, particularly children younger than 2 years - Are 65 years and older - Are pregnant or within two weeks of delivery, including women who have had pregnancy loss - Are younger than 19 years of age and are receiving long-term aspirin therapy, because of an increased risk of developing Reye's syndrome, a rare but potentially fatal disease that can occur when using aspirin during a viral illness - Are morbidly obese, defined as having a body mass index above 40 - Have certain chronic medical conditions, including asthma, emphysema, heart disease, diabetes, neuromuscular disease, or kidney, liver or blood disease - Are immunosuppressed due to certain medications or HIV - Are American Indians or Native Alaskans",
+    "https://www.mayoclinic.org/diseases-conditions/swine-flu/symptoms-causes/syc-20378103"
+  ],
+  [
+    "Swine flu (H1N1 flu) (Risk factors): If you've traveled to an area where many people are affected by swine flu (H1N1 flu), you may have been exposed to the virus, particularly if you spent time in large crowds. Swine farmers and veterinarians have the highest risk of true swine flu because of their exposure to pigs.",
+    "https://www.mayoclinic.org/diseases-conditions/swine-flu/symptoms-causes/syc-20378103"
+  ],
+  [
+    "Swine flu (H1N1 flu) (Symptoms): H1N1 flu signs and symptoms in humans are similar to those of other flu strains: - Fever (but not always) - Cough - Sore throat - Runny or stuffy nose - Watery, red eyes - Body aches - Headache - Fatigue - Diarrhea - Nausea and vomiting H1N1 flu symptoms develop about one to three days after you're exposed to the virus. When to see a doctor It's not necessary to see a doctor if you're generally healthy and develop flu signs and symptoms, such as fever, cough and body aches. Call your doctor, however, if you have flu symptoms and you're pregnant or you have a chronic disease, such as asthma, emphysema, diabetes or a heart condition, because you have a higher risk of complications from the flu.",
+    "https://www.mayoclinic.org/diseases-conditions/swine-flu/symptoms-causes/syc-20378103"
+  ],
+  [
+    "What are the symptoms of Flu?: Flu symptoms will often start quickly. You can start to feel sick about 1 to 7 days after you come in contact with the virus. Most of the time symptoms appear within 2 to 3 days. The flu spreads easily. It can affect a large group of people in a very short amount of time. For example, students and co-workers get sick within 2 or 3 weeks of the flu's arrival in a school or workplace. The first symptom is a fever between 102F (38C) and 106F (41.1C). An adult often has a lower fever than a child. Other common symptoms include: - Body aches - Chills - Dizziness - Flushed face - Headache - Lack of energy - Nausea and vomiting The fever, aches, and pains begin to go away on days 2 through 4. But new symptoms occur, including: - Dry cough - Increased symptoms that affect breathing - Runny nose (clear and watery) - Sneezing - Sore throat Most symptoms go away in 4 to 7 days. The cough and tired feeling may last for weeks. Sometimes, the fever comes back. Some people may not feel like eating. The flu can make asthma, breathing problems, and other long-term (chronic) illnesses and conditions worse.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000080.htm"
+  ],
+  [
+    "Myopathy with extrapyramidal signs (Symptoms): The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Ataxia Occasional Microcephaly Occasional Ophthalmoplegia Occasional Optic atrophy Occasional Peripheral axonal neuropathy Occasional Ptosis Occasional Abnormality of extrapyramidal motor function Very rare Chorea Very rare Dystonia Very rare Orofacial dyskinesia Very rare Proximal muscle weakness Very rare Specific learning disability Very rare Tremor Very rare Autosomal recessive inheritance - Difficulty running - Difficulty walking - Elevated serum creatine phosphokinase - Motor delay - View complete list of signs and symptoms...",
+    "https://rarediseases.info.nih.gov/diseases/12978/myopathy-with-extrapyramidal-signs"
+  ],
+  [
+    "Symptoms and Causes of Diabetes (What are the symptoms of diabetes?): Symptoms of diabetes includeincreased thirst and urination increased hunger fatigue blurred vision numbness or tingling in the feet or hands sores that do not heal unexplained weight lossSymptoms of type 1 diabetes can start quickly, in a matter of weeks. Symptoms of type 2 diabetes often develop slowly\u2014over the course of several years\u2014and can be so mild that you might not even notice them. Many people with type 2 diabetes have no symptoms. Some people do not find out they have the disease until they have diabetes-related health problems, such as blurred vision or heart trouble.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes"
+  ],
+  [
+    "Vital signs: Vital signs reflect essential body functions, including your heartbeat, breathing rate, temperature, and blood pressure. Your health care provider may watch, measure, or monitor your vital signs to check your level of physical functioning. Normal vital signs change with age, sex, weight, exercise capability, and overall health. Normal vital sign ranges for the average healthy adult while resting are: - Blood pressure: 90/60 mm Hg to 120/80 mm Hg - Breathing: 12 to 18 breaths per minute - Pulse: 60 to 100 beats per minute - Temperature: 97.8\u00b0F to 99.1\u00b0F (36.5\u00b0C to 37.3\u00b0C)/average 98.6\u00b0F (37\u00b0C) Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002341.htm"
+  ],
+  [
+    "Headaches - danger signs: A headache is a pain or discomfort in the head, scalp, or neck. Common types of headaches include tension headaches, migraine or cluster headaches, sinus headaches, and headaches that begin in your neck. You may have a mild headache with a cold, the flu, or other viral illnesses when you also have a low fever. Most people with headaches feel better by making lifestyle changes, such as learning ways to relax. Taking certain medicines, such as pain medicine, may also help. Problems with blood vessels and bleeding in the brain can cause a headache. These problems include: - Abnormal connection between the arteries and veins in the brain that usually forms before birth. This problem is called an arteriovenous malformation, or AVM. - Blood flow to part of the brain stops. This is called a stroke. - Weakening of the wall of a blood vessel that can break open and bleed into the brain. This is known as a brain aneurysm. - Bleeding in the area between the brain and the thin tissue that covers the brain. This is called a subarachnoid hemorrhage. Other causes of headaches that should be checked by a health care provider right away include: - Blood pressure that is very high - Brain tumor - Buildup of fluid inside the skull that leads to brain swelling (hydrocephalus) - Buildup of pressure inside the skull that appears to be, but is not, a tumor (pseudotumor cerebri) - Carbon monoxide poisoning - Infection in the brain or the tissue that surrounds the brain, as well as a brain abscess - Swollen, inflamed artery that supplies blood to part of the head, temple, and neck area (temporal arteritis) If you cannot see your provider right away, go to the emergency room or call 911 if: - This is the first severe headache you have ever had in your life and it interferes with your daily activities. - You develop a headache right after activities such as weightlifting, aerobics, jogging, or sex. - Your headache comes on suddenly and is explosive or violent. - Your headache is \"the worst ever,\" even if you regularly get headaches. - You also have slurred speech, a change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss with your headache. - Your headache gets worse over 24 hours. - You also have fever, stiff neck, nausea, and vomiting with your headache. - Your headache occurs with a head injury. - Your headache is severe and just in 1 eye, with redness in that eye. - You just started getting headaches, especially if your are older than 50. - You have headaches along with vision problems and pain while chewing, or weight loss. - You have a history of cancer and develop a new headache. - Your immune system is weakened by disease (such as HIV infection) or by medicines (such as chemotherapy drugs and steroids). See your provider soon if: - Your headaches wake you up from sleep. - A headache lasts more than a few days. - Headaches are worse in the morning. - You have a history of headaches but they have changed in pattern or intensity . - You have headaches often and there is no known cause. Updated by: Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000424.htm"
+  ],
+  [
+    "Myopathy with extrapyramidal signs: Myopathy with extrapyramidal signs is a disorder characterized by early childhood onset of proximal muscle weakness (muscles closest to the body\u2019s midline) and learning disabilities. The muscle weakness does not progress, but most patients develop progressive atypical involuntary muscle contractions that influence gait, movement, and posture (extrapyramidal signs) that may be disabling. Signs and symptoms are variable and include brief, repetitive, jerky and uncontrolled movements caused by muscle contractions ( chorea), tremor, abnormal posturing, and involuntary repetitive movements of the mouth and face. [1] \u00a0Other symptoms may include uncoordinated movements ( ataxia ), a very small head ( microcephaly ), drooping of the eyelids, wasting of the eye nerve ( optic atrophy), and axonal peripheral neuropathy. It is caused by changes ( mutations ) in the MICU1 gene and is inherited in an autosomal recessive \u00a0 pattern. [1] [2] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Ataxia Occasional Microcephaly Occasional Ophthalmoplegia Occasional Optic atrophy Occasional Peripheral axonal neuropathy Occasional Ptosis Occasional Abnormality of extrapyramidal motor function Very rare Chorea Very rare Dystonia Very rare Orofacial dyskinesia Very rare Proximal muscle weakness Very rare Specific learning disability Very rare Tremor Very rare Autosomal recessive inheritance - Difficulty running - Difficulty walking - Elevated serum creatine phosphokinase - Motor delay - View complete list of signs and symptoms...",
+    "https://rarediseases.info.nih.gov/diseases/12978/myopathy-with-extrapyramidal-signs"
+  ],
+  [
+    "Warning signs and symptoms of heart disease: Heart disease often develops over time. You may have early signs or symptoms long before you have serious heart problems. Or you may not realize you are developing heart disease. The warning signs of heart disease may not be obvious. Also, not every person has the same symptoms. Certain symptoms, such as chest pain, ankle swelling, and shortness of breath may be signals that something is wrong. Learning the warning signs can help you get treatment and help prevent a heart attack or stroke. Chest pain is discomfort or pain that you feel along the front of your body, between your neck and upper abdomen. There are many causes of chest pain that have nothing to do with your heart. But chest pain is still the most common symptom of poor blood flow to the heart or a heart attack. This type of chest pain is called angina. Chest pain can occur when the heart is not getting enough blood or oxygen. The amount and type of pain can vary from person to person. The intensity of the pain does not always relate to how severe the problem is. - Some people may feel a crushing pain, while others feel only mild discomfort. - Your chest may feel heavy or like someone is squeezing your heart. You may also feel a sharp, burning pain in your chest. - You may feel the pain under your breastbone (sternum), or in your neck, arms, stomach, jaw, or upper back. - Chest pain from angina often occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin. - Bad indigestion can also cause chest pain. Women, older adults, and people with diabetes may have little or no chest pain. They are more likely to have symptoms other than chest pain, such as: - Fatigue - Shortness of breath - General weakness - Change in skin color or greyish pallor (episodes of change in skin color associated with weakness) Other symptoms of a heart attack can include: - Extreme anxiety - Fainting or loss of consciousness - Lightheadedness or dizziness - Nausea or vomiting - Palpitations (feeling like your heart is beating too fast or irregularly) - Shortness of breath - Sweating, which may be very heavy When the heart can't pump blood as well as it should, blood backs up in the veins that go from the lungs to the heart. Fluid leaks into the lungs and causes shortness of breath. This is a symptom of heart failure. You may notice shortness of breath: - During activity - While you're resting - When you're lying flat on your back -- it may even wake you from sleep Coughing or wheezing that doesn't go away can be another sign that fluid is building up in your lungs. You may also cough up mucus that is pink or bloody. Swelling (edema) in your lower legs is another sign of a heart problem. When your heart doesn't work as well, blood flow slows and backs up in the veins in your legs. This causes fluid to build up in your tissues. You may also have swelling in your stomach or notice some weight gain. Narrowing of the blood vessels that bring blood to other parts of the body may mean you have a much higher risk for heart attack. It can occur when cholesterol and other fatty material (plaque) build up on the walls of your arteries. Poor blood supply to the legs may lead to: - Pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs. - Symptoms that often appear during walking or exercise, and go away after several minutes of rest. - Numbness in your legs or feet when you are at rest. Your legs may also feel cool to the touch, and the skin may look pale. A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a \"brain attack.\" Symptoms of stroke can include difficulty moving the limbs on one side of your body, one side of the face drooping, difficulty with speaking or understanding language. Tiredness can have many causes. Often it simply means that you need more rest. But feeling run down can be a sign of a more serious problem. Fatigue may be a sign of heart trouble when: - You feel much more tired than normal. It's common for women to feel severely tired before or during a heart attack. - You feel so tired that you can't do your normal daily activities. - You have sudden, severe weakness. If your heart can't pump blood as well, it may beat faster to try to keep up. You may feel your heart racing or throbbing. A fast or uneven heartbeat can also be the sign of an arrhythmia. This is a problem with your heart rate or rhythm. If you have any signs of heart disease, call your health care provider right away. Don't wait to see if the symptoms go away or dismiss them as nothing. Call your local emergency number (such as 911) if: - You have chest pain or other symptoms of a heart attack - If you know you have angina and have chest pain that doesn't go away after 5 minutes of rest or after taking nitroglycerine - If you think you may be having a heart attack - If you become extremely short of breath - If you think you may have lost consciousness Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000775.htm"
+  ],
+  [
+    "Swine flu (H1N1 flu) (Treatment): Most cases of flu, including H1N1 flu, require only symptom relief. If you have a chronic respiratory disease, your doctor may prescribe additional medications to help relieve your symptoms. The antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) are sometimes prescribed within the first day or two of symptoms to reduce the severity of your symptoms, and possibly the risk of complications. But, flu viruses can develop resistance to these drugs. To make development of resistance less likely and maintain supplies of these drugs for those who need them most, antivirals are reserved for people at high risk of complications. High-risk groups are those who: - Are in a hospital, nursing home or other long-term care facility - Are younger than 5 years of age, particularly children younger than 2 years - Are 65 years and older - Are pregnant or within two weeks of delivery, including women who have had pregnancy loss - Are younger than 19 years of age and are receiving long-term aspirin therapy, because of an increased risk of developing Reye's syndrome, a rare but potentially fatal disease that can occur when using aspirin during a viral illness - Are morbidly obese, defined as having a body mass index above 40 - Have certain chronic medical conditions, including asthma, emphysema, heart disease, diabetes, neuromuscular disease, or kidney, liver or blood disease - Are immunosuppressed due to certain medications or HIV - Are American Indians or Native Alaskans",
+    "https://www.mayoclinic.org/diseases-conditions/swine-flu/symptoms-causes/syc-20378103"
+  ],
+  [
+    "What are the treatments for Flu?: HOME CARE Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever. Providers sometimes suggest you to use both types of medicine. DO NOT use aspirin. A fever does not need to come all the way down to normal. Most people feel better when the temperature drops by 1 degree. Over-the-counter cold medicines may make some of your symptoms better. Cough drops or throat sprays will help with your sore throat. You will need a lot of rest. Drink plenty of liquids. DO NOT smoke or drink alcohol. ANTIVIRAL DRUGS Most people with milder symptoms feel better in 3 to 4 days. They do not need to see a provider or take antiviral medicines. Providers may give antiviral drugs to people who get very sick with the flu. You may need these medicines if you are more likely to have flu complications The health problems below may increase your risk of getting sicker with the flu: - Lung disease (including asthma) - Heart conditions (except high blood pressure) - Kidney, liver, nerve, and muscle conditions - Blood disorders (including sickle cell disease) - Diabetes - A weakened immune system due to diseases (such as AIDS), radiation therapy, or certain medicines, including chemotherapy and corticosteroids - Other long-term medical problem These medicines may shorten the time you have symptoms by about 1 day. They work better if you start taking them within 2 days of your first symptoms. Children at risk of a severe case of the flu may also need these medicines.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000080.htm"
+  ],
+  [
+    "Influenza (flu) (Treatment): Usually, you'll need nothing more than bed rest and plenty of fluids to treat the flu. But in some cases, your doctor may prescribe an antiviral medication, such as oseltamivir (Tamiflu) or zanamivir (Relenza). If taken soon after you notice symptoms, these drugs may shorten your illness by a day or so and help prevent serious complications. Oseltamivir is an oral medication. Zanamivir is inhaled through a device similar to an asthma inhaler and shouldn't be used by anyone with respiratory problems, such as asthma and lung disease. Antiviral medication side effects may include nausea and vomiting. These side effects may be lessened if the drug is taken with food. Oseltamivir has also been associated with delirium and self-harm behaviors in teenagers. Some researchers recommend further study on both of these drugs because of uncertainty about their effects beyond a slight reduction in the time of illness. Some studies have suggested that these medications can also help reduce the severity of complications. The Centers for Disease Control and Prevention still recommends their use for some people. An additional concern is that some strains of influenza have become resistant to oseltamivir, amantadine and rimantadine (Flumadine), which are older antiviral drugs.",
+    "https://www.mayoclinic.org/diseases-conditions/flu/symptoms-causes/syc-20351719"
+  ],
+  [
+    "Insulin, Medicines, and Other Diabetes Treatments (Do I have other treatment options for my diabetes?): When medicines and lifestyle changes are not enough to manage your diabetes, a less common treatment may be an option. Other treatments include bariatric surgery for certain people with type 1 or type 2 diabetes, and an \"artificial pancreas\" and\u00a0pancreatic islet transplantation for some people with type 1 diabetes.Bariatric surgeryAlso called weight-loss surgery or metabolic surgery, bariatric surgery may help some people with obesity and type 2 diabetes lose a large amount of weight and regain normal blood glucose levels. Some people with diabetes may no longer need their diabetes medicine after bariatric surgery. Whether and for how long blood glucose levels improve seems to vary by the patient, type of weight-loss surgery, and amount of weight the person loses. Other factors include how long someone has had diabetes and whether or not the person uses insulin.1Recent research suggests that weight-loss surgery also may help improve blood glucose control in people with type 1 diabetes who are obese.2Researchers are studying the long-term results of bariatric surgery in people with type 1 and type 2 diabetes.Artificial PancreasThe NIDDK has played an important role in developing \u201cartificial pancreas\u201d technology. An artificial pancreas replaces manual blood glucose testing and the use of insulin shots or a pump. A single system monitors blood glucose levels around the clock and provides insulin or a combination of insulin and a second hormone, glucagon, automatically. The system can also be monitored remotely, for example by parents or medical staff.In 2016, the FDA approved a type of artificial pancreas system called a hybrid closed-loop system. This system tests your glucose level every 5 minutes throughout the day and night, and automatically gives you the right amount of insulin.You still need to manually adjust the amount of insulin the pump delivers at mealtimes. But, the artificial pancreas may free you from some of the daily tasks needed to keep your blood glucose stable\u2014or help you sleep through the night without the need to wake and test your glucose or take medicine.The hybrid closed-loop system is expected to be available in the U.S. in 2017. Talk with your health care provider about whether this system might be right for you.The NIDDK has funded several important studies on different types of artificial pancreas devices to better help people with type 1 diabetes manage their disease. The devices may also help people with type 2 diabetes and gestational diabetes.Pancreatic islet transplantationPancreatic islet transplantation is an experimental treatment for poorly controlled type 1 diabetes. Pancreatic islets are clusters of cells in the pancreas that make the hormone insulin. In type 1 diabetes, the body\u2019s immune system attacks these cells. A pancreatic islet transplant replaces destroyed islets with new ones that make and release insulin. This procedure takes islets from the pancreas of an organ donor and transfers them to a person with type 1 diabetes. Because researchers are still studying pancreatic islet transplantation, the procedure is only available to people enrolled in research studies. Learn more about islet transplantation studies.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/insulin-medicines-treatments"
+  ],
+  [
+    "Avian influenza (Treatment): Treatment varies, and is\u00a0based on your symptoms. In general, treatment with the antiviral medicine oseltamivir (Tamiflu) or zanamivir (Relenza) may make the disease less severe. For\u00a0the medicine\u00a0to work, you need to start taking\u00a0it within 48 hours after your symptoms start. Oseltamivir may also be prescribed for people who live in the same house people with avian flu. This may prevent them from getting the illness. The virus that causes human avian flu is resistant to the antiviral medicines amantadine and rimantadine. These medicines should not be used in the case of an H5N1 outbreak. People with severe infection may need to be placed on a breathing machine. People infected with the virus also should be kept separate from non-infected people. Providers recommend that people get an influenza (flu) shot. This may cut down the chance that the avian flu virus will mix with a human flu virus. This might create a new virus that may easily spread.",
+    "https://medlineplus.gov/ency/article/007263.htm"
+  ],
+  [
+    "Your baby and the flu (Information): FLU SYMPTOMS IN INFANTS AND TODDLERS The flu is an infection of the nose, throat, and (sometimes) lungs. Call your baby\u2019s health care provider if you notice any of the following signs: - Acting tired and cranky much of the time and not feeding well - Cough - Diarrhea and vomiting - Has a fever or feels feverish (if no thermometer available) - Runny nose HOW IS THE FLU TREATED IN BABIES? Children younger than 2 years old will often need to be treated with medicine that fights off the flu virus. This is called antiviral medicine. The medicine works best if started within 48 hours after symptoms begin, if possible. Oseltamivir (Tamiflu) in liquid form will likely be used. Although this drug is not approved for use in children younger than 1 year of age, serious side effects are quite rare. After talking about the risk of side effects against the possible complications of the flu in your baby, you and your health care provider may decide to use this medicine to treat the flu. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever in children. Sometimes, your health care provider will tell you to use both types of medicine. Always check with your health care provider before giving any cold medicines to your infant or toddler. SHOULD MY BABY GET THE FLU VACCINE? All infants 6 months or older should get the flu vaccine, even if they have had a flu-like illness. The flu vaccine is not approved for children under 6 months old. - Your child will need a second flu vaccine around 4 weeks after receiving the vaccine for the first time. - There are two types of flu vaccine. One is given as a shot, and the other is sprayed into your child's nose. The flu shot contains killed (inactive) viruses. It is not possible to get the flu from this type of vaccine. The flu shot is approved for people age 6 months and older. A nasal spray-type flu vaccine uses a live, weakened virus instead of a dead one like the flu shot. It is approved for healthy children over 2 years. Anyone who lives with or has close contact with a child younger than 6 months old should also have a flu shot. WILL THE VACCINE HARM MY BABY? You or your baby can NOT get the flu from either vaccine. Some children may get a low-grade fever for a day or two after the shot. If more severe symptoms develop or they last for more than 2 days, you should call your health care provider. Some parents are afraid the vaccine could hurt their baby. But children under 2 years of age are more likely to get a severe case of the flu. It is hard to predict how ill your child may get from flu because children often have a mild illness at first. They may become sick very fast. A small amount of mercury (called thimerosal) is a common preservative in multidose vaccines. Despite concerns, thimerosal-containing vaccines have NOT been shown to cause autism, ADHD, or any other medical problems. However, all of the routine vaccines are also available without added thimerosal. Ask your health care provider if they offer this type of vaccine. HOW CAN I PREVENT MY BABY FROM GETTING THE FLU? Anyone who has flu symptoms should not care for a newborn or infant, including feeding. If a person with symptoms must care for the child, the caretaker should use a face mask and wash their hands well. Everyone who comes in close contact with your baby should do the following: - Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue away after using it. - Wash your hands often with soap and water for 15\u00a0to 20 seconds, especially after you cough or sneeze. You may also use alcohol-based hand cleaners. If your baby is\u00a0younger than 6 months old and has close contact with someone with the flu, inform your health care provider. IF I HAVE FLU SYMPTOMS, CAN I BREASTFEED MY BABY? If a mother is not ill with the flu, breastfeeding is encouraged. If you are sick, you may need to express your milk for use in bottle feedings given by a healthy person. It is unlikely a newborn can catch flu from drinking your breast milk when you are sick. Breast milk is considered safe if you are taking antivirals. WHEN SHOULD I CALL THE DOCTOR? Talk to your child's health care provider or go to the emergency room if: - Your child does not act alert or more comfortable when the fever goes down. - Fever and flu symptoms come back after they have gone away. - The child does not have tears when crying. - The child's diapers are not wet, or the child has not urinated for the last 8 hours.",
+    "https://medlineplus.gov/ency/article/007444.htm"
+  ],
+  [
+    "Your baby and the flu: The flu is an easily spread disease. Children under age 2 have a higher risk of developing complications if they get the flu. The information in this article has been put together to help you protect children under age 2 from the flu. This is not a substitute for medical advice from your health care provider. If you think your baby may have the flu, you should contact a health care provider right away. FLU SYMPTOMS IN INFANTS AND TODDLERS The flu is an infection of the nose, throat, and (sometimes) lungs. Call your baby\u2019s health care provider if you notice any of the following signs: - Acting tired and cranky much of the time and not feeding well - Cough - Diarrhea and vomiting - Has a fever or feels feverish (if no thermometer available) - Runny nose HOW IS THE FLU TREATED IN BABIES? Children younger than 2 years old will often need to be treated with medicine that fights off the flu virus. This is called antiviral medicine. The medicine works best if started within 48 hours after symptoms begin, if possible. Oseltamivir (Tamiflu) in liquid form will likely be used. Although this drug is not approved for use in children younger than 1 year of age, serious side effects are quite rare. After talking about the risk of side effects against the possible complications of the flu in your baby, you and your health care provider may decide to use this medicine to treat the flu. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever in children. Sometimes, your health care provider will tell you to use both types of medicine. Always check with your health care provider before giving any cold medicines to your infant or toddler. SHOULD MY BABY GET THE FLU VACCINE? All infants 6 months or older should get the flu vaccine, even if they have had a flu-like illness. The flu vaccine is not approved for children under 6 months old. - Your child will need a second flu vaccine around 4 weeks after receiving the vaccine for the first time. - There are two types of flu vaccine. One is given as a shot, and the other is sprayed into your child's nose. The flu shot contains killed (inactive) viruses. It is not possible to get the flu from this type of vaccine. The flu shot is approved for people age 6 months and older. A nasal spray-type flu vaccine uses a live, weakened virus instead of a dead one like the flu shot. It is approved for healthy children over 2 years. Anyone who lives with or has close contact with a child younger than 6 months old should also have a flu shot. WILL THE VACCINE HARM MY BABY? You or your baby can NOT get the flu from either vaccine. Some children may get a low-grade fever for a day or two after the shot. If more severe symptoms develop or they last for more than 2 days, you should call your health care provider. Some parents are afraid the vaccine could hurt their baby. But children under 2 years of age are more likely to get a severe case of the flu. It is hard to predict how ill your child may get from flu because children often have a mild illness at first. They may become sick very fast. A small amount of mercury (called thimerosal) is a common preservative in multidose vaccines. Despite concerns, thimerosal-containing vaccines have NOT been shown to cause autism, ADHD, or any other medical problems. However, all of the routine vaccines are also available without added thimerosal. Ask your health care provider if they offer this type of vaccine. HOW CAN I PREVENT MY BABY FROM GETTING THE FLU? Anyone who has flu symptoms should not care for a newborn or infant, including feeding. If a person with symptoms must care for the child, the caretaker should use a face mask and wash their hands well. Everyone who comes in close contact with your baby should do the following: - Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue away after using it. - Wash your hands often with soap and water for 15\u00a0to 20 seconds, especially after you cough or sneeze. You may also use alcohol-based hand cleaners. If your baby is\u00a0younger than 6 months old and has close contact with someone with the flu, inform your health care provider. IF I HAVE FLU SYMPTOMS, CAN I BREASTFEED MY BABY? If a mother is not ill with the flu, breastfeeding is encouraged. If you are sick, you may need to express your milk for use in bottle feedings given by a healthy person. It is unlikely a newborn can catch flu from drinking your breast milk when you are sick. Breast milk is considered safe if you are taking antivirals. WHEN SHOULD I CALL THE DOCTOR? Talk to your child's health care provider or go to the emergency room if: - Your child does not act alert or more comfortable when the fever goes down. - Fever and flu symptoms come back after they have gone away. - The child does not have tears when crying. - The child's diapers are not wet, or the child has not urinated for the last 8 hours. Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007444.htm"
+  ],
+  [
+    "Insulin, Medicines, and Other Diabetes Treatments (What oral medicines treat type 2 diabetes?): You may need medicines along with healthy eating and physical activity habits to manage your type 2 diabetes. You can take many diabetes medicines by mouth. These medicines are called oral medicines.Most people with type 2 diabetes start medical treatment with metformin pills. Metformin also comes as a liquid. Metformin lowers the amount of glucose that your liver makes and helps your body use insulin better. This drug may help you lose a small amount of weight.Other oral medicines act in different ways to lower blood glucose levels. You may need to add another diabetes medicine after a while or use a combination treatment. Combining two or three kinds of diabetes medicines can lower blood glucose levels more than taking just one.Read about different kinds of diabetes medicines from the Food and Drug Administration (FDA).",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/insulin-medicines-treatments"
+  ],
+  [
+    "H1N1 Flu (Swine Flu) (Summary): Summary Swine flu is an infection caused by a virus. It's named for a virus that pigs can get. People do not normally get swine flu, but human infections can and do happen. In 2009 a strain of swine flu called H1N1 infected many people around the world. The virus is contagious and can spread from human to human. Symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. There are antiviral medicines you can take to prevent or treat swine flu. There is a vaccine available to protect against swine flu. You can help prevent the spread of germs that cause respiratory illnesses like influenza by - Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. - Washing your hands often with soap and water, especially after you cough or sneeze. You can also use alcohol-based hand cleaners. - Avoiding touching your eyes, nose or mouth. Germs spread this way. - Trying to avoid close contact with sick people. - Staying home from work or school if you are sick. Centers for Disease Control and Prevention",
+    "#"
+  ],
+  [
+    "Bird flu (avian influenza) (Treatment): Many influenza viruses have become resistant to the effects of a category of antiviral drugs that includes amantadine and rimantadine (Flumadine). Health officials recommend the use of oseltamivir (Tamiflu) or, if oseltamivir can't be used, zanamivir (Relenza). These drugs must be taken within two days after the appearance of symptoms.",
+    "https://www.mayoclinic.org/diseases-conditions/bird-flu/symptoms-causes/syc-20368455"
+  ],
+  [
+    "Influenza (flu) (Diagnosis): Your doctor will conduct a physical exam, look for signs and symptoms of influenza, and possibly order a test that detects influenza viruses. The most commonly used test is called a rapid influenza diagnostics test, which looks for substances (antigens) on a swab sample from the back of the nose or throat. These tests can provide results in 30 minutes or less. However, results vary greatly and are not always accurate. Your doctor may diagnose you with influenza based on symptoms, despite having a negative test result. More-sensitive flu tests are available in some specialized hospitals and labs.",
+    "https://www.mayoclinic.org/diseases-conditions/flu/symptoms-causes/syc-20351719"
+  ],
+  [
+    "How to diagnose Flu?: Most people do not need to see a health care provider when they have flu symptoms. This is because most people are not at risk for a severe case of the flu. If you are very sick with the flu, you may want to see your provider. People who are at high risk for flu complications may also want to see a provider if they get the flu. When many people in an area have flu, a provider can make a diagnosis after hearing about your symptoms. No further testing is needed. There is a test to detect the flu. It is done by swabbing the nose or throat. Most of the time, test results are available very fast. The test can help your provider prescribe the best treatment.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000080.htm"
+  ],
+  [
+    "Bird flu (avian influenza) (Diagnosis): Laboratory tests Samples of fluids from your nose or throat can be tested for evidence of bird flu virus. These samples must be taken within the first few days after symptoms appear. Imaging tests X-rays may be useful in assessing the condition of your lungs, which can help determine the proper diagnosis and the best treatment options for your signs and symptoms.",
+    "https://www.mayoclinic.org/diseases-conditions/bird-flu/symptoms-causes/syc-20368455"
+  ],
+  [
+    "Your baby and the flu (Information): FLU SYMPTOMS IN INFANTS AND TODDLERS The flu is an infection of the nose, throat, and (sometimes) lungs. Call your baby\u2019s health care provider if you notice any of the following signs: - Acting tired and cranky much of the time and not feeding well - Cough - Diarrhea and vomiting - Has a fever or feels feverish (if no thermometer available) - Runny nose HOW IS THE FLU TREATED IN BABIES? Children younger than 2 years old will often need to be treated with medicine that fights off the flu virus. This is called antiviral medicine. The medicine works best if started within 48 hours after symptoms begin, if possible. Oseltamivir (Tamiflu) in liquid form will likely be used. Although this drug is not approved for use in children younger than 1 year of age, serious side effects are quite rare. After talking about the risk of side effects against the possible complications of the flu in your baby, you and your health care provider may decide to use this medicine to treat the flu. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever in children. Sometimes, your health care provider will tell you to use both types of medicine. Always check with your health care provider before giving any cold medicines to your infant or toddler. SHOULD MY BABY GET THE FLU VACCINE? All infants 6 months or older should get the flu vaccine, even if they have had a flu-like illness. The flu vaccine is not approved for children under 6 months old. - Your child will need a second flu vaccine around 4 weeks after receiving the vaccine for the first time. - There are two types of flu vaccine. One is given as a shot, and the other is sprayed into your child's nose. The flu shot contains killed (inactive) viruses. It is not possible to get the flu from this type of vaccine. The flu shot is approved for people age 6 months and older. A nasal spray-type flu vaccine uses a live, weakened virus instead of a dead one like the flu shot. It is approved for healthy children over 2 years. Anyone who lives with or has close contact with a child younger than 6 months old should also have a flu shot. WILL THE VACCINE HARM MY BABY? You or your baby can NOT get the flu from either vaccine. Some children may get a low-grade fever for a day or two after the shot. If more severe symptoms develop or they last for more than 2 days, you should call your health care provider. Some parents are afraid the vaccine could hurt their baby. But children under 2 years of age are more likely to get a severe case of the flu. It is hard to predict how ill your child may get from flu because children often have a mild illness at first. They may become sick very fast. A small amount of mercury (called thimerosal) is a common preservative in multidose vaccines. Despite concerns, thimerosal-containing vaccines have NOT been shown to cause autism, ADHD, or any other medical problems. However, all of the routine vaccines are also available without added thimerosal. Ask your health care provider if they offer this type of vaccine. HOW CAN I PREVENT MY BABY FROM GETTING THE FLU? Anyone who has flu symptoms should not care for a newborn or infant, including feeding. If a person with symptoms must care for the child, the caretaker should use a face mask and wash their hands well. Everyone who comes in close contact with your baby should do the following: - Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue away after using it. - Wash your hands often with soap and water for 15\u00a0to 20 seconds, especially after you cough or sneeze. You may also use alcohol-based hand cleaners. If your baby is\u00a0younger than 6 months old and has close contact with someone with the flu, inform your health care provider. IF I HAVE FLU SYMPTOMS, CAN I BREASTFEED MY BABY? If a mother is not ill with the flu, breastfeeding is encouraged. If you are sick, you may need to express your milk for use in bottle feedings given by a healthy person. It is unlikely a newborn can catch flu from drinking your breast milk when you are sick. Breast milk is considered safe if you are taking antivirals. WHEN SHOULD I CALL THE DOCTOR? Talk to your child's health care provider or go to the emergency room if: - Your child does not act alert or more comfortable when the fever goes down. - Fever and flu symptoms come back after they have gone away. - The child does not have tears when crying. - The child's diapers are not wet, or the child has not urinated for the last 8 hours.",
+    "https://medlineplus.gov/ency/article/007444.htm"
+  ],
+  [
+    "Your baby and the flu: The flu is an easily spread disease. Children under age 2 have a higher risk of developing complications if they get the flu. The information in this article has been put together to help you protect children under age 2 from the flu. This is not a substitute for medical advice from your health care provider. If you think your baby may have the flu, you should contact a health care provider right away. FLU SYMPTOMS IN INFANTS AND TODDLERS The flu is an infection of the nose, throat, and (sometimes) lungs. Call your baby\u2019s health care provider if you notice any of the following signs: - Acting tired and cranky much of the time and not feeding well - Cough - Diarrhea and vomiting - Has a fever or feels feverish (if no thermometer available) - Runny nose HOW IS THE FLU TREATED IN BABIES? Children younger than 2 years old will often need to be treated with medicine that fights off the flu virus. This is called antiviral medicine. The medicine works best if started within 48 hours after symptoms begin, if possible. Oseltamivir (Tamiflu) in liquid form will likely be used. Although this drug is not approved for use in children younger than 1 year of age, serious side effects are quite rare. After talking about the risk of side effects against the possible complications of the flu in your baby, you and your health care provider may decide to use this medicine to treat the flu. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever in children. Sometimes, your health care provider will tell you to use both types of medicine. Always check with your health care provider before giving any cold medicines to your infant or toddler. SHOULD MY BABY GET THE FLU VACCINE? All infants 6 months or older should get the flu vaccine, even if they have had a flu-like illness. The flu vaccine is not approved for children under 6 months old. - Your child will need a second flu vaccine around 4 weeks after receiving the vaccine for the first time. - There are two types of flu vaccine. One is given as a shot, and the other is sprayed into your child's nose. The flu shot contains killed (inactive) viruses. It is not possible to get the flu from this type of vaccine. The flu shot is approved for people age 6 months and older. A nasal spray-type flu vaccine uses a live, weakened virus instead of a dead one like the flu shot. It is approved for healthy children over 2 years. Anyone who lives with or has close contact with a child younger than 6 months old should also have a flu shot. WILL THE VACCINE HARM MY BABY? You or your baby can NOT get the flu from either vaccine. Some children may get a low-grade fever for a day or two after the shot. If more severe symptoms develop or they last for more than 2 days, you should call your health care provider. Some parents are afraid the vaccine could hurt their baby. But children under 2 years of age are more likely to get a severe case of the flu. It is hard to predict how ill your child may get from flu because children often have a mild illness at first. They may become sick very fast. A small amount of mercury (called thimerosal) is a common preservative in multidose vaccines. Despite concerns, thimerosal-containing vaccines have NOT been shown to cause autism, ADHD, or any other medical problems. However, all of the routine vaccines are also available without added thimerosal. Ask your health care provider if they offer this type of vaccine. HOW CAN I PREVENT MY BABY FROM GETTING THE FLU? Anyone who has flu symptoms should not care for a newborn or infant, including feeding. If a person with symptoms must care for the child, the caretaker should use a face mask and wash their hands well. Everyone who comes in close contact with your baby should do the following: - Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue away after using it. - Wash your hands often with soap and water for 15\u00a0to 20 seconds, especially after you cough or sneeze. You may also use alcohol-based hand cleaners. If your baby is\u00a0younger than 6 months old and has close contact with someone with the flu, inform your health care provider. IF I HAVE FLU SYMPTOMS, CAN I BREASTFEED MY BABY? If a mother is not ill with the flu, breastfeeding is encouraged. If you are sick, you may need to express your milk for use in bottle feedings given by a healthy person. It is unlikely a newborn can catch flu from drinking your breast milk when you are sick. Breast milk is considered safe if you are taking antivirals. WHEN SHOULD I CALL THE DOCTOR? Talk to your child's health care provider or go to the emergency room if: - Your child does not act alert or more comfortable when the fever goes down. - Fever and flu symptoms come back after they have gone away. - The child does not have tears when crying. - The child's diapers are not wet, or the child has not urinated for the last 8 hours. Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007444.htm"
+  ],
+  [
+    "H1N1 Flu (Swine Flu) (Summary): Summary Swine flu is an infection caused by a virus. It's named for a virus that pigs can get. People do not normally get swine flu, but human infections can and do happen. In 2009 a strain of swine flu called H1N1 infected many people around the world. The virus is contagious and can spread from human to human. Symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. There are antiviral medicines you can take to prevent or treat swine flu. There is a vaccine available to protect against swine flu. You can help prevent the spread of germs that cause respiratory illnesses like influenza by - Covering your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. - Washing your hands often with soap and water, especially after you cough or sneeze. You can also use alcohol-based hand cleaners. - Avoiding touching your eyes, nose or mouth. Germs spread this way. - Trying to avoid close contact with sick people. - Staying home from work or school if you are sick. Centers for Disease Control and Prevention",
+    "#"
+  ],
+  [
+    "Flu: The flu is an infection of the nose, throat, and lungs. It spreads easily. This article discusses influenza types A and B. Another type of the flu is the swine flu (H1N1). The flu is caused by an influenza virus. Most people get the flu when they breathe in tiny airborne droplets from the coughs or sneezes of someone who has the flu. You can also catch the flu if you touch something with the virus on it, and then touch your mouth, nose, or eyes. People often confuse colds and flu. They are different, but you might have some of the same symptoms. Most people get a cold several times a year. On the contrary, people get the flu only once every few years. Sometimes, you can get a virus that makes you throw up or have diarrhea. Some people call this the \"stomach flu.\" This is a misleading name because this virus is not the actual flu. The flu mostly affects your nose, throat, and lungs. Flu symptoms will often start quickly. You can start to feel sick about 1 to 7 days after you come in contact with the virus. Most of the time symptoms appear within 2 to 3 days. The flu spreads easily. It can affect a large group of people in a very short amount of time. For example, students and co-workers get sick within 2 or 3 weeks of the flu's arrival in a school or workplace. The first symptom is a fever between 102\u00b0F (39\u00b0C) and 106\u00b0F (41\u00b0C). An adult often has a lower fever than a child. Other common symptoms include: - Body aches - Chills - Dizziness - Flushed face - Headache - Lack of energy - Nausea and vomiting The fever, aches, and pains begin to go away on days 2 through 4. But new symptoms occur, including: - Dry cough - Increased symptoms that affect breathing - Runny nose (clear and watery) - Sneezing - Sore throat Most symptoms go away in 4 to 7 days. The cough and tired feeling may last for weeks. Sometimes, the fever comes back. Some people may not feel like eating. The flu can make asthma, breathing problems, and other long-term (chronic) illnesses and conditions worse. Most people do not need to see a health care provider when they have flu symptoms. This is because most people are not at risk for a severe case of the flu. If you are very sick with the flu, you may want to see your provider. People who are at high risk for flu complications may also want to see a provider if they get the flu. When many people in an area have flu, a provider can make a diagnosis after hearing about your symptoms. No further testing is needed. There is a test to detect the flu. It is done by swabbing the nose or throat. Most of the time, test results are available very fast. The test can help your provider prescribe the best treatment. HOME CARE Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) help lower fever. Providers sometimes suggest you to use both types of medicine. DO NOT use aspirin. A fever does not need to come all the way down to normal. Most people feel better when the temperature drops by 1 degree. Over-the-counter cold medicines may make some of your symptoms better. Cough drops or throat sprays will help with your sore throat. You will need a lot of rest. Drink plenty of liquids. DO NOT smoke or drink alcohol. ANTIVIRAL DRUGS Most people with milder symptoms feel better in 3 to 4 days. They do not need to see a provider or take antiviral medicines. Providers may give antiviral drugs to people who get very sick with the flu. You may need these medicines if you are more likely to have flu complications The health problems below may increase your risk of getting sicker with the flu: - Lung disease (including asthma) - Heart conditions (except high blood pressure) - Kidney, liver, nerve, and muscle conditions - Blood disorders (including sickle cell disease) - Diabetes - A weakened immune system due to diseases (such as AIDS), radiation therapy, or certain medicines, including chemotherapy and corticosteroids - Other long-term medical problem These medicines may shorten the time you have symptoms by about 1 day. They work better if you start taking them within 2 days of your first symptoms. Children at risk of a severe case of the flu may also need these medicines. Millions of people in the United States get the flu each year. Most people get better within a week or two, but thousands of people with the flu develop pneumonia or a brain infection. They need to stay in the hospital. About 36,000 people in the United States die each year of problems from the flu. Anyone at any age can have serious complications from the flu. Those at highest risk include: - People over the age of 65 - Children younger than 2 years old - Women who are more than 3 months pregnant - Anyone living in a long-term care facility - Anyone with chronic heart, lung, or kidney conditions, diabetes, or a weakened immune system Complications may include: - Pneumonia - Encephalitis (infection of the brain) - Meningitis - Seizures Call your provider if you get the flu and think you are at risk for having complications. Also, call your provider if your flu symptoms are very bad and self-treatment is not working. You can take steps to avoid catching or spreading the flu. The best step is to get a flu vaccine. If you have the flu: - Stay in your apartment, dorm room, or home for at least 24 hours after your fever has gone. - Wear a mask if you leave your room. - Avoid sharing food, utensils, cups, or bottles. - Use hand sanitizer often during the day and always after touching your face. - Cover your mouth with a tissue when coughing and throw it away after use. - Cough into your sleeve if a tissue is not available. Avoid touching your eyes, nose, and mouth. The Centers for Disease Control and Prevention (CDC) recommends that everyone 6 months and older should receive the influenza vaccine. For the 2016-2017 season, CDC recommends use of the flu shot (inactivated influenza vaccine or IIV) and the recombinant influenza vaccine (RIV). The nasal spray flu vaccine (live attenuated influenza vaccine or LAIV) should not be used during 2016-2017. Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000080.htm"
+  ],
+  [
+    "Swine flu (H1N1 flu) (Symptoms): H1N1 flu signs and symptoms in humans are similar to those of other flu strains: - Fever (but not always) - Cough - Sore throat - Runny or stuffy nose - Watery, red eyes - Body aches - Headache - Fatigue - Diarrhea - Nausea and vomiting H1N1 flu symptoms develop about one to three days after you're exposed to the virus. When to see a doctor It's not necessary to see a doctor if you're generally healthy and develop flu signs and symptoms, such as fever, cough and body aches. Call your doctor, however, if you have flu symptoms and you're pregnant or you have a chronic disease, such as asthma, emphysema, diabetes or a heart condition, because you have a higher risk of complications from the flu.",
+    "https://www.mayoclinic.org/diseases-conditions/swine-flu/symptoms-causes/syc-20378103"
+  ],
+  [
+    "Seasonal affective disorder (SAD): Seasonal affective disorder (SAD) is a type of depression that's related to changes in seasons - SAD begins and ends at about the same times every year. If you're like most people with SAD, your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody. Less often, SAD causes depression in the spring or early summer. Treatment for SAD may include light therapy (phototherapy), medications and psychotherapy. Don't brush off that yearly feeling as simply a case of the \"winter blues\" or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year. In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. Less commonly, people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses. Signs and symptoms of SAD may include: - Feeling depressed most of the day, nearly every day - Losing interest in activities you once enjoyed - Having low energy - Having problems with sleeping - Experiencing changes in your appetite or weight - Feeling sluggish or agitated - Having difficulty concentrating - Feeling hopeless, worthless or guilty - Having frequent thoughts of death or suicide Fall and winter SAD Symptoms specific to winter-onset SAD, sometimes called winter depression, may include: - Oversleeping - Appetite changes, especially a craving for foods high in carbohydrates - Weight gain - Tiredness or low energy Spring and summer SAD Symptoms specific to summer-onset seasonal affective disorder, sometimes called summer depression, may include: - Trouble sleeping (insomnia) - Poor appetite - Weight loss - Agitation or anxiety Seasonal changes in bipolar disorder In some people with bipolar disorder, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania), and fall and winter can be a time of depression. When to see a doctor It's normal to have some days when you feel down. But if you feel down for days at a time and you can't get motivated to do activities you normally enjoy, see your doctor. This is especially important if your sleep patterns and appetite have changed, you turn to alcohol for comfort or relaxation, or you feel hopeless or think about suicide. The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include: - Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression. - Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression. - Melatonin levels. The change in season can disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood. Seasonal affective disorder is diagnosed more often in women than in men. And SAD occurs more frequently in younger adults than in older adults. Factors that may increase your risk of seasonal affective disorder include: - Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression. - Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions. - Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months. Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health professional to diagnose seasonal affective disorder because other types of depression or other mental health conditions can cause similar symptoms. To help diagnose SAD, your doctor or mental health professional may do a thorough evaluation, which generally includes: - Physical exam. Your doctor may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem. - Lab tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it's functioning properly. - Psychological evaluation. To check for signs of depression, your doctor or mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may fill out a questionnaire to help answer these questions. - DSM-5. Your mental health professional may use the criteria for seasonal depressive episodes listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, tell your doctor - this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode. Light therapy In light therapy, also called phototherapy, you sit a few feet from a special light box so that you're exposed to bright light within the first hour of waking up each day. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood. Light therapy is one of the first line treatments for fall-onset SAD. It generally starts working in a few days to a few weeks and causes few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving SAD symptoms. Before you purchase a light box, talk with your doctor about the best one for you, and familiarize yourself with the variety of features and options so that you buy a high-quality product that's safe and effective. Also ask your doctor about how and when to use the light box. Medications Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe. An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants also may commonly be used to treat SAD. Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away. Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects. Psychotherapy Psychotherapy, also called talk therapy, is another option to treat SAD. A type of psychotherapy known as cognitive behavioral therapy can help you: - Identify and change negative thoughts and behaviors that may be making you feel worse - Learn healthy ways to cope with SAD, especially with reducing avoidance behavior and scheduling activities - Learn how to manage stress Mind-body connection Examples of mind-body techniques that some people may choose to try to help cope with SAD include: - Relaxation techniques such as yoga or tai chi - Meditation - Guided imagery - Music or art therapy In addition to your treatment plan for seasonal affective disorder: - Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office. - Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help - especially if you spend some time outside within two hours of getting up in the morning. - Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood. Certain herbal remedies, supplements or mind-body techniques are sometimes used to try to relieve depression symptoms, though it's not clear how effective these treatments are for seasonal affective disorder. Herbal remedies and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are, so you can't always be certain of what you're getting and whether it's safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your doctor or pharmacist before taking any supplements. Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. When it comes to depression, alternative treatments aren't a substitute for medical care.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "How to diagnose Seasonal affective disorder?: There is no test for SAD. Your health care provider can make a diagnosis by asking about your history of symptoms. Your provider may also perform a physical exam and blood tests to rule out other disorders that are similar to SAD.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/001532.htm"
+  ],
+  [
+    "IMH \u00bb Seasonal Affective Disorder: Seasonal Affective Disorder (SAD) is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer. Depressive episodes linked to the summer can occur, but are much less common than winter episodes of SAD. Seasonal Affective Disorder (SAD) is not considered as a separate disorder. It is a type of depression displaying a recurring seasonal pattern. To be diagnosed with SAD, people must meet full criteria for major depression coinciding with specific seasons (appearing in the winter or summer months) for at least 2 years. Seasonal depressions must be much more frequent than any non-seasonal depressions. Symptoms of Major Depression - Feeling depressed most of the day, nearly every day - Feeling hopeless or worthless - Having low energy - Losing interest in activities you once enjoyed - Having problems with sleep - Experiencing changes in your appetite or weight - Feeling sluggish or agitated - Having difficulty concentrating - Having frequent thoughts of death or suicide. Symptoms of the Winter Pattern of SAD include: - Having low energy - Hypersomnia - Overeating - Weight gain - Craving for carbohydrates - Social withdrawal (feel like \u201chibernating\u201d) Symptoms of the less frequently occurring summer seasonal affective disorder include: - Poor appetite with associated weight loss - Insomnia - Agitation - Restlessness - Anxiety - Episodes of violent behavior Attributes that may increase your risk of SAD include: - Being female. SAD is diagnosed four times\u00a0 more often in women than men. - Living far from the equator. SAD is more frequent in people who live far north or south of the equator. For example, 1 percent of those who live in Florida and 9 percent of those who live in New England or Alaska suffer from SAD.\u00a0 - Family history. People with a family history of other types of depression are more likely to develop SAD than people who do not have a family history of depression. - Having depression or bipolar disorder. The symptoms of depression may worsen with the seasons if you have one of these conditions (but SAD is diagnosed only if seasonal depressions are the most common). - Younger Age. Younger adults have a higher risk of SAD than older adults. SAD has been reported even in children and teens. The causes of SAD are unknown, but research has found some biological clues:\u00a0 - People with SAD may have trouble regulating one of the key neurotransmitters involved in mood, serotonin. One study found that people with SAD have 5 percent more serotonin transporter protein in winter months than summer months. Higher serotonin transporter protein leaves less serotonin available at the synapse because the function of the transporter is to recycle neurotransmitter back into the pre-synaptic neuron. - People with SAD may overproduce the hormone melatonin. Darkness increases production of melatonin, which regulates sleep. As winter days become shorter, melatonin production increases, leaving people with SAD to feel sleepier and more lethargic, often with delayed circadian rhythms. - People with SAD also may produce less Vitamin D. Vitamin D is believed to play a role in serotonin activity. Vitamin D insufficiency may be associated with clinically significant depression symptoms. There are four major types of treatment for SAD: - Medication - Light therapy - Psychotherapy - Vitamin D \u00a0These may be used alone or in combination. Medication Selective Serotonin Reuptake Inhibitors (SSRIs) are used to treat SAD. The FDA has also approved the use of bupropion\u00a0, another type of antidepressant, for treating SAD. As with other medications, there are side effects to SSRIs. Talk to your doctor about the possible risks of using this medication for your condition. You may need to try several different antidepressant medications before finding the one that improves your symptoms without causing problematic side effects. For basic information about SSRIs and other mental health medications, visit NIMH\u2019s Medications webpage. Check the FDA\u2019s website\u00a0 for the latest information on warnings, patient medication guides, or newly approved medications. Light Therapy Light therapy has been a mainstay of treatment for SAD since the 1980s. The idea behind light therapy is to replace the diminished sunshine of the fall and winter months using daily exposure to bright, artificial light. Symptoms of SAD may be relieved by sitting in front of a light box first thing in the morning, on a daily basis from the early fall until spring. Most typically, light boxes filter out the ultraviolet rays and require 20-60 minutes of exposure to 10,000 lux of cool-white fluorescent light, an amount that is about 20 times greater than ordinary indoor lighting. Psychotherapy Cognitive behavioral therapy (CBT) is type of psychotherapy that is effective for SAD. Traditional cognitive behavioral therapy has been adapted for use with SAD (CBT-SAD). CBT-SAD relies on basic techniques of CBT such as identifying negative thoughts and replacing them with more positive thoughts along with a technique called behavioral activation. Behavioral activation seeks to help the person identify activities that are engaging and pleasurable, whether indoors or outdoors, to improve coping with winter. Vitamin D At present, vitamin D supplementation by itself is not regarded as an effective SAD treatment. The reason behind its use is that low blood levels of vitamin D were found in people with SAD. The low levels are usually due to insufficient dietary intake or insufficient exposure to sunshine. However, the evidence for its use has been mixed. While some studies suggest vitamin D supplementation may be as effective as light therapy, others found vitamin D had no effect\u00a0.",
+    "https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Risk factors): Seasonal affective disorder is diagnosed more often in women than in men. And SAD occurs more frequently in younger adults than in older adults. Factors that may increase your risk of seasonal affective disorder include: - Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression. - Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions. - Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "IMH \u00bb Seasonal Affective Disorder (Signs and Symptoms): Seasonal Affective Disorder (SAD) is not considered as a separate disorder. It is a type of depression displaying a recurring seasonal pattern. To be diagnosed with SAD, people must meet full criteria for major depression coinciding with specific seasons (appearing in the winter or summer months) for at least 2 years. Seasonal depressions must be much more frequent than any non-seasonal depressions. Symptoms of Major Depression - Feeling depressed most of the day, nearly every day - Feeling hopeless or worthless - Having low energy - Losing interest in activities you once enjoyed - Having problems with sleep - Experiencing changes in your appetite or weight - Feeling sluggish or agitated - Having difficulty concentrating - Having frequent thoughts of death or suicide. Symptoms of the Winter Pattern of SAD include: - Having low energy - Hypersomnia - Overeating - Weight gain - Craving for carbohydrates - Social withdrawal (feel like \u201chibernating\u201d) Symptoms of the less frequently occurring summer seasonal affective disorder include: - Poor appetite with associated weight loss - Insomnia - Agitation - Restlessness - Anxiety - Episodes of violent behavior",
+    "https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml"
+  ],
+  [
+    "Seasonal affective disorder: Seasonal affective disorder (SAD) is a type of depression that occurs at a certain time of the year, usually in winter. SAD may begin during the teen years or in adulthood. Like other forms of depression, it occurs more often in women than in men. People who live in places with long winter nights are at high risk of developing SAD. A less common form of the disorder involves depression during the summer months. Symptoms usually build up slowly in the late autumn and winter months. Symptoms are often the same as with other forms of depression: - Hopelessness - Increased appetite with weight gain (weight loss is more common with other forms of depression) - Increased sleep (too little sleep is more common with other forms of depression) - Less energy and ability to concentrate - Loss of interest in work or other activities - Sluggish movements - Social withdrawal - Unhappiness and irritability SAD can sometimes become long-term depression. Bipolar disorder or thoughts of suicide are also possible. There is no test for SAD. Your health care provider can make a diagnosis by asking about your history of symptoms. Your provider may also perform a physical exam and blood tests to rule out other disorders that are similar to SAD. As with other types of depression, antidepressant medicines and talk therapy can be effective. MANAGING YOUR DEPRESSION AT HOME To manage your symptoms at home: - Get enough sleep. - Eat healthy foods. - Take medicines the right way. Ask your provider how to manage side effects. - Learn to watch for early signs that your depression is getting worse. Have a plan if it does get worse. - Try to exercise more often. Do activities that make you happy. DO NOT use alcohol or illegal drugs. These can make depression worse. They can also cause you to think about suicide. When you are struggling with depression, talk about how you are feeling with someone you trust. Try to be around people who are caring and positive. Volunteer or get involved in group activities. LIGHT THERAPY Your provider may prescribe light therapy. Light therapy uses a special lamp with a very bright light that mimics light from the sun: - Treatment is started in the fall or early winter, before the symptoms of SAD begin. - Follow your provider's instructions about how to use light therapy. One way that may be recommended is to sit a couple of feet (60 centimeters) away from the light box for about 30 minutes each day. This is often done in the early morning, to mimic sunrise. - Keep your eyes open, but do not look straight into the light source. If light therapy is going to help, symptoms of depression should improve within 3 to 4 weeks. Side effects of light therapy include: - Eye strain or headache - Mania (rarely) People who take medicines that make them more sensitive to light, such as certain psoriasis drugs, antibiotics, or antipsychotics, should not use light therapy. A checkup with your eye doctor is recommended before starting treatment. With no treatment, symptoms usually get better on their own with the change of seasons. Symptoms can improve more quickly with treatment. The outcome is usually good with treatment. But some people have SAD throughout their lives. Get medical help right away if you have thoughts of hurting yourself or anyone else. Updated by: Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/001532.htm"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Alternative medicine): Certain herbal remedies, supplements or mind-body techniques are sometimes used to try to relieve depression symptoms, though it's not clear how effective these treatments are for seasonal affective disorder. Herbal remedies and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are, so you can't always be certain of what you're getting and whether it's safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your doctor or pharmacist before taking any supplements. Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. When it comes to depression, alternative treatments aren't a substitute for medical care.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Causes): The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include: - Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression. - Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression. - Melatonin levels. The change in season can disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Risk factors): Seasonal affective disorder is diagnosed more often in women than in men. And SAD occurs more frequently in younger adults than in older adults. Factors that may increase your risk of seasonal affective disorder include: - Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression. - Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions. - Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "How to diagnose Seasonal affective disorder?: There is no test for SAD. Your health care provider can make a diagnosis by asking about your history of symptoms. Your provider may also perform a physical exam and blood tests to rule out other disorders that are similar to SAD.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/001532.htm"
+  ],
+  [
+    "IMH \u00bb Seasonal Affective Disorder (Signs and Symptoms): Seasonal Affective Disorder (SAD) is not considered as a separate disorder. It is a type of depression displaying a recurring seasonal pattern. To be diagnosed with SAD, people must meet full criteria for major depression coinciding with specific seasons (appearing in the winter or summer months) for at least 2 years. Seasonal depressions must be much more frequent than any non-seasonal depressions. Symptoms of Major Depression - Feeling depressed most of the day, nearly every day - Feeling hopeless or worthless - Having low energy - Losing interest in activities you once enjoyed - Having problems with sleep - Experiencing changes in your appetite or weight - Feeling sluggish or agitated - Having difficulty concentrating - Having frequent thoughts of death or suicide. Symptoms of the Winter Pattern of SAD include: - Having low energy - Hypersomnia - Overeating - Weight gain - Craving for carbohydrates - Social withdrawal (feel like \u201chibernating\u201d) Symptoms of the less frequently occurring summer seasonal affective disorder include: - Poor appetite with associated weight loss - Insomnia - Agitation - Restlessness - Anxiety - Episodes of violent behavior",
+    "https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml"
+  ],
+  [
+    "IMH \u00bb Seasonal Affective Disorder (Overview): Seasonal Affective Disorder (SAD) is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer. Depressive episodes linked to the summer can occur, but are much less common than winter episodes of SAD.",
+    "https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml"
+  ],
+  [
+    "Seasonal affective disorder (SAD): Seasonal affective disorder (SAD) is a type of depression that's related to changes in seasons - SAD begins and ends at about the same times every year. If you're like most people with SAD, your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody. Less often, SAD causes depression in the spring or early summer. Treatment for SAD may include light therapy (phototherapy), medications and psychotherapy. Don't brush off that yearly feeling as simply a case of the \"winter blues\" or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year. In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. Less commonly, people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses. Signs and symptoms of SAD may include: - Feeling depressed most of the day, nearly every day - Losing interest in activities you once enjoyed - Having low energy - Having problems with sleeping - Experiencing changes in your appetite or weight - Feeling sluggish or agitated - Having difficulty concentrating - Feeling hopeless, worthless or guilty - Having frequent thoughts of death or suicide Fall and winter SAD Symptoms specific to winter-onset SAD, sometimes called winter depression, may include: - Oversleeping - Appetite changes, especially a craving for foods high in carbohydrates - Weight gain - Tiredness or low energy Spring and summer SAD Symptoms specific to summer-onset seasonal affective disorder, sometimes called summer depression, may include: - Trouble sleeping (insomnia) - Poor appetite - Weight loss - Agitation or anxiety Seasonal changes in bipolar disorder In some people with bipolar disorder, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania), and fall and winter can be a time of depression. When to see a doctor It's normal to have some days when you feel down. But if you feel down for days at a time and you can't get motivated to do activities you normally enjoy, see your doctor. This is especially important if your sleep patterns and appetite have changed, you turn to alcohol for comfort or relaxation, or you feel hopeless or think about suicide. The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include: - Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression. - Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression. - Melatonin levels. The change in season can disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood. Seasonal affective disorder is diagnosed more often in women than in men. And SAD occurs more frequently in younger adults than in older adults. Factors that may increase your risk of seasonal affective disorder include: - Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression. - Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions. - Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months. Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health professional to diagnose seasonal affective disorder because other types of depression or other mental health conditions can cause similar symptoms. To help diagnose SAD, your doctor or mental health professional may do a thorough evaluation, which generally includes: - Physical exam. Your doctor may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem. - Lab tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it's functioning properly. - Psychological evaluation. To check for signs of depression, your doctor or mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may fill out a questionnaire to help answer these questions. - DSM-5. Your mental health professional may use the criteria for seasonal depressive episodes listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, tell your doctor - this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode. Light therapy In light therapy, also called phototherapy, you sit a few feet from a special light box so that you're exposed to bright light within the first hour of waking up each day. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood. Light therapy is one of the first line treatments for fall-onset SAD. It generally starts working in a few days to a few weeks and causes few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving SAD symptoms. Before you purchase a light box, talk with your doctor about the best one for you, and familiarize yourself with the variety of features and options so that you buy a high-quality product that's safe and effective. Also ask your doctor about how and when to use the light box. Medications Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe. An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants also may commonly be used to treat SAD. Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away. Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects. Psychotherapy Psychotherapy, also called talk therapy, is another option to treat SAD. A type of psychotherapy known as cognitive behavioral therapy can help you: - Identify and change negative thoughts and behaviors that may be making you feel worse - Learn healthy ways to cope with SAD, especially with reducing avoidance behavior and scheduling activities - Learn how to manage stress Mind-body connection Examples of mind-body techniques that some people may choose to try to help cope with SAD include: - Relaxation techniques such as yoga or tai chi - Meditation - Guided imagery - Music or art therapy In addition to your treatment plan for seasonal affective disorder: - Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office. - Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help - especially if you spend some time outside within two hours of getting up in the morning. - Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood. Certain herbal remedies, supplements or mind-body techniques are sometimes used to try to relieve depression symptoms, though it's not clear how effective these treatments are for seasonal affective disorder. Herbal remedies and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are, so you can't always be certain of what you're getting and whether it's safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your doctor or pharmacist before taking any supplements. Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. When it comes to depression, alternative treatments aren't a substitute for medical care.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Alternative medicine): Certain herbal remedies, supplements or mind-body techniques are sometimes used to try to relieve depression symptoms, though it's not clear how effective these treatments are for seasonal affective disorder. Herbal remedies and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are, so you can't always be certain of what you're getting and whether it's safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your doctor or pharmacist before taking any supplements. Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. When it comes to depression, alternative treatments aren't a substitute for medical care.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Causes): The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include: - Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression. - Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression. - Melatonin levels. The change in season can disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Lifestyle and home remedies): In addition to your treatment plan for seasonal affective disorder: - Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office. - Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help - especially if you spend some time outside within two hours of getting up in the morning. - Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Diagnosis): Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health professional to diagnose seasonal affective disorder because other types of depression or other mental health conditions can cause similar symptoms. To help diagnose SAD, your doctor or mental health professional may do a thorough evaluation, which generally includes: - Physical exam. Your doctor may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem. - Lab tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it's functioning properly. - Psychological evaluation. To check for signs of depression, your doctor or mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may fill out a questionnaire to help answer these questions. - DSM-5. Your mental health professional may use the criteria for seasonal depressive episodes listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "IMH \u00bb Seasonal Affective Disorder (Signs and Symptoms): Seasonal Affective Disorder (SAD) is not considered as a separate disorder. It is a type of depression displaying a recurring seasonal pattern. To be diagnosed with SAD, people must meet full criteria for major depression coinciding with specific seasons (appearing in the winter or summer months) for at least 2 years. Seasonal depressions must be much more frequent than any non-seasonal depressions. Symptoms of Major Depression - Feeling depressed most of the day, nearly every day - Feeling hopeless or worthless - Having low energy - Losing interest in activities you once enjoyed - Having problems with sleep - Experiencing changes in your appetite or weight - Feeling sluggish or agitated - Having difficulty concentrating - Having frequent thoughts of death or suicide. Symptoms of the Winter Pattern of SAD include: - Having low energy - Hypersomnia - Overeating - Weight gain - Craving for carbohydrates - Social withdrawal (feel like \u201chibernating\u201d) Symptoms of the less frequently occurring summer seasonal affective disorder include: - Poor appetite with associated weight loss - Insomnia - Agitation - Restlessness - Anxiety - Episodes of violent behavior",
+    "https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml"
+  ],
+  [
+    "What are the symptoms of Seasonal affective disorder?: Symptoms usually build up slowly in the late autumn and winter months. Symptoms are usually the same as with other forms of depression: - Hopelessness - Increased appetite with weight gain (weight loss is more common with other forms of depression) - Increased sleep (too little sleep is more common with other forms of depression) - Less energy and ability to concentrate - Loss of interest in work or other activities - Sluggish movements - Social withdrawal - Unhappiness and irritability SAD can sometimes become long-term depression. Bipolar disorder or thoughts of suicide are also possible.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/001532.htm"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Risk factors): Seasonal affective disorder is diagnosed more often in women than in men. And SAD occurs more frequently in younger adults than in older adults. Factors that may increase your risk of seasonal affective disorder include: - Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression. - Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions. - Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD): Seasonal affective disorder (SAD) is a type of depression that's related to changes in seasons - SAD begins and ends at about the same times every year. If you're like most people with SAD, your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody. Less often, SAD causes depression in the spring or early summer. Treatment for SAD may include light therapy (phototherapy), medications and psychotherapy. Don't brush off that yearly feeling as simply a case of the \"winter blues\" or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year. In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. Less commonly, people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses. Signs and symptoms of SAD may include: - Feeling depressed most of the day, nearly every day - Losing interest in activities you once enjoyed - Having low energy - Having problems with sleeping - Experiencing changes in your appetite or weight - Feeling sluggish or agitated - Having difficulty concentrating - Feeling hopeless, worthless or guilty - Having frequent thoughts of death or suicide Fall and winter SAD Symptoms specific to winter-onset SAD, sometimes called winter depression, may include: - Oversleeping - Appetite changes, especially a craving for foods high in carbohydrates - Weight gain - Tiredness or low energy Spring and summer SAD Symptoms specific to summer-onset seasonal affective disorder, sometimes called summer depression, may include: - Trouble sleeping (insomnia) - Poor appetite - Weight loss - Agitation or anxiety Seasonal changes in bipolar disorder In some people with bipolar disorder, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania), and fall and winter can be a time of depression. When to see a doctor It's normal to have some days when you feel down. But if you feel down for days at a time and you can't get motivated to do activities you normally enjoy, see your doctor. This is especially important if your sleep patterns and appetite have changed, you turn to alcohol for comfort or relaxation, or you feel hopeless or think about suicide. The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include: - Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression. - Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression. - Melatonin levels. The change in season can disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood. Seasonal affective disorder is diagnosed more often in women than in men. And SAD occurs more frequently in younger adults than in older adults. Factors that may increase your risk of seasonal affective disorder include: - Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression. - Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions. - Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months. Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health professional to diagnose seasonal affective disorder because other types of depression or other mental health conditions can cause similar symptoms. To help diagnose SAD, your doctor or mental health professional may do a thorough evaluation, which generally includes: - Physical exam. Your doctor may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem. - Lab tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it's functioning properly. - Psychological evaluation. To check for signs of depression, your doctor or mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may fill out a questionnaire to help answer these questions. - DSM-5. Your mental health professional may use the criteria for seasonal depressive episodes listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, tell your doctor - this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode. Light therapy In light therapy, also called phototherapy, you sit a few feet from a special light box so that you're exposed to bright light within the first hour of waking up each day. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood. Light therapy is one of the first line treatments for fall-onset SAD. It generally starts working in a few days to a few weeks and causes few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving SAD symptoms. Before you purchase a light box, talk with your doctor about the best one for you, and familiarize yourself with the variety of features and options so that you buy a high-quality product that's safe and effective. Also ask your doctor about how and when to use the light box. Medications Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe. An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants also may commonly be used to treat SAD. Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away. Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects. Psychotherapy Psychotherapy, also called talk therapy, is another option to treat SAD. A type of psychotherapy known as cognitive behavioral therapy can help you: - Identify and change negative thoughts and behaviors that may be making you feel worse - Learn healthy ways to cope with SAD, especially with reducing avoidance behavior and scheduling activities - Learn how to manage stress Mind-body connection Examples of mind-body techniques that some people may choose to try to help cope with SAD include: - Relaxation techniques such as yoga or tai chi - Meditation - Guided imagery - Music or art therapy In addition to your treatment plan for seasonal affective disorder: - Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office. - Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help - especially if you spend some time outside within two hours of getting up in the morning. - Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood. Certain herbal remedies, supplements or mind-body techniques are sometimes used to try to relieve depression symptoms, though it's not clear how effective these treatments are for seasonal affective disorder. Herbal remedies and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are, so you can't always be certain of what you're getting and whether it's safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your doctor or pharmacist before taking any supplements. Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. When it comes to depression, alternative treatments aren't a substitute for medical care.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "IMH \u00bb Seasonal Affective Disorder (Overview): Seasonal Affective Disorder (SAD) is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer. Depressive episodes linked to the summer can occur, but are much less common than winter episodes of SAD.",
+    "https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Alternative medicine): Certain herbal remedies, supplements or mind-body techniques are sometimes used to try to relieve depression symptoms, though it's not clear how effective these treatments are for seasonal affective disorder. Herbal remedies and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are, so you can't always be certain of what you're getting and whether it's safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your doctor or pharmacist before taking any supplements. Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. When it comes to depression, alternative treatments aren't a substitute for medical care.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Lifestyle and home remedies): In addition to your treatment plan for seasonal affective disorder: - Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office. - Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help - especially if you spend some time outside within two hours of getting up in the morning. - Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Diagnosis): Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health professional to diagnose seasonal affective disorder because other types of depression or other mental health conditions can cause similar symptoms. To help diagnose SAD, your doctor or mental health professional may do a thorough evaluation, which generally includes: - Physical exam. Your doctor may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem. - Lab tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it's functioning properly. - Psychological evaluation. To check for signs of depression, your doctor or mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may fill out a questionnaire to help answer these questions. - DSM-5. Your mental health professional may use the criteria for seasonal depressive episodes listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Causes): The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include: - Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression. - Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression. - Melatonin levels. The change in season can disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Treatment): Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, tell your doctor - this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode. Light therapy In light therapy, also called phototherapy, you sit a few feet from a special light box so that you're exposed to bright light within the first hour of waking up each day. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood. Light therapy is one of the first line treatments for fall-onset SAD. It generally starts working in a few days to a few weeks and causes few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving SAD symptoms. Before you purchase a light box, talk with your doctor about the best one for you, and familiarize yourself with the variety of features and options so that you buy a high-quality product that's safe and effective. Also ask your doctor about how and when to use the light box. Medications Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe. An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants also may commonly be used to treat SAD. Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away. Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects. Psychotherapy Psychotherapy, also called talk therapy, is another option to treat SAD. A type of psychotherapy known as cognitive behavioral therapy can help you: - Identify and change negative thoughts and behaviors that may be making you feel worse - Learn healthy ways to cope with SAD, especially with reducing avoidance behavior and scheduling activities - Learn how to manage stress Mind-body connection Examples of mind-body techniques that some people may choose to try to help cope with SAD include: - Relaxation techniques such as yoga or tai chi - Meditation - Guided imagery - Music or art therapy",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "What are the treatments for Seasonal affective disorder?: As with other types of depression, antidepressant medicines and talk therapy can be effective. MANAGING YOUR DEPRESSION AT HOME To manage your symptoms at home: - Get enough sleep. - Eat healthy foods. - Take medicines the right way. Ask your provider how to manage side effects. - Learn to watch for early signs that your depression is getting worse. Have a plan if it does get worse. - Try to exercise more often. Do activities that make you happy. DO NOT use alcohol or illegal drugs. These can make depression worse. They can also cause you to think about suicide. When you are struggling with depression, talk about how you are feeling with someone you trust. Try to be around people who are caring and positive. Volunteer or get involved in group activities. LIGHT THERAPY Your provider may prescribe light therapy. Light therapy uses a special lamp with a very bright light that mimics light from the sun: - Treatment is started in the fall or early winter, before the symptoms of SAD begin. - Follow your provider's instructions about how to use light therapy. One way that may be recommended is to sit a couple of feet away from the light box for about 30 minutes each day. This is usually done in the early morning, to mimic sunrise. - Keep your eyes open, but do not look straight into the light source. If light therapy is going to help, symptoms of depression should improve within 3 to 4 weeks. Side effects of light therapy include: - Eye strain or headache - Mania (rarely) People who take medicines that make them more sensitive to light, such as certain psoriasis drugs, antibiotics, or antipsychotics, should not use light therapy. A checkup with your eye doctor is recommended before starting treatment. With no treatment, symptoms usually get better on their own with the change of seasons. Symptoms can improve more quickly with treatment.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/001532.htm"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Risk factors): Seasonal affective disorder is diagnosed more often in women than in men. And SAD occurs more frequently in younger adults than in older adults. Factors that may increase your risk of seasonal affective disorder include: - Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression. - Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions. - Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "IMH \u00bb Seasonal Affective Disorder (Signs and Symptoms): Seasonal Affective Disorder (SAD) is not considered as a separate disorder. It is a type of depression displaying a recurring seasonal pattern. To be diagnosed with SAD, people must meet full criteria for major depression coinciding with specific seasons (appearing in the winter or summer months) for at least 2 years. Seasonal depressions must be much more frequent than any non-seasonal depressions. Symptoms of Major Depression - Feeling depressed most of the day, nearly every day - Feeling hopeless or worthless - Having low energy - Losing interest in activities you once enjoyed - Having problems with sleep - Experiencing changes in your appetite or weight - Feeling sluggish or agitated - Having difficulty concentrating - Having frequent thoughts of death or suicide. Symptoms of the Winter Pattern of SAD include: - Having low energy - Hypersomnia - Overeating - Weight gain - Craving for carbohydrates - Social withdrawal (feel like \u201chibernating\u201d) Symptoms of the less frequently occurring summer seasonal affective disorder include: - Poor appetite with associated weight loss - Insomnia - Agitation - Restlessness - Anxiety - Episodes of violent behavior",
+    "https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml"
+  ],
+  [
+    "Seasonal affective disorder (SAD): Seasonal affective disorder (SAD) is a type of depression that's related to changes in seasons - SAD begins and ends at about the same times every year. If you're like most people with SAD, your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody. Less often, SAD causes depression in the spring or early summer. Treatment for SAD may include light therapy (phototherapy), medications and psychotherapy. Don't brush off that yearly feeling as simply a case of the \"winter blues\" or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year. In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. Less commonly, people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses. Signs and symptoms of SAD may include: - Feeling depressed most of the day, nearly every day - Losing interest in activities you once enjoyed - Having low energy - Having problems with sleeping - Experiencing changes in your appetite or weight - Feeling sluggish or agitated - Having difficulty concentrating - Feeling hopeless, worthless or guilty - Having frequent thoughts of death or suicide Fall and winter SAD Symptoms specific to winter-onset SAD, sometimes called winter depression, may include: - Oversleeping - Appetite changes, especially a craving for foods high in carbohydrates - Weight gain - Tiredness or low energy Spring and summer SAD Symptoms specific to summer-onset seasonal affective disorder, sometimes called summer depression, may include: - Trouble sleeping (insomnia) - Poor appetite - Weight loss - Agitation or anxiety Seasonal changes in bipolar disorder In some people with bipolar disorder, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania), and fall and winter can be a time of depression. When to see a doctor It's normal to have some days when you feel down. But if you feel down for days at a time and you can't get motivated to do activities you normally enjoy, see your doctor. This is especially important if your sleep patterns and appetite have changed, you turn to alcohol for comfort or relaxation, or you feel hopeless or think about suicide. The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include: - Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression. - Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression. - Melatonin levels. The change in season can disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood. Seasonal affective disorder is diagnosed more often in women than in men. And SAD occurs more frequently in younger adults than in older adults. Factors that may increase your risk of seasonal affective disorder include: - Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression. - Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions. - Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months. Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health professional to diagnose seasonal affective disorder because other types of depression or other mental health conditions can cause similar symptoms. To help diagnose SAD, your doctor or mental health professional may do a thorough evaluation, which generally includes: - Physical exam. Your doctor may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem. - Lab tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it's functioning properly. - Psychological evaluation. To check for signs of depression, your doctor or mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may fill out a questionnaire to help answer these questions. - DSM-5. Your mental health professional may use the criteria for seasonal depressive episodes listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, tell your doctor - this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode. Light therapy In light therapy, also called phototherapy, you sit a few feet from a special light box so that you're exposed to bright light within the first hour of waking up each day. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood. Light therapy is one of the first line treatments for fall-onset SAD. It generally starts working in a few days to a few weeks and causes few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving SAD symptoms. Before you purchase a light box, talk with your doctor about the best one for you, and familiarize yourself with the variety of features and options so that you buy a high-quality product that's safe and effective. Also ask your doctor about how and when to use the light box. Medications Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe. An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants also may commonly be used to treat SAD. Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away. Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects. Psychotherapy Psychotherapy, also called talk therapy, is another option to treat SAD. A type of psychotherapy known as cognitive behavioral therapy can help you: - Identify and change negative thoughts and behaviors that may be making you feel worse - Learn healthy ways to cope with SAD, especially with reducing avoidance behavior and scheduling activities - Learn how to manage stress Mind-body connection Examples of mind-body techniques that some people may choose to try to help cope with SAD include: - Relaxation techniques such as yoga or tai chi - Meditation - Guided imagery - Music or art therapy In addition to your treatment plan for seasonal affective disorder: - Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office. - Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help - especially if you spend some time outside within two hours of getting up in the morning. - Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood. Certain herbal remedies, supplements or mind-body techniques are sometimes used to try to relieve depression symptoms, though it's not clear how effective these treatments are for seasonal affective disorder. Herbal remedies and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are, so you can't always be certain of what you're getting and whether it's safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your doctor or pharmacist before taking any supplements. Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. When it comes to depression, alternative treatments aren't a substitute for medical care.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "IMH \u00bb Seasonal Affective Disorder (Overview): Seasonal Affective Disorder (SAD) is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer. Depressive episodes linked to the summer can occur, but are much less common than winter episodes of SAD.",
+    "https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Alternative medicine): Certain herbal remedies, supplements or mind-body techniques are sometimes used to try to relieve depression symptoms, though it's not clear how effective these treatments are for seasonal affective disorder. Herbal remedies and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are, so you can't always be certain of what you're getting and whether it's safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your doctor or pharmacist before taking any supplements. Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. When it comes to depression, alternative treatments aren't a substitute for medical care.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Lifestyle and home remedies): In addition to your treatment plan for seasonal affective disorder: - Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office. - Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help - especially if you spend some time outside within two hours of getting up in the morning. - Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Causes): The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include: - Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression. - Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression. - Melatonin levels. The change in season can disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Diagnosis): Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health professional to diagnose seasonal affective disorder because other types of depression or other mental health conditions can cause similar symptoms. To help diagnose SAD, your doctor or mental health professional may do a thorough evaluation, which generally includes: - Physical exam. Your doctor may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem. - Lab tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it's functioning properly. - Psychological evaluation. To check for signs of depression, your doctor or mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may fill out a questionnaire to help answer these questions. - DSM-5. Your mental health professional may use the criteria for seasonal depressive episodes listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "How to diagnose Seasonal affective disorder?: There is no test for SAD. Your health care provider can make a diagnosis by asking about your history of symptoms. Your provider may also perform a physical exam and blood tests to rule out other disorders that are similar to SAD.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/001532.htm"
+  ],
+  [
+    "Seasonal affective disorder (SAD): Seasonal affective disorder (SAD) is a type of depression that's related to changes in seasons - SAD begins and ends at about the same times every year. If you're like most people with SAD, your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody. Less often, SAD causes depression in the spring or early summer. Treatment for SAD may include light therapy (phototherapy), medications and psychotherapy. Don't brush off that yearly feeling as simply a case of the \"winter blues\" or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year. In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. Less commonly, people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses. Signs and symptoms of SAD may include: - Feeling depressed most of the day, nearly every day - Losing interest in activities you once enjoyed - Having low energy - Having problems with sleeping - Experiencing changes in your appetite or weight - Feeling sluggish or agitated - Having difficulty concentrating - Feeling hopeless, worthless or guilty - Having frequent thoughts of death or suicide Fall and winter SAD Symptoms specific to winter-onset SAD, sometimes called winter depression, may include: - Oversleeping - Appetite changes, especially a craving for foods high in carbohydrates - Weight gain - Tiredness or low energy Spring and summer SAD Symptoms specific to summer-onset seasonal affective disorder, sometimes called summer depression, may include: - Trouble sleeping (insomnia) - Poor appetite - Weight loss - Agitation or anxiety Seasonal changes in bipolar disorder In some people with bipolar disorder, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania), and fall and winter can be a time of depression. When to see a doctor It's normal to have some days when you feel down. But if you feel down for days at a time and you can't get motivated to do activities you normally enjoy, see your doctor. This is especially important if your sleep patterns and appetite have changed, you turn to alcohol for comfort or relaxation, or you feel hopeless or think about suicide. The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include: - Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression. - Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression. - Melatonin levels. The change in season can disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood. Seasonal affective disorder is diagnosed more often in women than in men. And SAD occurs more frequently in younger adults than in older adults. Factors that may increase your risk of seasonal affective disorder include: - Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression. - Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions. - Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months. Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health professional to diagnose seasonal affective disorder because other types of depression or other mental health conditions can cause similar symptoms. To help diagnose SAD, your doctor or mental health professional may do a thorough evaluation, which generally includes: - Physical exam. Your doctor may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem. - Lab tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it's functioning properly. - Psychological evaluation. To check for signs of depression, your doctor or mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may fill out a questionnaire to help answer these questions. - DSM-5. Your mental health professional may use the criteria for seasonal depressive episodes listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, tell your doctor - this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode. Light therapy In light therapy, also called phototherapy, you sit a few feet from a special light box so that you're exposed to bright light within the first hour of waking up each day. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood. Light therapy is one of the first line treatments for fall-onset SAD. It generally starts working in a few days to a few weeks and causes few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving SAD symptoms. Before you purchase a light box, talk with your doctor about the best one for you, and familiarize yourself with the variety of features and options so that you buy a high-quality product that's safe and effective. Also ask your doctor about how and when to use the light box. Medications Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe. An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants also may commonly be used to treat SAD. Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away. Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects. Psychotherapy Psychotherapy, also called talk therapy, is another option to treat SAD. A type of psychotherapy known as cognitive behavioral therapy can help you: - Identify and change negative thoughts and behaviors that may be making you feel worse - Learn healthy ways to cope with SAD, especially with reducing avoidance behavior and scheduling activities - Learn how to manage stress Mind-body connection Examples of mind-body techniques that some people may choose to try to help cope with SAD include: - Relaxation techniques such as yoga or tai chi - Meditation - Guided imagery - Music or art therapy In addition to your treatment plan for seasonal affective disorder: - Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office. - Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help - especially if you spend some time outside within two hours of getting up in the morning. - Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood. Certain herbal remedies, supplements or mind-body techniques are sometimes used to try to relieve depression symptoms, though it's not clear how effective these treatments are for seasonal affective disorder. Herbal remedies and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are, so you can't always be certain of what you're getting and whether it's safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your doctor or pharmacist before taking any supplements. Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. When it comes to depression, alternative treatments aren't a substitute for medical care.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Risk factors): Seasonal affective disorder is diagnosed more often in women than in men. And SAD occurs more frequently in younger adults than in older adults. Factors that may increase your risk of seasonal affective disorder include: - Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression. - Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions. - Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "IMH \u00bb Seasonal Affective Disorder (Signs and Symptoms): Seasonal Affective Disorder (SAD) is not considered as a separate disorder. It is a type of depression displaying a recurring seasonal pattern. To be diagnosed with SAD, people must meet full criteria for major depression coinciding with specific seasons (appearing in the winter or summer months) for at least 2 years. Seasonal depressions must be much more frequent than any non-seasonal depressions. Symptoms of Major Depression - Feeling depressed most of the day, nearly every day - Feeling hopeless or worthless - Having low energy - Losing interest in activities you once enjoyed - Having problems with sleep - Experiencing changes in your appetite or weight - Feeling sluggish or agitated - Having difficulty concentrating - Having frequent thoughts of death or suicide. Symptoms of the Winter Pattern of SAD include: - Having low energy - Hypersomnia - Overeating - Weight gain - Craving for carbohydrates - Social withdrawal (feel like \u201chibernating\u201d) Symptoms of the less frequently occurring summer seasonal affective disorder include: - Poor appetite with associated weight loss - Insomnia - Agitation - Restlessness - Anxiety - Episodes of violent behavior",
+    "https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml"
+  ],
+  [
+    "IMH \u00bb Seasonal Affective Disorder (Overview): Seasonal Affective Disorder (SAD) is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer. Depressive episodes linked to the summer can occur, but are much less common than winter episodes of SAD.",
+    "https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Alternative medicine): Certain herbal remedies, supplements or mind-body techniques are sometimes used to try to relieve depression symptoms, though it's not clear how effective these treatments are for seasonal affective disorder. Herbal remedies and dietary supplements aren't monitored by the Food and Drug Administration (FDA) the same way medications are, so you can't always be certain of what you're getting and whether it's safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your doctor or pharmacist before taking any supplements. Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. When it comes to depression, alternative treatments aren't a substitute for medical care.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Causes): The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include: - Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression. - Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression. - Melatonin levels. The change in season can disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Seasonal affective disorder (SAD) (Lifestyle and home remedies): In addition to your treatment plan for seasonal affective disorder: - Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office. - Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help - especially if you spend some time outside within two hours of getting up in the morning. - Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.",
+    "https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651"
+  ],
+  [
+    "Stroke: A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. Brain cells die when they no longer receive oxygen and nutrients from the blood or there is sudden bleeding into or around the brain. The symptoms of a stroke include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble with walking, dizziness, or loss of balance or coordination; or sudden severe headache with no known cause. There are two forms of stroke:\u00a0ischemic\u00a0- blockage of a blood vessel supplying the brain, and\u00a0hemorrhagic\u00a0- bleeding into or around the brain. Generally there are three treatment stages for stroke: prevention, therapy immediately after the stroke, and post-stroke rehabilitation. Therapies to prevent a first or recurrent stroke are based on treating an individual's underlying risk factors for stroke, such as hypertension, atrial fibrillation, and diabetes. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Medication or drug therapy is the most common treatment for stroke. The most popular classes of drugs used to prevent or treat stroke are antithrombotics (antiplatelet agents and anticoagulants) and thrombolytics. Although stroke is a disease of the brain, it can affect the entire body. A common disability that results from stroke is complete paralysis on one side of the body, called\u00a0hemiplegia. A related disability that is not as debilitating as paralysis is one-sided weakness or\u00a0hemiparesis. Stroke may cause problems with thinking, awareness, attention, learning, judgment, and memory. Stroke survivors often have problems understanding or forming speech. A stroke can lead to emotional problems. Stroke patients may have difficulty controlling their emotions or may express inappropriate emotions. Many stroke patients experience depression. Stroke survivors may also have numbness or strange sensations. The pain is often worse in the hands and feet and is made worse by movement and temperature changes, especially cold temperatures. Recurrent stroke is frequent; about 25 percent of people who recover from their first stroke will have another stroke within 5 years.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Stroke-Information-Page"
+  ],
+  [
+    "Stroke: A stroke is serious, just like a heart attack, so it's important to know the signs of stroke and act quickly if you suspect someone is having one. Stroke is the fourth leading cause of death in the United States, and causes more serious long-term disabilities than any other disease. Older people are at higher risk. You can take steps to lower your chance of having a stroke.Know the Signs of Stroke Knowing the symptoms of a stroke and acting quickly could mean the difference between life and disability or death. Call 911 RIGHT AWAY if you see or have any of these symptoms: - Sudden numbness or weakness in the face, arm, or leg-especially on one side of the body - Sudden confusion or trouble speaking or understanding - Sudden problems seeing in one eye or both eyes - Sudden dizziness, loss of balance or coordination, or trouble walking - Sudden severe headache with no known cause Other danger signs that may occur include double vision, drowsiness, and nausea or vomiting. Stroke strikes fast. You should too. Call 911. Never ignore the symptoms of stroke. Call 911 if you have any stroke symptoms, even if they don't last long. DON'T IGNORE THE SIGNS OF STROKE! A stroke is serious, just like a heart attack, so it's important to know the signs of stroke and act quickly if you suspect someone is having one. Stroke is the fourth leading cause of death in the United States, and causes more serious long-term disabilities than any other disease. Older people are at higher risk. You can take steps to lower your chance of having a stroke.Know the Signs of Stroke Knowing the symptoms of a stroke and acting quickly could mean the difference between life and disability or death. Call 911 RIGHT AWAY if you see or have any of these symptoms: - Sudden numbness or weakness in the face, arm, or leg-especially on one side of the body - Sudden confusion or trouble speaking or understanding - Sudden problems seeing in one eye or both eyes - Sudden dizziness, loss of balance or coordination, or trouble walking - Sudden severe headache with no known cause Other danger signs that may occur include double vision, drowsiness, and nausea or vomiting. Stroke strikes fast. You should too. Call 911. Never ignore the symptoms of stroke. Call 911 if you have any stroke symptoms, even if they don't last long. DON'T IGNORE THE SIGNS OF STROKE! A stroke happens when something changes how blood flows through the brain. Blood brings oxygen and nutrients to brain cells. If blood can't flow to a part of the brain, cells that do not receive enough oxygen suffer and eventually die. If brain cells are without oxygen for only a short time, they can sometimes get better. But brain cells that have died can't be brought back to life. So, someone who has had a stroke may have trouble speaking, thinking, or walking.There are two major types of stroke. The most common kind, ischemic, is caused by a blood clot or the narrowing of a blood vessel (an artery) leading to the brain. This keeps blood from flowing into other parts of the brain and keeps needed oxygen and nutrients from reaching brain cells. Blockages that cause ischemic strokes stem from three conditions:- Formation of a clot within a blood vessel of the brain or neck, called thrombosis - Movement of a clot from another part of the body, such as from the heart to the neck or brain, called an embolism - Severe narrowing of an artery (stenosis) in or leading to the brain, due to fatty deposits lining the blood vessel wallsIn the second major kind of stroke, hemorrhagic, a broken blood vessel causes bleeding in the brain. This break in the vessel also stops oxygen and nutrients from reaching brain cells.Sometimes the symptoms of a stroke last only a few minutes and then go away. That could be a transient ischemic attack (TIA), also called a mini-stroke. A TIA is a medical emergency. You should get medical help right away. If a TIA is not treated quickly, it could be followed within hours or days by a major disabling stroke. Some risk factors for stroke, like age, race, and family history, can't be controlled. But you can make changes to lower your risk of stroke. Talk to your doctor about what you can do. Even if you're in perfect health, follow these suggestions:- Control your blood pressure. Have your blood pressure checked often. If it is high, follow your doctor's advice to lower it. Treating high blood pressure lowers the risk of both stroke and heart disease. - Stop smoking. Smoking increases your risk for stroke. It's never too late to quit. - Control your cholesterol. If you have high cholesterol, work with your doctor to lower it. Cholesterol, a type of fat in the blood, can build up on the walls of your arteries. In time, this can block blood flow and lead to a stroke. - Control your diabetes. Untreated diabetes can damage blood vessels and also leads to narrowed arteries and stroke. Follow your doctor's suggestions for keeping diabetes under control. - Eat healthy foods. Eat foods that are low in cholesterol and saturated fats. Include a variety of fruits and vegetables every day. - Exercise regularly. Try to make physical activity a part of your everyday life. Do things you like; for example, take a brisk walk, ride a bicycle, or go swimming. Talk with your healthcare provider if you haven't been exercising and you want to start a vigorous program or increase your physical activity. For more information on exercise and physical activity from the National Institute on Aging at NIH, visit www.nia.nih.gov/Go4Life.If you have had a stroke in the past, it's important to reduce your risk of a second stroke. Your brain helps you recover from a stroke by drawing on body systems that now do double duty. That means a second stroke can be twice as bad. A doctor will diagnose a stroke based on symptoms, medical history, and medical tests such as a CT scan. A CT scan is a test that lets doctors look closely at pictures of the brain.All strokes benefit from immediate medical treatment! But only people with ischemic stroke, the kind caused by a blood clot, can be helped by a drug called t-PA (tissue-plasminogen activator). This drug breaks up blood clots and can greatly lessen the damage caused by an ischemic stroke. Starting treatment with t-PA within 3 hours after an ischemic stroke is important to recovery. To be evaluated and receive treatment, patients need to get to the hospital within 60 minutes. Getting to a hospital right away allows time for a CT scan of the brain. This scan will show whether the clot-busting medicine is the right treatment choice.With stroke, treatment depends on the stage of the disease. There are three treatment stages for stroke: prevention, therapy immediately after stroke, and rehabilitation after stroke. Stroke therapies include medications, surgery, and rehabilitation.Medication or drug therapy is the most common treatment for stroke. The most popular kinds of drugs to prevent or treat stroke are antithrombotics--which include antiplatelet agents and anticoagulants--and thrombolytics. Thrombolytic drugs, like t-PA, halt the stroke by dissolving the blood clot that is blocking blood flow to the brain. Antithrombotics prevent the formation of blood clots that can become stuck in an artery of the brain and cause strokes.Surgery and vascular procedures can be used to prevent stroke, treat stroke, or repair damage to the blood vessels or malformations in and around the brain. These include angioplasty, stenting, and carotid endarterectomy. A stroke can cause a variety of health problems. How a stroke affects a person depends on which part of the brain is damaged.Someone who has had a stroke might be paralyzed or have weakness, usually on one side of the body. He or she might have trouble speaking or using words. There could be swallowing problems. There might be pain or numbness.Stroke may cause problems with thinking, awareness, attention, learning, judgment, and memory. Someone who has had a stroke might feel depressed or find it hard to control emotions. Post-stroke depression may be more than general sadness resulting from the stroke incident. It is a serious behavioral problem that can hamper recovery and rehabilitation and may even lead to suicide.There are many different ways to help people get better after a stroke. Many treatments start in the hospital and continue at home. Drugs and physical therapy can help improve balance, coordination, and problems such as trouble speaking and using words. Occupational therapy can make it easier to do things like taking a bath or cooking.Some people make a full recovery soon after a stroke. Others take months or even years. But, sometimes the damage is so serious that therapy cannot really help.Learn about rehabilitation after stroke. Stroke is the number one cause of serious adult disability in the United States. Stroke disability is devastating to the stroke patient and family, but therapies are available to help rehabilitate patients after stroke.For most stroke patients, rehabilitation mainly involves physical therapy. The aim of physical therapy is to have the stroke patient relearn simple motor activities such as walking, sitting, standing, lying down, and the process of switching from one type of movement to another.Another type of therapy to help patients relearn daily activities is occupational therapy. This type of therapy also involves exercise and training. Its goal is to help the stroke patient relearn everyday activities such as eating, drinking and swallowing, dressing, bathing, cooking, reading and writing, and using the toilet. Occupational therapists seek to help the patient become independent or semi-independent.Speech therapy helps stroke patients relearn language and speaking skills, or learn other forms of communication. Speech therapy is appropriate for patients who have no problems with cognition or thinking, but have problems understanding speech or written words, or problems forming speech. With time and patience, a stroke survivor should be able to regain some, and sometimes all, language and speaking abilities.Learn more about stroke signs, treatment, and prevention from the Centers for Disease Control and Prevention. Stroke is the number one cause of serious adult disability in the United States. Stroke disability is devastating to the stroke patient and family, but therapies are available to help rehabilitate patients after stroke.For most stroke patients, rehabilitation mainly involves physical therapy. The aim of physical therapy is to have the stroke patient relearn simple motor activities such as walking, sitting, standing, lying down, and the process of switching from one type of movement to another.Another type of therapy to help patients relearn daily activities is occupational therapy. This type of therapy also involves exercise and training. Its goal is to help the stroke patient relearn everyday activities such as eating, drinking and swallowing, dressing, bathing, cooking, reading and writing, and using the toilet. Occupational therapists seek to help the patient become independent or semi-independent.Speech therapy helps stroke patients relearn language and speaking skills, or learn other forms of communication. Speech therapy is appropriate for patients who have no problems with cognition or thinking, but have problems understanding speech or written words, or problems forming speech. With time and patience, a stroke survivor should be able to regain some, and sometimes all, language and speaking abilities.Learn more about stroke signs, treatment, and prevention from the Centers for Disease Control and Prevention. Stroke is the number one cause of serious adult disability in the United States. Stroke disability is devastating to the stroke patient and family, but therapies are available to help rehabilitate patients after stroke.For most stroke patients, rehabilitation mainly involves physical therapy. The aim of physical therapy is to have the stroke patient relearn simple motor activities such as walking, sitting, standing, lying down, and the process of switching from one type of movement to another.Another type of therapy to help patients relearn daily activities is occupational therapy. This type of therapy also involves exercise and training. Its goal is to help the stroke patient relearn everyday activities such as eating, drinking and swallowing, dressing, bathing, cooking, reading and writing, and using the toilet. Occupational therapists seek to help the patient become independent or semi-independent.Speech therapy helps stroke patients relearn language and speaking skills, or learn other forms of communication. Speech therapy is appropriate for patients who have no problems with cognition or thinking, but have problems understanding speech or written words, or problems forming speech. With time and patience, a stroke survivor should be able to regain some, and sometimes all, language and speaking abilities.Learn more about stroke signs, treatment, and prevention from the Centers for Disease Control and Prevention.",
+    "https://www.nia.nih.gov/health/topics/stroke"
+  ],
+  [
+    "What is Stroke?: Stroke -- A Serious Event A stroke is serious, just like a heart attack. Each year in the United States, approximately 795,000 people have a stroke. About 610,000 of these are first or new strokes. On average, one American dies from stroke every four minutes. Stroke is the fourth leading cause of death in the United States, and causes more serious long-term disabilities than any other disease. Nearly three-quarters of all strokes occur in people over the age of 65. And the risk of having a stroke more than doubles each decade between the ages of 55 and 85. Stroke occurs in all age groups, in both sexes, and in all races in every country. It can even occur before birth, when the fetus is still in the womb. Learning about stroke can help you act in time to save a relative, neighbor, or friend. And making changes in your lifestyle can help you prevent stroke. What Is Stroke? A stroke is sometimes called a \"brain attack.\" Most often, stroke occurs when blood flow to the brain stops because it is blocked by a clot. When this happens, the brain cells in the immediate area begin to die. Some brain cells die because they stop getting the oxygen and nutrients they need to function. Other brain cells die because they are damaged by sudden bleeding into or around the brain. The brain cells that don't die immediately remain at risk for death. These cells can linger in a compromised or weakened state for several hours. With timely treatment, these cells can be saved. New treatments are available that greatly reduce the damage caused by a stroke. But you need to arrive at the hospital as soon as possible after symptoms start to prevent disability and to greatly improve your chances for recovery. Knowing stroke symptoms, calling 911 immediately, and getting to a hospital as quickly as possible are critical. Ischemic Stroke There are two kinds of stroke. The most common kind of stroke is called ischemic stroke. It accounts for approximately 80 percent of all strokes. An ischemic stroke is caused by a blood clot that blocks or plugs a blood vessel supplying blood to the brain. Blockages that cause ischemic strokes stem from three conditions: - the formation of a clot within a blood vessel of the brain or neck, called thrombosis - the movement of a clot from another part of the body, such as from the heart to the neck or brain, called an embolism - a severe narrowing of an artery (stenosis) in or leading to the brain, due to fatty deposits lining the blood vessel walls. the formation of a clot within a blood vessel of the brain or neck, called thrombosis the movement of a clot from another part of the body, such as from the heart to the neck or brain, called an embolism a severe narrowing of an artery (stenosis) in or leading to the brain, due to fatty deposits lining the blood vessel walls. Hemorrhagic Stroke The other kind of stroke is called hemorrhagic stroke. A hemorrhagic stroke is caused by a blood vessel that breaks and bleeds into the brain. One common cause of a hemorrhagic stroke is a bleeding aneurysm. An aneurysm is a weak or thin spot on an artery wall. Over time, these weak spots stretch or balloon out due to high blood pressure. The thin walls of these ballooning aneurysms can rupture and spill blood into the space surrounding brain cells. Artery walls can also break open because they become encrusted, or covered with fatty deposits called plaque, eventually lose their elasticity and become brittle, thin, and prone to cracking. Hypertension, or high blood pressure, increases the risk that a brittle artery wall will give way and release blood into the surrounding brain tissue.",
+    "http://nihseniorhealth.gov/stroke/toc.html"
+  ],
+  [
+    "Stroke (What Happens After a Stroke?): A stroke can cause a variety of health problems. How a stroke affects a person depends on which part of the brain is damaged.Someone who has had a stroke might be paralyzed or have weakness, usually on one side of the body. He or she might have trouble speaking or using words. There could be swallowing problems. There might be pain or numbness.Stroke may cause problems with thinking, awareness, attention, learning, judgment, and memory. Someone who has had a stroke might feel depressed or find it hard to control emotions. Post-stroke depression may be more than general sadness resulting from the stroke incident. It is a serious behavioral problem that can hamper recovery and rehabilitation and may even lead to suicide.There are many different ways to help people get better after a stroke. Many treatments start in the hospital and continue at home. Drugs and physical therapy can help improve balance, coordination, and problems such as trouble speaking and using words. Occupational therapy can make it easier to do things like taking a bath or cooking.Some people make a full recovery soon after a stroke. Others take months or even years. But, sometimes the damage is so serious that therapy cannot really help.Learn about rehabilitation after stroke.",
+    "https://www.nia.nih.gov/health/topics/stroke"
+  ],
+  [
+    "What is Stroke?: Some brain cells die because they stop getting the oxygen and nutrients they need to function. Other brain cells die because they are damaged by sudden bleeding into or around the brain. The brain cells that don't die immediately remain at risk for death. These cells can linger in a compromised or weakened state for several hours. With timely treatment these cells can be saved. Knowing stroke symptoms, calling 911 immediately, and getting to a hospital as quickly as possible are critical.",
+    "http://nihseniorhealth.gov/stroke/toc.html"
+  ],
+  [
+    "What is Stroke?: There are two kinds of stroke. The most common kind of stroke is called ischemic stroke. It accounts for approximately 80 percent of all strokes. An ischemic stroke is caused by a blood clot that blocks or plugs a blood vessel in the brain. The other kind of stroke is called hemorrhagic stroke. A hemorrhagic stroke is caused by a blood vessel that breaks and bleeds into the brain.",
+    "http://nihseniorhealth.gov/stroke/toc.html"
+  ],
+  [
+    "Stroke: A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications. The good news is that strokes can be treated and prevented, and many fewer Americans die of stroke now than in the past. Watch for these signs and symptoms if you think you or someone else may be having a stroke. Pay attention to when the signs and symptoms begin. The length of time they have been present can affect your treatment options: - Trouble with speaking and understanding. You may experience confusion. You may slur your words or have difficulty understanding speech. - Paralysis or numbness of the face, arm or leg. You may develop sudden numbness, weakness or paralysis in your face, arm or leg. This often happens just on one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Also, one side of your mouth may droop when you try to smile. - Trouble with seeing in one or both eyes. You may suddenly have blurred or blackened vision in one or both eyes, or you may see double. - Headache. A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate you're having a stroke. - Trouble with walking. You may stumble or experience sudden dizziness, loss of balance or loss of coordination. When to see a doctor Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear. Think \"FAST\" and do the following: - Face. Ask the person to smile. Does one side of the face droop? - Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise up? - Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or strange? - Time. If you observe any of these signs, call 911 immediately. Call 911 or your local emergency number right away. Don't wait to see if symptoms stop. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability. If you're with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance. A stroke may be caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may experience only a temporary disruption of blood flow to the brain (transient ischemic attack, or TIA) that doesn't cause permanent damage. Ischemic stroke About 80 percent of strokes are ischemic strokes. Ischemic strokes occur when the arteries to your brain become narrowed or blocked, causing severely reduced blood flow (ischemia). The most common ischemic strokes include: - Thrombotic stroke. A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot may be caused by fatty deposits (plaque) that build up in arteries and cause reduced blood flow (atherosclerosis) or other artery conditions. - Embolic stroke. An embolic stroke occurs when a blood clot or other debris forms away from your brain - commonly in your heart - and is swept through your bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus. Hemorrhagic stroke Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels. These include: - Uncontrolled high blood pressure (hypertension) - Overtreatment with anticoagulants (blood thinners) - Weak spots in your blood vessel walls (aneurysms) A less common cause of hemorrhage is the rupture of an abnormal tangle of thin-walled blood vessels (arteriovenous malformation). Types of hemorrhagic stroke include: - Intracerebral hemorrhage. In an intracerebral hemorrhage, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging brain cells. Brain cells beyond the leak are deprived of blood and are also damaged. High blood pressure, trauma, vascular malformations, use of blood-thinning medications and other conditions may cause an intracerebral hemorrhage. - Subarachnoid hemorrhage. In a subarachnoid hemorrhage, an artery on or near the surface of your brain bursts and spills into the space between the surface of your brain and your skull. This bleeding is often signaled by a sudden, severe headache. A subarachnoid hemorrhage is commonly caused by the bursting of a small sack-shaped or berry-shaped aneurysm. After the hemorrhage, the blood vessels in your brain may widen and narrow erratically (vasospasm), causing brain cell damage by further limiting blood flow. Transient ischemic attack (TIA) A transient ischemic attack (TIA) - sometimes known as a ministroke - is a temporary period of symptoms similar to those you'd have in a stroke. A temporary decrease in blood supply to part of your brain causes TIAs, which may last as little as five minutes. Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of your nervous system - but there is no permanent tissue damage and no lasting symptoms. Seek emergency care even if your symptoms seem to clear up. Having a TIA puts you at greater risk of having a full-blown stroke, causing permanent damage later. If you've had a TIA, it means there's likely a partially blocked or narrowed artery leading to your brain or a clot source in the heart. It's not possible to tell if you're having a stroke or a TIA based only on your symptoms. Even when symptoms last for under an hour, there is still a risk of permanent tissue damage. Many factors can increase your stroke risk. Some factors can also increase your chances of having a heart attack. Potentially treatable stroke risk factors include: Lifestyle risk factors - Being overweight or obese - Physical inactivity - Heavy or binge drinking - Use of illicit drugs such as cocaine and methamphetamines Medical risk factors - Blood pressure readings higher than 120/80 millimeters of mercury (mm Hg) - Cigarette smoking or exposure to secondhand smoke - High cholesterol - Diabetes - Obstructive sleep apnea - Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm - Personal or family history of stroke, heart attack or transient ischemic attack. Other factors associated with a higher risk of stroke include: - Age -People age 55 or older have a higher risk of stroke than do younger people. - Race - African-Americans have a higher risk of stroke than do people of other races. - Sex - Men have a higher risk of stroke than women. Women are usually older when they have strokes, and they're more likely to die of strokes than are men. - Hormones - use of birth control pills or hormone therapies that include estrogen, as well as increased estrogen levels from pregnancy and childbirth. A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected. Complications may include: - Paralysis or loss of muscle movement. You may become paralyzed on one side of your body, or lose control of certain muscles, such as those on one side of your face or one arm. Physical therapy may help you return to activities affected by paralysis, such as walking, eating and dressing. - Difficulty talking or swallowing. A stroke might affect control of the muscles in your mouth and throat, making it difficult for you to talk clearly (dysarthria), swallow (dysphagia) or eat. You also may have difficulty with language (aphasia), including speaking or understanding speech, reading, or writing. Therapy with a speech-language pathologist might help. - Memory loss or thinking difficulties. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, making judgments, reasoning and understanding concepts. - Emotional problems. People who have had strokes may have more difficulty controlling their emotions, or they may develop depression. - Pain. Pain, numbness or other strange sensations may occur in the parts of the body affected by stroke. For example, if a stroke causes you to lose feeling in your left arm, you may develop an uncomfortable tingling sensation in that arm. People also may be sensitive to temperature changes, especially extreme cold, after a stroke. This complication is known as central stroke pain or central pain syndrome. This condition generally develops several weeks after a stroke, and it may improve over time. But because the pain is caused by a problem in your brain, rather than a physical injury, there are few treatments. - Changes in behavior and self-care ability. People who have had strokes may become more withdrawn and less social or more impulsive. They may need help with grooming and daily chores. As with any brain injury, the success of treating these complications varies from person to person. To determine the most appropriate treatment for your stroke, your emergency team needs to evaluate the type of stroke you're having and the areas of your brain affected by the stroke. They also need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction. Your doctor may use several tests to determine your risk of stroke, including: - Physical examination. Your doctor will ask you or a family member what symptoms you've been having, when they started and what you were doing when they began. Your doctor then will evaluate whether these symptoms are still present. Your doctor will want to know what medications you take and whether you have experienced any head injuries. You'll be asked about your personal and family history of heart disease, transient ischemic attack and stroke. Your doctor will check your blood pressure and use a stethoscope to listen to your heart and to listen for a whooshing sound (bruit) over your neck (carotid) arteries, which may indicate atherosclerosis. Your doctor may also use an ophthalmoscope to check for signs of tiny cholesterol crystals or clots in the blood vessels at the back of your eyes. - Blood tests. You may have several blood tests, which tell your care team how fast your blood clots, whether your blood sugar is abnormally high or low, whether critical blood chemicals are out of balance, or whether you may have an infection. Managing your blood's clotting time and levels of sugar and other key chemicals will be part of your stroke care. - Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show a hemorrhage, tumor, stroke and other conditions. Doctors may inject a dye into your bloodstream to view your blood vessels in your neck and brain in greater detail (computerized tomography angiography). There are different types of CT scans that your doctor may use depending on your situation. - Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography, or magnetic resonance venography). - Carotid ultrasound. In this test, sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries. - Cerebral angiogram. In this test, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck. - Echocardiogram. An echocardiogram uses sound waves to create detailed images of your heart. An echocardiogram can find a source of clots in your heart that may have traveled from your heart to your brain and caused your stroke. You may have a transesophageal echocardiogram. In this test, your doctor inserts a flexible tube with a small device (transducer) attached into your throat and down into the tube that connects the back of your mouth to your stomach (esophagus). Because your esophagus is directly behind your heart, a transesophageal echocardiogram can create clear, detailed ultrasound images of your heart and any blood clots. Emergency treatment for stroke depends on whether you're having an ischemic stroke blocking an artery - the most common kind - or a hemorrhagic stroke that involves bleeding into the brain. Ischemic stroke To treat an ischemic stroke, doctors must quickly restore blood flow to your brain. Emergency treatment with medications. Therapy with clot-busting drugs must start within 4.5 hours if they are given into the vein - and the sooner, the better. Quick treatment not only improves your chances of survival but also may reduce complications. You may be given: - Intravenous injection of tissue plasminogen activator (tPA). This injection of recombinant tissue plasminogen activator (tPA), also called alteplase, is considered the gold standard treatment for ischemic stroke. An injection of tPA is usually given through a vein in the arm. This potent clot-busting drug ideally is given within three hours. In some instances, tPA can be given up to 4.5 hours after stroke symptoms begin. This drug restores blood flow by dissolving the blood clot causing your stroke, and it may help people who have had strokes recover more fully. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if tPA is appropriate for you. Emergency endovascular procedures. Doctors sometimes treat ischemic strokes with procedures performed directly inside the blocked blood vessel. These procedures must be performed as soon as possible, depending on features of the blood clot: - Medications delivered directly to the brain. Doctors may insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver tPA directly into the area where the stroke is occurring. This is called intra-arterial thrombolysis. The time window for this treatment is somewhat longer than for intravenous tPA, but is still limited. - Removing the clot with a stent retriever. Doctors may use a catheter to maneuver a device into the blocked blood vessel in your brain and trap and remove the clot. This procedure is particularly beneficial for people with large clots that can't be completely dissolved with tPA, though this procedure is often performed in combination with intravenous tPA. Several large and recent studies suggest that, depending on the location of the clot and other factors, endovascular therapy might be the most effective treatment. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after ischemic stroke. Other procedures. To decrease your risk of having another stroke or transient ischemic attack, your doctor may recommend a procedure to open up an artery that's narrowed by plaque. Doctors sometimes recommend the following procedures to prevent a stroke. Options will vary depending on your situation: - Carotid endarterectomy. In a carotid endarterectomy, a surgeon removes plaques from arteries that run along each side of your neck to your brain (carotid arteries). In this procedure, your surgeon makes an incision along the front of your neck, opens your carotid artery and removes plaque that blocks the carotid artery. Your surgeon then repairs the artery with stitches or a patch made from a vein or artificial material (graft). The procedure may reduce your risk of ischemic stroke. However, a carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions. - Angioplasty and stents. In an angioplasty, a surgeon usually accesses your carotid arteries through an artery in your groin. Here, your surgeon can gently and safely navigate to the carotid arteries in your neck. A balloon is then inflated to expand the narrowed artery. Then a stent can be inserted to support the opened artery. Hemorrhagic stroke Emergency treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing pressure in your brain. You might also need surgery to help reduce future risk. Emergency measures. If you take warfarin (Coumadin, Jantoven) or anti-platelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners' effects. You may also be given drugs to lower pressure in your brain (intracranial pressure), lower your blood pressure, prevent vasospasm or prevent seizures. Once the bleeding in your brain stops, treatment usually involves supportive medical care while your body absorbs the blood. Healing is similar to what happens while a bad bruise goes away. If the area of bleeding is large, your doctor may perform surgery to remove the blood and relieve pressure on your brain. Surgical blood vessel repair. Surgery may be used to repair blood vessel abnormalities associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if an aneurysm or arteriovenous malformation (AVM) or other type of vascular malformation caused your hemorrhagic stroke: - Surgical clipping. A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This clamp can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged. - Coiling (endovascular embolization). A surgeon inserts a catheter into an artery in your groin and guides it to your brain using X-ray imaging. Tiny detachable coils are guided into the aneurysm (aneurysm coiling). The coils fill the aneurysm, which blocks blood flow into the aneurysm and causes the blood to clot. - Surgical AVM removal. Surgeons may remove a smaller AVM if it's located in an accessible area of your brain, to eliminate the risk of rupture and lower the risk of hemorrhagic stroke. However, it's not always possible to remove an AVM if its removal would cause too large a reduction in brain function, or if it's large or located deep within your brain. - Stereotactic radiosurgery. Using multiple beams of highly focused radiation, stereotactic radiosurgery is an advanced minimally invasive treatment used to repair vascular malformations. Stroke recovery and rehabilitation After emergency treatment, stroke care focuses on helping you recover as much function as possible and return to independent living. The impact of your stroke depends on the area of the brain involved and the amount of tissue damaged. If your stroke affected the right side of your brain, your movement and sensation on the left side of your body may be affected. If your stroke damaged the brain tissue on the left side of your brain, your movement and sensation on the right side of your body may be affected. Brain damage to the left side of your brain may cause speech and language disorders. In addition, if you've had a stroke, you may have problems with breathing, swallowing, balancing and vision. Most stroke survivors receive treatment in a rehabilitation program. Your doctor will recommend the most rigorous therapy program you can handle based on your age, overall health and degree of disability from your stroke. Your doctor will take into consideration your lifestyle, interests and priorities, and the availability of family members or other caregivers. Your rehabilitation program may begin before you leave the hospital. After discharge, you might continue your program in a rehabilitation unit of the same hospital, another rehabilitation unit or skilled nursing facility, an outpatient unit, or your home. Every person's stroke recovery is different. Depending on your condition, your treatment team may include: - Doctor trained in brain conditions (neurologist) - Rehabilitation doctor (physiatrist) - Nurse - Dietitian - Physical therapist - Occupational therapist - Recreational therapist - Speech pathologist - Social worker - Case manager - Psychologist or psychiatrist - Chaplain One way to evaluate the care of patients diagnosed with stroke is to look at the percentage of patients receiving the timely and effective care measures that are appropriate. The goal is 100 percent. The graph below displays the percentage of eligible Mayo Clinic patients diagnosed with stroke receiving all of the appropriate care measures. Timely and effective care Carotid Endarterectomy Mortality Rate See related graph. Carotid Stenting Mortality Rate See related graph. Comprehensive Stroke Measure See related graph. Comprehensive Stroke - Post Thrombolysis Revascularization Rate See related graph. Comprehensive Stroke - Timeliness of IV t-PA Therapy See related graph. For additional information and data visit Medicare Hospital Compare. For additional information about quality at Mayo Clinic visit Quality Measures.",
+    "https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113"
+  ],
+  [
+    "What is Stroke?: Transient ischemic attacks, or TIAs, occur when the warning signs of stroke last only a few moments and then disappear. These brief episodes are also sometimes called \"mini-strokes.\" Although brief, they identify an underlying serious condition that isn't going away without medical help. Unfortunately, since they clear up, many people ignore them. Don't ignore them. Heeding them can save your life.",
+    "http://nihseniorhealth.gov/stroke/toc.html"
+  ],
+  [
+    "Stroke (What Is a Stroke?): A stroke happens when something changes how blood flows through the brain. Blood brings oxygen and nutrients to brain cells. If blood can't flow to a part of the brain, cells that do not receive enough oxygen suffer and eventually die. If brain cells are without oxygen for only a short time, they can sometimes get better. But brain cells that have died can't be brought back to life. So, someone who has had a stroke may have trouble speaking, thinking, or walking.There are two major types of stroke. The most common kind, ischemic, is caused by a blood clot or the narrowing of a blood vessel (an artery) leading to the brain. This keeps blood from flowing into other parts of the brain and keeps needed oxygen and nutrients from reaching brain cells. Blockages that cause ischemic strokes stem from three conditions:- Formation of a clot within a blood vessel of the brain or neck, called thrombosis - Movement of a clot from another part of the body, such as from the heart to the neck or brain, called an embolism - Severe narrowing of an artery (stenosis) in or leading to the brain, due to fatty deposits lining the blood vessel wallsIn the second major kind of stroke, hemorrhagic, a broken blood vessel causes bleeding in the brain. This break in the vessel also stops oxygen and nutrients from reaching brain cells.Sometimes the symptoms of a stroke last only a few minutes and then go away. That could be a transient ischemic attack (TIA), also called a mini-stroke. A TIA is a medical emergency. You should get medical help right away. If a TIA is not treated quickly, it could be followed within hours or days by a major disabling stroke.",
+    "https://www.nia.nih.gov/health/topics/stroke"
+  ],
+  [
+    "What is Stroke?: Atherosclerosis, also known as hardening of the arteries, is the most common blood vessel disease. It is caused by the buildup of fatty deposits in the arteries, and is a risk factor for stroke.",
+    "http://nihseniorhealth.gov/stroke/toc.html"
+  ],
+  [
+    "Ischemic Stroke (Summary): Summary A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Ischemic stroke is the most common type. It is usually caused by a blood clot that blocks or plugs a blood vessel in the brain. This keeps blood from flowing to the brain. Within minutes, brain cells begin to die. Another cause is stenosis, or narrowing of the artery. This can happen because of atherosclerosis, a disease in which plaque builds up inside your arteries. Transient ischemic attacks (TIAs) occur when the blood supply to the brain is interrupted briefly. Having a TIA can mean you are at risk for having a more serious stroke. Symptoms of stroke are - Sudden numbness or weakness of the face, arm or leg (especially on one side of the body) - Sudden confusion, trouble speaking or understanding speech - Sudden trouble seeing in one or both eyes - Sudden trouble walking, dizziness, loss of balance or coordination - Sudden severe headache with no known cause It is important to treat strokes as quickly as possible. Blood thinners may be used to stop a stroke while it is happening by quickly dissolving the blood clot. Post-stroke rehabilitation can help people overcome disabilities caused by stroke damage. NIH: National Institute of Neurological Disorders and Stroke",
+    "#"
+  ],
+  [
+    "What causes Stroke?: Ischemic Stroke and Transient Ischemic Attack An ischemic stroke or transient ischemic attack (TIA) occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Many medical conditions can increase the risk of ischemic stroke or TIA. For example, atherosclerosis (ath-er-o-skler-O-sis) is a disease in which a fatty substance called plaque builds up on the inner walls of the arteries. Plaque hardens and narrows the arteries, which limits the flow of blood to tissues and organs (such as the heart and brain). Plaque in an artery can crack or rupture (break open). Blood platelets (PLATE-lets), which are disc-shaped cell fragments, stick to the site of the plaque injury and clump together to form blood clots. These clots can partly or fully block an artery. Plaque can build up in any artery in the body, including arteries in the heart, brain, and neck. The two main arteries on each side of the neck are called the carotid (ka-ROT-id) arteries. These arteries supply oxygen-rich blood to the brain, face, scalp, and neck. When plaque builds up in the carotid arteries, the condition is called carotid artery disease. Carotid artery disease causes many of the ischemic strokes and TIAs that occur in the United States. An embolic stroke (a type of ischemic stroke) or TIA also can occur if a blood clot or piece of plaque breaks away from the wall of an artery. The clot or plaque can travel through the bloodstream and get stuck in one of the brains arteries. This stops blood flow through the artery and damages brain cells. Heart conditions and blood disorders also can cause blood clots that can lead to a stroke or TIA. For example, atrial fibrillation (A-tre-al fi-bri-LA-shun), or AF, is a common cause of embolic stroke. In AF, the upper chambers of the heart contract in a very fast and irregular way. As a result, some blood pools in the heart. The pooling increases the risk of blood clots forming in the heart chambers. An ischemic stroke or TIA also can occur because of lesions caused by atherosclerosis. These lesions may form in the small arteries of the brain, and they can block blood flow to the brain. Hemorrhagic Stroke Sudden bleeding in the brain can cause a hemorrhagic stroke. The bleeding causes swelling of the brain and increased pressure in the skull. The swelling and pressure damage brain cells and tissues. Examples of conditions that can cause a hemorrhagic stroke include high blood pressure, aneurysms, and arteriovenous (ar-TEER-e-o-VE-nus) malformations (AVMs). \"Blood pressure\" is the force of blood pushing against the walls of the arteries as the heart pumps blood. If blood pressure rises and stays high over time, it can damage the body in many ways. Aneurysms are balloon-like bulges in an artery that can stretch and burst. AVMs are tangles of faulty arteries and veins that can rupture within the brain. High blood pressure can increase the risk of hemorrhagic stroke in people who have aneurysms or AVMs.",
+    "http://www.nhlbi.nih.gov/health/health-topics/topics/stroke"
+  ],
+  [
+    "Recovering after stroke (Summary): A stroke happens when blood flow to any part of the brain stops. Each person has a different recovery time and need for long-term care. Problems with moving, thinking, and talking often improve in the first weeks or months after a stroke. Some people will keep improving months or years after a stroke.",
+    "https://medlineplus.gov/ency/article/007419.htm"
+  ],
+  [
+    "Recovering after stroke (Information): WHERE TO LIVE AFTER A STROKE Most people will need stroke rehabilitation (rehab) to help them recover after they leave the hospital. Stroke rehab will help you regain the ability to care for yourself. Most types of therapy can be done where you live, including in the home. - People who are not able to care for themselves at home after a stroke may have therapy in a special part of a hospital or in a nursing or rehabilitation center. - Those who are able to go back home might go to a special clinic or have someone come to their home. Whether you can go back home after a stroke depends on: - Whether you can take care of yourself - How much help there will be at home - Whether the home is a safe place (for example, stairs in the home might not be safe for a stroke patient who has trouble walking) You may need to go to a boarding home or convalescent home to have a safe environment. For people who are cared for at home: - Changes may be needed to stay safe from falls in the home and bathroom, prevent wandering, and make the home easier to use. The bed and bathroom should be easy to reach. Items (such as throw rugs) that may cause a fall should be removed. - A number of devices can help with activities such as cooking or eating, bathing or showering, moving around the home or elsewhere, dressing and grooming, writing and using a computer, and many more activities. - Family counseling may help you cope with the changes needed for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, adult day care, and other community resources (such as a local Department of Aging) may be helpful. - Legal advice may be needed. Advance directives, power of attorney, and other legal actions may make it easier to make decisions about care. SPEAKING AND COMMUNICATING After a stroke, some people may have problems finding a word or being able to speak more than one word or phrase at a time. Or, they may have trouble speaking at all. This is called aphasia. - People who have had a stroke may be able to put many words together, but they may not make sense. Many people do not know that what they are saying is not easy to understand. They may get frustrated when they realize other people cannot understand. Family and caregivers should learn how to best help communicate. - It can take up to 2 years to recover speech. Not everyone will fully recover. A stroke can also damage the muscles that help you speak. As a result, these muscles do not move the right way when you try to speak. A speech and language therapist can work with you and your family or caregivers. You can learn new ways to communicate. THINKING AND MEMORY After a stroke, people may have: - Changes in their ability to think or reason - Changes in behavior and sleep patterns - Memory problems - Poor judgment These changes may lead to: - An increase in the need for safety measures - Changes in ability to drive - Other changes or precauations Depression after a stroke is common. Depression can start soon after a stroke, but symptoms may not begin for up to 2 years after the stroke. Treatments for depression include: - Increased social activity. More visits in the home or going to an adult day care center for activities. - Medicines for depression and visits to a therapist or counselor MUSCLE, JOINT, AND NERVE PROBLEMS Moving around and doing normal daily tasks such as dressing and feeding may be harder after a stroke. Muscles on one side of the body may be weaker or may not move at all. This may involve only part of the arm or leg, or the whole side of the body. - Muscles on the weak side of the body may be very tight. - Different joints and muscles in the body may become hard to move. The shoulder and other joints may dislocate. Many of these problems can cause pain after a stroke. Pain may also occur from changes in the brain itself. You may use pain medicines, but check with your health care provider first. People who have pain due to tight muscles may get medicines that help with muscle spasms. Physical therapists, occupational therapists, and rehabilitation doctors will help you relearn how to: - Dress, groom, and eat - Bathe, shower, and use the toilet - Use canes, walkers, wheelchairs, and other devices to stay as mobile as possible - Possibly return to work - Keep all of the muscles as strong as possible and stay as physically active as possible, even if you cannot walk - Manage muscle spasms or tightness with stretching exercises and braces that fit around the ankle, elbow, shoulder, and other joints BLADDER AND BOWEL CARE A stroke can lead to problems with bladder or bowel control. These problems may be caused by: - Damage to part of the brain that helps the bowels and bladder work smoothly - Not noticing the need to go to the bathroom - Problems getting to the toilet in time Symptoms may include: - Loss of bowel control, diarrhea (loose bowel movements), or constipation (hard bowel movements) - Loss of bladder control, feeling the need to urinate often, or problems emptying the bladder Your provider may prescribe medicines to help with bladder control. You may need a referral to a bladder or bowel specialist. Sometimes, a bladder or bowel schedule will help. It can also help to place a commode chair close to where you sit most of the day. Some people need a permanent urinary catheter to drain urine from their body. To prevent skin or pressure sores: - Clean up after incontinence - Change position often and know how to move in a bed, chair, or wheelchair - Make sure the wheelchair fits correctly - Have family members or other caregivers learn how to watch out for skin sores SWALLOWING AND EATING AFTER A STROKE Swallowing problems may be due to a lack of attention when eating or damage to the nerves that help you swallow. Symptoms of swallowing problems are: - Coughing or choking, either during or after eating - Gurgling sounds from the throat during or after eating - Throat clearing after drinking or swallowing - Slow chewing or eating - Coughing food back up after eating - Hiccups after swallowing - Chest discomfort during or after swallowing A speech therapist can help with swallowing and eating problems after a stroke. Diet changes, such as thickening liquids or eating pureed foods, may be needed. Some people will need a permanent feeding tube, called a gastrostomy. Some people do not take in enough calories after a stroke. High-calorie foods or food supplements that also contain vitamins or minerals can prevent weight loss and keep you healthy. OTHER IMPORTANT ISSUES Both men and women may have problems with sexual function after a stroke. Medicines called phosphodiesterase type 5 inhibitors (Viagra or Cialis) may be helpful. Ask your provider whether these drugs are right for you. Talking with a therapist or counselor may also help. Treatment and lifestyle changes to prevent another stroke are important. This includes healthy eating, controlling illnesses such as diabetes and high blood pressure, and sometimes taking medicine to help prevent stroke.",
+    "https://medlineplus.gov/ency/article/007419.htm"
+  ],
+  [
+    "Stroke (Outlook (Prognosis)): How well a person does after a stroke depends on: - The type of stroke - How much brain tissue is damaged - What body functions have been affected - How quickly treatment is given Problems moving, thinking, and talking often improve in the weeks to months after a stroke. Many people who have had a stroke will keep improving in the months or years after their stroke. Over half of people who have a stroke are able to function and live at home. Others are not able to care for themselves. If treatment with clot-busting drugs is successful, the symptoms of a stroke may go away. However, people often do not get to the hospital soon enough to receive these drugs, or they cannot take these drugs because of a health condition. People who have a stroke from a blood clot (ischemic stroke) have a better chance of surviving than those who have a stroke from bleeding in the brain (hemorrhagic stroke). The risk for a second stroke is highest during the weeks or months after the first stroke. The risk begins to decrease after this period.",
+    "https://medlineplus.gov/ency/article/000726.htm"
+  ],
+  [
+    "Stroke (Treatment): Generally there are three treatment stages for stroke: prevention, therapy immediately after the stroke, and post-stroke rehabilitation. Therapies to prevent a first or recurrent stroke are based on treating an individual's underlying risk factors for stroke, such as hypertension, atrial fibrillation, and diabetes. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Medication or drug therapy is the most common treatment for stroke. The most popular classes of drugs used to prevent or treat stroke are antithrombotics (antiplatelet agents and anticoagulants) and thrombolytics.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Stroke-Information-Page"
+  ],
+  [
+    "Etiology: Etiology describes the cause or causes of a disease. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002356.htm"
+  ],
+  [
+    "Stroke: A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. Brain cells die when they no longer receive oxygen and nutrients from the blood or there is sudden bleeding into or around the brain. The symptoms of a stroke include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble with walking, dizziness, or loss of balance or coordination; or sudden severe headache with no known cause. There are two forms of stroke:\u00a0ischemic\u00a0- blockage of a blood vessel supplying the brain, and\u00a0hemorrhagic\u00a0- bleeding into or around the brain. Generally there are three treatment stages for stroke: prevention, therapy immediately after the stroke, and post-stroke rehabilitation. Therapies to prevent a first or recurrent stroke are based on treating an individual's underlying risk factors for stroke, such as hypertension, atrial fibrillation, and diabetes. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Medication or drug therapy is the most common treatment for stroke. The most popular classes of drugs used to prevent or treat stroke are antithrombotics (antiplatelet agents and anticoagulants) and thrombolytics. Although stroke is a disease of the brain, it can affect the entire body. A common disability that results from stroke is complete paralysis on one side of the body, called\u00a0hemiplegia. A related disability that is not as debilitating as paralysis is one-sided weakness or\u00a0hemiparesis. Stroke may cause problems with thinking, awareness, attention, learning, judgment, and memory. Stroke survivors often have problems understanding or forming speech. A stroke can lead to emotional problems. Stroke patients may have difficulty controlling their emotions or may express inappropriate emotions. Many stroke patients experience depression. Stroke survivors may also have numbness or strange sensations. The pain is often worse in the hands and feet and is made worse by movement and temperature changes, especially cold temperatures. Recurrent stroke is frequent; about 25 percent of people who recover from their first stroke will have another stroke within 5 years.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Stroke-Information-Page"
+  ],
+  [
+    "Stroke (Prognosis): Although stroke is a disease of the brain, it can affect the entire body. A common disability that results from stroke is complete paralysis on one side of the body, called\u00a0hemiplegia. A related disability that is not as debilitating as paralysis is one-sided weakness or\u00a0hemiparesis. Stroke may cause problems with thinking, awareness, attention, learning, judgment, and memory. Stroke survivors often have problems understanding or forming speech. A stroke can lead to emotional problems. Stroke patients may have difficulty controlling their emotions or may express inappropriate emotions. Many stroke patients experience depression. Stroke survivors may also have numbness or strange sensations. The pain is often worse in the hands and feet and is made worse by movement and temperature changes, especially cold temperatures. Recurrent stroke is frequent; about 25 percent of people who recover from their first stroke will have another stroke within 5 years.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Stroke-Information-Page"
+  ],
+  [
+    "Myopathy with extrapyramidal signs (Symptoms): The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Ataxia Occasional Microcephaly Occasional Ophthalmoplegia Occasional Optic atrophy Occasional Peripheral axonal neuropathy Occasional Ptosis Occasional Abnormality of extrapyramidal motor function Very rare Chorea Very rare Dystonia Very rare Orofacial dyskinesia Very rare Proximal muscle weakness Very rare Specific learning disability Very rare Tremor Very rare Autosomal recessive inheritance - Difficulty running - Difficulty walking - Elevated serum creatine phosphokinase - Motor delay - View complete list of signs and symptoms...",
+    "https://rarediseases.info.nih.gov/diseases/12978/myopathy-with-extrapyramidal-signs"
+  ],
+  [
+    "What are the symptoms of Stroke?: The signs and symptoms of a stroke often develop quickly. However, they can develop over hours or even days. The type of symptoms depends on the type of stroke and the area of the brain thats affected. How long symptoms last and how severe they are vary among different people. Signs and symptoms of a stroke may include: Sudden weakness Paralysis (an inability to move) or numbness of the face, arms, or legs, especially on one side of the body Confusion Trouble speaking or understanding speech Trouble seeing in one or both eyes Problems breathing Dizziness, trouble walking, loss of balance or coordination, and unexplained falls Loss of consciousness Sudden and severe headache A transient ischemic attack (TIA) has the same signs and symptoms as a stroke. However, TIA symptoms usually last less than 12 hours (although they may last up to 24 hours). A TIA may occur only once in a persons lifetime or more often. At first, it may not be possible to tell whether someone is having a TIA or stroke. All stroke-like symptoms require medical care. If you think you or someone else is having a TIA or stroke, call 911 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts. Stroke Complications After youve had a stroke, you may develop other complications, such as: Blood clots and muscle weakness. Being immobile (unable to move around) for a long time can raise your risk of developing blood clots in the deep veins of the legs. Being immobile also can lead to muscle weakness and decreased muscle flexibility. Problems swallowing and pneumonia. If a stroke affects the muscles used for swallowing, you may have a hard time eating or drinking. You also may be at risk of inhaling food or drink into your lungs. If this happens, you may develop pneumonia. Loss of bladder control. Some strokes affect the muscles used to urinate. You may need a urinary catheter (a tube placed into the bladder) until you can urinate on your own. Use of these catheters can lead to urinary tract infections. Loss of bowel control or constipation also may occur after a stroke.",
+    "http://www.nhlbi.nih.gov/health/health-topics/topics/stroke"
+  ],
+  [
+    "Warning signs and symptoms of heart disease: Heart disease often develops over time. You may have early signs or symptoms long before you have serious heart problems. Or you may not realize you are developing heart disease. The warning signs of heart disease may not be obvious. Also, not every person has the same symptoms. Certain symptoms, such as chest pain, ankle swelling, and shortness of breath may be signals that something is wrong. Learning the warning signs can help you get treatment and help prevent a heart attack or stroke. Chest pain is discomfort or pain that you feel along the front of your body, between your neck and upper abdomen. There are many causes of chest pain that have nothing to do with your heart. But chest pain is still the most common symptom of poor blood flow to the heart or a heart attack. This type of chest pain is called angina. Chest pain can occur when the heart is not getting enough blood or oxygen. The amount and type of pain can vary from person to person. The intensity of the pain does not always relate to how severe the problem is. - Some people may feel a crushing pain, while others feel only mild discomfort. - Your chest may feel heavy or like someone is squeezing your heart. You may also feel a sharp, burning pain in your chest. - You may feel the pain under your breastbone (sternum), or in your neck, arms, stomach, jaw, or upper back. - Chest pain from angina often occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin. - Bad indigestion can also cause chest pain. Women, older adults, and people with diabetes may have little or no chest pain. They are more likely to have symptoms other than chest pain, such as: - Fatigue - Shortness of breath - General weakness - Change in skin color or greyish pallor (episodes of change in skin color associated with weakness) Other symptoms of a heart attack can include: - Extreme anxiety - Fainting or loss of consciousness - Lightheadedness or dizziness - Nausea or vomiting - Palpitations (feeling like your heart is beating too fast or irregularly) - Shortness of breath - Sweating, which may be very heavy When the heart can't pump blood as well as it should, blood backs up in the veins that go from the lungs to the heart. Fluid leaks into the lungs and causes shortness of breath. This is a symptom of heart failure. You may notice shortness of breath: - During activity - While you're resting - When you're lying flat on your back -- it may even wake you from sleep Coughing or wheezing that doesn't go away can be another sign that fluid is building up in your lungs. You may also cough up mucus that is pink or bloody. Swelling (edema) in your lower legs is another sign of a heart problem. When your heart doesn't work as well, blood flow slows and backs up in the veins in your legs. This causes fluid to build up in your tissues. You may also have swelling in your stomach or notice some weight gain. Narrowing of the blood vessels that bring blood to other parts of the body may mean you have a much higher risk for heart attack. It can occur when cholesterol and other fatty material (plaque) build up on the walls of your arteries. Poor blood supply to the legs may lead to: - Pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs. - Symptoms that often appear during walking or exercise, and go away after several minutes of rest. - Numbness in your legs or feet when you are at rest. Your legs may also feel cool to the touch, and the skin may look pale. A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a \"brain attack.\" Symptoms of stroke can include difficulty moving the limbs on one side of your body, one side of the face drooping, difficulty with speaking or understanding language. Tiredness can have many causes. Often it simply means that you need more rest. But feeling run down can be a sign of a more serious problem. Fatigue may be a sign of heart trouble when: - You feel much more tired than normal. It's common for women to feel severely tired before or during a heart attack. - You feel so tired that you can't do your normal daily activities. - You have sudden, severe weakness. If your heart can't pump blood as well, it may beat faster to try to keep up. You may feel your heart racing or throbbing. A fast or uneven heartbeat can also be the sign of an arrhythmia. This is a problem with your heart rate or rhythm. If you have any signs of heart disease, call your health care provider right away. Don't wait to see if the symptoms go away or dismiss them as nothing. Call your local emergency number (such as 911) if: - You have chest pain or other symptoms of a heart attack - If you know you have angina and have chest pain that doesn't go away after 5 minutes of rest or after taking nitroglycerine - If you think you may be having a heart attack - If you become extremely short of breath - If you think you may have lost consciousness Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000775.htm"
+  ],
+  [
+    "What are the symptoms of Stroke?: Know the Signs Knowing the warning signs of stroke and controlling stroke's risk factors can lower your risk of death or disability. If you suffer a stroke, you may not realize it at first. The people around you might not know it, either. Your family, friends, or neighbors may think you are unaware or confused. You may not be able to call 911 on your own. That's why everyone should know the signs of stroke and know how to act fast. Warning signs are clues your body sends to tell you that your brain is not receiving enough oxygen. If you observe one or more of the following signs of a stroke or \"brain attack,\" don't wait. Call 911 right away! Common Signs of Stroke These are warning signs of a stroke: - sudden numbness or weakness of the face, arm, or leg, especially on one side of the body - sudden confusion, trouble speaking or understanding - sudden trouble seeing in one or both eyes - sudden trouble walking, dizziness, loss of balance or coordination - sudden severe headache with no known cause. sudden numbness or weakness of the face, arm, or leg, especially on one side of the body sudden confusion, trouble speaking or understanding sudden trouble seeing in one or both eyes sudden trouble walking, dizziness, loss of balance or coordination sudden severe headache with no known cause. Other danger signs that may occur include double vision, drowsiness, and nausea or vomiting. Don't Ignore \"Mini-Strokes\" Sometimes the warning signs of stroke may last only a few moments and then disappear. These brief episodes, known as transient ischemic attacks or TIAs, are sometimes called \"mini-strokes.\" Although brief, TIAs identify an underlying serious condition that isn't going away without medical help. Unfortunately, since they clear up, many people ignore them. Don't ignore them. Heeding them can save your life. Why It's Important To Act Fast Stroke is a medical emergency. Every minute counts when someone is having a stroke. The longer blood flow is cut off to the brain, the greater the damage. Immediate treatment can save peoples lives and enhance their chances for successful recovery. Ischemic strokes, the most common type of strokes, can be treated with a drug called t-PA that dissolves blood clots obstructing blood flow to the brain. The window of opportunity to start treating stroke patients is three hours, but to be evaluated and receive treatment, patients need to get to the hospital within 60 minutes. What Should You Do? Don't wait for the symptoms of stroke to improve or worsen. If you believe you are having a stroke, call 911 immediately. Making the decision to call for medical help can make the difference in avoiding a lifelong disability and in greatly improving your chances for recovery. If you observe someone having a stroke if he or she suddenly loses the ability to speak, or move an arm or leg on one side, or experiences facial paralysis on one side call 911 immediately.",
+    "http://nihseniorhealth.gov/stroke/toc.html"
+  ],
+  [
+    "Symptoms and Causes of Diabetes (What are the symptoms of diabetes?): Symptoms of diabetes includeincreased thirst and urination increased hunger fatigue blurred vision numbness or tingling in the feet or hands sores that do not heal unexplained weight lossSymptoms of type 1 diabetes can start quickly, in a matter of weeks. Symptoms of type 2 diabetes often develop slowly\u2014over the course of several years\u2014and can be so mild that you might not even notice them. Many people with type 2 diabetes have no symptoms. Some people do not find out they have the disease until they have diabetes-related health problems, such as blurred vision or heart trouble.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes"
+  ],
+  [
+    "What are the symptoms of Stroke?: Warning signs are clues your body sends to tell you that your brain is not receiving enough oxygen. These are warning signs of a stroke, or brain attack: - sudden numbness or weakness of the face, arm, or leg, especially on one side of the body - sudden confusion, trouble speaking or understanding - sudden trouble seeing in one or both eyes - sudden trouble walking, dizziness, loss of balance or coordination - sudden severe headache with no known cause. sudden numbness or weakness of the face, arm, or leg, especially on one side of the body sudden confusion, trouble speaking or understanding sudden trouble seeing in one or both eyes sudden trouble walking, dizziness, loss of balance or coordination sudden severe headache with no known cause. If you observe one or more of these signs, don't wait. Call 911 right away!",
+    "http://nihseniorhealth.gov/stroke/toc.html"
+  ],
+  [
+    "Myopathy with extrapyramidal signs: Myopathy with extrapyramidal signs is a disorder characterized by early childhood onset of proximal muscle weakness (muscles closest to the body\u2019s midline) and learning disabilities. The muscle weakness does not progress, but most patients develop progressive atypical involuntary muscle contractions that influence gait, movement, and posture (extrapyramidal signs) that may be disabling. Signs and symptoms are variable and include brief, repetitive, jerky and uncontrolled movements caused by muscle contractions ( chorea), tremor, abnormal posturing, and involuntary repetitive movements of the mouth and face. [1] \u00a0Other symptoms may include uncoordinated movements ( ataxia ), a very small head ( microcephaly ), drooping of the eyelids, wasting of the eye nerve ( optic atrophy), and axonal peripheral neuropathy. It is caused by changes ( mutations ) in the MICU1 gene and is inherited in an autosomal recessive \u00a0 pattern. [1] [2] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Ataxia Occasional Microcephaly Occasional Ophthalmoplegia Occasional Optic atrophy Occasional Peripheral axonal neuropathy Occasional Ptosis Occasional Abnormality of extrapyramidal motor function Very rare Chorea Very rare Dystonia Very rare Orofacial dyskinesia Very rare Proximal muscle weakness Very rare Specific learning disability Very rare Tremor Very rare Autosomal recessive inheritance - Difficulty running - Difficulty walking - Elevated serum creatine phosphokinase - Motor delay - View complete list of signs and symptoms...",
+    "https://rarediseases.info.nih.gov/diseases/12978/myopathy-with-extrapyramidal-signs"
+  ],
+  [
+    "Vital signs: Vital signs reflect essential body functions, including your heartbeat, breathing rate, temperature, and blood pressure. Your health care provider may watch, measure, or monitor your vital signs to check your level of physical functioning. Normal vital signs change with age, sex, weight, exercise capability, and overall health. Normal vital sign ranges for the average healthy adult while resting are: - Blood pressure: 90/60 mm Hg to 120/80 mm Hg - Breathing: 12 to 18 breaths per minute - Pulse: 60 to 100 beats per minute - Temperature: 97.8\u00b0F to 99.1\u00b0F (36.5\u00b0C to 37.3\u00b0C)/average 98.6\u00b0F (37\u00b0C) Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002341.htm"
+  ],
+  [
+    "Headaches - danger signs: A headache is a pain or discomfort in the head, scalp, or neck. Common types of headaches include tension headaches, migraine or cluster headaches, sinus headaches, and headaches that begin in your neck. You may have a mild headache with a cold, the flu, or other viral illnesses when you also have a low fever. Most people with headaches feel better by making lifestyle changes, such as learning ways to relax. Taking certain medicines, such as pain medicine, may also help. Problems with blood vessels and bleeding in the brain can cause a headache. These problems include: - Abnormal connection between the arteries and veins in the brain that usually forms before birth. This problem is called an arteriovenous malformation, or AVM. - Blood flow to part of the brain stops. This is called a stroke. - Weakening of the wall of a blood vessel that can break open and bleed into the brain. This is known as a brain aneurysm. - Bleeding in the area between the brain and the thin tissue that covers the brain. This is called a subarachnoid hemorrhage. Other causes of headaches that should be checked by a health care provider right away include: - Blood pressure that is very high - Brain tumor - Buildup of fluid inside the skull that leads to brain swelling (hydrocephalus) - Buildup of pressure inside the skull that appears to be, but is not, a tumor (pseudotumor cerebri) - Carbon monoxide poisoning - Infection in the brain or the tissue that surrounds the brain, as well as a brain abscess - Swollen, inflamed artery that supplies blood to part of the head, temple, and neck area (temporal arteritis) If you cannot see your provider right away, go to the emergency room or call 911 if: - This is the first severe headache you have ever had in your life and it interferes with your daily activities. - You develop a headache right after activities such as weightlifting, aerobics, jogging, or sex. - Your headache comes on suddenly and is explosive or violent. - Your headache is \"the worst ever,\" even if you regularly get headaches. - You also have slurred speech, a change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss with your headache. - Your headache gets worse over 24 hours. - You also have fever, stiff neck, nausea, and vomiting with your headache. - Your headache occurs with a head injury. - Your headache is severe and just in 1 eye, with redness in that eye. - You just started getting headaches, especially if your are older than 50. - You have headaches along with vision problems and pain while chewing, or weight loss. - You have a history of cancer and develop a new headache. - Your immune system is weakened by disease (such as HIV infection) or by medicines (such as chemotherapy drugs and steroids). See your provider soon if: - Your headaches wake you up from sleep. - A headache lasts more than a few days. - Headaches are worse in the morning. - You have a history of headaches but they have changed in pattern or intensity . - You have headaches often and there is no known cause. Updated by: Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000424.htm"
+  ],
+  [
+    "Common symptoms during pregnancy: Growing a baby is hard work. Your body will go through a lot of changes as your baby grows and your hormones change. Along with the aches and pains of pregnancy, you will feel other new or changing symptoms. Even so, many pregnant women say that they feel healthier than ever. Being tired is common during pregnancy. Most women feel tired the first few months, then again toward the end. Exercise, rest, and a proper diet can make you feel less tired. It may also help to take rest breaks or naps every day. Early on in the pregnancy, you will likely be making more trips to the bathroom. - As your uterus grows and rises higher in your abdomen (belly), the need to urinate often may lessen. - Even so, you will continue to urinate more throughout pregnancy. That means that you also need to drink more water, and may be thirstier than before you were pregnant. - As you get closer to delivery and your baby descends into your pelvis, you will need to pee much more, and the amount of urine passed at one time will be less (the bladder holds less due to pressure from the baby). If you have pain when you urinate or a change in urine odor or color, call your health care provider. These could be signs of a bladder infection. Some pregnant women also leak urine when they cough or sneeze. For most women, this goes away after the baby is born. If this happens to you, start doing Kegel exercises to strengthen the muscles of your pelvic floor. You may see more vaginal discharge while pregnant. Call your provider if the discharge: - Has a foul odor - Has a greenish color - Makes you feel itchy - Causes pain or soreness Having a hard time moving the bowels is normal during pregnancy. This is because: - Hormone changes during pregnancy slow down your digestive system. - Later in your pregnancy, the pressure from your uterus on your rectum may also worsen the problem. You can ease constipation by: - Eating raw fruits and vegetables, such as prunes, to get extra fiber. - Eating whole grain or bran cereals for more fiber. - Using a fiber supplement regularly. - Drinking plenty of water (8 to 9 cups daily). Ask your provider about trying a stool softener. Also ask before using laxatives during pregnancy. While you are pregnant, food stays in your stomach and bowels longer. This may cause heartburn (stomach acid moving back up into the esophagus). You can reduce heartburn by: - Eating small meals - Avoiding spicy and greasy foods - Not drinking large amounts of liquid before bedtime - Not exercising for at least 2 hours after you eat - Not lying down flat right after a meal If you continue to have heartburn, talk to your provider about medicines that can help. Some women have nose and gum bleeding while they are pregnant. This is because the tissues in their nose and gums get dry, and the blood vessels dilate and are closer to the surface. You can avoid or reduce this bleeding by: - Drinking lots of fluids - Getting lots of vitamin C, from orange juice or other fruits and juices - Using a humidifier (a device that puts water in the air) to decrease dryness of the nose or sinuses - Brushing your teeth with a soft toothbrush to decrease bleeding gums - Maintaining good dental hygiene and using floss every day to keep your gums healthy Swelling in your legs is common. You may see more swelling as you get closer to giving birth. The swelling is caused by your uterus pressing on the veins. - You may also notice that the veins in your lower body are becoming larger. - In the legs, these are called varicose veins. - You may also have veins close to your vulva and vagina that swell. - In your rectum, veins that swell are called hemorrhoids. To reduce swelling: - Raise your legs and rest your feet on a surface higher than your belly. - Lie on your side in bed. Lying on the left side is better if you can do it comfortably. It also provides better circulation for the baby. - Wear support pantyhose or compression stockings. - Limit salty foods. Salt works like a sponge and makes your body hold more water. - Try not to strain during bowel movements. This can worsen hemorrhoids. Leg swelling that occurs with headaches or high blood pressure can be a sign of a serious medical complication of pregnancy called preeclampsia. It is important to discuss leg swelling with your provider. Some women feel short of breath at times while they are pregnant. It happens more often in the early part of the pregnancy due to the changes in your hormones. It may also happen again toward the end of your pregnancy because of pressure from the baby. Mild shortness of breath from exercise that quickly gets better is not serious. Severe chest pain or shortness of breath that does not go away can be a sign of a serious medical complication. Call 911 or go to an emergency room right away if you have these symptoms. You may get short of breath again in the later weeks of pregnancy. This is because the uterus takes up so much room that your lungs do not have as much space to expand. Doing these things might help with shortness of breath: - Sitting up straight - Sleeping propped up on a pillow - Resting when you feel short of breath - Moving at a slower pace If you suddenly have a hard time breathing that is unusual for you, see your provider right away or go to the emergency room. Updated by: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000583.htm"
+  ],
+  [
+    "Stroke (Treatment): A stroke is a medical emergency. Quick treatment is needed. Call 9-1-1 or your local emergency number right away or seek urgent medical care at the first signs of a stroke. People who are having stroke symptoms need to get to a hospital as quickly as possible. - If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot. - To be effective, this treatment must be started within 3 to 4 1/2 hours of when the symptoms first started. The sooner this treatment is started, the better the chance of a good outcome. Other treatments given in the hospital depend on the cause of the stroke. These may include: - Blood thinners such as heparin, warfarin (Coumadin), aspirin, or clopidogrel (Plavix) - Medicine to control risk factors, such as high blood pressure, diabetes, and high cholesterol - Special procedures or surgery to relieve symptoms or prevent more strokes - Nutrients and fluids Physical therapy, occupational therapy, speech therapy, and swallowing therapy will all begin in the hospital. If the person has severe swallowing problems, a feeding tube in the stomach (gastrostomy tube) will likely be needed. The goal of treatment after a stroke is to help you recover as much function as possible and prevent future strokes. Recovery from your stroke will begin while you are still in the hospital or at a rehabilitation center. It will continue when you go home from the hospital or center. Be sure to follow up with your health care provider after you go home.",
+    "https://medlineplus.gov/ency/article/000726.htm"
+  ],
+  [
+    "What are the treatments for Stroke?: Generally there are three treatment stages for stroke: prevention, therapy immediately after the stroke, and post-stroke rehabilitation. Therapies to prevent a first or recurrent stroke are based on treating an individual's underlying risk factors for stroke, such as hypertension, atrial fibrillation, and diabetes. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Medication or drug therapy is the most common treatment for stroke. The most popular classes of drugs used to prevent or treat stroke are antithrombotics (antiplatelet agents and anticoagulants) and thrombolytics.",
+    "http://www.ninds.nih.gov/disorders/stroke/stroke.htm"
+  ],
+  [
+    "What are the treatments for Stroke?: Treatment for a stroke depends on whether it is ischemic or hemorrhagic. Treatment for a transient ischemic attack (TIA) depends on its cause, how much time has passed since symptoms began, and whether you have other medical conditions. Strokes and TIAs are medical emergencies. If you have stroke symptoms, call 911 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin lifesaving treatment on the way to the emergency room. During a stroke, every minute counts. Once you receive immediate treatment, your doctor will try to treat your stroke risk factors and prevent complications by recommending heart-healthy lifestyle changes. Treating an Ischemic Stroke or Transient Ischemic Attack An ischemic stroke or TIA occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Often, blood clots cause the blockages that lead to ischemic strokes and TIAs. Treatment for an ischemic stroke or TIA may include medicines and medical procedures. Medicines If you have a stroke caused by a blood clot, you may be given a clot-dissolving, or clot-busting, medication called tissue plasminogen activator (tPA). A doctor will inject tPA into a vein in your arm. This type of medication must be given within 4hours of symptom onset. Ideally, it should be given as soon as possible. The sooner treatment begins, the better your chances of recovery. Thus, its important to know the signs and symptoms of a stroke and to call 911 right away for emergency care. If you cant have tPA for medical reasons, your doctor may give you antiplatelet medicine that helps stop platelets from clumping together to form blood clots or anticoagulant medicine (blood thinner) that keeps existing blood clots from getting larger. Two common medicines are aspirin and clopidogrel. Medical Procedures If you have carotid artery disease, your doctor may recommend a carotid endarterectomy or carotid arteryangioplasty. Both procedures open blocked carotid arteries. Researchers are testing other treatments for ischemic stroke, such as intra-arterial thrombolysis and mechanical clot removal in cerebral ischemia (MERCI). In intra-arterial thrombolysis, a long flexible tube called a catheter is put into your groin (upper thigh) and threaded to the tiny arteries of the brain. Your doctor can deliver medicine through this catheter to break up a blood clot in the brain. MERCI is a device that can remove blood clots from an artery. During the procedure, a catheter is threaded through a carotid artery to the affected artery in the brain. The device is then used to pull the blood clot out through the catheter. Treating a Hemorrhagic Stroke A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures. The first steps in treating a hemorrhagic stroke are to find the cause of bleeding in the brain and then control it. Unlike ischemic strokes, hemorrhagic strokes arent treated with antiplatelet medicines and blood thinners because these medicines can make bleeding worse. If youre taking antiplatelet medicines or blood thinners and have a hemorrhagic stroke, youll be taken off the medicine. If high blood pressure is the cause of bleeding in the brain, your doctor may prescribe medicines to lower your blood pressure. This can help prevent further bleeding. Surgery also may be needed to treat a hemorrhagic stroke. The types of surgery used include aneurysm clipping, coil embolization, and arteriovenous malformation (AVM) repair. Aneurysm Clipping and Coil Embolization If an aneurysm (a balloon-like bulge in an artery) is the cause of a stroke, your doctor may recommend aneurysm clipping or coil embolization. Aneurysm clipping is done to block off the aneurysm from the blood vessels in the brain. This surgery helps prevent further leaking of blood from the aneurysm. It also can help prevent the aneurysm from bursting again.During the procedure, a surgeon will make an incision (cut) in the brain and place a tiny clamp at the base of the aneurysm. Youll be given medicine to make you sleep during the surgery. After the surgery, youll need to stay in the hospitals intensive care unit for a few days. Coil embolization is a less complex procedure for treating an aneurysm. The surgeon will insert a tube called a catheter into an artery in the groin. He or she will thread the tube to the site of the aneurysm.Then, a tiny coil will be pushed through the tube and into the aneurysm. The coil will cause a blood clot to form, which will block blood flow through the aneurysm and prevent it from burstingagain.Coil embolization is done in a hospital. Youll be given medicine to make you sleep during thesurgery. Arteriovenous Malformation Repair If an AVM is the cause of a stroke, your doctor may recommend an AVM repair. (An AVM is a tangle of faulty arteries and veins that can rupture within the brain.) AVM repair helps prevent further bleeding in the brain. Doctors use several methods to repair AVMs. These methods include: Injecting a substance into the blood vessels of the AVM to block blood flow Surgery to remove the AVM Using radiation to shrink the blood vessels of the AVM Treating Stroke Risk Factors After initial treatment for a stroke or TIA, your doctor will treat your risk factors. He or she may recommend heart-healthy lifestyle changes to help control your risk factors. Heart-healthy lifestyle changes may include: heart-healthy eating maintaining a healthy weight managing stress physical activity quitting smoking If lifestyle changes arent enough, you may need medicine to control your risk factors. Heart-Healthy Eating Your doctor may recommend heart-healthy eating, which should include: Fat-free or low-fat dairy products, such as skim milk Fish high in omega-3 fatty acids, such as salmon, tuna, and trout, about twice a week Fruits, such as apples, bananas, oranges, pears, and prunes Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans Vegetables, such as broccoli, cabbage, and carrots Whole grains, such as oatmeal, brown rice, and corn tortillas When following a heart-healthy diet, you should avoid eating: A lot of red meat Palm and coconut oils Sugary foods and beverages Two nutrients in your diet make blood cholesterol levels rise: Saturated fatfound mostly in foods that come from animals Trans fat (trans fatty acids)found in foods made with hydrogenated oils and fats, such as stick margarine; baked goods, such as cookies, cakes, and pies; crackers; frostings; and coffee creamers. Some trans fats also occur naturally in animal fats and meats. Saturated fat raises your blood cholesterol more than anything else in your diet. When you follow a heart-healthy eating plan, only 5percent to 6percent of your daily calories should come from saturated fat. Food labels list the amounts of saturated fat. To help you stay on track, here are some examples: 1,200 calories a day 8 grams of saturated fat a day 1,500 calories a day 10 grams of saturated fat a day 1,800 calories a day 12 grams of saturated fat a day 2,000 calories a day 13 grams of saturated fat a day 2,500 calories a day 17 grams of saturated fat a day Not all fats are bad. Monounsaturated and polyunsaturated fats actually help lower blood cholesterol levels. Some sources of monounsaturated and polyunsaturated fats are: Avocados Corn, sunflower, and soybean oils Nuts and seeds, such as walnuts Olive, canola, peanut, safflower, and sesame oils Peanut butter Salmon and trout Tofu Sodium Try to limit the amount of sodium that you eat. This means choosing and preparing foods that are lower in salt and sodium. Try to use low-sodium and no added salt foods and seasonings at the table or while cooking. Food labels tell you what you need to know about choosing foods that are lower in sodium. Try to eat no more than 2,300 milligrams of sodium a day. If you have high blood pressure, you may need to restrict your sodium intake even more. Dietary Approaches to Stop Hypertension Your doctor may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium and salt. The DASH eating plan is a good heart-healthy eating plan, even for those who dont have high blood pressure. Read more about DASH. Alcohol Try to limit alcohol intake. Too much alcohol can raise your blood pressure and triglyceride levels, a type of fat found in the blood. Alcohol also adds extra calories, which may cause weight gain. Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is: 12 ounces of beer 5 ounces of wine 1 ounces of liquor Maintaining a Healthy Weight Maintaining a healthy weight is important for overall health and can lower your risk for stroke. Aim for a Healthy Weight by following a heart-healthy eating plan and keeping physically active. Knowing your body mass index (BMI) helps you find out if youre a healthy weight in relation to your height and gives an estimate of your total body fat. To figure out your BMI, check out the National Heart, Lung, and Blood Institutes (NHLBI) online BMI calculator or talk to your doctor. A BMI: Below 18.5 is a sign that you are underweight. Between 18.5 and 24.9 is in the normal range. Between 25.0 and 29.9 is considered overweight. Of 30.0 or higher is considered obese. A general goal to aim for is a BMI of less than 25. Your doctor or health care provider can help you set an appropriate BMI goal. Measuring waist circumference helps screen for possible health risks. If most of your fat is around your waist rather than at your hips, youre at a higher risk for heart disease and type2 diabetes. This risk may be high with a waist size that is greater than 35 inches for women or greater than 40 inches for men. To learn how to measure your waist, visit Assessing Your Weight and Health Risk. If youre overweight or obese, try to lose weight. A loss of just 3 percent to 5 percent of your current weight can lower your triglycerides, blood glucose, and the risk of developing type 2 diabetes. Greater amounts of weight loss can improve blood pressure readings, lower LDL cholesterol, and increase HDL cholesterol. Managing Stress Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Consider healthy stress-reducing activities, such as: A stress management program Meditation Physical activity Relaxation therapy Talking things out with friends or family Physical Activity Regular physical activity can lower many risk factors for stroke. Everyone should try to participate in moderate-intensity aerobic exercise at least 2hours and 30minutes per week or vigorous aerobic exercise for 1hour and 15minutes per week. Aerobic exercise, such as brisk walking, is any exercise in which your heart beats faster and you use more oxygen than usual. The more active you are, the more you will benefit. Participate in aerobic exercise for at least 10minutes at a time spread throughout the week. Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you. Read more about physical activity at: Physical Activity and Your Heart U.S. Department of Health and Human Services, 2008 Physical Activity Guidelines for Americans Quitting Smoking If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk for stroke. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. For more information about how to quit smoking, visit Smoking and Your Heart.",
+    "http://www.nhlbi.nih.gov/health/health-topics/topics/stroke"
+  ],
+  [
+    "Stroke (Treatment outcomes): One way to evaluate the care of patients diagnosed with stroke is to look at the percentage of patients receiving the timely and effective care measures that are appropriate. The goal is 100 percent. The graph below displays the percentage of eligible Mayo Clinic patients diagnosed with stroke receiving all of the appropriate care measures.",
+    "https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113"
+  ],
+  [
+    "What are the treatments for Stroke?: Medication or drug therapy is the most common treatment for stroke. The most popular kinds of drugs to prevent or treat stroke are antithrombotics -- which include antiplatelet agents and anticoagulants -- and thrombolytics. Antithrombotics prevent the formation of blood clots that can become stuck in an artery of the brain and cause strokes. - In the case of stroke, doctors prescribe antiplatelet drugs mainly for prevention. The most widely known and used antiplatelet drug is aspirin. Other antiplatelet drugs include clopidogrel, ticlopidine, and dipyridamole. In the case of stroke, doctors prescribe antiplatelet drugs mainly for prevention. The most widely known and used antiplatelet drug is aspirin. Other antiplatelet drugs include clopidogrel, ticlopidine, and dipyridamole. - Anticoagulants reduce the risk of stroke by reducing the clotting property of the blood. The most commonly used oral anticoagulants include warfarin, also known as Coumadin, dabigatran (Pradaxa) and rivaroxaban (Xarelto). Injectable anticoagulants include heparin, enoxaparin (Lovenox), and dalteparin (Fragmin). Anticoagulants reduce the risk of stroke by reducing the clotting property of the blood. The most commonly used oral anticoagulants include warfarin, also known as Coumadin, dabigatran (Pradaxa) and rivaroxaban (Xarelto). Injectable anticoagulants include heparin, enoxaparin (Lovenox), and dalteparin (Fragmin). Thrombolytic drugs halt the stroke by dissolving the blood clot that is blocking blood flow to the brain. Ischemic strokes -- the most common kind -- can be treated with thrombolytic drugs. But a person needs to be at the hospital as soon as possible after symptoms start to be evaluated and receive treatment. A thrombolytic drug known as t-PA can be effective if a person receives it intravenously (in a vein) within 3 hours after his or her stroke symptoms have started. Because there is such a narrow time window for giving t-PA, it is important to note the time any stroke symptoms appear. Since thrombolytic drugs can increase bleeding, t-PA should be used only after the doctor is certain that the patient has suffered an ischemic and not a hemorrhagic stroke. Neuroprotectants are medications or other treatments that protect the brain from secondary injury caused by stroke. Although the FDA (Food and Drug Administration) has not approved any neuroprotectants for use in stroke at this time, many have been tested or are being tested in clinical trials. Cooling of the brain (hypothermia) is beneficial for improving neurological function after a cardiac arrest.",
+    "http://nihseniorhealth.gov/stroke/toc.html"
+  ],
+  [
+    "Atrial Fibrillation and Stroke (Treatment): Within a few hours after onset of a stroke, treatment with drugs or devices that dissolve or break up the clot can restore blood flow to the brain and lead to a better recovery. To prevent strokes related to AF, doctors often prescribe medications to prevent formation of clots in the heart, which can travel to the brain and cause stroke. Immediately after a stroke, doctors may temporarily administer heparin by injection, while starting an oral medication for long-term protection from clots. The most commonly used drug has been warfarin. People taking warfarin must be closely monitored to make sure their blood is thin enough to prevent clots, but not so thin as to promote bleeding. Since some foods, vitamin supplements, and medications can affect warfarin action, keeping the blood just thin enough can be tricky. More recently, a number of new blood thinners, including dabigatran, rivaroxaban, and apixaban, have been shown to be as effective as warfarin in stroke prevention. These newer medications do not require regular blood test monitoring and may have less tendency to cause bleeding due to making the blood too thin. Some individuals with AF may have a lower risk of stroke and may be treated with aspirin, either alone or with another antiplatelet agency like clopidogrel. Other treatments for AF include medications such as beta blockers or calcium channel blockers to slow the heartbeat, and anti-arrhythmic drugs or electrical cardioversion (which delivers an electrical shock to the heart) to normalize the heartbeat.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Atrial-Fibrillation-and-Stroke-Information-Page"
+  ],
+  [
+    "What are the treatments for Stroke?: Surgery Surgery can be used to prevent stroke, to treat stroke, or to repair damage to the blood vessels or malformations in and around the brain. - Carotid endarterectomy is a surgical procedure in which a surgeon removes fatty deposits, or plaque, from the inside of one of the carotid arteries. The procedure is performed to prevent stroke. The carotid arteries are located in the neck and are the main suppliers of blood to the brain. Carotid endarterectomy is a surgical procedure in which a surgeon removes fatty deposits, or plaque, from the inside of one of the carotid arteries. The procedure is performed to prevent stroke. The carotid arteries are located in the neck and are the main suppliers of blood to the brain. Vascular Interventions In addition to surgery, a variety of techniques have been developed to allow certain vascular problems to be treated from inside the artery using specialized catheters with the goal of improving blood flow. (Vascular is a word that refers to blood vessels, arteries, and veins that carry blood throughout the body.) A catheter is a very thin, flexible tube that can be inserted into one of the major arteries of the leg or arm and then directed through the blood vessels to the diseased artery. Physicians trained in this technique called angiography undergo additional training to treat problems in the arteries of the brain or spinal cord. These physicians are called neurointerventionalists. - Angioplasty is widely used by angiographers to open blocked heart arteries, and is also used to prevent stroke. Angioplasty is a procedure in which a special catheter is inserted into the narrowed artery and then a balloon at the tip of the catheter is inflated to open the blocked artery. The procedure improves blood flow to the brain. Angioplasty is widely used by angiographers to open blocked heart arteries, and is also used to prevent stroke. Angioplasty is a procedure in which a special catheter is inserted into the narrowed artery and then a balloon at the tip of the catheter is inflated to open the blocked artery. The procedure improves blood flow to the brain. - Stenting is another procedure used to prevent stroke. In this procedure an angiographer inserts a catheter into the artery in the groin and then positions the tip of the catheter inside the narrowed artery. A stent is a tube-like device made of a mesh-like material that can be slipped into position over the catheter. When positioned inside the narrowed segment the stent is expanded to widen the artery and the catheter is removed. Angioplasty or stenting of the carotid artery can cause pieces of the diseased plaque to loosen. An umbrella-like device is often temporarily expanded above to prevent these pieces from traveling to the brain. Stenting is another procedure used to prevent stroke. In this procedure an angiographer inserts a catheter into the artery in the groin and then positions the tip of the catheter inside the narrowed artery. A stent is a tube-like device made of a mesh-like material that can be slipped into position over the catheter. When positioned inside the narrowed segment the stent is expanded to widen the artery and the catheter is removed. Angioplasty or stenting of the carotid artery can cause pieces of the diseased plaque to loosen. An umbrella-like device is often temporarily expanded above to prevent these pieces from traveling to the brain. - Angiographers also sometimes use clot removal devices to treat stroke patients in the very early stage. One device involves threading a catheter through the artery to the site of the blockage and then vacuuming out the clot. Another corkscrew-like device can be extended from the tip of a catheter and used to grab the clot and pull it out. Drugs can also be injected through the catheter directly into the clot to help dissolve the clot. Angiographers also sometimes use clot removal devices to treat stroke patients in the very early stage. One device involves threading a catheter through the artery to the site of the blockage and then vacuuming out the clot. Another corkscrew-like device can be extended from the tip of a catheter and used to grab the clot and pull it out. Drugs can also be injected through the catheter directly into the clot to help dissolve the clot.",
+    "http://nihseniorhealth.gov/stroke/toc.html"
+  ],
+  [
+    "Ischemic Stroke (Summary): Summary A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Ischemic stroke is the most common type. It is usually caused by a blood clot that blocks or plugs a blood vessel in the brain. This keeps blood from flowing to the brain. Within minutes, brain cells begin to die. Another cause is stenosis, or narrowing of the artery. This can happen because of atherosclerosis, a disease in which plaque builds up inside your arteries. Transient ischemic attacks (TIAs) occur when the blood supply to the brain is interrupted briefly. Having a TIA can mean you are at risk for having a more serious stroke. Symptoms of stroke are - Sudden numbness or weakness of the face, arm or leg (especially on one side of the body) - Sudden confusion, trouble speaking or understanding speech - Sudden trouble seeing in one or both eyes - Sudden trouble walking, dizziness, loss of balance or coordination - Sudden severe headache with no known cause It is important to treat strokes as quickly as possible. Blood thinners may be used to stop a stroke while it is happening by quickly dissolving the blood clot. Post-stroke rehabilitation can help people overcome disabilities caused by stroke damage. NIH: National Institute of Neurological Disorders and Stroke",
+    "#"
+  ],
+  [
+    "Hereditary endotheliopathy, retinopathy, nephropathy, and stroke (Treatment): At this time there is no effective treatment for hereditary endotheliopathy with retinopathy, nephropathy, and stroke (HERNS). Treatment of HERNS is largely palliative, which means that it is aimed at decreasing pain and suffering by providing treatments for relief of symptoms along with comfort and support. In some cases, aspirin may be recommended. Laser treatment to prevent retinal hemorrhage may be beneficial to some affected individuals. A continuous maintenance dose of corticosteroids may be prescribed to manage cerebral edema (swelling in the brain). [1] [2] [3]",
+    "https://rarediseases.info.nih.gov/diseases/10534/hereditary-endotheliopathy-retinopathy-nephropathy-and-stroke"
+  ],
+  [
+    "Stroke (What Is...): A stroke occurs if the flow of oxygen-rich blood to a portion of the brain is blocked. Without oxygen, brain cells start to die after a few minutes. Sudden bleeding in the brain also can cause a stroke if it damages brain cells. If brain cells die or are damaged because of a stroke, symptoms occur in the parts of the body that these brain cells control. Examples of stroke symptoms include sudden weakness; paralysis or numbness of the face, arms, or legs (paralysis is an inability to move); trouble speaking or understanding speech; and trouble seeing. A stroke is a serious medical condition that requires emergency care. A stroke can cause lasting brain damage, long-term disability, or even death. If you think you or someone else is having a stroke, call 9\u20131\u20131 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts. Overview The two main types of stroke are ischemic (is-KE-mik) and hemorrhagic (hem-ah-RAJ-ik). Ischemic is the more common type of stroke. An ischemic stroke occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes. A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures (breaks open). The pressure from the leaked blood damages brain cells. High blood pressure and aneurysms (AN-u-risms) are examples of conditions that can cause hemorrhagic strokes. (Aneurysms are balloon-like bulges in an artery that can stretch and burst.) Another condition that\u2019s similar to a stroke is a transient ischemic attack, also called a TIA or \u201cmini-stroke.\u201d A TIA occurs if blood flow to a portion of the brain is blocked only for a short time. Thus, damage to the brain cells isn\u2019t permanent (lasting). Like ischemic strokes, TIAs often are caused by blood clots. Although TIAs are not full-blown strokes, they greatly increase the risk of having a stroke. If you have a TIA, it\u2019s important for your doctor to find the cause so you can take steps to prevent a stroke. Both strokes and TIAs require emergency care. Outlook Stroke is a leading cause of death in the United States. Many factors can raise your risk of having a stroke. Talk with your doctor about how you can control these risk factors and help prevent a stroke. If you have a stroke, prompt treatment can reduce damage to your brain and help you avoid lasting disabilities. Prompt treatment also may help prevent another stroke. Researchers continue to study the causes and risk factors for stroke. They\u2019re also finding new and better treatments and new ways to help the brain repair itself after a stroke.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/stroke"
+  ],
+  [
+    "Stroke (Diagnosis): Your doctor will diagnose a stroke based on your signs and symptoms, your medical history, a physical exam, and test results. Your doctor will want to find out the type of stroke you\u2019ve had, its cause, the part of the brain that's affected, and whether you have bleeding in the brain. If your doctor thinks you\u2019ve had a transient ischemic attack (TIA), he or she will look for its cause to help prevent a future stroke. Medical History and Physical Exam Your doctor will ask you or a family member about your risk factors for stroke. Examples of risk factors include high blood pressure, smoking, heart disease, and a personal or family history of stroke. Your doctor also will ask about your signs and symptoms and when they began. During the physical exam, your doctor will check your mental alertness and your coordination and balance. He or she will check for numbness or weakness in your face, arms, and legs; confusion; and trouble speaking and seeing clearly. Your doctor will look for signs of carotid artery disease, a common cause of ischemic stroke. He or she will listen to your carotid arteries with a stethoscope. A whooshing sound called a bruit (broo-E) may suggest changed or reduced blood flow due to plaque buildup in the carotid arteries. Diagnostic Tests and Procedures Your doctor may recommend one or more of the following tests to diagnose a stroke or TIA. Brain Computed Tomography A brain computed tomography (to-MOG-rah-fee) scan, or brain CT scan, is a painless test that uses x rays to take clear, detailed pictures of your brain. This test often is done right after a stroke is suspected. A brain CT scan can show bleeding in the brain or damage to the brain cells from a stroke. The test also can show other brain conditions that may be causing your symptoms. Magnetic Resonance Imaging Magnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of the organs and structures in your body. This test can detect changes in brain tissue and damage to brain cells from a stroke. An MRI may be used instead of, or in addition to, a CT scan to diagnose a stroke. Computed Tomography Arteriogram and Magnetic Resonance Arteriogram A CT arteriogram (CTA) and magnetic resonance arteriogram (MRA) can show the large blood vessels in the brain. These tests may give your doctor more information about the site of a blood clot and the flow of blood through your brain. Carotid Ultrasound Carotid ultrasound is a painless and harmless test that uses sound waves to create pictures of the insides of your carotid arteries. These arteries supply oxygen-rich blood to your brain. Carotid ultrasound shows whether plaque has narrowed or blocked your carotid arteries. Your carotid ultrasound test may include a Doppler ultrasound. Doppler ultrasound is a special test that shows the speed and direction of blood moving through your blood vessels. Carotid Angiography Carotid angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the insides of your carotid arteries. For this test, a small tube called a catheter is put into an artery, usually in the groin (upper thigh). The tube is then moved up into one of your carotid arteries. Your doctor will inject a substance (called contrast dye) into the carotid artery. The dye helps make the artery visible on x-ray pictures. Heart Tests EKG (Electrocardiogram) An EKG is a simple, painless test that records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart. An EKG can help detect heart problems that may have led to a stroke. For example, the test can help diagnose atrial fibrillation or a previous heart attack. Echocardiography Echocardiography (EK-o-kar-de-OG-ra-fee), or echo, is a painless test that uses sound waves to create pictures of your heart. The test gives information about the size and shape of your heart and how well your heart's chambers and valves are working. Echo can detect possible blood clots inside the heart and problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to all parts of your body. Blood Tests Your doctor also may use blood tests to help diagnose a stroke. A blood glucose test measures the amount of glucose (sugar) in your blood. Low blood glucose levels may cause symptoms similar to those of a stroke. A platelet count measures the number of platelets in your blood. Blood platelets are cell fragments that help your blood clot. Abnormal platelet levels may be a sign of a bleeding disorder (not enough clotting) or a thrombotic disorder (too much clotting). Your doctor also may recommend blood tests to measure how long it takes for your blood to clot. Two tests that may be used are called PT and PTT tests. These tests show whether your blood is clotting normally.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/stroke"
+  ],
+  [
+    "Stroke (Diagnosis): To determine the most appropriate treatment for your stroke, your emergency team needs to evaluate the type of stroke you're having and the areas of your brain affected by the stroke. They also need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction. Your doctor may use several tests to determine your risk of stroke, including: - Physical examination. Your doctor will ask you or a family member what symptoms you've been having, when they started and what you were doing when they began. Your doctor then will evaluate whether these symptoms are still present. Your doctor will want to know what medications you take and whether you have experienced any head injuries. You'll be asked about your personal and family history of heart disease, transient ischemic attack and stroke. Your doctor will check your blood pressure and use a stethoscope to listen to your heart and to listen for a whooshing sound (bruit) over your neck (carotid) arteries, which may indicate atherosclerosis. Your doctor may also use an ophthalmoscope to check for signs of tiny cholesterol crystals or clots in the blood vessels at the back of your eyes. - Blood tests. You may have several blood tests, which tell your care team how fast your blood clots, whether your blood sugar is abnormally high or low, whether critical blood chemicals are out of balance, or whether you may have an infection. Managing your blood's clotting time and levels of sugar and other key chemicals will be part of your stroke care. - Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show a hemorrhage, tumor, stroke and other conditions. Doctors may inject a dye into your bloodstream to view your blood vessels in your neck and brain in greater detail (computerized tomography angiography). There are different types of CT scans that your doctor may use depending on your situation. - Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography, or magnetic resonance venography). - Carotid ultrasound. In this test, sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries. - Cerebral angiogram. In this test, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck. - Echocardiogram. An echocardiogram uses sound waves to create detailed images of your heart. An echocardiogram can find a source of clots in your heart that may have traveled from your heart to your brain and caused your stroke. You may have a transesophageal echocardiogram. In this test, your doctor inserts a flexible tube with a small device (transducer) attached into your throat and down into the tube that connects the back of your mouth to your stomach (esophagus). Because your esophagus is directly behind your heart, a transesophageal echocardiogram can create clear, detailed ultrasound images of your heart and any blood clots.",
+    "https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113"
+  ],
+  [
+    "How to diagnose Stroke?: Doctors have several techniques and imaging tools to help diagnose stroke quickly and accurately. The first step in diagnosis is a short neurological examination, or an evaluation of the nervous system. When a possible stroke patient arrives at a hospital, a health care professional, usually a doctor or nurse, will ask the patient or a companion what happened and when the symptoms began. Blood tests, an electrocardiogram, and a brain scan such as computed tomography (CT) or magnetic resonance imaging (MRI) will often be done.",
+    "http://nihseniorhealth.gov/stroke/toc.html"
+  ],
+  [
+    "Mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes (Diagnosis): Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. Orphanet lists international laboratories offering diagnostic testing for this condition.",
+    "https://rarediseases.info.nih.gov/diseases/7009/mitochondrial-encephalomyopathy-lactic-acidosis-and-stroke-like-episodes"
+  ],
+  [
+    "How to diagnose Stroke?: The doctor will do a physical exam to: - Check for problems with vision, movement, feeling, reflexes, understanding, and speaking. Your doctor and nurses will repeat this exam over time to see if your stroke is getting worse or improving. - Listen to the carotid arteries in the neck with a stethoscope for an abnormal sound, called a bruit, which is caused by abnormal blood flow. - Check for high blood pressure. You may have the following tests to help find the type, location, and cause of the stroke and rule out other problems: - Angiogram of the head to look for a blood vessel that is blocked or bleeding - Carotid duplex (ultrasound) to see if the carotid arteries in your neck have narrowed - Echocardiogram to see if the stroke could have been caused by a blood clot from the heart - Magnetic resonance angiography (MRA) or CT angiography to check for abnormal blood vessels in the brain Other tests include: - Blood tests - Electrocardiogram (ECG) and heart rhythm monitoring",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000726.htm"
+  ],
+  [
+    "Stroke (Diagnosing and Treating Stroke): A doctor will diagnose a stroke based on symptoms, medical history, and medical tests such as a CT scan. A CT scan is a test that lets doctors look closely at pictures of the brain.All strokes benefit from immediate medical treatment! But only people with ischemic stroke, the kind caused by a blood clot, can be helped by a drug called t-PA (tissue-plasminogen activator). This drug breaks up blood clots and can greatly lessen the damage caused by an ischemic stroke. Starting treatment with t-PA within 3 hours after an ischemic stroke is important to recovery. To be evaluated and receive treatment, patients need to get to the hospital within 60 minutes. Getting to a hospital right away allows time for a CT scan of the brain. This scan will show whether the clot-busting medicine is the right treatment choice.With stroke, treatment depends on the stage of the disease. There are three treatment stages for stroke: prevention, therapy immediately after stroke, and rehabilitation after stroke. Stroke therapies include medications, surgery, and rehabilitation.Medication or drug therapy is the most common treatment for stroke. The most popular kinds of drugs to prevent or treat stroke are antithrombotics--which include antiplatelet agents and anticoagulants--and thrombolytics. Thrombolytic drugs, like t-PA, halt the stroke by dissolving the blood clot that is blocking blood flow to the brain. Antithrombotics prevent the formation of blood clots that can become stuck in an artery of the brain and cause strokes.Surgery and vascular procedures can be used to prevent stroke, treat stroke, or repair damage to the blood vessels or malformations in and around the brain. These include angioplasty, stenting, and carotid endarterectomy.",
+    "https://www.nia.nih.gov/health/topics/stroke"
+  ],
+  [
+    "Ischemic Stroke (Summary): Summary A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Ischemic stroke is the most common type. It is usually caused by a blood clot that blocks or plugs a blood vessel in the brain. This keeps blood from flowing to the brain. Within minutes, brain cells begin to die. Another cause is stenosis, or narrowing of the artery. This can happen because of atherosclerosis, a disease in which plaque builds up inside your arteries. Transient ischemic attacks (TIAs) occur when the blood supply to the brain is interrupted briefly. Having a TIA can mean you are at risk for having a more serious stroke. Symptoms of stroke are - Sudden numbness or weakness of the face, arm or leg (especially on one side of the body) - Sudden confusion, trouble speaking or understanding speech - Sudden trouble seeing in one or both eyes - Sudden trouble walking, dizziness, loss of balance or coordination - Sudden severe headache with no known cause It is important to treat strokes as quickly as possible. Blood thinners may be used to stop a stroke while it is happening by quickly dissolving the blood clot. Post-stroke rehabilitation can help people overcome disabilities caused by stroke damage. NIH: National Institute of Neurological Disorders and Stroke",
+    "#"
+  ],
+  [
+    "Stroke: A stroke occurs if the flow of oxygen-rich blood to a portion of the brain is blocked. Without oxygen, brain cells start to die after a few minutes. Sudden bleeding in the brain also can cause a stroke if it damages brain cells. If brain cells die or are damaged because of a stroke, symptoms occur in the parts of the body that these brain cells control. Examples of stroke symptoms include sudden weakness; paralysis or numbness of the face, arms, or legs (paralysis is an inability to move); trouble speaking or understanding speech; and trouble seeing. A stroke is a serious medical condition that requires emergency care. A stroke can cause lasting brain damage, long-term disability, or even death. If you think you or someone else is having a stroke, call 9\u20131\u20131 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts. Overview The two main types of stroke are ischemic (is-KE-mik) and hemorrhagic (hem-ah-RAJ-ik). Ischemic is the more common type of stroke. An ischemic stroke occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes. A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures (breaks open). The pressure from the leaked blood damages brain cells. High blood pressure and aneurysms (AN-u-risms) are examples of conditions that can cause hemorrhagic strokes. (Aneurysms are balloon-like bulges in an artery that can stretch and burst.) Another condition that\u2019s similar to a stroke is a transient ischemic attack, also called a TIA or \u201cmini-stroke.\u201d A TIA occurs if blood flow to a portion of the brain is blocked only for a short time. Thus, damage to the brain cells isn\u2019t permanent (lasting). Like ischemic strokes, TIAs often are caused by blood clots. Although TIAs are not full-blown strokes, they greatly increase the risk of having a stroke. If you have a TIA, it\u2019s important for your doctor to find the cause so you can take steps to prevent a stroke. Both strokes and TIAs require emergency care. Outlook Stroke is a leading cause of death in the United States. Many factors can raise your risk of having a stroke. Talk with your doctor about how you can control these risk factors and help prevent a stroke. If you have a stroke, prompt treatment can reduce damage to your brain and help you avoid lasting disabilities. Prompt treatment also may help prevent another stroke. Researchers continue to study the causes and risk factors for stroke. They\u2019re also finding new and better treatments and new ways to help the brain repair itself after a stroke. Ischemic Stroke An ischemic stroke occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes. The two types of ischemic stroke are thrombotic (throm-BOT-ik) and embolic (em-BOL-ik). In a thrombotic stroke, a blood clot (thrombus) forms in an artery that supplies blood to the brain. In an embolic stroke, a blood clot or other substance (such as plaque, a fatty material) travels through the bloodstream to an artery in the brain. (A blood clot or piece of plaque that travels through the bloodstream is called an embolus.) With both types of ischemic stroke, the blood clot or plaque blocks the flow of oxygen-rich blood to a portion of the brain. Ischemic Stroke Hemorrhagic Stroke A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures (breaks open). The pressure from the leaked blood damages brain cells. The two types of hemorrhagic stroke are intracerebral (in-trah-SER-e-bral) and subarachnoid (sub-ah-RAK-noyd). In an intracerebral hemorrhage, a blood vessel inside the brain leaks blood or ruptures. In a subarachnoid hemorrhage, a blood vessel on the surface of the brain leaks blood or ruptures. When this happens, bleeding occurs between the inner and middle layers of the membranes that cover the brain. In both types of hemorrhagic stroke, the leaked blood causes swelling of the brain and increased pressure in the skull. The swelling and pressure damage cells and tissues in the brain. Hemorrhagic Stroke Brain attack Cerebrovascular accident (CVA) Hemorrhagic stroke (includes intracerebral hemorrhage and subarachnoid hemorrhage) Ischemic stroke (includes thrombotic stroke and embolic stroke) A transient ischemic attack sometimes is called a TIA or mini-stroke. A TIA has the same symptoms as a stroke, and it increases your risk of having a stroke. Ischemic Stroke and Transient Ischemic Attack An ischemic stroke or transient ischemic attack (TIA) occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Many medical conditions can increase the risk of ischemic stroke or TIA. For example, atherosclerosis (ath-er-o-skler-O-sis) is a disease in which a fatty substance called plaque builds up on the inner walls of the arteries. Plaque hardens and narrows the arteries, which limits the flow of blood to tissues and organs (such as the heart and brain). Plaque in an artery can crack or rupture (break open). Blood platelets (PLATE-lets), which are disc-shaped cell fragments, stick to the site of the plaque injury and clump together to form blood clots. These clots can partly or fully block an artery. Plaque can build up in any artery in the body, including arteries in the heart, brain, and neck. The two main arteries on each side of the neck are called the carotid (ka-ROT-id) arteries. These arteries supply oxygen-rich blood to the brain, face, scalp, and neck. When plaque builds up in the carotid arteries, the condition is called carotid artery disease. Carotid artery disease causes many of the ischemic strokes and TIAs that occur in the United States. An embolic stroke (a type of ischemic stroke) or TIA also can occur if a blood clot or piece of plaque breaks away from the wall of an artery. The clot or plaque can travel through the bloodstream and get stuck in one of the brain\u2019s arteries. This stops blood flow through the artery and damages brain cells. Heart conditions and blood disorders also can cause blood clots that can lead to a stroke or TIA. For example, atrial fibrillation (A-tre-al fi-bri-LA-shun), or AF, is a common cause of embolic stroke. In AF, the upper chambers of the heart contract in a very fast and irregular way. As a result, some blood pools in the heart. The pooling increases the risk of blood clots forming in the heart chambers. An ischemic stroke or TIA also can occur because of lesions caused by atherosclerosis. These lesions may form in the small arteries of the brain, and they can block blood flow to the brain. Hemorrhagic Stroke Sudden bleeding in the brain can cause a hemorrhagic stroke. The bleeding causes swelling of the brain and increased pressure in the skull. The swelling and pressure damage brain cells and tissues. Examples of conditions that can cause a hemorrhagic stroke include high blood pressure, aneurysms, and arteriovenous (ar-TEER-e-o-VE-nus) malformations (AVMs). \"Blood pressure\" is the force of blood pushing against the walls of the arteries as the heart pumps blood. If blood pressure rises and stays high over time, it can damage the body in many ways. Aneurysms are balloon-like bulges in an artery that can stretch and burst. AVMs are tangles of faulty arteries and veins that can rupture within the brain. High blood pressure can increase the risk of hemorrhagic stroke in people who have aneurysms or AVMs. Certain traits, conditions, and habits can raise your risk of having a stroke or transient ischemic attack (TIA). These traits, conditions, and habits are known as risk factors. The more risk factors you have, the more likely you are to have a stroke. You can treat or control some risk factors, such as high blood pressure and smoking. Other risk factors, such as age and gender, you can\u2019t control. The major risk factors for stroke include: High blood pressure. High blood pressure is the main risk factor for stroke. Blood pressure is considered high if it stays at or above 140/90 millimeters of mercury (mmHg) over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher. Diabetes. Diabetes is a disease in which the blood sugar level is high because the body doesn\u2019t make enough insulin or doesn\u2019t use its insulin properly. Insulin is a hormone that helps move blood sugar into cells where it\u2019s used for energy. Heart diseases.\u00a0Coronary heart disease,\u00a0cardiomyopathy,\u00a0heart failure, and\u00a0atrial fibrillation\u00a0can cause blood clots that can lead to a stroke. Smoking. Smoking can damage blood vessels and raise blood pressure. Smoking also may reduce the amount of oxygen that reaches your body\u2019s tissues. Exposure to secondhand smoke also can damage the blood vessels. Age and gender. Your risk of stroke increases as you get older. At younger ages, men are more likely than women to have strokes. However, women are more likely to die from strokes. Women who take birth control pills also are at slightly higher risk of stroke. Race and ethnicity. Strokes occur more often in African American, Alaska Native, and American Indian adults than in white, Hispanic, or Asian American adults. Personal or family history of stroke or TIA. If you\u2019ve had a stroke, you\u2019re at higher risk for another one. Your risk of having a repeat stroke is the highest right after a stroke. A TIA also increases your risk of having a stroke, as does having a family history of stroke. Brain\u00a0aneurysms\u00a0or arteriovenous malformations (AVMs). Aneurysms are balloon-like bulges in an artery that can stretch and burst. AVMs are tangles of faulty arteries and veins that can rupture (break open) within the brain. AVMs may be present at birth, but often aren\u2019t diagnosed until they rupture. Other risk factors for stroke, many of which of you can control, include: Alcohol and illegal drug use, including cocaine, amphetamines, and other drugs Certain medical conditions, such as sickle cell disease, vasculitis (inflammation of the blood vessels), and bleeding disorders Lack of physical activity Overweight and Obesity Stress and depression Unhealthy cholesterol levels Unhealthy diet Use of nonsteroidal anti-inflammatory drugs (NSAIDs), but not aspirin, may increase the risk of heart attack or stroke, particularly in patients who have had a heart attack or cardiac bypass surgery. The risk may increase the longer NSAIDs are used. Common NSAIDs include ibuprofen and naproxen. Following a heart-healthy lifestyle can lower the risk of stroke. Some people also may need to take medicines to lower their risk. Sometimes strokes can occur in people who don\u2019t have any known risk factors. The signs and symptoms of a stroke often develop quickly. However, they can develop over hours or even days. The type of symptoms depends on the type of stroke and the area of the brain that\u2019s affected. How long symptoms last and how severe they are vary among different people. Signs and symptoms of a stroke may include: Sudden weakness Paralysis (an inability to move) or numbness of the face, arms, or legs, especially on one side of the body Confusion Trouble speaking or understanding speech Trouble seeing in one or both eyes Problems breathing Dizziness, trouble walking, loss of balance or coordination, and unexplained falls Loss of consciousness Sudden and severe headache A transient ischemic attack (TIA) has the same signs and symptoms as a stroke. However, TIA symptoms usually last less than 1\u20132 hours (although they may last up to 24 hours). A TIA may occur only once in a person\u2019s lifetime or more often. At first, it may not be possible to tell whether someone is having a TIA or stroke. All stroke-like symptoms require medical care. If you think you or someone else is having a TIA or stroke, call 9\u20131\u20131 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. During a stroke, every minute counts. Stroke Complications After you\u2019ve had a stroke, you may develop other complications, such as: Blood clots and muscle weakness. Being immobile (unable to move around) for a long time can raise your risk of developing blood clots in the deep veins of the legs. Being immobile also can lead to muscle weakness and decreased muscle flexibility. Problems swallowing and pneumonia. If a stroke affects the muscles used for swallowing, you may have a hard time eating or drinking. You also may be at risk of inhaling food or drink into your lungs. If this happens, you may develop pneumonia. Loss of bladder control. Some strokes affect the muscles used to urinate. You may need a urinary catheter (a tube placed into the bladder) until you can urinate on your own. Use of these catheters can lead to urinary tract infections. Loss of bowel control or constipation also may occur after a stroke. Your doctor will diagnose a stroke based on your signs and symptoms, your medical history, a physical exam, and test results. Your doctor will want to find out the type of stroke you\u2019ve had, its cause, the part of the brain that's affected, and whether you have bleeding in the brain. If your doctor thinks you\u2019ve had a transient ischemic attack (TIA), he or she will look for its cause to help prevent a future stroke. Medical History and Physical Exam Your doctor will ask you or a family member about your risk factors for stroke. Examples of risk factors include high blood pressure, smoking, heart disease, and a personal or family history of stroke. Your doctor also will ask about your signs and symptoms and when they began. During the physical exam, your doctor will check your mental alertness and your coordination and balance. He or she will check for numbness or weakness in your face, arms, and legs; confusion; and trouble speaking and seeing clearly. Your doctor will look for signs of carotid artery disease, a common cause of ischemic stroke. He or she will listen to your carotid arteries with a stethoscope. A whooshing sound called a bruit (broo-E) may suggest changed or reduced blood flow due to plaque buildup in the carotid arteries. Diagnostic Tests and Procedures Your doctor may recommend one or more of the following tests to diagnose a stroke or TIA. Brain Computed Tomography A brain computed tomography (to-MOG-rah-fee) scan, or brain CT scan, is a painless test that uses x rays to take clear, detailed pictures of your brain. This test often is done right after a stroke is suspected. A brain CT scan can show bleeding in the brain or damage to the brain cells from a stroke. The test also can show other brain conditions that may be causing your symptoms. Magnetic Resonance Imaging Magnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of the organs and structures in your body. This test can detect changes in brain tissue and damage to brain cells from a stroke. An MRI may be used instead of, or in addition to, a CT scan to diagnose a stroke. Computed Tomography Arteriogram and Magnetic Resonance Arteriogram A CT arteriogram (CTA) and magnetic resonance arteriogram (MRA) can show the large blood vessels in the brain. These tests may give your doctor more information about the site of a blood clot and the flow of blood through your brain. Carotid Ultrasound Carotid ultrasound is a painless and harmless test that uses sound waves to create pictures of the insides of your carotid arteries. These arteries supply oxygen-rich blood to your brain. Carotid ultrasound shows whether plaque has narrowed or blocked your carotid arteries. Your carotid ultrasound test may include a Doppler ultrasound. Doppler ultrasound is a special test that shows the speed and direction of blood moving through your blood vessels. Carotid Angiography Carotid angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the insides of your carotid arteries. For this test, a small tube called a catheter is put into an artery, usually in the groin (upper thigh). The tube is then moved up into one of your carotid arteries. Your doctor will inject a substance (called contrast dye) into the carotid artery. The dye helps make the artery visible on x-ray pictures. Heart Tests EKG (Electrocardiogram) An EKG is a simple, painless test that records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart. An EKG can help detect heart problems that may have led to a stroke. For example, the test can help diagnose atrial fibrillation or a previous heart attack. Echocardiography Echocardiography (EK-o-kar-de-OG-ra-fee), or echo, is a painless test that uses sound waves to create pictures of your heart. The test gives information about the size and shape of your heart and how well your heart's chambers and valves are working. Echo can detect possible blood clots inside the heart and problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to all parts of your body. Blood Tests Your doctor also may use blood tests to help diagnose a stroke. A blood glucose test measures the amount of glucose (sugar) in your blood. Low blood glucose levels may cause symptoms similar to those of a stroke. A platelet count measures the number of platelets in your blood. Blood platelets are cell fragments that help your blood clot. Abnormal platelet levels may be a sign of a bleeding disorder (not enough clotting) or a thrombotic disorder (too much clotting). Your doctor also may recommend blood tests to measure how long it takes for your blood to clot. Two tests that may be used are called PT and PTT tests. These tests show whether your blood is clotting normally. Treatment for a stroke depends on whether it is ischemic or hemorrhagic. Treatment for a transient ischemic attack (TIA) depends on its cause, how much time has passed since symptoms began, and whether you have other medical conditions. Strokes and TIAs are medical emergencies. If you have stroke symptoms, call 9\u20131\u20131 right away. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin lifesaving treatment on the way to the emergency room. During a stroke, every minute counts. Once you receive immediate treatment, your doctor will try to treat your stroke risk factors and prevent complications by recommending heart-healthy lifestyle changes. Treating an Ischemic Stroke or Transient Ischemic Attack An ischemic stroke or TIA occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked. Often, blood clots cause the blockages that lead to ischemic strokes and TIAs. Treatment for an ischemic stroke or TIA may include medicines and medical procedures. Medicines If you have a stroke caused by a blood clot, you may be given a clot-dissolving, or clot-busting, medication called tissue plasminogen activator (tPA). A doctor will inject tPA into a vein in your arm. This type of medication must be given within 4\u00a0hours of symptom onset. Ideally, it should be given as soon as possible. The sooner treatment begins, the better your chances of recovery. Thus, it\u2019s important to know the signs and symptoms of a stroke and to call 9\u20131\u20131 right away for emergency care. If you can\u2019t have tPA for medical reasons, your doctor may give you antiplatelet medicine that helps stop platelets from clumping together to form blood clots or anticoagulant medicine (blood thinner) that keeps existing blood clots from getting larger. Two common medicines are aspirin and clopidogrel. Medical Procedures If you have carotid artery disease, your doctor may recommend a carotid endarterectomy or carotid artery\u00a0angioplasty. Both procedures open blocked carotid arteries. Researchers are testing other treatments for ischemic stroke, such as intra-arterial thrombolysis and mechanical clot removal in cerebral ischemia (MERCI). In intra-arterial thrombolysis, a long flexible tube called a catheter is put into your groin (upper thigh) and threaded to the tiny arteries of the brain. Your doctor can deliver medicine through this catheter to break up a blood clot in the brain. MERCI is a device that can remove blood clots from an artery. During the procedure, a catheter is threaded through a carotid artery to the affected artery in the brain. The device is then used to pull the blood clot out through the catheter. Treating a Hemorrhagic Stroke A hemorrhagic stroke occurs if an artery in the brain leaks blood or ruptures. The first steps in treating a hemorrhagic stroke are to find the cause of bleeding in the brain and then control it. Unlike ischemic strokes, hemorrhagic strokes aren\u2019t treated with antiplatelet medicines and blood thinners because these medicines can make bleeding worse. If you\u2019re taking antiplatelet medicines or blood thinners and have a hemorrhagic stroke, you\u2019ll be taken off the medicine. If high blood pressure is the cause of bleeding in the brain, your doctor may prescribe medicines to lower your blood pressure. This can help prevent further bleeding. Surgery also may be needed to treat a hemorrhagic stroke. The types of surgery used include aneurysm clipping, coil embolization, and arteriovenous malformation (AVM) repair. Aneurysm Clipping and Coil Embolization If an aneurysm (a balloon-like bulge in an artery) is the cause of a stroke, your doctor may recommend aneurysm clipping or coil embolization. Aneurysm clipping is done to block off the aneurysm from the blood vessels in the brain. This surgery helps prevent further leaking of blood from the aneurysm. It also can help prevent the aneurysm from bursting again.\u00a0During the procedure, a surgeon will make an incision (cut) in the brain and place a tiny clamp at the base of the aneurysm. You\u2019ll be given medicine to make you sleep during the surgery. After the surgery, you\u2019ll need to stay in the hospital\u2019s intensive care unit for a few days. Coil embolization is a less complex procedure for treating an aneurysm. The surgeon will insert a tube called a catheter into an artery in the groin. He or she will thread the tube to the site of the aneurysm.\u00a0Then, a tiny coil will be pushed through the tube and into the aneurysm. The coil will cause a blood clot to form, which will block blood flow through the aneurysm and prevent it from bursting\u00a0again.\u00a0Coil embolization is done in a hospital. You\u2019ll be given medicine to make you sleep during the\u00a0surgery. Arteriovenous Malformation Repair If an AVM is the cause of a stroke, your doctor may recommend an AVM repair. (An AVM is a tangle of faulty arteries and veins that can rupture within the brain.) AVM repair helps prevent further bleeding in the brain. Doctors use several methods to repair AVMs. These methods include: Injecting a substance into the blood vessels of the AVM to block blood flow Surgery to remove the AVM Using radiation to shrink the blood vessels of the AVM Treating Stroke Risk Factors After initial treatment for a stroke or TIA, your doctor will treat your risk factors. He or she may recommend heart-healthy lifestyle changes to help control your risk factors. Heart-healthy lifestyle changes may include: Heart-healthy eating Aiming for a healthy weight Managing stress Physical activity Quitting smoking If heart-healthy lifestyle changes aren\u2019t enough, you may need medicine to control your risk factors. \u00a0 Taking action to control your risk factors can help prevent or delay a stroke. If you\u2019ve already had a stroke.\u00a0Talk to your doctor about whether you may benefit from aspirin\u00a0primary prevention, or using aspirin to help prevent your first stroke. The following heart-healthy lifestyle changes can help prevent your first stroke and help prevent you from having another one. Be physically active. Physical activity can improve your fitness level and health. Talk with your doctor about what types and amounts of activity are safe for you. Don\u2019t smoke, or if you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and raise your risk of stroke. Talk with your doctor about programs and products that can help you quit. Also, secondhand smoke can damage the blood\u00a0vessels. Aim for a healthy weight. If you\u2019re overweight or obese, work with your doctor to create a reasonable weight loss plan. Controlling your weight helps you control risk factors for stroke. Make heart-healthy eating choices. Heart-healthy eating can help lower your risk or prevent a stroke. Manage stress. Use techniques to lower your stress levels. If you or someone in your family has had a stroke, be sure to tell your doctor. By knowing your family history of stroke, you may be able to lower your risk factors and prevent or delay a stroke. If you\u2019ve had a transient ischemic attack (TIA), don\u2019t ignore it. TIAs are warnings, and it\u2019s important for your doctor to find the cause of the TIA so you can take steps to prevent a stroke. \u00a0 The time it takes to recover from a stroke varies\u2014it can take weeks, months, or even years. Some people recover fully, while others have long-term or lifelong disabilities. Ongoing care, rehabilitation, and emotional support can help you recover and may even help prevent another stroke. If you\u2019ve had a stroke, you\u2019re at risk of having another one. Know the warning signs and what to do if a stroke or transient ischemic attack (TIA) occurs. Call 9\u20131\u20131 as soon as symptoms start. Do not drive to the hospital or let someone else drive you. By calling an ambulance, medical personnel can begin lifesaving treatment on the way to the emergency room. During a stroke, every minute counts. Ongoing Care Heart-Healthy Lifestyle Changes Heart-healthy lifestyle changes can help you recover from a stroke and may help prevent another one. Examples of these changes include heart-healthy eating, aiming for a healthy weight, managing stress, physical activity, and quitting smoking. Medicines Your doctor also may prescribe medicines to help you recover from a stroke or control your stroke risk factors. Take all of your medicines as your doctor prescribes. Don\u2019t cut back on the dosage unless your doctor tells you to do so. If you have side effects or other problems related to your medicines, talk with your doctor. Medicines called anticoagulants or blood thinners, which prevent blood clots or keep existing blood clots from getting larger, are the main treatment for people who have known carotid artery disease, which can lead to a stroke. Two common medicines are aspirin and clopidogrel. You\u2019ll likely need routine blood tests to check how well these medicines are working. The most common side effect of blood thinners is bleeding. This happens if the medicine thins your blood too much. This side effect can be life-threatening. Bleeding can occur inside your body cavities (internal bleeding) or from the surface of your skin (external bleeding). Know the warning signs of bleeding so you can get help right away. They include: Blood in your urine, bright red blood in your stools, or black tarry stools Bright red vomit or vomit that looks like coffee grounds Increased menstrual flow Pain in your abdomen or severe pain in your head Unexplained bleeding from the gums and nose Unexplained bruising or tiny red or purple dots on the skin A lot of bleeding after a fall or injury or easy bruising or bleeding also may mean that your blood is too thin. Call your doctor right away if you have any of these signs. If you have severe bleeding, call 9\u20131\u20131. Your doctor also may discuss beginning statin treatment. Doctors recommend statin medications for many people because they help lower or control blood cholesterol levels and decrease the chance for heart attack and stroke. Doctors usually prescribe statins for people who have: Diabetes Heart disease or have had a stroke High LDL cholesterol levels You should still follow a heart-healthy lifestyle, even if you take medicines to control your risk factors for stroke. Take all medicines regularly, as your doctor prescribes. Don\u2019t change the amount of your medicine or skip a dose unless your doctor tells you to. Talk with your doctor about how often you should schedule follow-up visits or tests. These visits and tests can help your doctor monitor your stroke risk factors and adjust your treatment as\u00a0needed. Rehabilitation After a stroke, you may need rehabilitation (rehab) to help you recover. Rehab may include working with speech, physical, and occupational therapists. Language, Speech, and Memory You may have trouble communicating after a stroke. You may not be able to find the right words, put complete sentences together, or put words together in a way that makes sense. You also may have problems with your memory and thinking clearly. These problems can be very frustrating. Speech and language therapists can help you learn ways to communicate again and improve your memory. Muscle and Nerve Problems A stroke may affect only one side of the body or part of one side. It can cause paralysis (an inability to move) or muscle weakness, which can put you at risk for falling. Physical and occupational therapists can help you strengthen and stretch your muscles. They also can help you relearn how to do daily activities, such as dressing, eating, and bathing. Bladder and Bowel Problems A stroke can affect the muscles and nerves that control the bladder and bowels. You may feel like you have to urinate often, even if your bladder isn\u2019t full. You may not be able to get to the bathroom in time. Medicines and a bladder or bowel specialist can help with these problems. Swallowing and Eating Problems You may have trouble swallowing after a stroke. Signs of this problem are coughing or choking during eating or coughing up food after eating. A speech therapist can help you with these issues. He or she may suggest changes to your diet, such as eating pur\u00e9ed (finely chopped) foods or drinking thick liquids. Mental Health Care and Support After a stroke, you may have changes in your behavior or judgment. For example, your mood may change quickly. Because of these and other changes, you may feel scared, anxious, and depressed. Recovering from a stroke can be slow and frustrating. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you\u2019re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life. Joining a patient support group may help you adjust to life after a stroke. You can see how other people have coped with having strokes. Talk with your doctor about local support groups, or check with an area medical center. Support from family and friends also can help relieve fear and anxiety. Let your loved ones know how you feel and what they can do to help you.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/stroke"
+  ],
+  [
+    "Stroke: A stroke is serious, just like a heart attack, so it's important to know the signs of stroke and act quickly if you suspect someone is having one. Stroke is the fourth leading cause of death in the United States, and causes more serious long-term disabilities than any other disease. Older people are at higher risk. You can take steps to lower your chance of having a stroke.Know the Signs of Stroke Knowing the symptoms of a stroke and acting quickly could mean the difference between life and disability or death. Call 911 RIGHT AWAY if you see or have any of these symptoms: - Sudden numbness or weakness in the face, arm, or leg-especially on one side of the body - Sudden confusion or trouble speaking or understanding - Sudden problems seeing in one eye or both eyes - Sudden dizziness, loss of balance or coordination, or trouble walking - Sudden severe headache with no known cause Other danger signs that may occur include double vision, drowsiness, and nausea or vomiting. Stroke strikes fast. You should too. Call 911. Never ignore the symptoms of stroke. Call 911 if you have any stroke symptoms, even if they don't last long. DON'T IGNORE THE SIGNS OF STROKE! A stroke is serious, just like a heart attack, so it's important to know the signs of stroke and act quickly if you suspect someone is having one. Stroke is the fourth leading cause of death in the United States, and causes more serious long-term disabilities than any other disease. Older people are at higher risk. You can take steps to lower your chance of having a stroke.Know the Signs of Stroke Knowing the symptoms of a stroke and acting quickly could mean the difference between life and disability or death. Call 911 RIGHT AWAY if you see or have any of these symptoms: - Sudden numbness or weakness in the face, arm, or leg-especially on one side of the body - Sudden confusion or trouble speaking or understanding - Sudden problems seeing in one eye or both eyes - Sudden dizziness, loss of balance or coordination, or trouble walking - Sudden severe headache with no known cause Other danger signs that may occur include double vision, drowsiness, and nausea or vomiting. Stroke strikes fast. You should too. Call 911. Never ignore the symptoms of stroke. Call 911 if you have any stroke symptoms, even if they don't last long. DON'T IGNORE THE SIGNS OF STROKE! A stroke happens when something changes how blood flows through the brain. Blood brings oxygen and nutrients to brain cells. If blood can't flow to a part of the brain, cells that do not receive enough oxygen suffer and eventually die. If brain cells are without oxygen for only a short time, they can sometimes get better. But brain cells that have died can't be brought back to life. So, someone who has had a stroke may have trouble speaking, thinking, or walking.There are two major types of stroke. The most common kind, ischemic, is caused by a blood clot or the narrowing of a blood vessel (an artery) leading to the brain. This keeps blood from flowing into other parts of the brain and keeps needed oxygen and nutrients from reaching brain cells. Blockages that cause ischemic strokes stem from three conditions:- Formation of a clot within a blood vessel of the brain or neck, called thrombosis - Movement of a clot from another part of the body, such as from the heart to the neck or brain, called an embolism - Severe narrowing of an artery (stenosis) in or leading to the brain, due to fatty deposits lining the blood vessel wallsIn the second major kind of stroke, hemorrhagic, a broken blood vessel causes bleeding in the brain. This break in the vessel also stops oxygen and nutrients from reaching brain cells.Sometimes the symptoms of a stroke last only a few minutes and then go away. That could be a transient ischemic attack (TIA), also called a mini-stroke. A TIA is a medical emergency. You should get medical help right away. If a TIA is not treated quickly, it could be followed within hours or days by a major disabling stroke. Some risk factors for stroke, like age, race, and family history, can't be controlled. But you can make changes to lower your risk of stroke. Talk to your doctor about what you can do. Even if you're in perfect health, follow these suggestions:- Control your blood pressure. Have your blood pressure checked often. If it is high, follow your doctor's advice to lower it. Treating high blood pressure lowers the risk of both stroke and heart disease. - Stop smoking. Smoking increases your risk for stroke. It's never too late to quit. - Control your cholesterol. If you have high cholesterol, work with your doctor to lower it. Cholesterol, a type of fat in the blood, can build up on the walls of your arteries. In time, this can block blood flow and lead to a stroke. - Control your diabetes. Untreated diabetes can damage blood vessels and also leads to narrowed arteries and stroke. Follow your doctor's suggestions for keeping diabetes under control. - Eat healthy foods. Eat foods that are low in cholesterol and saturated fats. Include a variety of fruits and vegetables every day. - Exercise regularly. Try to make physical activity a part of your everyday life. Do things you like; for example, take a brisk walk, ride a bicycle, or go swimming. Talk with your healthcare provider if you haven't been exercising and you want to start a vigorous program or increase your physical activity. For more information on exercise and physical activity from the National Institute on Aging at NIH, visit www.nia.nih.gov/Go4Life.If you have had a stroke in the past, it's important to reduce your risk of a second stroke. Your brain helps you recover from a stroke by drawing on body systems that now do double duty. That means a second stroke can be twice as bad. A doctor will diagnose a stroke based on symptoms, medical history, and medical tests such as a CT scan. A CT scan is a test that lets doctors look closely at pictures of the brain.All strokes benefit from immediate medical treatment! But only people with ischemic stroke, the kind caused by a blood clot, can be helped by a drug called t-PA (tissue-plasminogen activator). This drug breaks up blood clots and can greatly lessen the damage caused by an ischemic stroke. Starting treatment with t-PA within 3 hours after an ischemic stroke is important to recovery. To be evaluated and receive treatment, patients need to get to the hospital within 60 minutes. Getting to a hospital right away allows time for a CT scan of the brain. This scan will show whether the clot-busting medicine is the right treatment choice.With stroke, treatment depends on the stage of the disease. There are three treatment stages for stroke: prevention, therapy immediately after stroke, and rehabilitation after stroke. Stroke therapies include medications, surgery, and rehabilitation.Medication or drug therapy is the most common treatment for stroke. The most popular kinds of drugs to prevent or treat stroke are antithrombotics--which include antiplatelet agents and anticoagulants--and thrombolytics. Thrombolytic drugs, like t-PA, halt the stroke by dissolving the blood clot that is blocking blood flow to the brain. Antithrombotics prevent the formation of blood clots that can become stuck in an artery of the brain and cause strokes.Surgery and vascular procedures can be used to prevent stroke, treat stroke, or repair damage to the blood vessels or malformations in and around the brain. These include angioplasty, stenting, and carotid endarterectomy. A stroke can cause a variety of health problems. How a stroke affects a person depends on which part of the brain is damaged.Someone who has had a stroke might be paralyzed or have weakness, usually on one side of the body. He or she might have trouble speaking or using words. There could be swallowing problems. There might be pain or numbness.Stroke may cause problems with thinking, awareness, attention, learning, judgment, and memory. Someone who has had a stroke might feel depressed or find it hard to control emotions. Post-stroke depression may be more than general sadness resulting from the stroke incident. It is a serious behavioral problem that can hamper recovery and rehabilitation and may even lead to suicide.There are many different ways to help people get better after a stroke. Many treatments start in the hospital and continue at home. Drugs and physical therapy can help improve balance, coordination, and problems such as trouble speaking and using words. Occupational therapy can make it easier to do things like taking a bath or cooking.Some people make a full recovery soon after a stroke. Others take months or even years. But, sometimes the damage is so serious that therapy cannot really help.Learn about rehabilitation after stroke. Stroke is the number one cause of serious adult disability in the United States. Stroke disability is devastating to the stroke patient and family, but therapies are available to help rehabilitate patients after stroke.For most stroke patients, rehabilitation mainly involves physical therapy. The aim of physical therapy is to have the stroke patient relearn simple motor activities such as walking, sitting, standing, lying down, and the process of switching from one type of movement to another.Another type of therapy to help patients relearn daily activities is occupational therapy. This type of therapy also involves exercise and training. Its goal is to help the stroke patient relearn everyday activities such as eating, drinking and swallowing, dressing, bathing, cooking, reading and writing, and using the toilet. Occupational therapists seek to help the patient become independent or semi-independent.Speech therapy helps stroke patients relearn language and speaking skills, or learn other forms of communication. Speech therapy is appropriate for patients who have no problems with cognition or thinking, but have problems understanding speech or written words, or problems forming speech. With time and patience, a stroke survivor should be able to regain some, and sometimes all, language and speaking abilities.Learn more about stroke signs, treatment, and prevention from the Centers for Disease Control and Prevention. Stroke is the number one cause of serious adult disability in the United States. Stroke disability is devastating to the stroke patient and family, but therapies are available to help rehabilitate patients after stroke.For most stroke patients, rehabilitation mainly involves physical therapy. The aim of physical therapy is to have the stroke patient relearn simple motor activities such as walking, sitting, standing, lying down, and the process of switching from one type of movement to another.Another type of therapy to help patients relearn daily activities is occupational therapy. This type of therapy also involves exercise and training. Its goal is to help the stroke patient relearn everyday activities such as eating, drinking and swallowing, dressing, bathing, cooking, reading and writing, and using the toilet. Occupational therapists seek to help the patient become independent or semi-independent.Speech therapy helps stroke patients relearn language and speaking skills, or learn other forms of communication. Speech therapy is appropriate for patients who have no problems with cognition or thinking, but have problems understanding speech or written words, or problems forming speech. With time and patience, a stroke survivor should be able to regain some, and sometimes all, language and speaking abilities.Learn more about stroke signs, treatment, and prevention from the Centers for Disease Control and Prevention. Stroke is the number one cause of serious adult disability in the United States. Stroke disability is devastating to the stroke patient and family, but therapies are available to help rehabilitate patients after stroke.For most stroke patients, rehabilitation mainly involves physical therapy. The aim of physical therapy is to have the stroke patient relearn simple motor activities such as walking, sitting, standing, lying down, and the process of switching from one type of movement to another.Another type of therapy to help patients relearn daily activities is occupational therapy. This type of therapy also involves exercise and training. Its goal is to help the stroke patient relearn everyday activities such as eating, drinking and swallowing, dressing, bathing, cooking, reading and writing, and using the toilet. Occupational therapists seek to help the patient become independent or semi-independent.Speech therapy helps stroke patients relearn language and speaking skills, or learn other forms of communication. Speech therapy is appropriate for patients who have no problems with cognition or thinking, but have problems understanding speech or written words, or problems forming speech. With time and patience, a stroke survivor should be able to regain some, and sometimes all, language and speaking abilities.Learn more about stroke signs, treatment, and prevention from the Centers for Disease Control and Prevention.",
+    "https://www.nia.nih.gov/health/topics/stroke"
+  ],
+  [
+    "Recovering after stroke (Summary): A stroke happens when blood flow to any part of the brain stops. Each person has a different recovery time and need for long-term care. Problems with moving, thinking, and talking often improve in the first weeks or months after a stroke. Some people will keep improving months or years after a stroke.",
+    "https://medlineplus.gov/ency/article/007419.htm"
+  ],
+  [
+    "Familial breast cancer: Familial breast cancer is a cluster of breast cancer within a family. Most cases of breast cancer occur sporadically in people with little to no family history of the condition. Approximately 5-10% of breast cancer is considered \"hereditary\" and is thought to be caused by an inherited predisposition to breast cancer that is passed down through a family in an autosomal dominant \u00a0manner. In some of these families, the underlying genetic cause is not known; however, many of these cases are caused by changes ( mutations ) in the BRCA1 , BRCA2, PTEN, TP53, CDH1, or STK11 genes (which are each associated with a unique hereditary cancer syndrome ).\u00a0 CHEK2 BRIP1 RAD51 ATM \u00a0About 15-20% of women diagnosed with breast cancer have a significant family history of breast cancer (two or more first-degree or second-degree relatives with breast cancer) but have no identifiable mutation in a gene known to cause a hereditary predisposition to breast cancer. These clusters of breast cancer are likely due to a combination of gene(s) and other shared factors such as environment and lifestyle. [1] [2] [3] High-risk cancer screening and other preventative measures such as chemoprevention and/or prophylactic surgeries are typically recommended in women who have an increased risk for breast cancer based on their personal and/or family histories. [4] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Autosomal dominant inheritance - Breast carcinoma - Heterogeneous - Most cases of breast cancer occur sporadically in people with little to no family history of the condition. They are due to random changes ( mutations ) that occur only in the cells of the breast. These mutations (called somatic mutations )\u00a0accumulate during a person's lifetime and are not inherited or passed on to future generations. [1] Approximately 15-20% of women diagnosed with breast cancer have a significant family history of breast cancer (two or more first-degree or second-degree relatives with breast cancer) but have no identifiable mutation in a gene known to cause a hereditary predisposition to breast cancer. These clusters of breast cancer are likely due to a combination of gene(s) and other shared factors such as environment and lifestyle. [3] An additional 5-10% of breast cancer is\u00a0considered \"hereditary.\" These cases are thought to be caused by an inherited\u00a0predisposition to breast cancer that is passed down through a family in an autosomal dominant \u00a0manner. In some of these families, the underlying genetic cause is not known. However, many of these cases are part of a hereditary cancer syndrome . The following cancer syndromes are associated with an increased risk of breast cancer and several other types of cancer: [1] [2] [3] Hereditary breast and ovarian cancer syndrome due to mutations in the BRCA1 or BRCA2 gene is the most common known cause of hereditary breast cancer Cowden syndrome is caused by mutations in PTEN gene Li Fraumeni syndrome is caused by mutations in the TP53 gene Hereditary Diffuse Gastric Cancer is caused by mutations in the CDH1 gene Peutz-Jeghers syndrome is caused by mutations in the STK11 gene Of note, some research suggests that inherited mutations in several other genes (including CHEK2, BRIP1, ATM, PALB2, RAD51, BARD1, MRE11A, NBN, and RAD50) may also be associated with an increased risk for breast cancer. However, the risk associated with many of these genes is not well understood. Most are termed \"moderate- or low-penetrant\" genes which means that, on their own, they would be expected to have a relatively small effect on breast cancer risk. However, in combination with other genes and/or environmental factors , these genes may lead to a significant risk of breast cancer. [1] [3] [2] Most cases of breast cancer occur sporadically in people with little to no family history of the condition. However, approximately 5-10% is thought to be\u00a0 inherited in an autosomal dominant manner. In these cases, a person is born with a mutation in a gene known to cause a hereditary predisposition to breast cancer and has a 50% chance with each pregnancy of passing along the mutated gene to his or her child. A person only needs a mutation in one copy of the responsible gene in each cell to have an increased risk for breast cancer. In some cases, a person with familial breast cancer inherits the mutation from a parent who has had or has familial breast cancer. Other cases may result from new ( de novo) mutations in the gene. [1] [2] [3]\u00a0 An additional 15-20% of women who are diagnosed with breast cancer have a significant family history of breast cancer (two or more first-degree or second-degree relatives who have or have had breast cancer) but the cancer follows no clear pattern of inheritance. These cases\u00a0of breast cancer may be due to inherited gene(s); shared factors such as environment and lifestyle; or a combination of all these factors. [3] Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. Management of familial breast cancer is generally focused on high-risk cancer screening to allow for early detection and treatment of cancer. In general, the National Comprehensive Cancer Network recommends high-risk breast cancer screening for women who have: (1) a personal and family history suggestive of a hereditary cancer syndrome that is associated with breast cancer or (2) a greater than 20% risk of developing breast cancer in their lifetime based largely on family history. The recommended screening protocol includes: [4] Breast awareness and breast self-exams Clinical breast exams every 6-12 months beginning at age 30 or individualized based on the earliest breast cancer diagnosis in the family Annual mammogram and breast MRI beginning at age 30 or individualized based on the earliest breast cancer diagnosis in the family Discussion of\u00a0other risk reduction strategies such as chemoprevention and/or prophylactic surgeries If the familial breast cancer is part of a known hereditary cancer syndrome, management will also include screening for the other associated cancers. Please click on the following links for more information regarding the treatment and management of each condition: Hereditary Breast and Ovarian Cancer Cowden syndrome Li Fraumeni syndrome Hereditary Diffuse Gastric Cancer Peutz-Jeghers syndrome The following diseases are related to Familial breast cancer. If you have a question about any of these diseases, you can contact GARD. BRCA1 hereditary breast and ovarian cancer syndrome BRCA2 hereditary breast and ovarian cancer syndrome Breast cancer, childhood Cowden syndrome Hereditary diffuse gastric cancer Li-Fraumeni syndrome Peutz-Jeghers syndrome",
+    "https://rarediseases.info.nih.gov/diseases/10415/familial-breast-cancer"
+  ],
+  [
+    "Breast cancer, childhood: This condition doesn't have a summary yet. Please see our page(s) on Familial breast cancer. The following diseases are related to Breast cancer, childhood. If you have a question about any of these diseases, you can contact GARD. Familial breast cancer",
+    "https://rarediseases.info.nih.gov/diseases/9311/breast-cancer-childhood"
+  ],
+  [
+    "Breast Cancer: The breast is made up of glands called lobules that can make milk and thin tubes called ducts that carry the milk from the lobules to the nipple. Breast tissue also contains fat and connective tissue, lymph nodes, and blood vessels. The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Breast cancer can also begin in the cells of the lobules and in other tissues in the breast. Ductal carcinoma in situ is a condition in which abnormal cells are found in the lining of the ducts but they haven't spread outside the duct. Breast cancer that has spread from where it began in the ducts or lobules to surrounding tissue is called invasive breast cancer. In inflammatory breast cancer, the breast looks red and swollen and feels warm because the cancer cells block the lymph vessels in the skin. In the U.S., breast cancer is the second most common cancer in women after skin cancer. It can occur in both men and women, but it is rare in men. Each year there are about 100 times more new cases of breast cancer in women than in men. - Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. - A family history of breast cancer and other factors increase the risk of breast cancer. - Breast cancer is sometimes caused by inherited gene mutations (changes). - The use of certain medicines and other factors decrease the risk of breast cancer. - Signs of breast cancer include a lump or change in the breast. - Tests that examine the breasts are used to detect (find) and diagnose breast cancer. - If cancer is found, tests are done to study the cancer cells. - Certain factors affect prognosis (chance of recovery) and treatment options. - Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. - A family history of breast cancer and other factors increase the risk of breast cancer. - Breast cancer is sometimes caused by inherited gene mutations (changes). - The use of certain medicines and other factors decrease the risk of breast cancer. - Signs of breast cancer include a lump or change in the breast. - Tests that examine the breasts are used to detect (find) and diagnose breast cancer. - If cancer is found, tests are done to study the cancer cells. - Certain factors affect prognosis (chance of recovery) and treatment options. - After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - The following stages are used for breast cancer: - Stage 0 (carcinoma in situ) - Stage I - Stage II - Stage IIIA - Stage IIIB - Stage IIIC - Stage IV - The treatment of breast cancer depends partly on the stage of the disease. - After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - The following stages are used for breast cancer: - Stage 0 (carcinoma in situ) - Stage I - Stage II - Stage IIIA - Stage IIIB - Stage IIIC - Stage IV - The treatment of breast cancer depends partly on the stage of the disease. - There are different types of treatment for patients with breast cancer. - Five types of standard treatment are used: - Surgery - Radiation therapy - Chemotherapy - Hormone therapy - Targeted therapy - Treatment for breast cancer may cause side effects. - Patients may want to think about taking part in a clinical trial. - Patients can enter clinical trials before, during, or after starting their cancer treatment. - Follow-up tests may be needed. - There are different types of treatment for patients with breast cancer. - Five types of standard treatment are used: - Surgery - Radiation therapy - Chemotherapy - Hormone therapy - Targeted therapy - Treatment for breast cancer may cause side effects. - Patients may want to think about taking part in a clinical trial. - Patients can enter clinical trials before, during, or after starting their cancer treatment. - Follow-up tests may be needed. Early, Localized, or Operable Breast Cancer Treatment of early, localized, or operable breast cancer may include the following: Surgery - Breast-conserving surgery and sentinel lymph node biopsy. If cancer is found in the lymph nodes, a lymph node dissection may be done. - Modified radical mastectomy. Breast reconstruction surgery may also be done. Postoperative radiation therapy For women who had breast-conserving surgery, radiation therapy is given to the whole breast to lessen the chance the cancer will come back. Radiation therapy may also be given to lymph nodes in the area. For women who had a modified radical mastectomy, radiation therapy may be given to lessen the chance the cancer will come back if any of the following are true: - Cancer was found in 4 or more lymph nodes. - Cancer had spread to tissue around the lymph nodes. - The tumor was large. - There is tumor close to or remaining in the tissue near the edges of where the tumor was removed. Postoperative systemic therapy Systemic therapy is the use of drugs that can enter the bloodstream and reach cancer cells throughout the body. Postoperative systemic therapy is given to lessen the chance the cancer will come back after surgery to remove the tumor. Postoperative systemic therapy is given depending on whether: - The tumor is hormone receptor negative or positive. - The tumor is HER2/neu negative or positive. - The tumor is hormone receptor negative and HER2/neu negative (triple negative). - The size of the tumor. In premenopausal women with hormone receptor positive tumors, no more treatment may be needed or postoperative therapy may include: - Tamoxifen therapy with or without chemotherapy. - Tamoxifen therapy and treatment to stop or lessen how much estrogen is made by the ovaries. Drug therapy, surgery to remove the ovaries, or radiation therapy to the ovaries may be used. - Aromatase inhibitor therapy and treatment to stop or lessen how much estrogen is made by the ovaries. Drug therapy, surgery to remove the ovaries, or radiation therapy to the ovaries may be used. In postmenopausal women with hormone receptor positive tumors, no more treatment may be needed or postoperative therapy may include: - Aromatase inhibitor therapy with or without chemotherapy. - Tamoxifen followed by aromatase inhibitor therapy, with or without chemotherapy. In women with hormone receptor negative tumors, no more treatment may be needed or postoperative therapy may include: - Chemotherapy. In women with HER2/neu negative tumors, postoperative therapy may include: - Chemotherapy. In women with small, HER2/neu positive tumors, and no cancer in the lymph nodes, no more treatment may be needed. If there is cancer in the lymph nodes, or the tumor is large, postoperative therapy may include: - Chemotherapy and targeted therapy (trastuzumab). - Hormone therapy, such as tamoxifen or aromatase inhibitor therapy, for tumors that are also hormone receptor positive. In women with small, hormone receptor negative and HER2/neu negative tumors (triple negative) and no cancer in the lymph nodes, no more treatment may be needed. If there is cancer in the lymph nodes or the tumor is large, postoperative therapy may include: - Chemotherapy. - Radiation therapy. - A clinical trial of a new chemotherapy regimen. - A clinical trial of PARP inhibitor therapy. Preoperative systemic therapy Systemic therapy is the use of drugs that can enter the bloodstream and reach cancer cells throughout the body. Preoperative systemic therapy is given to shrink the tumor before surgery. In postmenopausal women with hormone receptor positive tumors, preoperative therapy may include: - Chemotherapy. - Hormone therapy, such as tamoxifen or aromatase inhibitor therapy, for women who cannot have chemotherapy. In premenopausal women with hormone receptor positive tumors, preoperative therapy may include: - A clinical trial of hormone therapy, such as tamoxifen or aromatase inhibitor therapy. In women with HER2/neu positive tumors, preoperative therapy may include: - Chemotherapy and targeted therapy (trastuzumab). - Targeted therapy (pertuzumab). In women with HER2/neu negative tumors or triple negative tumors, preoperative therapy may include: - Chemotherapy. - A clinical trial of a new chemotherapy regimen. - A clinical trial of monoclonal antibody therapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Surgery - Breast-conserving surgery and sentinel lymph node biopsy. If cancer is found in the lymph nodes, a lymph node dissection may be done. - Modified radical mastectomy. Breast reconstruction surgery may also be done. Postoperative radiation therapy For women who had breast-conserving surgery, radiation therapy is given to the whole breast to lessen the chance the cancer will come back. Radiation therapy may also be given to lymph nodes in the area. For women who had a modified radical mastectomy, radiation therapy may be given to lessen the chance the cancer will come back if any of the following are true: - Cancer was found in 4 or more lymph nodes. - Cancer had spread to tissue around the lymph nodes. - The tumor was large. - There is tumor close to or remaining in the tissue near the edges of where the tumor was removed. Postoperative systemic therapy Systemic therapy is the use of drugs that can enter the bloodstream and reach cancer cells throughout the body. Postoperative systemic therapy is given to lessen the chance the cancer will come back after surgery to remove the tumor. Postoperative systemic therapy is given depending on whether: - The tumor is hormone receptor negative or positive. - The tumor is HER2/neu negative or positive. - The tumor is hormone receptor negative and HER2/neu negative (triple negative). - The size of the tumor. In premenopausal women with hormone receptor positive tumors, no more treatment may be needed or postoperative therapy may include: - Tamoxifen therapy with or without chemotherapy. - Tamoxifen therapy and treatment to stop or lessen how much estrogen is made by the ovaries. Drug therapy, surgery to remove the ovaries, or radiation therapy to the ovaries may be used. - Aromatase inhibitor therapy and treatment to stop or lessen how much estrogen is made by the ovaries. Drug therapy, surgery to remove the ovaries, or radiation therapy to the ovaries may be used. In postmenopausal women with hormone receptor positive tumors, no more treatment may be needed or postoperative therapy may include: - Aromatase inhibitor therapy with or without chemotherapy. - Tamoxifen followed by aromatase inhibitor therapy, with or without chemotherapy. In women with hormone receptor negative tumors, no more treatment may be needed or postoperative therapy may include: - Chemotherapy. In women with HER2/neu negative tumors, postoperative therapy may include: - Chemotherapy. In women with small, HER2/neu positive tumors, and no cancer in the lymph nodes, no more treatment may be needed. If there is cancer in the lymph nodes, or the tumor is large, postoperative therapy may include: - Chemotherapy and targeted therapy (trastuzumab). - Hormone therapy, such as tamoxifen or aromatase inhibitor therapy, for tumors that are also hormone receptor positive. In women with small, hormone receptor negative and HER2/neu negative tumors (triple negative) and no cancer in the lymph nodes, no more treatment may be needed. If there is cancer in the lymph nodes or the tumor is large, postoperative therapy may include: - Chemotherapy. - Radiation therapy. - A clinical trial of a new chemotherapy regimen. - A clinical trial of PARP inhibitor therapy. Preoperative systemic therapy Systemic therapy is the use of drugs that can enter the bloodstream and reach cancer cells throughout the body. Preoperative systemic therapy is given to shrink the tumor before surgery. In postmenopausal women with hormone receptor positive tumors, preoperative therapy may include: - Chemotherapy. - Hormone therapy, such as tamoxifen or aromatase inhibitor therapy, for women who cannot have chemotherapy. In premenopausal women with hormone receptor positive tumors, preoperative therapy may include: - A clinical trial of hormone therapy, such as tamoxifen or aromatase inhibitor therapy. In women with HER2/neu positive tumors, preoperative therapy may include: - Chemotherapy and targeted therapy (trastuzumab). - Targeted therapy (pertuzumab). In women with HER2/neu negative tumors or triple negative tumors, preoperative therapy may include: - Chemotherapy. - A clinical trial of a new chemotherapy regimen. - A clinical trial of monoclonal antibody therapy. Locally Advanced or Inflammatory Breast Cancer Treatment of locally advanced or inflammatory breast cancer is a combination of therapies that may include the following: - Surgery (breast-conserving surgery or total mastectomy) with lymph node dissection. - Chemotherapy before and/or after surgery. - Radiation therapy after surgery. - Hormone therapy after surgery for tumors that are estrogen receptor positive or estrogen receptor unknown. - Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Locoregional Recurrent Breast Cancer Treatment of locoregional recurrent breast cancer (cancer that has come back after treatment in the breast, in the chest wall, or in nearby lymph nodes), may include the following: - Chemotherapy. - Hormone therapy for tumors that are hormone receptor positive. - Radiation therapy. - Surgery. - Targeted therapy (trastuzumab). - A clinical trial of a new treatment. See the Metastatic Breast Cancer section for information about treatment options for breast cancer that has spread to parts of the body outside the breast, chest wall, or nearby lymph nodes. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Metastatic Breast Cancer Treatment options for metastatic breast cancer (cancer that has spread to distant parts of the body) may include the following: Hormone therapy In postmenopausal women who have just been diagnosed with metastatic breast cancer that is hormone receptor positive or if the hormone receptor status is not known, treatment may include: - Tamoxifen therapy. - Aromatase inhibitor therapy (anastrozole, letrozole, or exemestane). Sometimes cyclin-dependent kinase inhibitor therapy (palbociclib, ribociclib, or abemaciclib) is also given. In premenopausal women who have just been diagnosed with metastatic breast cancer that is hormone receptor positive, treatment may include: - Tamoxifen, an LHRH agonist, or both. In women whose tumors are hormone receptor positive or hormone receptor unknown, with spread to the bone or soft tissue only, and who have been treated with tamoxifen, treatment may include: - Aromatase inhibitor therapy. - Other hormone therapy such as megestrol acetate, estrogen or androgen therapy, or anti-estrogen therapy such as fulvestrant. Targeted therapy In women with metastatic breast cancer that is hormone receptor positive and has not responded to other treatments, options may include targeted therapy such as: - Trastuzumab, lapatinib, pertuzumab, or mTOR inhibitors. - Antibody-drug conjugate therapy with ado-trastuzumab emtansine. - Cyclin-dependent kinase inhibitor therapy (palbociclib, ribociclib, or abemaciclib) which may be combined with hormone therapy. In women with metastatic breast cancer that is HER2/neu positive, treatment may include: - Targeted therapy such as trastuzumab, pertuzumab, ado-trastuzumab emtansine, or lapatinib. Chemotherapy In women with metastatic breast cancer that is hormone receptor negative, has not responded to hormone therapy, has spread to other organs or has caused symptoms, treatment may include: - Chemotherapy with one or more drugs. Surgery - Total mastectomy for women with open or painful breast lesions. Radiation therapy may be given after surgery. - Surgery to remove cancer that has spread to the brain or spine. Radiation therapy may be given after surgery. - Surgery to remove cancer that has spread to the lung. - Surgery to repair or help support weak or broken bones. Radiation therapy may be given after surgery. - Surgery to remove fluid that has collected around the lungs or heart. Radiation therapy - Radiation therapy to the bones, brain, spinal cord, breast, or chest wall to relieve symptoms and improve quality of life. - Strontium-89 (a radionuclide) to relieve pain from cancer that has spread to bones throughout the body. Other treatment options Other treatment options for metastatic breast cancer include: - Drug therapy with bisphosphonates or denosumab to reduce bone disease and pain when cancer has spread to the bone. (See the PDQ summary on Cancer Pain for more information about bisphosphonates.) - A clinical trial of high-dose chemotherapy with stem cell transplant. - Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Hormone therapy In postmenopausal women who have just been diagnosed with metastatic breast cancer that is hormone receptor positive or if the hormone receptor status is not known, treatment may include: - Tamoxifen therapy. - Aromatase inhibitor therapy (anastrozole, letrozole, or exemestane). Sometimes cyclin-dependent kinase inhibitor therapy (palbociclib, ribociclib, or abemaciclib) is also given. In premenopausal women who have just been diagnosed with metastatic breast cancer that is hormone receptor positive, treatment may include: - Tamoxifen, an LHRH agonist, or both. In women whose tumors are hormone receptor positive or hormone receptor unknown, with spread to the bone or soft tissue only, and who have been treated with tamoxifen, treatment may include: - Aromatase inhibitor therapy. - Other hormone therapy such as megestrol acetate, estrogen or androgen therapy, or anti-estrogen therapy such as fulvestrant. Targeted therapy In women with metastatic breast cancer that is hormone receptor positive and has not responded to other treatments, options may include targeted therapy such as: - Trastuzumab, lapatinib, pertuzumab, or mTOR inhibitors. - Antibody-drug conjugate therapy with ado-trastuzumab emtansine. - Cyclin-dependent kinase inhibitor therapy (palbociclib, ribociclib, or abemaciclib) which may be combined with hormone therapy. In women with metastatic breast cancer that is HER2/neu positive, treatment may include: - Targeted therapy such as trastuzumab, pertuzumab, ado-trastuzumab emtansine, or lapatinib. Chemotherapy In women with metastatic breast cancer that is hormone receptor negative, has not responded to hormone therapy, has spread to other organs or has caused symptoms, treatment may include: - Chemotherapy with one or more drugs. Surgery - Total mastectomy for women with open or painful breast lesions. Radiation therapy may be given after surgery. - Surgery to remove cancer that has spread to the brain or spine. Radiation therapy may be given after surgery. - Surgery to remove cancer that has spread to the lung. - Surgery to repair or help support weak or broken bones. Radiation therapy may be given after surgery. - Surgery to remove fluid that has collected around the lungs or heart. Radiation therapy - Radiation therapy to the bones, brain, spinal cord, breast, or chest wall to relieve symptoms and improve quality of life. - Strontium-89 (a radionuclide) to relieve pain from cancer that has spread to bones throughout the body. Other treatment options Other treatment options for metastatic breast cancer include: - Drug therapy with bisphosphonates or denosumab to reduce bone disease and pain when cancer has spread to the bone. (See the PDQ summary on Cancer Pain for more information about bisphosphonates.) - A clinical trial of high-dose chemotherapy with stem cell transplant. - Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment. - Male breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. - A family history of breast cancer and other factors can increase a man's risk of breast cancer. - Male breast cancer is sometimes caused by inherited gene mutations (changes). - Men with breast cancer usually have lumps that can be felt. - Tests that examine the breasts are used to detect (find) and diagnose breast cancer in men. - If cancer is found, tests are done to study the cancer cells. - Survival for men with breast cancer is similar to survival for women with breast cancer. - Certain factors affect prognosis (chance of recovery) and treatment options. - Male breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. - A family history of breast cancer and other factors can increase a man's risk of breast cancer. - Male breast cancer is sometimes caused by inherited gene mutations (changes). - Men with breast cancer usually have lumps that can be felt. - Tests that examine the breasts are used to detect (find) and diagnose breast cancer in men. - If cancer is found, tests are done to study the cancer cells. - Survival for men with breast cancer is similar to survival for women with breast cancer. - Certain factors affect prognosis (chance of recovery) and treatment options. - After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - The following stages are used for male breast cancer: - Stage 0 (carcinoma in situ) - Stage I - Stage II - Stage IIIA - Stage IIIB - Stage IIIC - Stage IV - After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - The following stages are used for male breast cancer: - Stage 0 (carcinoma in situ) - Stage I - Stage II - Stage IIIA - Stage IIIB - Stage IIIC - Stage IV - There are different types of treatment for men with breast cancer. - Five types of standard treatment are used to treat men with breast cancer: - Surgery - Chemotherapy - Hormone therapy - Radiation therapy - Targeted therapy - Treatment for male breast cancer may cause side effects. - There are different types of treatment for men with breast cancer. - Five types of standard treatment are used to treat men with breast cancer: - Surgery - Chemotherapy - Hormone therapy - Radiation therapy - Targeted therapy - Treatment for male breast cancer may cause side effects. Initial Surgery Treatment for men diagnosed with breast cancer is usually modified radical mastectomy. Breast-conserving surgery with lumpectomy may be used for some men. Adjuvant Therapy Therapy given after an operation when cancer cells can no longer be seen is called adjuvant therapy. Even if the doctor removes all the cancer that can be seen at the time of the operation, the patient may be given radiation therapy, chemotherapy, hormone therapy, and/or targeted therapy after surgery, to try to kill any cancer cells that may be left. - Node-negative: For men whose cancer is node-negative (cancer has not spread to the lymph nodes), adjuvant therapy should be considered on the same basis as for a woman with breast cancer because there is no evidence that response to therapy is different for men and women. - Node-positive: For men whose cancer is node-positive (cancer has spread to the lymph nodes), adjuvant therapy may include the following: - Chemotherapy. - Targeted therapy with a monoclonal antibody (trastuzumab). - Tamoxifen (to block the effect of estrogen). - Other hormone therapy. These treatments appear to increase survival in men as they do in women. The patient's response to hormone therapy depends on whether there are hormone receptors (proteins) in the tumor. Most breast cancers in men have these receptors. Hormone therapy is usually recommended for male breast cancer patients, but it can have many side effects, including hot flashes and impotence (the inability to have an erection adequate for sexual intercourse). Distant Metastases Treatment options for metastatic breast cancer (cancer that has spread to distant parts of the body) may include the following: Hormone therapy In men who have just been diagnosed with metastatic breast cancer that is hormone receptor positive or if the hormone receptor status is not known, treatment may include: - Tamoxifen therapy. - Aromatase inhibitor therapy (anastrozole, letrozole, or exemestane) with or without an LHRH agonist. Sometimes cyclin-dependent kinase inhibitor therapy (palbociclib) is also given. In men whose tumors are hormone receptor positive or hormone receptor unknown, with spread to the bone or soft tissue only, and who have been treated with tamoxifen, treatment may include: - Aromatase inhibitor therapy with or without LHRH agonist. - Other hormone therapy such as megestrol acetate, estrogen or androgen therapy, or anti-estrogen therapy such as fulvestrant. Targeted therapy In men with metastatic breast cancer that is hormone receptor positive and has not responded to other treatments, options may include targeted therapy such as: - Trastuzumab, lapatinib, pertuzumab, or mTOR inhibitors. - Antibody-drug conjugate therapy with ado-trastuzumab emtansine. - Cyclin-dependent kinase inhibitor therapy (palbociclib) combined with letrozole. In men with metastatic breast cancer that is HER2/neu positive, treatment may include: - Targeted therapy such as trastuzumab, pertuzumab, ado-trastuzumab emtansine, or lapatinib. Chemotherapy In men with metastatic breast cancer that is hormone receptor negative, has not responded to hormone therapy, has spread to other organs or has caused symptoms, treatment may include: - Chemotherapy with one or more drugs. Surgery - Total mastectomy for men with open or painful breast lesions. Radiation therapy may be given after surgery. - Surgery to remove cancer that has spread to the brain or spine. Radiation therapy may be given after surgery. - Surgery to remove cancer that has spread to the lung. - Surgery to repair or help support weak or broken bones. Radiation therapy may be given after surgery. - Surgery to remove fluid that has collected around the lungs or heart. Radiation therapy - Radiation therapy to the bones, brain, spinal cord, breast, or chest wall to relieve symptoms and improve quality of life. - Strontium-89 (a radionuclide) to relieve pain from cancer that has spread to bones throughout the body. Other treatment options Other treatment options for metastatic breast cancer include: - Drug therapy with bisphosphonates or denosumab to reduce bone disease and pain when cancer has spread to the bone. (See the PDQ summary on Cancer Pain for more information about bisphosphonates.) - Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment. Hormone therapy In men who have just been diagnosed with metastatic breast cancer that is hormone receptor positive or if the hormone receptor status is not known, treatment may include: - Tamoxifen therapy. - Aromatase inhibitor therapy (anastrozole, letrozole, or exemestane) with or without an LHRH agonist. Sometimes cyclin-dependent kinase inhibitor therapy (palbociclib) is also given. In men whose tumors are hormone receptor positive or hormone receptor unknown, with spread to the bone or soft tissue only, and who have been treated with tamoxifen, treatment may include: - Aromatase inhibitor therapy with or without LHRH agonist. - Other hormone therapy such as megestrol acetate, estrogen or androgen therapy, or anti-estrogen therapy such as fulvestrant. Targeted therapy In men with metastatic breast cancer that is hormone receptor positive and has not responded to other treatments, options may include targeted therapy such as: - Trastuzumab, lapatinib, pertuzumab, or mTOR inhibitors. - Antibody-drug conjugate therapy with ado-trastuzumab emtansine. - Cyclin-dependent kinase inhibitor therapy (palbociclib) combined with letrozole. In men with metastatic breast cancer that is HER2/neu positive, treatment may include: - Targeted therapy such as trastuzumab, pertuzumab, ado-trastuzumab emtansine, or lapatinib. Chemotherapy In men with metastatic breast cancer that is hormone receptor negative, has not responded to hormone therapy, has spread to other organs or has caused symptoms, treatment may include: - Chemotherapy with one or more drugs. Surgery - Total mastectomy for men with open or painful breast lesions. Radiation therapy may be given after surgery. - Surgery to remove cancer that has spread to the brain or spine. Radiation therapy may be given after surgery. - Surgery to remove cancer that has spread to the lung. - Surgery to repair or help support weak or broken bones. Radiation therapy may be given after surgery. - Surgery to remove fluid that has collected around the lungs or heart. Radiation therapy - Radiation therapy to the bones, brain, spinal cord, breast, or chest wall to relieve symptoms and improve quality of life. - Strontium-89 (a radionuclide) to relieve pain from cancer that has spread to bones throughout the body. Other treatment options Other treatment options for metastatic breast cancer include: - Drug therapy with bisphosphonates or denosumab to reduce bone disease and pain when cancer has spread to the bone. (See the PDQ summary on Cancer Pain for more information about bisphosphonates.) - Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment. - Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. - Sometimes breast cancer occurs in women who are pregnant or have just given birth. - Signs of breast cancer include a lump or change in the breast. - It may be difficult to detect (find) breast cancer early in pregnant or nursing women. - Breast exams should be part of prenatal and postnatal care. - Tests that examine the breasts are used to detect (find) and diagnose breast cancer. - If cancer is found, tests are done to study the cancer cells. - Certain factors affect prognosis (chance of recovery) and treatment options. - Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. - Sometimes breast cancer occurs in women who are pregnant or have just given birth. - Signs of breast cancer include a lump or change in the breast. - It may be difficult to detect (find) breast cancer early in pregnant or nursing women. - Breast exams should be part of prenatal and postnatal care. - Tests that examine the breasts are used to detect (find) and diagnose breast cancer. - If cancer is found, tests are done to study the cancer cells. - Certain factors affect prognosis (chance of recovery) and treatment options. - After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - The following stages are used for breast cancer: - Stage 0 (carcinoma in situ) - Stage I - Stage II - Stage IIIA - Stage IIIB - Stage IIIC - Stage IV - After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - The following stages are used for breast cancer: - Stage 0 (carcinoma in situ) - Stage I - Stage II - Stage IIIA - Stage IIIB - Stage IIIC - Stage IV - Treatment options for pregnant women depend on the stage of the disease and the age of the unborn baby. - Three types of standard treatment are used: - Surgery - Radiation therapy - Chemotherapy - Ending the pregnancy does not seem to improve the mother's chance of survival. - Treatment for breast cancer may cause side effects. - Treatment options for pregnant women depend on the stage of the disease and the age of the unborn baby. - Three types of standard treatment are used: - Surgery - Radiation therapy - Chemotherapy - Ending the pregnancy does not seem to improve the mother's chance of survival. - Treatment for breast cancer may cause side effects. Early Stage Breast Cancer (Stage I and Stage II) Treatment of early-stage breast cancer (stage I and stage II) may include the following: - Modified radical mastectomy, if the breast cancer was diagnosed early in pregnancy. - Breast-conserving surgery followed by radiation therapy, if the breast cancer was diagnosed late in pregnancy. In pregnant women, radiation therapy is delayed until after the baby is born. - Modified radical mastectomy or breast-conserving surgery during pregnancy followed by chemotherapy after the first 3 months of pregnancy. Late Stage Breast Cancer (Stage III and Stage IV) Treatment of late-stage breast cancer (stage III and stage IV) may include the following: - Radiation therapy. - Chemotherapy. Radiation therapy and chemotherapy should not be given during the first 3 months of pregnancy. - Lactation (breast milk production) and breast-feeding should be stopped if surgery or chemotherapy is planned. - Breast cancer does not appear to harm the unborn baby. - Pregnancy does not seem to affect the survival of women who have had breast cancer in the past. - Lactation (breast milk production) and breast-feeding should be stopped if surgery or chemotherapy is planned. - Breast cancer does not appear to harm the unborn baby. - Pregnancy does not seem to affect the survival of women who have had breast cancer in the past.",
+    "https://www.cancer.gov/types/breast"
+  ],
+  [
+    "Breast cancer screening: Breast cancer screenings can help find breast cancer early, before you notice any symptoms. In many cases, finding breast cancer early makes it easier to treat or cure. But screenings also have risks, such as missing signs of cancer. When to start screenings may depend on your age and risk factors. A mammogram is the most common type of screening. It is an x-ray of the breast using a special machine. This test is done in a hospital or clinic and only takes a few minutes. Mammograms can find tumors that are too small to feel. Mammography is performed to screen women to detect early breast cancer when it is more likely to be cured. Mammography is generally recommended for: - Women starting at age 40, repeated every 1 to 2 years. (This is not recommended by all expert organizations.) - All women starting at age 50, repeated every 1 to 2 years. - Women with a mother or sister who had breast cancer at a younger age should consider yearly mammograms. They should begin earlier than the age at which their youngest family member was diagnosed. Mammograms work best at finding breast cancer in women ages 50 to 74. For women younger than age 50, the screening can be helpful, but may miss some cancers. This may be because younger women have denser breast tissue, which makes it harder to spot cancer. It is not clear how well mammograms work at finding cancer in women age 75 and older. This is an exam to feel the breasts and underarms for lumps or unusual changes. Your health care provider may perform a clinical breast exam (CBE). You can also check your breasts on your own. This is called a breast self-exam (BSE). Doing self-exams may help you become more familiar with your breasts. This may make it easier to notice unusual breast changes. Keep in mind that breast exams do not reduce the risk of dying from breast cancer. They also do not work as well as mammograms to find cancer. For this reason, you should not rely only on breast exams to screen for cancer. Not all experts agree about when to have or start having breast exams. In fact, some groups do not recommend them at all. However, this does not mean you should not do or have breast exams. Some women prefer to have exams. Talk with your provider about the benefits and risks for breast exams and if they are right for you. An MRI uses powerful magnets and radio waves to find signs of cancer. This screening is done only in women who have a high risk for breast cancer. Women at high risk for breast cancer (greater than 20% to 25% lifetime risk) should have an MRI along with a mammogram every year. You may have a high risk if you have: - A family history of breast cancer, most often when your mother or sister had breast cancer at an early age - Lifetime risk for breast cancer is 20% to 25% or higher - Certain BRCA mutations, whether you carry this marker or a first degree relative does and you have not been tested - First degree relatives with certain genetic syndromes (Li-Fraumeni syndrome, Cowden and Bannayan-Riley-Ruvalcaba syndromes) It is not clear how well MRIs work to find breast cancer. Although MRIs find more breast cancers than mammograms, they are also more likely to show signs of cancer when there is no cancer. This is called a false-positive result. For women who have had cancer in one breast, MRIs can be very helpful for finding hidden tumors in the other breast. You should do a MRI screening if you: - Are at very high risk for breast cancer (those with a strong family history or genetic markers for breast cancer) - Have very dense breast tissue When and how often to have a breast screening test is a choice you must make. Different expert groups do not fully agree on the best timing for screening. Before having a mammogram, talk to your provider about the pros and cons. Ask about: - Your risk for breast cancer. - Whether screening decreases your chance of dying from breast cancer. - Whether there is any harm from breast cancer screening, such as side effects from testing or overtreatment of cancer when it's discovered. Risks of screenings can include: - False-positive results. This occurs when a test shows cancer when there is none. This can lead to having more tests that also have risks. It can also cause anxiety. You may be more likely to have a false-positive result if you are younger, have a family history of breast cancer, have had breast biopsies in the past, or take hormones. - False-negative results. These are tests that come back normal even though there is cancer. Women who have false-negative results do not know they have breast cancer and delay treatment. - Exposure to radiation is a risk factor for breast cancer. Mammograms expose your breasts to radiation. - Overtreatment. Mammograms and MRIs may find slow-growing cancers. These are cancers that may not shorten your life. At this time, it is not possible to know which cancers will grow and spread, so when cancer is found it is usually treated. Treatment can cause serious side effects. Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists and Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000837.htm"
+  ],
+  [
+    "Breast Cancer (Stages of Breast Cancer): - After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - The following stages are used for breast cancer: - Stage 0 (carcinoma in situ) - Stage I - Stage II - Stage IIIA - Stage IIIB - Stage IIIC - Stage IV - The treatment of breast cancer depends partly on the stage of the disease.",
+    "https://www.cancer.gov/types/breast"
+  ],
+  [
+    "Familial breast cancer (Summary): Familial breast cancer is a cluster of breast cancer within a family. Most cases of breast cancer occur sporadically in people with little to no family history of the condition. Approximately 5-10% of breast cancer is considered \"hereditary\" and is thought to be caused by an inherited predisposition to breast cancer that is passed down through a family in an autosomal dominant \u00a0manner. In some of these families, the underlying genetic cause is not known; however, many of these cases are caused by changes ( mutations ) in the BRCA1 , BRCA2, PTEN, TP53, CDH1, or STK11 genes (which are each associated with a unique hereditary cancer syndrome ).\u00a0 CHEK2 BRIP1 RAD51 ATM \u00a0About 15-20% of women diagnosed with breast cancer have a significant family history of breast cancer (two or more first-degree or second-degree relatives with breast cancer) but have no identifiable mutation in a gene known to cause a hereditary predisposition to breast cancer. These clusters of breast cancer are likely due to a combination of gene(s) and other shared factors such as environment and lifestyle. [1] [2] [3] High-risk cancer screening and other preventative measures such as chemoprevention and/or prophylactic surgeries are typically recommended in women who have an increased risk for breast cancer based on their personal and/or family histories. [4]",
+    "https://rarediseases.info.nih.gov/diseases/10415/familial-breast-cancer"
+  ],
+  [
+    "What causes Breast cancer in men?: The cause of breast cancer is not clear. But there are risk factors that make breast cancer more likely in men: - Exposure to radiation - Higher estrogen levels due to factors such as heavy drinking, cirrhosis, obesity, and some medicines to treat prostate cancer - Heredity, such as a family history of breast cancer, mutated BRCA1 or BRCA2 gene, and certain genetic disorders, such as Klinefelter syndrome - Excess breast tissue (gynecomastia) - Age. Most men are diagnosed with breast cancer between ages 60 to 70.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/007653.htm"
+  ],
+  [
+    "Familial breast cancer (Related Diseases): The following diseases are related to Familial breast cancer. If you have a question about any of these diseases, you can contact GARD. BRCA1 hereditary breast and ovarian cancer syndrome BRCA2 hereditary breast and ovarian cancer syndrome Breast cancer, childhood Cowden syndrome Hereditary diffuse gastric cancer Li-Fraumeni syndrome Peutz-Jeghers syndrome",
+    "https://rarediseases.info.nih.gov/diseases/10415/familial-breast-cancer"
+  ],
+  [
+    "Breast cancer screening: Breast cancer screenings can help find breast cancer early, before you notice any symptoms. In many cases, finding breast cancer early makes it easier to treat or cure. But screenings also have risks, such as missing signs of cancer. When to start screenings may depend on your age and risk factors. A mammogram is the most common type of screening. It is an x-ray of the breast using a special machine. This test is done in a hospital or clinic and only takes a few minutes. Mammograms can find tumors that are too small to feel. Mammography is performed to screen women to detect early breast cancer when it is more likely to be cured. Mammography is generally recommended for: - Women starting at age 40, repeated every 1 to 2 years. (This is not recommended by all expert organizations.) - All women starting at age 50, repeated every 1 to 2 years. - Women with a mother or sister who had breast cancer at a younger age should consider yearly mammograms. They should begin earlier than the age at which their youngest family member was diagnosed. Mammograms work best at finding breast cancer in women ages 50 to 74. For women younger than age 50, the screening can be helpful, but may miss some cancers. This may be because younger women have denser breast tissue, which makes it harder to spot cancer. It is not clear how well mammograms work at finding cancer in women age 75 and older. This is an exam to feel the breasts and underarms for lumps or unusual changes. Your health care provider may perform a clinical breast exam (CBE). You can also check your breasts on your own. This is called a breast self-exam (BSE). Doing self-exams may help you become more familiar with your breasts. This may make it easier to notice unusual breast changes. Keep in mind that breast exams do not reduce the risk of dying from breast cancer. They also do not work as well as mammograms to find cancer. For this reason, you should not rely only on breast exams to screen for cancer. Not all experts agree about when to have or start having breast exams. In fact, some groups do not recommend them at all. However, this does not mean you should not do or have breast exams. Some women prefer to have exams. Talk with your provider about the benefits and risks for breast exams and if they are right for you. An MRI uses powerful magnets and radio waves to find signs of cancer. This screening is done only in women who have a high risk for breast cancer. Women at high risk for breast cancer (greater than 20% to 25% lifetime risk) should have an MRI along with a mammogram every year. You may have a high risk if you have: - A family history of breast cancer, most often when your mother or sister had breast cancer at an early age - Lifetime risk for breast cancer is 20% to 25% or higher - Certain BRCA mutations, whether you carry this marker or a first degree relative does and you have not been tested - First degree relatives with certain genetic syndromes (Li-Fraumeni syndrome, Cowden and Bannayan-Riley-Ruvalcaba syndromes) It is not clear how well MRIs work to find breast cancer. Although MRIs find more breast cancers than mammograms, they are also more likely to show signs of cancer when there is no cancer. This is called a false-positive result. For women who have had cancer in one breast, MRIs can be very helpful for finding hidden tumors in the other breast. You should do a MRI screening if you: - Are at very high risk for breast cancer (those with a strong family history or genetic markers for breast cancer) - Have very dense breast tissue When and how often to have a breast screening test is a choice you must make. Different expert groups do not fully agree on the best timing for screening. Before having a mammogram, talk to your provider about the pros and cons. Ask about: - Your risk for breast cancer. - Whether screening decreases your chance of dying from breast cancer. - Whether there is any harm from breast cancer screening, such as side effects from testing or overtreatment of cancer when it's discovered. Risks of screenings can include: - False-positive results. This occurs when a test shows cancer when there is none. This can lead to having more tests that also have risks. It can also cause anxiety. You may be more likely to have a false-positive result if you are younger, have a family history of breast cancer, have had breast biopsies in the past, or take hormones. - False-negative results. These are tests that come back normal even though there is cancer. Women who have false-negative results do not know they have breast cancer and delay treatment. - Exposure to radiation is a risk factor for breast cancer. Mammograms expose your breasts to radiation. - Overtreatment. Mammograms and MRIs may find slow-growing cancers. These are cancers that may not shorten your life. At this time, it is not possible to know which cancers will grow and spread, so when cancer is found it is usually treated. Treatment can cause serious side effects. Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists and Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000837.htm"
+  ],
+  [
+    "Breast cancer screening (Benefits and Risks of Screenings): When and how often to have a breast screening test is a choice you must make. Different expert groups do not fully agree on the best timing for screening. Before having a mammogram, talk to your provider about the pros and cons. Ask about: - Your risk for breast cancer. - Whether screening decreases your chance of dying from breast cancer. - Whether there is any harm from breast cancer screening, such as side effects from testing or overtreatment of cancer when it's discovered. Risks of screenings can include: - False-positive results. This occurs when a test shows cancer when there is none. This can lead to having more tests that also have risks. It can also cause anxiety. You may be more likely to have a false-positive result if you are younger, have a family history of breast cancer, have had breast biopsies in the past, or take hormones. - False-negative results. These are tests that come back normal even though there is cancer. Women who have false-negative results do not know they have breast cancer and delay treatment. - Exposure to radiation is a risk factor for breast cancer. Mammograms expose your breasts to radiation. - Overtreatment. Mammograms and MRIs may find slow-growing cancers. These are cancers that may not shorten your life. At this time, it is not possible to know which cancers will grow and spread, so when cancer is found it is usually treated. Treatment can cause serious side effects.",
+    "https://medlineplus.gov/ency/patientinstructions/000837.htm"
+  ],
+  [
+    "Breast cancer (Symptoms): Signs and symptoms of breast cancer may include: - A breast lump or thickening that feels different from the surrounding tissue - Change in the size, shape or appearance of a breast - Changes to the skin over the breast, such as dimpling - A newly inverted nipple - Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin - Redness or pitting of the skin over your breast, like the skin of an orange When to see a doctor If you find a lump or other change in your breast - even if a recent mammogram was normal - make an appointment with your doctor for prompt evaluation.",
+    "https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470"
+  ],
+  [
+    "Familial breast cancer (Symptoms): The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Autosomal dominant inheritance - Breast carcinoma - Heterogeneous -",
+    "https://rarediseases.info.nih.gov/diseases/10415/familial-breast-cancer"
+  ],
+  [
+    "Breast cancer (Symptoms): Early breast cancer often does not cause symptoms. This is why regular breast exams and mammograms are important, so cancers that don't have symptoms may be found earlier. As the cancer grows, symptoms may include: - Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt. - Change in the size, shape, or feel of the breast or nipple. For example, you may have redness, dimpling, or puckering that looks like the skin of an orange. - Fluid from the nipple. Fluid may be bloody, clear to yellow, green, or look like pus. In men, breast cancer symptoms include breast lump and breast pain and tenderness. Symptoms of advanced breast cancer may include: - Bone pain - Breast pain or discomfort - Skin ulcers - Swelling of the lymph nodes in the armpit (next to the breast with cancer) - Weight loss",
+    "https://medlineplus.gov/ency/article/000913.htm"
+  ],
+  [
+    "Familial breast cancer (Treatment): Management of familial breast cancer is generally focused on high-risk cancer screening to allow for early detection and treatment of cancer. In general, the National Comprehensive Cancer Network recommends high-risk breast cancer screening for women who have: (1) a personal and family history suggestive of a hereditary cancer syndrome that is associated with breast cancer or (2) a greater than 20% risk of developing breast cancer in their lifetime based largely on family history. The recommended screening protocol includes: [4] Breast awareness and breast self-exams Clinical breast exams every 6-12 months beginning at age 30 or individualized based on the earliest breast cancer diagnosis in the family Annual mammogram and breast MRI beginning at age 30 or individualized based on the earliest breast cancer diagnosis in the family Discussion of\u00a0other risk reduction strategies such as chemoprevention and/or prophylactic surgeries If the familial breast cancer is part of a known hereditary cancer syndrome, management will also include screening for the other associated cancers. Please click on the following links for more information regarding the treatment and management of each condition: Hereditary Breast and Ovarian Cancer Cowden syndrome Li Fraumeni syndrome Hereditary Diffuse Gastric Cancer Peutz-Jeghers syndrome",
+    "https://rarediseases.info.nih.gov/diseases/10415/familial-breast-cancer"
+  ],
+  [
+    "What are the treatments for Breast cancer in men?: Treatment options for breast cancer in men include: - Surgery to remove the breast, lymph nodes under the arm, the lining over chest muscles, and chest muscles, if needed - Radiation therapy after surgery to kill any remaining cancer cells and to target specific tumors - Chemotherapy to kill cancer cells that have spread to other parts of the body - Hormone therapy to block hormones that may help certain types of breast cancer grow During and after treatment, your provider may ask you to have more tests. This may include tests you had during diagnosis. The follow-up tests will show how the treatment is working. They will also show if the cancer comes back.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/007653.htm"
+  ],
+  [
+    "Recurrent breast cancer (Treatment): Your treatment options will depend on several factors, including the extent of the disease, its hormone receptor status, the type of treatment you received for your first breast cancer and your overall health. Your doctor also considers your goals and your preferences for treatment. Treating a local recurrence Treatment for a local recurrence typically starts with an operation and may include radiation if you haven't had it before. Chemotherapy and hormone therapy may also be recommended. - Surgery. For recurrent breast cancer that's confined to the breast, treatment usually involves removing any remaining breast tissue. If your first cancer was treated with lumpectomy, your doctor may recommend a mastectomy to remove all of your breast tissue - lobules, ducts, fatty tissue, skin and nipple. If your first breast cancer was treated with mastectomy and the cancer comes back in the chest wall, you may have surgery to remove the new cancer along with a margin of normal tissue. A local recurrence may be accompanied by hidden cancer in nearby lymph nodes. For this reason, the surgeon may remove some or all of the nearby lymph nodes if they weren't removed during your initial treatment. - Radiation therapy. Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells. If you didn't have radiation therapy for your first breast cancer, your doctor may recommend it now. But if you had radiation after a lumpectomy, radiation to treat the recurrence isn't usually recommended because of the risk of side effects. - Chemotherapy. Chemotherapy uses drugs to kill cancer cells. Your doctor may recommend chemotherapy after surgery to reduce your risk of another cancer recurrence. - Hormone therapy. Medications that block the growth-promoting effects of the hormones estrogen and progesterone may be recommended if your cancer is hormone receptor positive. Treating a regional recurrence Treatments for a regional breast cancer recurrence include: - Surgery. If it's possible, surgery to remove the cancer is the recommended treatment for a regional recurrence. Your surgeon may also remove the lymph nodes under your arm if they're still present. - Radiation therapy. Sometimes radiation therapy may be used after surgery. If surgery isn't possible, radiation therapy may be used as the main treatment for a regional breast cancer recurrence. - Drug treatments. Chemotherapy, targeted therapy or hormone therapy also may be recommended as the main treatment or may follow surgery or radiation. Treating a metastatic recurrence Many treatments exist for metastatic breast cancer. Your options will depend on where your cancer has spread. If one treatment doesn't work or stops working, you may be able to try other treatments. In general, the goal of treatment for a metastatic breast cancer isn't to cure the disease. Treatment may allow you to live longer and can help relieve symptoms the cancer is causing. Your doctor works to achieve a balance between controlling your symptoms while minimizing toxic effects from treatment. The aim is to help you live as well as possible for as long as possible. Treatments may include: - Hormone therapy. If your cancer is hormone receptor positive, you may benefit from hormone therapy. In general, hormone therapy has fewer side effects than chemotherapy, so in many cases it's the first treatment used for metastatic breast cancer. - Chemotherapy. Your doctor may recommend chemotherapy if your cancer is hormone receptor negative or if hormone therapy is no longer working. - Targeted therapy. If your cancer cells have certain characteristics that make them vulnerable to targeted therapy, your doctor may recommend these medications. - Bone-building drugs. If cancer has spread to your bones, your doctor may recommend a bone-building drug to reduce your risk of broken bones or reduce bone pain you may experience. - Other treatments. Radiation therapy and surgery may be used in certain situations to control signs and symptoms of advanced breast cancer.",
+    "https://www.mayoclinic.org/diseases-conditions/recurrent-breast-cancer/symptoms-causes/syc-20377135"
+  ],
+  [
+    "Breast Cancer (Treatment Option Overview): - There are different types of treatment for men with breast cancer. - Five types of standard treatment are used to treat men with breast cancer: - Surgery - Chemotherapy - Hormone therapy - Radiation therapy - Targeted therapy - Treatment for male breast cancer may cause side effects.",
+    "https://www.cancer.gov/types/breast"
+  ],
+  [
+    "Breast Cancer (Treatment Options by Stage): Early Stage Breast Cancer (Stage I and Stage II) Treatment of early-stage breast cancer (stage I and stage II) may include the following: - Modified radical mastectomy, if the breast cancer was diagnosed early in pregnancy. - Breast-conserving surgery followed by radiation therapy, if the breast cancer was diagnosed late in pregnancy. In pregnant women, radiation therapy is delayed until after the baby is born. - Modified radical mastectomy or breast-conserving surgery during pregnancy followed by chemotherapy after the first 3 months of pregnancy. Late Stage Breast Cancer (Stage III and Stage IV) Treatment of late-stage breast cancer (stage III and stage IV) may include the following: - Radiation therapy. - Chemotherapy. Radiation therapy and chemotherapy should not be given during the first 3 months of pregnancy.",
+    "https://www.cancer.gov/types/breast"
+  ],
+  [
+    "Breast Cancer (Treatment Options for Male Breast Cancer): Initial Surgery Treatment for men diagnosed with breast cancer is usually modified radical mastectomy. Breast-conserving surgery with lumpectomy may be used for some men. Adjuvant Therapy Therapy given after an operation when cancer cells can no longer be seen is called adjuvant therapy. Even if the doctor removes all the cancer that can be seen at the time of the operation, the patient may be given radiation therapy, chemotherapy, hormone therapy, and/or targeted therapy after surgery, to try to kill any cancer cells that may be left. - Node-negative: For men whose cancer is node-negative (cancer has not spread to the lymph nodes), adjuvant therapy should be considered on the same basis as for a woman with breast cancer because there is no evidence that response to therapy is different for men and women. - Node-positive: For men whose cancer is node-positive (cancer has spread to the lymph nodes), adjuvant therapy may include the following: - Chemotherapy. - Targeted therapy with a monoclonal antibody (trastuzumab). - Tamoxifen (to block the effect of estrogen). - Other hormone therapy. These treatments appear to increase survival in men as they do in women. The patient's response to hormone therapy depends on whether there are hormone receptors (proteins) in the tumor. Most breast cancers in men have these receptors. Hormone therapy is usually recommended for male breast cancer patients, but it can have many side effects, including hot flashes and impotence (the inability to have an erection adequate for sexual intercourse). Distant Metastases Treatment options for metastatic breast cancer (cancer that has spread to distant parts of the body) may include the following: Hormone therapy In men who have just been diagnosed with metastatic breast cancer that is hormone receptor positive or if the hormone receptor status is not known, treatment may include: - Tamoxifen therapy. - Aromatase inhibitor therapy (anastrozole, letrozole, or exemestane) with or without an LHRH agonist. Sometimes cyclin-dependent kinase inhibitor therapy (palbociclib) is also given. In men whose tumors are hormone receptor positive or hormone receptor unknown, with spread to the bone or soft tissue only, and who have been treated with tamoxifen, treatment may include: - Aromatase inhibitor therapy with or without LHRH agonist. - Other hormone therapy such as megestrol acetate, estrogen or androgen therapy, or anti-estrogen therapy such as fulvestrant. Targeted therapy In men with metastatic breast cancer that is hormone receptor positive and has not responded to other treatments, options may include targeted therapy such as: - Trastuzumab, lapatinib, pertuzumab, or mTOR inhibitors. - Antibody-drug conjugate therapy with ado-trastuzumab emtansine. - Cyclin-dependent kinase inhibitor therapy (palbociclib) combined with letrozole. In men with metastatic breast cancer that is HER2/neu positive, treatment may include: - Targeted therapy such as trastuzumab, pertuzumab, ado-trastuzumab emtansine, or lapatinib. Chemotherapy In men with metastatic breast cancer that is hormone receptor negative, has not responded to hormone therapy, has spread to other organs or has caused symptoms, treatment may include: - Chemotherapy with one or more drugs. Surgery - Total mastectomy for men with open or painful breast lesions. Radiation therapy may be given after surgery. - Surgery to remove cancer that has spread to the brain or spine. Radiation therapy may be given after surgery. - Surgery to remove cancer that has spread to the lung. - Surgery to repair or help support weak or broken bones. Radiation therapy may be given after surgery. - Surgery to remove fluid that has collected around the lungs or heart. Radiation therapy - Radiation therapy to the bones, brain, spinal cord, breast, or chest wall to relieve symptoms and improve quality of life. - Strontium-89 (a radionuclide) to relieve pain from cancer that has spread to bones throughout the body. Other treatment options Other treatment options for metastatic breast cancer include: - Drug therapy with bisphosphonates or denosumab to reduce bone disease and pain when cancer has spread to the bone. (See the PDQ summary on Cancer Pain for more information about bisphosphonates.) - Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment. Hormone therapy In men who have just been diagnosed with metastatic breast cancer that is hormone receptor positive or if the hormone receptor status is not known, treatment may include: - Tamoxifen therapy. - Aromatase inhibitor therapy (anastrozole, letrozole, or exemestane) with or without an LHRH agonist. Sometimes cyclin-dependent kinase inhibitor therapy (palbociclib) is also given. In men whose tumors are hormone receptor positive or hormone receptor unknown, with spread to the bone or soft tissue only, and who have been treated with tamoxifen, treatment may include: - Aromatase inhibitor therapy with or without LHRH agonist. - Other hormone therapy such as megestrol acetate, estrogen or androgen therapy, or anti-estrogen therapy such as fulvestrant. Targeted therapy In men with metastatic breast cancer that is hormone receptor positive and has not responded to other treatments, options may include targeted therapy such as: - Trastuzumab, lapatinib, pertuzumab, or mTOR inhibitors. - Antibody-drug conjugate therapy with ado-trastuzumab emtansine. - Cyclin-dependent kinase inhibitor therapy (palbociclib) combined with letrozole. In men with metastatic breast cancer that is HER2/neu positive, treatment may include: - Targeted therapy such as trastuzumab, pertuzumab, ado-trastuzumab emtansine, or lapatinib. Chemotherapy In men with metastatic breast cancer that is hormone receptor negative, has not responded to hormone therapy, has spread to other organs or has caused symptoms, treatment may include: - Chemotherapy with one or more drugs. Surgery - Total mastectomy for men with open or painful breast lesions. Radiation therapy may be given after surgery. - Surgery to remove cancer that has spread to the brain or spine. Radiation therapy may be given after surgery. - Surgery to remove cancer that has spread to the lung. - Surgery to repair or help support weak or broken bones. Radiation therapy may be given after surgery. - Surgery to remove fluid that has collected around the lungs or heart. Radiation therapy - Radiation therapy to the bones, brain, spinal cord, breast, or chest wall to relieve symptoms and improve quality of life. - Strontium-89 (a radionuclide) to relieve pain from cancer that has spread to bones throughout the body. Other treatment options Other treatment options for metastatic breast cancer include: - Drug therapy with bisphosphonates or denosumab to reduce bone disease and pain when cancer has spread to the bone. (See the PDQ summary on Cancer Pain for more information about bisphosphonates.) - Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.",
+    "https://www.cancer.gov/types/breast"
+  ],
+  [
+    "Breast cancer (Diagnosis): Diagnosing breast cancer Tests and procedures used to diagnose breast cancer include: - Breast exam. Your doctor will check both of your breasts and lymph nodes in your armpit, feeling for any lumps or other abnormalities. - Mammogram. A mammogram is an X-ray of the breast. Mammograms are commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram, your doctor may recommend a diagnostic mammogram to further evaluate that abnormality. - Breast ultrasound. Ultrasound uses sound waves to produce images of structures deep within the body. Ultrasound may be used to determine whether a new breast lump is a solid mass or a fluid-filled cyst. - Removing a sample of breast cells for testing (biopsy). A biopsy is the only definitive way to make a diagnosis of breast cancer. During a biopsy, your doctor uses a specialized needle device guided by X-ray or another imaging test to extract a core of tissue from the suspicious area. Often, a small metal marker is left at the site within your breast so the area can be easily identified on future imaging tests. Biopsy samples are sent to a laboratory for analysis where experts determine whether the cells are cancerous. A biopsy sample is also analyzed to determine the type of cells involved in the breast cancer, the aggressiveness (grade) of the cancer, and whether the cancer cells have hormone receptors or other receptors that may influence your treatment options. - Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. Before a breast MRI, you receive an injection of dye. Unlike other types of imaging tests, an MRI doesn't use radiation to create the images. Other tests and procedures may be used depending on your situation. Staging breast cancer Once your doctor has diagnosed your breast cancer, he or she works to establish the extent (stage) of your cancer. Your cancer's stage helps determine your prognosis and the best treatment options. Complete information about your cancer's stage may not be available until after you undergo breast cancer surgery. Tests and procedures used to stage breast cancer may include: - Blood tests, such as a complete blood count - Mammogram of the other breast to look for signs of cancer - Breast MRI - Bone scan - Computerized tomography (CT) scan - Positron emission tomography (PET) scan Not all women will need all of these tests and procedures. Your doctor selects the appropriate tests based on your specific circumstances and taking into account new symptoms you may be experiencing. Breast cancer stages range from 0 to IV with 0 indicating cancer that is noninvasive or contained within the milk ducts. Stage IV breast cancer, also called metastatic breast cancer, indicates cancer that has spread to other areas of the body. Breast cancer staging also takes into account your cancer's grade; the presence of tumor markers, such as receptors for estrogen, progesterone and HER2; and proliferation factors.",
+    "https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470"
+  ],
+  [
+    "How to diagnose Breast cancer in men?: You health care provider will take your medical history and family medical history. You will have a physical exam and a breast exam. Your provider may order other tests, including: - A mammogram - Breast ultrasound - An MRI of the breast - An exam of any nipple discharge - A blood test to check for signs of cancer - If any of the tests suggest cancer, your provider will do a biopsy to check for cancer. If cancer is found, your provider will order other tests to find out: - How quickly the cancer might grow - How likely it is to spread - What treatments might be best - What are the chances that the cancer might come back The tests may include: - Chest X-ray, specifically to see if it has spread to the lungs - Bone scan - CT scan - PET scan - Sentinel lymph node biopsy to check if the cancer has spread to the lymph nodes The biopsy and other tests will be used to grade and stage the tumor. The results of those tests will help determine your treatment.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/007653.htm"
+  ],
+  [
+    "Familial breast cancer (Diagnosis): Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional.",
+    "https://rarediseases.info.nih.gov/diseases/10415/familial-breast-cancer"
+  ],
+  [
+    "Recurrent breast cancer (Diagnosis): If your doctor suspects you may have recurrent breast cancer based on results of a mammogram or physical exam, or because of signs and symptoms, he or she may recommend additional tests to confirm the diagnosis. Tests and procedures may include: - Imaging tests. What imaging tests you'll undergo will depend on your situation. Imaging tests may include a magnetic resonance imaging (MRI), computerized tomography (CT) scan, X-ray, bone scan or positron emission tomography (PET) scan. Not every person needs every test. Your doctor will determine which tests are most helpful in your particular situation. - Removing a sample of tissue for lab testing (biopsy). Your doctor may recommend a biopsy procedure to collect suspicious cells for testing. Working in a laboratory, a pathologist examines the cells and determines the types of cells involved. A pathologist can determine if the cancer is a recurrence of cancer or a new type of cancer. Tests also show whether the cancer is sensitive to hormone treatment or targeted therapy.",
+    "https://www.mayoclinic.org/diseases-conditions/recurrent-breast-cancer/symptoms-causes/syc-20377135"
+  ],
+  [
+    "Male breast cancer (Diagnosis): Diagnosing male breast cancer Your doctor may conduct a number of diagnostic tests and procedures, such as: - Clinical breast exam. The doctor uses his or her fingertips to examine your breasts and surrounding areas for lumps or other changes. Your doctor assesses how large the lumps are, how they feel, and how close they are to your skin and muscles. - Imaging tests. Mammogram and ultrasound can detect suspicious masses in your breast tissue. - Biopsy. A fine needle is inserted into the breast to remove tissue for analysis in the laboratory. Test results can reveal whether you have breast cancer and if so, the type of breast cancer you have. Determining the extent of the cancer Determining the extent (stage) of your cancer helps your doctor evaluate treatment options. Biopsy, blood tests and imaging tests can be used to stage male breast cancer. The stages of male breast cancer are: - Stage I. The tumor is no more than 2 centimeters (cm) in diameter (about 3/4 inch) and hasn't spread to the lymph nodes. - Stage II. The tumor may be up to 5 cm (about 2 inches) in diameter and may have spread to nearby lymph nodes. Or the tumor may be larger than 5 cm but no cancer cells are found in the lymph nodes. - Stage III. The tumor may be larger than 5 cm (about 2 inches) in diameter and may involve several nearby lymph nodes. Lymph nodes above the collarbone may also contain cancer cells. - Stage IV. Cancer at this stage has spread beyond the breast to distant areas, such as the bone, brain, liver or lungs.",
+    "https://www.mayoclinic.org/diseases-conditions/male-breast-cancer/symptoms-causes/syc-20374740"
+  ],
+  [
+    "Heart Attack: Espa\u00f1ol A heart attack happens when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can\u2019t get oxygen. If blood flow isn\u2019t restored quickly, the section of heart muscle begins to die. Heart attack treatment works best when it\u2019s given right after symptoms occur. If you think you or someone else is having a heart attack, even if you\u2019re not sure, call 9\u20131\u20131 right away. Overview Heart attacks most often occur as a result of coronary heart disease (CHD), also called coronary artery disease. CHD is a condition in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart. When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years. Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque's surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery. If the blockage isn't treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems. Heart With Muscle Damage and a Blocked Artery A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren't affected by atherosclerosis. Heart attacks can be associated with or lead to severe health problems, such as heart failure and life-threatening arrhythmias. Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Arrhythmias are irregular heartbeats. Ventricular fibrillation is a life-threatening arrhythmia that can cause death if not treated right away. Don't Wait--Get Help Quickly Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment works best when it's given right after symptoms occur. \u00a0 Many people aren't sure what's wrong when they are having symptoms of a heart attack. Some of the most common warning symptoms of a heart attack for both men and women are: Chest pain or discomfort.\u00a0Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion. Upper body discomfort.\u00a0You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button). Shortness of breath.\u00a0This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity. Other possible symptoms of a heart attack include: Breaking out in a cold sweat Feeling unusually tired for no reason, sometimes for days (especially if you are a woman) Nausea (feeling sick to the stomach) and vomiting Light-headedness or sudden dizziness Any sudden, new symptom or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual) Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies, or other common symptoms such as chest discomfort. The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one.\u00a0 Quick Action Can Save Your Life: Call 9\u20131\u20131 If you think you or someone else may be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9\u20131\u20131 for emergency medical care. Acting fast can save your life. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. Take a nitroglycerin pill if your doctor has prescribed this type of treatment. Myocardial infarction (MI) Acute myocardial infarction (AMI) Acute coronary syndrome Coronary thrombosis Coronary occlusion Coronary Heart Disease A heart attack happens if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can't get oxygen. Most heart attacks occur as a result of coronary heart disease (CHD). CHD is a condition in which a waxy substance called plaque builds up inside of the coronary arteries. These arteries supply oxygen-rich blood to your heart. When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years. Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque's surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery. If the blockage isn't treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems. Coronary Artery Spasm A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren't affected by atherosclerosis. What causes a coronary artery to spasm isn't always clear. A spasm may be related to: Taking certain drugs, such as cocaine Emotional stress or pain Exposure to extreme cold Cigarette smoking Certain risk factors make it more likely that you'll develop coronary heart disease (CHD) and have a heart attack. You can control many of these risk factors. Risk Factors You Can Control The major risk factors for a heart attack that you can control include: Smoking High blood pressure High blood cholesterol Overweight and obesity An unhealthy diet (for example, a diet high in saturated fat, trans fat, cholesterol, and sodium) Lack of routine physical activity High blood sugar due to insulin resistance or diabetes Some of these risk factors\u2014such as obesity, high blood pressure, and high blood sugar\u2014tend to occur together. When they do, it's called metabolic syndrome. In general, a person who has metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone who doesn't have metabolic syndrome. For more information about the risk factors that are part of metabolic syndrome, go to the Health Topics Metabolic Syndrome article. Risk Factors You Can't Control Risk factors that you can't control include: Age. The risk of heart disease increases for men after age 45 and for women after age 55 (or after menopause). Family history of early heart disease. Your risk increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age. Preeclampsia (pre-e-KLAMP-se-ah). This condition can develop during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine. Preeclampsia is linked to an increased lifetime risk of heart disease, including CHD, heart attack, heart failure, and high blood pressure. Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. In one study, for example, one-third of the patients who had heart attacks had no chest pain. These patients were more likely to be older, female, or diabetic. The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one. It is important for you to know the most common symptoms of a heart attack and also remember these facts: Heart attacks can start slowly and cause only mild pain or discomfort. Symptoms can be mild or more intense and sudden. Symptoms also may come and go over several hours. People who have high blood sugar (diabetes) may have no symptoms or very mild ones. The most common symptom, in both men and women, is chest pain or discomfort. Women are somewhat more likely to have shortness of breath, nausea and vomiting, unusual tiredness (sometimes for days), and pain in the back, shoulders, and jaw. Some people don't have symptoms at all. Heart attacks that occur without any symptoms or with very mild symptoms are called silent heart attacks. Most Common Symptoms The most common warning symptoms of a heart attack for both men and women are: Chest pain or discomfort.\u00a0Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion. The feeling can be mild or severe. Upper body discomfort.\u00a0You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button). Shortness of breath.\u00a0This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity. The symptoms of angina (an-JI-nuh or AN-juh-nuh) can be similar to the symptoms of a heart attack. Angina is chest pain that occurs in people who have coronary heart disease, usually when they're active. Angina pain usually lasts for only a few minutes and goes away with rest. Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack. All chest pain should be checked by a doctor. Other Common Signs and Symptoms Pay attention to these other possible symptoms of a heart attack: Breaking out in a cold sweat Feeling unusually tired for no reason, sometimes for days (especially if you are a woman) Nausea (feeling sick to the stomach) and vomiting Light-headedness or sudden dizziness Any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual) Not everyone having a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. However, some people may have a pattern of symptoms that recur. The more signs and symptoms you have, the more likely it is that you're having a heart attack. Quick Action Can Save Your Life: Call 9\u20131\u20131\u00a0 The signs and symptoms of a heart attack can develop suddenly. However, they also can develop slowly\u2014sometimes within hours, days, or weeks of a heart attack. Any time you think you might be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9\u20131\u20131 for emergency medical care, even if you are not sure whether you're having a heart attack. Here's why: Acting fast can save your life. An ambulance is the best and safest way to get to the hospital. Emergency medical services (EMS) personnel can check how you are doing and start life-saving medicines and other treatments right away. People who arrive by ambulance often receive faster treatment at the hospital.\u00a0 The 9\u20131\u20131 operator or EMS technician can give you advice. You might be told to crush or chew an aspirin if you're not allergic, unless there is a medical reason for you not to take one. Aspirin taken during a heart attack can limit the damage to your heart and save your life. Every minute matters. Never delay calling 9\u20131\u20131 to take aspirin or do anything else you think might help. Your doctor will diagnose a heart attack based on your signs and symptoms, your medical and family histories, and test results. Diagnostic Tests EKG (Electrocardiogram) An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart. An EKG can show signs of heart damage due to coronary heart disease (CHD) and signs of a previous or current heart attack. Blood Tests During a heart attack, heart muscle cells die and release proteins into the bloodstream. Blood tests can measure the amount of these proteins in the bloodstream. Higher than normal levels of these proteins suggest a heart attack. Commonly used blood tests include troponin tests, CK or CK\u2013MB tests, and serum myoglobin tests. Blood tests often are repeated to check for changes over time. Coronary Angiography Coronary angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the insides of your coronary arteries. This test often is done during a heart attack to help find blockages in the coronary arteries. To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-e-ter-ih-ZA-shun). A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through the coronary arteries. The dye lets your doctor study the flow of blood through the heart and blood vessels. If your doctor finds a blockage, he or she may recommend a procedure calledpercutaneous (per-ku-TA-ne-us) coronary intervention (PCI), sometimes referred to as\u00a0coronary angioplasty\u00a0(AN-jee-oh-plas-tee). This procedure can help restore blood flow through a blocked artery. Sometimes a small mesh tube called a stent is placed in the artery to help prevent blockages after the procedure. Early treatment for a heart attack can pr event or limit damage to the heart muscle. Acting fast, by calling 9\u20131\u20131 at the first symptoms of a heart attack, can save your life. Medical personnel can begin diagnosis and treatment even before you get to the hospital. Immediate Treatment Certain treatments usually are started right away if a heart attack is suspected, even before the diagnosis is confirmed. These include: Aspirin to prevent further blood clotting Nitroglycerin to reduce your heart\u2019s workload and improve blood flow through the coronary arteries Oxygen therapy Treatment for chest pain Once the diagnosis of a heart attack is confirmed or strongly suspected, doctors start treatments promptly to try to restore blood flow through the blood vessels supplying the heart. The two main treatments are clot-busting medicines and percutaneous coronary intervention, also known as coronary angioplasty, a procedure used to open blocked coronary arteries. Clot-Busting Medicines Thrombolytic medicines, also called clot busters, are used to dissolve blood clots that are blocking the coronary arteries. To work best, these medicines must be given within several hours of the start of heart attack symptoms. Ideally, the medicine should be given as soon as possible. Percutaneous Coronary Intervention Percutaneous coronary intervention is a nonsurgical procedure that opens blocked or narrowed coronary arteries. A thin, flexible tube (catheter) with a balloon or other device on the end is threaded through a blood vessel, usually in the groin (upper thigh), to the narrowed or blocked coronary artery. Once in place, the balloon located at the tip of the catheter is inflated to compress the plaque and related clot against the wall of the artery. This restores blood flow through the artery. During the procedure, the doctor may put a small mesh tube called a stent in the artery. The stent helps to keep the blood vessel open to prevent blockages in the artery in the months or years after the procedure. Other Treatments for Heart Attack Other treatments for heart attack include: Medicines Medical procedures Heart-healthy lifestyle changes Cardiac rehabilitation Medicines Your doctor may prescribe one or more of the following medicines. ACE inhibitors. ACE inhibitors lower blood pressure and reduce strain on your heart. They also help slow down further weakening of the heart muscle. Anticlotting medicines. Anticlotting medicines stop platelets from clumping together and forming unwanted blood clots. Examples of anticlotting medicines include aspirin and clopidogrel. Anticoagulants. Anticoagulants, or blood thinners, prevent blood clots from forming in your arteries. These medicines also keep existing clots from getting larger. Beta blockers. Beta blockers decrease your heart\u2019s workload. These medicines also are used to relieve chest pain and discomfort and to help prevent another heart attack. Beta blockers also are used to treat arrhythmias (irregular heartbeats). Statin medicines. Statins control or lower your blood cholesterol. By lowering your blood cholesterol level, you can decrease your chance of having another heart attack or\u00a0stroke. You also may be given medicines to relieve pain and anxiety, and treat arrhythmias.\u00a0Take all medicines regularly, as your doctor prescribes. Don\u2019t change the amount of your medicine or skip a dose unless your doctor tells you to.\u00a0 Medical Procedures Coronary artery bypass grafting also may be used to treat a heart attack. During coronary artery bypass grafting, a surgeon removes a healthy artery or vein from your body. The artery or vein is then connected, or grafted, to bypass the blocked section of the coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This provides a new route for blood to flow to the heart muscle. Heart-Healthy Lifestyle Changes Treatment for a heart attack usually includes making heart-healthy lifestyle changes. Your doctor also may recommend: Heart-healthy eating Aiming for healthy weight Managing stress Physical activity Quitting smoking Taking these steps can lower your chances of having another heart attack. Cardiac Rehabilitation Your doctor may recommend cardiac rehabilitation (cardiac rehab) to help you recover from a heart attack and to help prevent another heart attack. Nearly everyone who has had a heart attack can benefit from rehab. Cardiac rehab is a medically supervised program that may help improve the health and well-being of people who have heart problems. The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists. Rehab has two parts: Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk for future heart problems. The rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and how to deal with your fears about the future. Exercise training. This part helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your personal abilities, needs, and interests. Lowering your risk factors for coronary heart disease can help you prevent a heart attack. Even if you already have coronary heart disease, you still can take steps to lower your risk for a heart attack. These steps involve making heart-healthy lifestyle changes\u00a0and getting ongoing\u00a0medical care for related conditions that make heart attack more likely. Talk to your doctor about whether you may benefit from aspirin primary prevention, or using aspirin to help prevent your first heart attack. Heart-Healthy Lifestyle Changes A heart-healthy lifestyle can help prevent a heart attack and includes heart-healthy eating, being physically active, quitting smoking, managing stress, and managing your weight. Ongoing Care Treat Related Conditions Treating conditions that make a heart attack more likely also can help lower your risk for a heart attack. These conditions may include: Diabetes (high blood sugar). If you have diabetes, try to control your blood sugar level through diet and physical activity (as your doctor recommends). If needed, take medicine as prescribed. High blood cholesterol. Your doctor may prescribe a statin medicine to lower your cholesterol if diet and exercise aren\u2019t enough. High blood pressure. Your doctor may prescribe medicine to keep your blood pressure under control. Chronic kidney disease. Your doctor may prescribe medicines to control your high blood pressure or high blood sugar levels. Peripheral artery disease. Your doctor may recommend surgery or procedures to unblock the affected arteries. Have an Emergency Action Plan Make sure that you have an emergency action plan in case you or someone in your family has a heart attack. This is very important if you\u2019re at high risk for, or have already had, a heart attack. Write down a list of medicines you are taking, medicines you are allergic to, your health care provider\u2019s phone numbers (both during and after office hours), and contact information for a friend or relative. Keep the list in a handy place (for example, fill out this wallet card) to share in a medical emergency. Talk with your doctor about the signs and symptoms of a heart attack, when you should call 9\u20131\u20131, and steps you can take while waiting for medical help to arrive. Many people survive heart attacks and live active, full lives. If you get help quickly, treatment can limit damage to your heart muscle. Less heart damage improves your chances for a better quality of life after a heart attack. Medical Followup After a heart attack, you'll need treatment for coronary heart disease (CHD). This will help prevent another heart attack. Your doctor may recommend: Lifestyle changes, such as following a healthy diet, being physically active, maintaining a healthy weight, and quitting smoking. Medicines to control chest pain or discomfort, high blood cholesterol, high blood pressure, and your heart's workload.\u00a0Some of these medicines can help you prevent another heart attack. Anticlotting medicines, such as aspirin, that your doctor may prescribe to help you prevent another heart attack. A cardiac rehabilitation program If you find it hard to get your medicines or or complete your cardiac rehabilitation program, talk with your doctor. Don't stop the medicines or program because it\u00a0can help you prevent another heart attack. Returning to Normal Activities After a heart attack, most people who don't have chest pain or discomfort or other problems can safely return to most of their normal activities within a few weeks. Most can begin walking right away. Sexual activity also can begin within a few weeks for most patients. Talk with your doctor about a safe schedule for returning to your normal routine. If allowed by State law, driving usually can begin within a week for most patients who don't have chest pain or discomfort or other disabling problems. Each State has rules about driving a motor vehicle following a serious illness. People who have complications shouldn't drive until their symptoms have been stable for a few weeks. Anxiety and Depression After a Heart Attack After a heart attack, many people worry about having another heart attack. Sometimes they feel depressed and have trouble adjusting to new lifestyle changes. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life. Joining a patient support group may help you adjust to life after a heart attack. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center. Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you. Risk of a Repeat Heart Attack Once you've had a heart attack, you're at higher risk for another one. Knowing the difference between angina and a heart attack is important. Angina is chest pain that occurs in people who have CHD. The pain from angina usually occurs after physical exertion and goes away in a few minutes when you rest or take medicine as directed. The pain from a heart attack usually is more severe than the pain from angina. Heart attack pain doesn't go away when you rest or take medicine. If you don't know whether your chest pain is angina or a heart attack, call 9\u20131\u20131. The symptoms of a second heart attack may not be the same as those of a first heart attack. Don't take a chance if you're in doubt. Always call 9\u20131\u20131 right away if you or someone else has heart attack symptoms. Unfortunately, most heart attack victims wait 2 hours or more after their symptoms start before they seek medical help. This delay can result in lasting heart damage or death.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack"
+  ],
+  [
+    "What is Heart attack first aid?: A heart attack is a medical emergency. Call 911 or your local emergency number if you think you or someone else is having a heart attack. The average person waits 3 hours before seeking help for symptoms of a heart attack. Many heart attack patients die before they reach a hospital. The sooner the person gets to the emergency room, the better the chance of survival. Prompt medical treatment reduces the amount of heart damage. This article discusses what to do if you think someone may be having a heart attack.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000063.htm"
+  ],
+  [
+    "Heart attack: A heart attack occurs when the flow of blood to the heart is blocked, most often by a build-up of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries). The interrupted blood flow can damage or destroy part of the heart muscle. A heart attack, also called a myocardial infarction, can be fatal, but treatment has improved dramatically over the years. It's crucial to call 911 or emergency medical help if you think you might be having a heart attack. Common heart attack signs and symptoms include: - Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back - Nausea, indigestion, heartburn or abdominal pain - Shortness of breath - Cold sweat - Fatigue - Lightheadedness or sudden dizziness Heart attack symptoms vary Not all people who have heart attacks have the same symptoms or have the same severity of symptoms. Some people have mild pain; others have more severe pain. Some people have no symptoms, while for others, the first sign may be sudden cardiac arrest. However, the more signs and symptoms you have, the greater the likelihood you're having a heart attack. Some heart attacks strike suddenly, but many people have warning signs and symptoms hours, days or weeks in advance. The earliest warning may be recurrent chest pain (angina) that's triggered by exertion and relieved by rest. Angina is caused by a temporary decrease in blood flow to the heart. A heart attack differs from a condition in which your heart suddenly stops (sudden cardiac arrest, which occurs when an electrical disturbance disrupts your heart's pumping action and causes blood to stop flowing to the rest of your body). A heart attack can cause cardiac arrest, but it's not the only cause. When to see a doctor Act immediately. Some people wait too long because they don't recognize the important signs and symptoms. Take these steps: - Call for emergency medical help. If you suspect you're having a heart attack, don't hesitate. Immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only if there are no other options. Because your condition can worsen, driving yourself puts you and others at risk. - Take nitroglycerin, if prescribed to you by a doctor. Take it as instructed while awaiting emergency help. - Take aspirin, if recommended. Taking aspirin during a heart attack could reduce heart damage by helping to keep your blood from clotting. Aspirin can interact with other medications, however, so don't take an aspirin unless your doctor or emergency medical personnel recommend it. Don't delay calling 911 to take an aspirin. Call for emergency help first. What to do if you see someone having a heart attack If you encounter someone who is unconscious, first call for emergency medical help. Then begin CPR to keep blood flowing. Push hard and fast on the person's chest in a fairly rapid rhythm - about 100 to 120 compressions a minute. It's not necessary to check the person's airway or deliver rescue breaths unless you've been trained in CPR. A heart attack occurs when one or more of your coronary arteries become blocked. Over time, a coronary artery can narrow from the buildup of various substances, including cholesterol (atherosclerosis). This condition, known as coronary artery disease, causes most heart attacks. During a heart attack, one of these plaques can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If large enough, the clot can completely block the flow of blood through the coronary artery. Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Use of tobacco and of illicit drugs, such as cocaine, can cause a life-threatening spasm. A heart attack can also occur due to a tear in the heart artery (spontaneous coronary artery dissection). Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body. You can improve or eliminate many of these risk factors to reduce your chances of having a first or subsequent heart attack. Heart attack risk factors include: - Age. Men age 45 or older and women age 55 or older are more likely to have a heart attack than are younger men and women. - Tobacco. Smoking and long-term exposure to secondhand smoke increase the risk of a heart attack. - High blood pressure. Over time, high blood pressure can damage arteries that feed your heart by accelerating atherosclerosis. High blood pressure that occurs with obesity, smoking, high cholesterol or diabetes increases your risk even more. - High blood cholesterol or triglyceride levels. A high level of low-density lipoprotein (LDL) cholesterol (the \"bad\" cholesterol) is most likely to narrow arteries. A high level of triglycerides, a type of blood fat related to your diet, also ups your risk of heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol (the \"good\" cholesterol) lowers your risk of heart attack. - Diabetes. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, a form of sugar. Having diabetes - not producing enough insulin or not responding to insulin properly - causes your body's blood sugar levels to rise. Diabetes, especially uncontrolled, increases your risk of a heart attack. - Family history of heart attack. If your siblings, parents or grandparents have had early heart attacks (by age 55 for male relatives and by age 65 for female relatives), you may be at increased risk. - Lack of physical activity. An inactive lifestyle contributes to high blood cholesterol levels and obesity. People who get regular aerobic exercise have better cardiovascular fitness, which decreases their overall risk of heart attack. Exercise is also beneficial in lowering high blood pressure. - Obesity. Obesity is associated with high blood cholesterol levels, high triglyceride levels, high blood pressure and diabetes. Losing just 10 percent of your body weight can lower this risk, however. - Stress. You may respond to stress in ways that can increase your risk of a heart attack. - Illegal drug use. Using stimulant drugs, such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack. - A history of preeclampsia. This condition causes high blood pressure during pregnancy and increases the lifetime risk of heart disease. - A history of an autoimmune condition, such as rheumatoid arthritis or lupus. Conditions such as rheumatoid arthritis, lupus and other autoimmune conditions can increase your risk of having a heart attack. Complications are often related to the damage done to your heart during an attack. Damage can lead to: - Abnormal heart rhythms (arrhythmias). Electrical \"short circuits\" can develop, resulting in abnormal heart rhythms, some of which can be serious, even fatal. - Heart failure. An attack may damage so much heart tissue that the remaining heart muscle can't adequately pump blood out of your heart. Heart failure may be temporary, or it can be a chronic condition resulting from extensive and permanent damage to your heart. - Heart rupture. Areas of heart muscle weakened by a heart attack can rupture, leaving a hole in part of the heart. This rupture is often fatal. - Valve problems. Heart valves damaged during a heart attack may develop severe leakage problems. Ideally, your doctor should screen you during regular physical exams for risk factors that can lead to a heart attack. If you're in an emergency setting for symptoms of a heart attack, you'll be asked to describe your symptoms and have your blood pressure, pulse and temperature checked. You'll be hooked up to a heart monitor and will almost immediately have tests to see if you're having a heart attack. Tests will help check if your signs and symptoms, such as chest pain, indicate a heart attack or another condition. These tests include: - Electrocardiogram (ECG). This first test done to diagnose a heart attack records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as waves displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress. - Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Emergency room doctors will take samples of your blood to test for the presence of these enzymes. Additional tests If you've had a heart attack or one is occurring, doctors will take immediate steps to treat your condition. You may also undergo these additional tests: - Chest X-ray. An X-ray image of your chest allows your doctor to check the size of your heart and its blood vessels and to look for fluid in your lungs. - Echocardiogram. During this test, sound waves directed at your heart from a wandlike device (transducer) held on your chest bounce off your heart and are processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged by a heart attack and isn't pumping normally or at peak capacity. - Coronary catheterization (angiogram). A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg or groin, to the arteries in your heart. The dye makes the arteries visible on X-ray, revealing areas of blockage. - Exercise stress test. In the days or weeks after your heart attack, you may also undergo a stress test. Stress tests measure how your heart and blood vessels respond to exertion. You may walk on a treadmill or pedal a stationary bike while attached to an ECG machine. Or you may receive a drug intravenously that stimulates your heart similar to exercise. Your doctor may also order a nuclear stress test, which is similar to an exercise stress test, but uses an injected dye and special imaging techniques to produce detailed images of your heart while you're exercising. These tests can help determine your long-term treatment. - Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). These tests can be used to diagnose heart problems, including the extent of damage from heart attacks. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. In a cardiac MRI, you lie on a table inside a long tubelike machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. The signals create images of your heart. Heart attack treatment at a hospital With each passing minute after a heart attack, more heart tissue loses oxygen and deteriorates or dies. The main way to prevent heart damage is to restore blood flow quickly. Medications Medications given to treat a heart attack include: - Aspirin. The 911 operator may instruct you to take aspirin, or emergency medical personnel may give you aspirin immediately. Aspirin reduces blood clotting, thus helping maintain blood flow through a narrowed artery. - Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you'll survive and with less heart damage. - Antiplatelet agents. Emergency room doctors may give you other drugs to help prevent new clots and keep existing clots from getting larger. These include medications, such as clopidogrel (Plavix) and others, called platelet aggregation inhibitors. - Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood less \"sticky\" and less likely to form clots. Heparin is given intravenously or by an injection under your skin. - Pain relievers. You may receive a pain reliever, such as morphine, to ease your discomfort. - Nitroglycerin. This medication, used to treat chest pain (angina), can help improve blood flow to the heart by widening (dilating) the blood vessels. - Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure, making your heart's job easier. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks. - ACE inhibitors. These drugs lower blood pressure and reduce stress on the heart. Surgical and other procedures In addition to medications, you may undergo one of the following procedures to treat your heart attack: - Coronary angioplasty and stenting. Doctors insert a long, thin tube (catheter) that's passed through an artery, usually in your leg or groin, to a blocked artery in your heart. If you've had a heart attack, this procedure is often done immediately after a cardiac catheterization, a procedure used to locate blockages. This catheter is equipped with a special balloon that, once in position, is briefly inflated to open a blocked coronary artery. A metal mesh stent may be inserted into the artery to keep it open long term, restoring blood flow to the heart. Depending on your condition, your doctor may opt to place a stent coated with a slow-releasing medication to help keep your artery open. - Coronary artery bypass surgery. In some cases, doctors may perform emergency bypass surgery at the time of a heart attack. If possible, your doctor may suggest that you have bypass surgery after your heart has had time - about three to seven days - to recover from your heart attack. Bypass surgery involves sewing veins or arteries in place beyond a blocked or narrowed coronary artery, allowing blood flow to the heart to bypass the narrowed section. Once blood flow to your heart is restored and your condition is stable, you're likely to remain in the hospital for several days. Your lifestyle affects your heart health. The following steps can help you not only prevent but also recover from a heart attack: - Avoid smoke. The most important thing you can do to improve your heart's health is to not smoke. Also, avoid being around secondhand smoke. If you need to quit, ask your doctor for help. - Control your blood pressure and cholesterol levels. If one or both of these is high, your doctor can prescribe changes to your diet and medications. Ask your doctor how often you need to have your blood pressure and cholesterol levels monitored. - Get regular medical checkups. Some of the major risk factors for heart attack - high blood cholesterol, high blood pressure and diabetes - cause no symptoms early on. Your doctor can perform tests to check for these conditions and help you manage them, if necessary. - Exercise regularly. Regular exercise helps improve heart muscle function after a heart attack and helps prevent a heart attack by helping you to control your weight, diabetes, cholesterol and blood pressure. Exercise needn't be vigorous. Walking 30 minutes a day, five days a week can improve your health. - Maintain a healthy weight. Excess weight strains your heart and can contribute to high cholesterol, high blood pressure and diabetes. - Eat a heart-healthy diet. Saturated fat, trans fats and cholesterol in your diet can narrow arteries to your heart, and too much salt can raise blood pressure. Eat a heart-healthy diet that includes lean proteins, such as fish and beans, plenty of fruits and vegetables and whole grains. - Manage diabetes. High blood sugar is damaging to your heart. Regular exercise, eating well and losing weight all help to keep blood sugar levels at more-desirable levels. Many people also need medication to manage their diabetes. - Control stress. Reduce stress in your day-to-day activities. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events in your life. - If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and men older than age 65, and up to two drinks a day for men age 65 and younger.",
+    "https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106"
+  ],
+  [
+    "Heart attack - what to ask your doctor: A heart attack occurs when blood flow to a part of your heart is blocked for a period of time and a part of the heart muscle is damaged. It is also called a myocardial infarction (MI). Watch this video about: Coronary artery disease Angina is pain or pressure in the chest. It occurs when your heart muscle is not getting enough blood or oxygen. You may feel angina in your neck or jaw. Sometimes you may notice that you are short of breath. Below are some questions you may want to ask your health care provider to help you take care of yourself after a heart attack. What are the signs and symptoms that I am having angina? Will I always have the same symptoms? - What are the activities that can cause me to have angina? - How should I treat my chest pain or angina when it happens? - When should I call the doctor? - When should I call 911? How much activity is ok for me? - Can I walk around the house? Is it ok to go up and down stairs? When can I start light housework or cooking? How much can I lift or carry? How much sleep do I need? - Which activities are better to start with? Are there activities that are not safe for me? - Is it safe for me to exercise on my own? Should I exercise inside or outside? - How long and how hard can I exercise? Do I need to have a stress test? Do I need to go to a cardiac rehabilitation program? When can I return to work? Are there limits on what I can do at work? What should I do if I feel sad or very worried about my heart disease? How can I change the way I live to make my heart healthier? - What is a heart-healthy diet? Is it ok to ever eat something that is not heart healthy? How can I make heart-healthy choices when I go eat out? - Is it OK to drink alcohol? How much? - Is it OK to be around other people who are smoking? - Is my blood pressure normal? - What is my cholesterol? Do l need to take medicines for it? Is it OK to be sexually active? Is it safe to use sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) for erection problems? What medicines am I taking to treat angina? - Do they have any side effects? - What should I do if I miss a dose? - Is it ever safe to stop taking any of these medicines on my own? If I am taking a blood thinner such as aspirin, clopidogrel (Plavix), can I use medicines such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn) for arthritis, headaches, or other pain problems? Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000231.htm"
+  ],
+  [
+    "Aspirin to Prevent a First Heart Attack or Stroke: Also known as aspirin primary prevention. Aspirin is a proven way to help some people prevent a second heart attack or stroke. When aspirin is used this way it is called aspirin secondary prevention. It appears that aspirin also may help prevent a first heart attack or stroke in some people. Learn more about what we know about aspirin primary prevention, or the use of aspirin to prevent a first heart attack or stroke. Who may benefit? Aspirin primary prevention is not right for everyone. Aspirin primary prevention may be beneficial for adults who: Are 50 to 69 years old, with the greatest benefit for adults aged 50 to 59; Have a 10 percent or higher risk of cardiovascular disease in the next 10 years; and Are able and willing to take low-dose aspirin, about 81 mg per day, for at least 10 years. Currently, there is not enough evidence to: Support the use of aspirin primary prevention in patients who are younger than 50 years or older than 70 years. Know whether aspirin primary prevention benefits or risks differ between men and women or between different races or ethnicities. Talk to your doctor to find out whether aspirin is right for you to help prevent heart attack, stroke, or other conditions. Do not start aspirin without first talking with your doctor about your risks and benefits.\u00a0There are conditions, such as atrial fibrillation and deep vein thrombosis, where aspirin alone would not be enough protection. If you have either of these conditions, be sure to talk with your doctor about what prevention method is best for you. Read more Why does aspirin prevent heart attack and stroke? Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that is commonly used to relieve pain. But, aspirin also may prevent the formation of blood clots. Aspirin does this by inhibiting platelets\u00a0from promoting clotting in blood vessels where cholesterol and plaque\u00a0may be partially blocking blood flow. This clotting can lead to heart attack and stroke. By inhibiting clotting, aspirin helps reduce damage to the heart and brain and helps prevent heart attack and stroke. What are the risks? Bleeding is the most common side effect of aspirin. The risk of bleeding is higher in men versus women, and the risk increases in patients who: Are older Are using aspirin at a higher dose or for longer periods of time Are using aspirin at the same time as other medicines that increase the risk of bleeding Have uncontrolled high blood pressure Have or previously had ulcers in their gastrointestinal tract Have other medical conditions such as kidney failure, liver disease, and certain bleeding or blood disorders Some patients with severe asthma may be sensitive to aspirin. These patients may experience serious respiratory problems when taking aspirin. Talk to your doctor to find out whether aspirin is right for you. Don\u2019t start taking aspirin without first talking to your doctor. Read more Why does aspirin cause bleeding as a side effect and is it serious? Aspirin can cause bleeding in many parts of the body, particularly in the brain or in the gastrointestinal tract including the stomach. This can happen because aspirin can make it easier for the stomach lining to be damaged and bleed. Because aspirin also inhibits clotting, bleeding in the stomach or brain can be fatal if left untreated and it requires immediate medical attention. What if I\u2019m taking aspirin to prevent another heart attack or stroke? The information discussed in Who may benefit? only applies to use of aspirin to prevent a first heart attack or stroke. Aspirin is a proven way to prevent a second heart attack or stroke in some people. If you\u2019ve already had a heart attack or stroke and are already taking aspirin to prevent another event, do not stop taking your aspirin without talking to your doctor. How else can you prevent heart attack and stroke? Heart-healthy lifestyle changes can help prevent a heart attack and stroke. These changes include: Heart-healthy eating Being physically active Quitting smoking Managing stress Aiming for a health weight It is also important to control other medical conditions that increase your risk of heart attack or stroke, such as high blood cholesterol, high blood pressure, diabetes, preeclampsia, and overweight and obesity. You and your doctor should monitor your cholesterol, blood pressure, and blood sugar numbers to know if you are at risk for a first heart attack or stroke or if you are meeting goals to help prevent another event. Can aspirin prevent other conditions? Aspirin also may prevent: Colorectal cancer in some patients. Read Colorectal Cancer Prevention (PDQ\u00ae) \u2013 Patient Version\u00a0for more information from the National Cancer Institute. Preeclampsia when used after the first trimester in pregnant women who are high risk for this pregnancy-related condition. Read An Aspirin a Day for Preeclampsia Prevention for more information from the National Institute of Child Health and Human Development. Repeat deep vein thrombosis or pulmonary embolism events in patients who discontinue anticoagulants. Aspirin is not preferred over other anticlotting medicines, but aspirin may be beneficial over no therapy to prevent another blood clot that causes deep vein thrombosis or pulmonary embolism. Related reading Atherosclerotic Cardiovascular Disease (ASCVD) Risk Calculator (AHA/ACA) Can an Aspirin a Day Help Prevent a Heart Attack? (FDA) Coronary Heart Disease Deep Vein Thrombosis Diabetes (NIDDK) Diabetic Heart Disease Heart-Healthy Lifestyle Changes Heart Attack Heart Disease in Women High Blood Cholesterol High Blood Pressure No Easy Answers about Whether Aspirin Lowers Cancer Risk (NCI) Stroke Preeclampsia (NICHD) Pulmonary Embolism Overweight and Obesity",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/aspirin-prevent-first-heart-attack-or-stroke"
+  ],
+  [
+    "Heart attack: Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. If the blood flow is blocked, the heart is starved of oxygen and heart cells die. The medical term for this is myocardial infarction. A substance called plaque can build up in the walls of your coronary arteries. This plaque is made up of cholesterol and other cells. A heart attack may occur when: - A tear in the plaque occurs. This triggers blood platelets and other substances to form a blood clot at the site that blocks most or all of the oxygen-carrying blood from flowing to a part of the heart muscle. This is the most common cause of heart attack. - A slow buildup of plaque may narrow one of the coronary arteries so that it is almost blocked. In either case, there is not enough blood flow to the heart muscle and heart muscle dies. The cause of heart attack is not always known. Heart attack may occur: - When you are resting or asleep - After a sudden increase in physical activity - When you are active outside in cold weather - After sudden, severe emotional or physical stress, including an illness Many risk factors may lead to the development of plaque buildup and a heart attack. A heart attack is a medical emergency. If you have symptoms of a heart attack, call 911 or your local emergency number right away. - DO NOT try to drive yourself to the hospital. - DO NOT WAIT. You are at greatest risk of sudden death in the early hours of a heart attack. Chest pain is the most common symptom of a heart attack. - You may feel the pain in only one part of your body OR - Pain may move from your chest to your arms, shoulder, neck, teeth, jaw, belly area, or back The pain can be severe or mild. It can feel like: - A tight band around the chest - Bad indigestion - Something heavy sitting on your chest - Squeezing or heavy pressure The pain most often lasts longer than 20 minutes. Rest and a medicine to relax the blood vessels (called nitroglycerin) may not completely relieve the pain of a heart attack. Symptoms may also go away and come back. Other symptoms of a heart attack can include: - Anxiety - Cough - Fainting - Lightheadedness, dizziness - Nausea and vomiting - Palpitations (feeling like your heart is beating too fast or irregularly) - Shortness of breath - Sweating, which may be very heavy Some people (the older adults, people with diabetes, and women) may have little or no chest pain. Or, they may have unusual symptoms such as shortness of breath, fatigue, and weakness. A \"silent heart attack\" is a heart attack with no symptoms. A health care provider will perform a physical exam and listen to your chest using a stethoscope. - The provider may hear abnormal sounds in your lungs (called crackles), a heart murmur, or other abnormal sounds. - You may have a fast or uneven pulse. - Your blood pressure may be normal, high, or low. You will have an electrocardiogram (ECG) to look for heart damage. Most of the time, certain changes on the ECG indicate you are having a heart attack. Sometimes these changes are not present, even though other tests indicate you have had a heart attack. This can be called non-ST elevation myocardial infarction (NSTEMI). A blood test can show if you have heart tissue damage. This test can confirm that you are having a heart attack. You will likely have this test 3 times over the first 6 to 12 hours. Coronary angiography may be done right away or when you are more stable. - This test uses a special dye and x-rays to see how blood flows through your heart. - It can help your doctor decide which treatments you need next. Other tests to look at your heart that may be done while you are in the hospital: - Echocardiography with or with stress testing - Exercise stress test - Nuclear stress test - Heart CT scan or heart MRI IMMEDIATE TREATMENT - You will be hooked up to a heart monitor, so the health care team can see how regularly your heart is beating. - You will receive oxygen so that your heart doesn't have to work as hard. - An intravenous line (IV) will be placed into one of your veins. Medicines and fluids pass through this IV. - You may get nitroglycerin and morphine to help reduce chest pain. - You may receive aspirin, unless it would not be safe for you. In that case, you will be given another medicine that prevents blood clots. - Dangerous abnormal heartbeats (arrhythmias) may be treated with medicine or electric shocks. EMERGENCY PROCEDURES Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. - Angioplasty is often the first choice of treatment. It should be done within 90 minutes after you get to the hospital, and usually no later than 12 hours after a heart attack. - A stent is a small, metal mesh tube that opens up (expands) inside a coronary artery. A stent is usually placed after or during angioplasty. It helps prevent the artery from closing up again. You may be given drugs to break up the clot. This is called thrombolytic therapy. It is best if these drugs are given soon after the onset of symptoms, usually no later than 12 hours after it and ideally within 30 minutes of arriving to the hospital. Some people may also have heart bypass surgery to open narrowed or blocked blood vessels that supply blood to the heart. This procedure is also called coronary artery bypass grafting and/or open heart surgery. TREATMENT AFTER A HEART ATTACK After several days, you will be discharged from the hospital. You will likely need to take medicines, some for the rest of your life. Always talk to your provider before stopping or changing how you take any medicines. Stopping certain medicines can be deadly. While under the care of your health care team, you will learn: - How to take medicines to treat your heart problem and prevent more heart attacks - How to eat a heart-healthy diet - How to be active and exercise safely - What to do when you have chest pain - How to stop smoking Strong emotions are common after a heart attack. - You may feel sad - You may feel anxious and worry about being careful about everything you do All of these feelings are normal. They go away for most people after 2 or 3 weeks. You may also feel tired when you leave the hospital to go home. Most people who have had a heart attack take part in a cardiac rehabilitation program. Many people benefit from taking part in support groups for people with heart disease. After a heart attack, you have a higher chance of having another heart attack. How well you do after a heart attack depends on several factors such as: - The amount of damage to your heart muscle and heart valves - Where that damage is located - Your medical care after the heart attack If your heart can no longer pump blood out to your body as well as it used to, you may develop heart failure. Abnormal heart rhythms can occur, and they can be life threatening. Most people can slowly go back to normal activities after a heart attack. This includes sexual activity. Talk to your provider about how much activity is good for you. Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000195.htm"
+  ],
+  [
+    "Heart Attack (Signs and Symptoms): Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. In one study, for example, one-third of the patients who had heart attacks had no chest pain. These patients were more likely to be older, female, or diabetic. The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one. It is important for you to know the most common symptoms of a heart attack and also remember these facts: Heart attacks can start slowly and cause only mild pain or discomfort. Symptoms can be mild or more intense and sudden. Symptoms also may come and go over several hours. People who have high blood sugar (diabetes) may have no symptoms or very mild ones. The most common symptom, in both men and women, is chest pain or discomfort. Women are somewhat more likely to have shortness of breath, nausea and vomiting, unusual tiredness (sometimes for days), and pain in the back, shoulders, and jaw. Some people don't have symptoms at all. Heart attacks that occur without any symptoms or with very mild symptoms are called silent heart attacks. Most Common Symptoms The most common warning symptoms of a heart attack for both men and women are: Chest pain or discomfort.\u00a0Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion. The feeling can be mild or severe. Upper body discomfort.\u00a0You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button). Shortness of breath.\u00a0This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity. The symptoms of angina (an-JI-nuh or AN-juh-nuh) can be similar to the symptoms of a heart attack. Angina is chest pain that occurs in people who have coronary heart disease, usually when they're active. Angina pain usually lasts for only a few minutes and goes away with rest. Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack. All chest pain should be checked by a doctor. Other Common Signs and Symptoms Pay attention to these other possible symptoms of a heart attack: Breaking out in a cold sweat Feeling unusually tired for no reason, sometimes for days (especially if you are a woman) Nausea (feeling sick to the stomach) and vomiting Light-headedness or sudden dizziness Any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual) Not everyone having a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. However, some people may have a pattern of symptoms that recur. The more signs and symptoms you have, the more likely it is that you're having a heart attack. Quick Action Can Save Your Life: Call 9\u20131\u20131\u00a0 The signs and symptoms of a heart attack can develop suddenly. However, they also can develop slowly\u2014sometimes within hours, days, or weeks of a heart attack. Any time you think you might be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9\u20131\u20131 for emergency medical care, even if you are not sure whether you're having a heart attack. Here's why: Acting fast can save your life. An ambulance is the best and safest way to get to the hospital. Emergency medical services (EMS) personnel can check how you are doing and start life-saving medicines and other treatments right away. People who arrive by ambulance often receive faster treatment at the hospital.\u00a0 The 9\u20131\u20131 operator or EMS technician can give you advice. You might be told to crush or chew an aspirin if you're not allergic, unless there is a medical reason for you not to take one. Aspirin taken during a heart attack can limit the damage to your heart and save your life. Every minute matters. Never delay calling 9\u20131\u20131 to take aspirin or do anything else you think might help.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack"
+  ],
+  [
+    "Heart attack - what to ask your doctor (Summary): A heart attack occurs when blood flow to a part of your heart is blocked for a period of time and a part of the heart muscle is damaged. It is also called a myocardial infarction (MI). Watch this video about: Coronary artery disease Angina is pain or pressure in the chest. It occurs when your heart muscle is not getting enough blood or oxygen. You may feel angina in your neck or jaw. Sometimes you may notice that you are short of breath. Below are some questions you may want to ask your health care provider to help you take care of yourself after a heart attack.",
+    "https://medlineplus.gov/ency/patientinstructions/000231.htm"
+  ],
+  [
+    "What causes Heart attack first aid?: A heart attack occurs when the blood flow that carries oxygen to the heart is blocked. The heart muscle becomes starved for oxygen and begins to die.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000063.htm"
+  ],
+  [
+    "Heart Attack (Life After): Many people survive heart attacks and live active, full lives. If you get help quickly, treatment can limit damage to your heart muscle. Less heart damage improves your chances for a better quality of life after a heart attack. Medical Followup After a heart attack, you'll need treatment for coronary heart disease (CHD). This will help prevent another heart attack. Your doctor may recommend: Lifestyle changes, such as following a healthy diet, being physically active, maintaining a healthy weight, and quitting smoking. Medicines to control chest pain or discomfort, high blood cholesterol, high blood pressure, and your heart's workload.\u00a0Some of these medicines can help you prevent another heart attack. Anticlotting medicines, such as aspirin, that your doctor may prescribe to help you prevent another heart attack. A cardiac rehabilitation program If you find it hard to get your medicines or or complete your cardiac rehabilitation program, talk with your doctor. Don't stop the medicines or program because it\u00a0can help you prevent another heart attack. Returning to Normal Activities After a heart attack, most people who don't have chest pain or discomfort or other problems can safely return to most of their normal activities within a few weeks. Most can begin walking right away. Sexual activity also can begin within a few weeks for most patients. Talk with your doctor about a safe schedule for returning to your normal routine. If allowed by State law, driving usually can begin within a week for most patients who don't have chest pain or discomfort or other disabling problems. Each State has rules about driving a motor vehicle following a serious illness. People who have complications shouldn't drive until their symptoms have been stable for a few weeks. Anxiety and Depression After a Heart Attack After a heart attack, many people worry about having another heart attack. Sometimes they feel depressed and have trouble adjusting to new lifestyle changes. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life. Joining a patient support group may help you adjust to life after a heart attack. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center. Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you. Risk of a Repeat Heart Attack Once you've had a heart attack, you're at higher risk for another one. Knowing the difference between angina and a heart attack is important. Angina is chest pain that occurs in people who have CHD. The pain from angina usually occurs after physical exertion and goes away in a few minutes when you rest or take medicine as directed. The pain from a heart attack usually is more severe than the pain from angina. Heart attack pain doesn't go away when you rest or take medicine. If you don't know whether your chest pain is angina or a heart attack, call 9\u20131\u20131. The symptoms of a second heart attack may not be the same as those of a first heart attack. Don't take a chance if you're in doubt. Always call 9\u20131\u20131 right away if you or someone else has heart attack symptoms. Unfortunately, most heart attack victims wait 2 hours or more after their symptoms start before they seek medical help. This delay can result in lasting heart damage or death.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack"
+  ],
+  [
+    "Heart Attack (Signs and Symptoms): Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. In one study, for example, one-third of the patients who had heart attacks had no chest pain. These patients were more likely to be older, female, or diabetic. The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one. It is important for you to know the most common symptoms of a heart attack and also remember these facts: Heart attacks can start slowly and cause only mild pain or discomfort. Symptoms can be mild or more intense and sudden. Symptoms also may come and go over several hours. People who have high blood sugar (diabetes) may have no symptoms or very mild ones. The most common symptom, in both men and women, is chest pain or discomfort. Women are somewhat more likely to have shortness of breath, nausea and vomiting, unusual tiredness (sometimes for days), and pain in the back, shoulders, and jaw. Some people don't have symptoms at all. Heart attacks that occur without any symptoms or with very mild symptoms are called silent heart attacks. Most Common Symptoms The most common warning symptoms of a heart attack for both men and women are: Chest pain or discomfort.\u00a0Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion. The feeling can be mild or severe. Upper body discomfort.\u00a0You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button). Shortness of breath.\u00a0This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity. The symptoms of angina (an-JI-nuh or AN-juh-nuh) can be similar to the symptoms of a heart attack. Angina is chest pain that occurs in people who have coronary heart disease, usually when they're active. Angina pain usually lasts for only a few minutes and goes away with rest. Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack. All chest pain should be checked by a doctor. Other Common Signs and Symptoms Pay attention to these other possible symptoms of a heart attack: Breaking out in a cold sweat Feeling unusually tired for no reason, sometimes for days (especially if you are a woman) Nausea (feeling sick to the stomach) and vomiting Light-headedness or sudden dizziness Any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual) Not everyone having a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. However, some people may have a pattern of symptoms that recur. The more signs and symptoms you have, the more likely it is that you're having a heart attack. Quick Action Can Save Your Life: Call 9\u20131\u20131\u00a0 The signs and symptoms of a heart attack can develop suddenly. However, they also can develop slowly\u2014sometimes within hours, days, or weeks of a heart attack. Any time you think you might be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9\u20131\u20131 for emergency medical care, even if you are not sure whether you're having a heart attack. Here's why: Acting fast can save your life. An ambulance is the best and safest way to get to the hospital. Emergency medical services (EMS) personnel can check how you are doing and start life-saving medicines and other treatments right away. People who arrive by ambulance often receive faster treatment at the hospital.\u00a0 The 9\u20131\u20131 operator or EMS technician can give you advice. You might be told to crush or chew an aspirin if you're not allergic, unless there is a medical reason for you not to take one. Aspirin taken during a heart attack can limit the damage to your heart and save your life. Every minute matters. Never delay calling 9\u20131\u20131 to take aspirin or do anything else you think might help.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack"
+  ],
+  [
+    "Heart attack: A heart attack occurs when the flow of blood to the heart is blocked, most often by a build-up of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries). The interrupted blood flow can damage or destroy part of the heart muscle. A heart attack, also called a myocardial infarction, can be fatal, but treatment has improved dramatically over the years. It's crucial to call 911 or emergency medical help if you think you might be having a heart attack. Common heart attack signs and symptoms include: - Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back - Nausea, indigestion, heartburn or abdominal pain - Shortness of breath - Cold sweat - Fatigue - Lightheadedness or sudden dizziness Heart attack symptoms vary Not all people who have heart attacks have the same symptoms or have the same severity of symptoms. Some people have mild pain; others have more severe pain. Some people have no symptoms, while for others, the first sign may be sudden cardiac arrest. However, the more signs and symptoms you have, the greater the likelihood you're having a heart attack. Some heart attacks strike suddenly, but many people have warning signs and symptoms hours, days or weeks in advance. The earliest warning may be recurrent chest pain (angina) that's triggered by exertion and relieved by rest. Angina is caused by a temporary decrease in blood flow to the heart. A heart attack differs from a condition in which your heart suddenly stops (sudden cardiac arrest, which occurs when an electrical disturbance disrupts your heart's pumping action and causes blood to stop flowing to the rest of your body). A heart attack can cause cardiac arrest, but it's not the only cause. When to see a doctor Act immediately. Some people wait too long because they don't recognize the important signs and symptoms. Take these steps: - Call for emergency medical help. If you suspect you're having a heart attack, don't hesitate. Immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only if there are no other options. Because your condition can worsen, driving yourself puts you and others at risk. - Take nitroglycerin, if prescribed to you by a doctor. Take it as instructed while awaiting emergency help. - Take aspirin, if recommended. Taking aspirin during a heart attack could reduce heart damage by helping to keep your blood from clotting. Aspirin can interact with other medications, however, so don't take an aspirin unless your doctor or emergency medical personnel recommend it. Don't delay calling 911 to take an aspirin. Call for emergency help first. What to do if you see someone having a heart attack If you encounter someone who is unconscious, first call for emergency medical help. Then begin CPR to keep blood flowing. Push hard and fast on the person's chest in a fairly rapid rhythm - about 100 to 120 compressions a minute. It's not necessary to check the person's airway or deliver rescue breaths unless you've been trained in CPR. A heart attack occurs when one or more of your coronary arteries become blocked. Over time, a coronary artery can narrow from the buildup of various substances, including cholesterol (atherosclerosis). This condition, known as coronary artery disease, causes most heart attacks. During a heart attack, one of these plaques can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If large enough, the clot can completely block the flow of blood through the coronary artery. Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Use of tobacco and of illicit drugs, such as cocaine, can cause a life-threatening spasm. A heart attack can also occur due to a tear in the heart artery (spontaneous coronary artery dissection). Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body. You can improve or eliminate many of these risk factors to reduce your chances of having a first or subsequent heart attack. Heart attack risk factors include: - Age. Men age 45 or older and women age 55 or older are more likely to have a heart attack than are younger men and women. - Tobacco. Smoking and long-term exposure to secondhand smoke increase the risk of a heart attack. - High blood pressure. Over time, high blood pressure can damage arteries that feed your heart by accelerating atherosclerosis. High blood pressure that occurs with obesity, smoking, high cholesterol or diabetes increases your risk even more. - High blood cholesterol or triglyceride levels. A high level of low-density lipoprotein (LDL) cholesterol (the \"bad\" cholesterol) is most likely to narrow arteries. A high level of triglycerides, a type of blood fat related to your diet, also ups your risk of heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol (the \"good\" cholesterol) lowers your risk of heart attack. - Diabetes. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, a form of sugar. Having diabetes - not producing enough insulin or not responding to insulin properly - causes your body's blood sugar levels to rise. Diabetes, especially uncontrolled, increases your risk of a heart attack. - Family history of heart attack. If your siblings, parents or grandparents have had early heart attacks (by age 55 for male relatives and by age 65 for female relatives), you may be at increased risk. - Lack of physical activity. An inactive lifestyle contributes to high blood cholesterol levels and obesity. People who get regular aerobic exercise have better cardiovascular fitness, which decreases their overall risk of heart attack. Exercise is also beneficial in lowering high blood pressure. - Obesity. Obesity is associated with high blood cholesterol levels, high triglyceride levels, high blood pressure and diabetes. Losing just 10 percent of your body weight can lower this risk, however. - Stress. You may respond to stress in ways that can increase your risk of a heart attack. - Illegal drug use. Using stimulant drugs, such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack. - A history of preeclampsia. This condition causes high blood pressure during pregnancy and increases the lifetime risk of heart disease. - A history of an autoimmune condition, such as rheumatoid arthritis or lupus. Conditions such as rheumatoid arthritis, lupus and other autoimmune conditions can increase your risk of having a heart attack. Complications are often related to the damage done to your heart during an attack. Damage can lead to: - Abnormal heart rhythms (arrhythmias). Electrical \"short circuits\" can develop, resulting in abnormal heart rhythms, some of which can be serious, even fatal. - Heart failure. An attack may damage so much heart tissue that the remaining heart muscle can't adequately pump blood out of your heart. Heart failure may be temporary, or it can be a chronic condition resulting from extensive and permanent damage to your heart. - Heart rupture. Areas of heart muscle weakened by a heart attack can rupture, leaving a hole in part of the heart. This rupture is often fatal. - Valve problems. Heart valves damaged during a heart attack may develop severe leakage problems. Ideally, your doctor should screen you during regular physical exams for risk factors that can lead to a heart attack. If you're in an emergency setting for symptoms of a heart attack, you'll be asked to describe your symptoms and have your blood pressure, pulse and temperature checked. You'll be hooked up to a heart monitor and will almost immediately have tests to see if you're having a heart attack. Tests will help check if your signs and symptoms, such as chest pain, indicate a heart attack or another condition. These tests include: - Electrocardiogram (ECG). This first test done to diagnose a heart attack records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as waves displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress. - Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Emergency room doctors will take samples of your blood to test for the presence of these enzymes. Additional tests If you've had a heart attack or one is occurring, doctors will take immediate steps to treat your condition. You may also undergo these additional tests: - Chest X-ray. An X-ray image of your chest allows your doctor to check the size of your heart and its blood vessels and to look for fluid in your lungs. - Echocardiogram. During this test, sound waves directed at your heart from a wandlike device (transducer) held on your chest bounce off your heart and are processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged by a heart attack and isn't pumping normally or at peak capacity. - Coronary catheterization (angiogram). A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg or groin, to the arteries in your heart. The dye makes the arteries visible on X-ray, revealing areas of blockage. - Exercise stress test. In the days or weeks after your heart attack, you may also undergo a stress test. Stress tests measure how your heart and blood vessels respond to exertion. You may walk on a treadmill or pedal a stationary bike while attached to an ECG machine. Or you may receive a drug intravenously that stimulates your heart similar to exercise. Your doctor may also order a nuclear stress test, which is similar to an exercise stress test, but uses an injected dye and special imaging techniques to produce detailed images of your heart while you're exercising. These tests can help determine your long-term treatment. - Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). These tests can be used to diagnose heart problems, including the extent of damage from heart attacks. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. In a cardiac MRI, you lie on a table inside a long tubelike machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. The signals create images of your heart. Heart attack treatment at a hospital With each passing minute after a heart attack, more heart tissue loses oxygen and deteriorates or dies. The main way to prevent heart damage is to restore blood flow quickly. Medications Medications given to treat a heart attack include: - Aspirin. The 911 operator may instruct you to take aspirin, or emergency medical personnel may give you aspirin immediately. Aspirin reduces blood clotting, thus helping maintain blood flow through a narrowed artery. - Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you'll survive and with less heart damage. - Antiplatelet agents. Emergency room doctors may give you other drugs to help prevent new clots and keep existing clots from getting larger. These include medications, such as clopidogrel (Plavix) and others, called platelet aggregation inhibitors. - Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood less \"sticky\" and less likely to form clots. Heparin is given intravenously or by an injection under your skin. - Pain relievers. You may receive a pain reliever, such as morphine, to ease your discomfort. - Nitroglycerin. This medication, used to treat chest pain (angina), can help improve blood flow to the heart by widening (dilating) the blood vessels. - Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure, making your heart's job easier. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks. - ACE inhibitors. These drugs lower blood pressure and reduce stress on the heart. Surgical and other procedures In addition to medications, you may undergo one of the following procedures to treat your heart attack: - Coronary angioplasty and stenting. Doctors insert a long, thin tube (catheter) that's passed through an artery, usually in your leg or groin, to a blocked artery in your heart. If you've had a heart attack, this procedure is often done immediately after a cardiac catheterization, a procedure used to locate blockages. This catheter is equipped with a special balloon that, once in position, is briefly inflated to open a blocked coronary artery. A metal mesh stent may be inserted into the artery to keep it open long term, restoring blood flow to the heart. Depending on your condition, your doctor may opt to place a stent coated with a slow-releasing medication to help keep your artery open. - Coronary artery bypass surgery. In some cases, doctors may perform emergency bypass surgery at the time of a heart attack. If possible, your doctor may suggest that you have bypass surgery after your heart has had time - about three to seven days - to recover from your heart attack. Bypass surgery involves sewing veins or arteries in place beyond a blocked or narrowed coronary artery, allowing blood flow to the heart to bypass the narrowed section. Once blood flow to your heart is restored and your condition is stable, you're likely to remain in the hospital for several days. Your lifestyle affects your heart health. The following steps can help you not only prevent but also recover from a heart attack: - Avoid smoke. The most important thing you can do to improve your heart's health is to not smoke. Also, avoid being around secondhand smoke. If you need to quit, ask your doctor for help. - Control your blood pressure and cholesterol levels. If one or both of these is high, your doctor can prescribe changes to your diet and medications. Ask your doctor how often you need to have your blood pressure and cholesterol levels monitored. - Get regular medical checkups. Some of the major risk factors for heart attack - high blood cholesterol, high blood pressure and diabetes - cause no symptoms early on. Your doctor can perform tests to check for these conditions and help you manage them, if necessary. - Exercise regularly. Regular exercise helps improve heart muscle function after a heart attack and helps prevent a heart attack by helping you to control your weight, diabetes, cholesterol and blood pressure. Exercise needn't be vigorous. Walking 30 minutes a day, five days a week can improve your health. - Maintain a healthy weight. Excess weight strains your heart and can contribute to high cholesterol, high blood pressure and diabetes. - Eat a heart-healthy diet. Saturated fat, trans fats and cholesterol in your diet can narrow arteries to your heart, and too much salt can raise blood pressure. Eat a heart-healthy diet that includes lean proteins, such as fish and beans, plenty of fruits and vegetables and whole grains. - Manage diabetes. High blood sugar is damaging to your heart. Regular exercise, eating well and losing weight all help to keep blood sugar levels at more-desirable levels. Many people also need medication to manage their diabetes. - Control stress. Reduce stress in your day-to-day activities. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events in your life. - If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and men older than age 65, and up to two drinks a day for men age 65 and younger.",
+    "https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106"
+  ],
+  [
+    "Heart attack (Risk factors): Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body. You can improve or eliminate many of these risk factors to reduce your chances of having a first or subsequent heart attack. Heart attack risk factors include: - Age. Men age 45 or older and women age 55 or older are more likely to have a heart attack than are younger men and women. - Tobacco. Smoking and long-term exposure to secondhand smoke increase the risk of a heart attack. - High blood pressure. Over time, high blood pressure can damage arteries that feed your heart by accelerating atherosclerosis. High blood pressure that occurs with obesity, smoking, high cholesterol or diabetes increases your risk even more. - High blood cholesterol or triglyceride levels. A high level of low-density lipoprotein (LDL) cholesterol (the \"bad\" cholesterol) is most likely to narrow arteries. A high level of triglycerides, a type of blood fat related to your diet, also ups your risk of heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol (the \"good\" cholesterol) lowers your risk of heart attack. - Diabetes. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, a form of sugar. Having diabetes - not producing enough insulin or not responding to insulin properly - causes your body's blood sugar levels to rise. Diabetes, especially uncontrolled, increases your risk of a heart attack. - Family history of heart attack. If your siblings, parents or grandparents have had early heart attacks (by age 55 for male relatives and by age 65 for female relatives), you may be at increased risk. - Lack of physical activity. An inactive lifestyle contributes to high blood cholesterol levels and obesity. People who get regular aerobic exercise have better cardiovascular fitness, which decreases their overall risk of heart attack. Exercise is also beneficial in lowering high blood pressure. - Obesity. Obesity is associated with high blood cholesterol levels, high triglyceride levels, high blood pressure and diabetes. Losing just 10 percent of your body weight can lower this risk, however. - Stress. You may respond to stress in ways that can increase your risk of a heart attack. - Illegal drug use. Using stimulant drugs, such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack. - A history of preeclampsia. This condition causes high blood pressure during pregnancy and increases the lifetime risk of heart disease. - A history of an autoimmune condition, such as rheumatoid arthritis or lupus. Conditions such as rheumatoid arthritis, lupus and other autoimmune conditions can increase your risk of having a heart attack.",
+    "https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106"
+  ],
+  [
+    "Heart attack (Causes): A heart attack occurs when one or more of your coronary arteries become blocked. Over time, a coronary artery can narrow from the buildup of various substances, including cholesterol (atherosclerosis). This condition, known as coronary artery disease, causes most heart attacks. During a heart attack, one of these plaques can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If large enough, the clot can completely block the flow of blood through the coronary artery. Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Use of tobacco and of illicit drugs, such as cocaine, can cause a life-threatening spasm. A heart attack can also occur due to a tear in the heart artery (spontaneous coronary artery dissection).",
+    "https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106"
+  ],
+  [
+    "Signs of an asthma attack (Other Warning Signs): Other early warning signs of an asthma attack are: - An itchy neck - Dark bags under your eyes - Fatigue - Being short-tempered or irritable - Feeling nervous or edgy",
+    "https://medlineplus.gov/ency/patientinstructions/000062.htm"
+  ],
+  [
+    "What are the symptoms of Heart attack first aid?: Symptoms of a heart attack can vary from person to person. They may be mild or severe. Women, older adults, and people with diabetes are more likely to have subtle or unusual symptoms. Symptoms in adults may include: - Changes in mental status, especially in older adults - Chest pain that feels like pressure, squeezing, or fullness. The pain is usually in the center of the chest. It may also be felt in the jaw, shoulder, arms, back, and stomach. It can last for more than a few minutes, or come and go. - Cold sweat - Light-headedness - Nausea (more common in women) - Numbness, aching, or tingling in the arm (usually the left arm, but the right arm may be affected alone, or along with the left) - Shortness of breath - Weakness or fatigue, especially in older adults and in women",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000063.htm"
+  ],
+  [
+    "Heart Attack (Signs and Symptoms): Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. In one study, for example, one-third of the patients who had heart attacks had no chest pain. These patients were more likely to be older, female, or diabetic. The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one. It is important for you to know the most common symptoms of a heart attack and also remember these facts: Heart attacks can start slowly and cause only mild pain or discomfort. Symptoms can be mild or more intense and sudden. Symptoms also may come and go over several hours. People who have high blood sugar (diabetes) may have no symptoms or very mild ones. The most common symptom, in both men and women, is chest pain or discomfort. Women are somewhat more likely to have shortness of breath, nausea and vomiting, unusual tiredness (sometimes for days), and pain in the back, shoulders, and jaw. Some people don't have symptoms at all. Heart attacks that occur without any symptoms or with very mild symptoms are called silent heart attacks. Most Common Symptoms The most common warning symptoms of a heart attack for both men and women are: Chest pain or discomfort.\u00a0Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion. The feeling can be mild or severe. Upper body discomfort.\u00a0You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button). Shortness of breath.\u00a0This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity. The symptoms of angina (an-JI-nuh or AN-juh-nuh) can be similar to the symptoms of a heart attack. Angina is chest pain that occurs in people who have coronary heart disease, usually when they're active. Angina pain usually lasts for only a few minutes and goes away with rest. Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack. All chest pain should be checked by a doctor. Other Common Signs and Symptoms Pay attention to these other possible symptoms of a heart attack: Breaking out in a cold sweat Feeling unusually tired for no reason, sometimes for days (especially if you are a woman) Nausea (feeling sick to the stomach) and vomiting Light-headedness or sudden dizziness Any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual) Not everyone having a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. However, some people may have a pattern of symptoms that recur. The more signs and symptoms you have, the more likely it is that you're having a heart attack. Quick Action Can Save Your Life: Call 9\u20131\u20131\u00a0 The signs and symptoms of a heart attack can develop suddenly. However, they also can develop slowly\u2014sometimes within hours, days, or weeks of a heart attack. Any time you think you might be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9\u20131\u20131 for emergency medical care, even if you are not sure whether you're having a heart attack. Here's why: Acting fast can save your life. An ambulance is the best and safest way to get to the hospital. Emergency medical services (EMS) personnel can check how you are doing and start life-saving medicines and other treatments right away. People who arrive by ambulance often receive faster treatment at the hospital.\u00a0 The 9\u20131\u20131 operator or EMS technician can give you advice. You might be told to crush or chew an aspirin if you're not allergic, unless there is a medical reason for you not to take one. Aspirin taken during a heart attack can limit the damage to your heart and save your life. Every minute matters. Never delay calling 9\u20131\u20131 to take aspirin or do anything else you think might help.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack"
+  ],
+  [
+    "Warning signs and symptoms of heart disease: Heart disease often develops over time. You may have early signs or symptoms long before you have serious heart problems. Or you may not realize you are developing heart disease. The warning signs of heart disease may not be obvious. Also, not every person has the same symptoms. Certain symptoms, such as chest pain, ankle swelling, and shortness of breath may be signals that something is wrong. Learning the warning signs can help you get treatment and help prevent a heart attack or stroke. Chest pain is discomfort or pain that you feel along the front of your body, between your neck and upper abdomen. There are many causes of chest pain that have nothing to do with your heart. But chest pain is still the most common symptom of poor blood flow to the heart or a heart attack. This type of chest pain is called angina. Chest pain can occur when the heart is not getting enough blood or oxygen. The amount and type of pain can vary from person to person. The intensity of the pain does not always relate to how severe the problem is. - Some people may feel a crushing pain, while others feel only mild discomfort. - Your chest may feel heavy or like someone is squeezing your heart. You may also feel a sharp, burning pain in your chest. - You may feel the pain under your breastbone (sternum), or in your neck, arms, stomach, jaw, or upper back. - Chest pain from angina often occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin. - Bad indigestion can also cause chest pain. Women, older adults, and people with diabetes may have little or no chest pain. They are more likely to have symptoms other than chest pain, such as: - Fatigue - Shortness of breath - General weakness - Change in skin color or greyish pallor (episodes of change in skin color associated with weakness) Other symptoms of a heart attack can include: - Extreme anxiety - Fainting or loss of consciousness - Lightheadedness or dizziness - Nausea or vomiting - Palpitations (feeling like your heart is beating too fast or irregularly) - Shortness of breath - Sweating, which may be very heavy When the heart can't pump blood as well as it should, blood backs up in the veins that go from the lungs to the heart. Fluid leaks into the lungs and causes shortness of breath. This is a symptom of heart failure. You may notice shortness of breath: - During activity - While you're resting - When you're lying flat on your back -- it may even wake you from sleep Coughing or wheezing that doesn't go away can be another sign that fluid is building up in your lungs. You may also cough up mucus that is pink or bloody. Swelling (edema) in your lower legs is another sign of a heart problem. When your heart doesn't work as well, blood flow slows and backs up in the veins in your legs. This causes fluid to build up in your tissues. You may also have swelling in your stomach or notice some weight gain. Narrowing of the blood vessels that bring blood to other parts of the body may mean you have a much higher risk for heart attack. It can occur when cholesterol and other fatty material (plaque) build up on the walls of your arteries. Poor blood supply to the legs may lead to: - Pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs. - Symptoms that often appear during walking or exercise, and go away after several minutes of rest. - Numbness in your legs or feet when you are at rest. Your legs may also feel cool to the touch, and the skin may look pale. A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a \"brain attack.\" Symptoms of stroke can include difficulty moving the limbs on one side of your body, one side of the face drooping, difficulty with speaking or understanding language. Tiredness can have many causes. Often it simply means that you need more rest. But feeling run down can be a sign of a more serious problem. Fatigue may be a sign of heart trouble when: - You feel much more tired than normal. It's common for women to feel severely tired before or during a heart attack. - You feel so tired that you can't do your normal daily activities. - You have sudden, severe weakness. If your heart can't pump blood as well, it may beat faster to try to keep up. You may feel your heart racing or throbbing. A fast or uneven heartbeat can also be the sign of an arrhythmia. This is a problem with your heart rate or rhythm. If you have any signs of heart disease, call your health care provider right away. Don't wait to see if the symptoms go away or dismiss them as nothing. Call your local emergency number (such as 911) if: - You have chest pain or other symptoms of a heart attack - If you know you have angina and have chest pain that doesn't go away after 5 minutes of rest or after taking nitroglycerine - If you think you may be having a heart attack - If you become extremely short of breath - If you think you may have lost consciousness Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000775.htm"
+  ],
+  [
+    "Signs of an asthma attack (Danger Signs): Call 911 or your local emergency number right away if you have any of the following symptoms. These are signs of a serious medical emergency. - You are having trouble walking or talking because it is so hard to breathe. - You are hunching over. - Your lips or fingernails are blue or gray. - You are confused or less responsive than usual. If your child has asthma, the child's caregivers must know to call 911 if your child has any of these symptoms. This includes teachers, babysitters, and others who take care of your child.",
+    "https://medlineplus.gov/ency/patientinstructions/000062.htm"
+  ],
+  [
+    "Signs of an asthma attack: If you do not know if you have asthma, these 4 symptoms could be signs that you do: - Coughing that sometimes wakes you up at night. - Wheezing, or a whistling sound when you breathe. You may hear it more when you breathe out. It can start as a low-sounding whistle and get higher. - Breathing problems that include having shortness of breath, feeling like you are out of breath, gasping for air, having trouble breathing out, or breathing faster than normal. When breathing gets very difficult, the skin of your chest and neck may suck inward. - Chest tightness Other early warning signs of an asthma attack are: - An itchy neck - Dark bags under your eyes - Fatigue - Being short-tempered or irritable - Feeling nervous or edgy Call 911 or your local emergency number right away if you have any of the following symptoms. These are signs of a serious medical emergency. - You are having trouble walking or talking because it is so hard to breathe. - You are hunching over. - Your lips or fingernails are blue or gray. - You are confused or less responsive than usual. If your child has asthma, the child's caregivers must know to call 911 if your child has any of these symptoms. This includes teachers, babysitters, and others who take care of your child. Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000062.htm"
+  ],
+  [
+    "Heart attack (Symptoms): A heart attack is a medical emergency. If you have symptoms of a heart attack, call 911 or your local emergency number right away. - DO NOT try to drive yourself to the hospital. - DO NOT WAIT. You are at greatest risk of sudden death in the early hours of a heart attack. Chest pain is the most common symptom of a heart attack. - You may feel the pain in only one part of your body OR - Pain may move from your chest to your arms, shoulder, neck, teeth, jaw, belly area, or back The pain can be severe or mild. It can feel like: - A tight band around the chest - Bad indigestion - Something heavy sitting on your chest - Squeezing or heavy pressure The pain most often lasts longer than 20 minutes. Rest and a medicine to relax the blood vessels (called nitroglycerin) may not completely relieve the pain of a heart attack. Symptoms may also go away and come back. Other symptoms of a heart attack can include: - Anxiety - Cough - Fainting - Lightheadedness, dizziness - Nausea and vomiting - Palpitations (feeling like your heart is beating too fast or irregularly) - Shortness of breath - Sweating, which may be very heavy Some people (the older adults, people with diabetes, and women) may have little or no chest pain. Or, they may have unusual symptoms such as shortness of breath, fatigue, and weakness. A \"silent heart attack\" is a heart attack with no symptoms.",
+    "https://medlineplus.gov/ency/article/000195.htm"
+  ],
+  [
+    "Warning signs and symptoms of heart disease (When to Call the Doctor): If you have any signs of heart disease, call your health care provider right away. Don't wait to see if the symptoms go away or dismiss them as nothing. Call your local emergency number (such as 911) if: - You have chest pain or other symptoms of a heart attack - If you know you have angina and have chest pain that doesn't go away after 5 minutes of rest or after taking nitroglycerine - If you think you may be having a heart attack - If you become extremely short of breath - If you think you may have lost consciousness",
+    "https://medlineplus.gov/ency/patientinstructions/000775.htm"
+  ],
+  [
+    "Heart attack (Treatment): Heart attack treatment at a hospital With each passing minute after a heart attack, more heart tissue loses oxygen and deteriorates or dies. The main way to prevent heart damage is to restore blood flow quickly. Medications Medications given to treat a heart attack include: - Aspirin. The 911 operator may instruct you to take aspirin, or emergency medical personnel may give you aspirin immediately. Aspirin reduces blood clotting, thus helping maintain blood flow through a narrowed artery. - Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you'll survive and with less heart damage. - Antiplatelet agents. Emergency room doctors may give you other drugs to help prevent new clots and keep existing clots from getting larger. These include medications, such as clopidogrel (Plavix) and others, called platelet aggregation inhibitors. - Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood less \"sticky\" and less likely to form clots. Heparin is given intravenously or by an injection under your skin. - Pain relievers. You may receive a pain reliever, such as morphine, to ease your discomfort. - Nitroglycerin. This medication, used to treat chest pain (angina), can help improve blood flow to the heart by widening (dilating) the blood vessels. - Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure, making your heart's job easier. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks. - ACE inhibitors. These drugs lower blood pressure and reduce stress on the heart. Surgical and other procedures In addition to medications, you may undergo one of the following procedures to treat your heart attack: - Coronary angioplasty and stenting. Doctors insert a long, thin tube (catheter) that's passed through an artery, usually in your leg or groin, to a blocked artery in your heart. If you've had a heart attack, this procedure is often done immediately after a cardiac catheterization, a procedure used to locate blockages. This catheter is equipped with a special balloon that, once in position, is briefly inflated to open a blocked coronary artery. A metal mesh stent may be inserted into the artery to keep it open long term, restoring blood flow to the heart. Depending on your condition, your doctor may opt to place a stent coated with a slow-releasing medication to help keep your artery open. - Coronary artery bypass surgery. In some cases, doctors may perform emergency bypass surgery at the time of a heart attack. If possible, your doctor may suggest that you have bypass surgery after your heart has had time - about three to seven days - to recover from your heart attack. Bypass surgery involves sewing veins or arteries in place beyond a blocked or narrowed coronary artery, allowing blood flow to the heart to bypass the narrowed section. Once blood flow to your heart is restored and your condition is stable, you're likely to remain in the hospital for several days.",
+    "https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106"
+  ],
+  [
+    "What are the treatments for Heart Attack?: Heart attacks are a leading killer of both men and women in the United States. The good news is that excellent treatments are available for heart attacks. These treatments can save lives and prevent disabilities. Heart attack treatment works best when it's given right after symptoms occur. Act Fast The signs and symptoms of a heart attack can develop suddenly. However, they also can develop slowlysometimes within hours, days, or weeks of a heart attack. Know the warning signs of a heart attack so you can act fast to get treatment for yourself or someone else. The sooner you get emergency help, the less damage your heart will sustain. Call 911 for an ambulance right away if you think you or someone else may be having a heart attack. You also should call for help if your chest pain doesn't go away as it usually does when you take medicine prescribed for angina. Treatment May Start Right Away Treatment for a heart attack may begin in the ambulance or in the emergency department and continue in a special area of the hospital called a coronary care unit. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room. Restoring Blood Flow to the Heart The coronary care unit is specially equipped with monitors that continuously monitor your vital signs. These include - an EKG which detects any heart rhythm problems - a blood pressure monitor, and - pulse oximetry, which measures the amount of oxygen in the blood. an EKG which detects any heart rhythm problems a blood pressure monitor, and pulse oximetry, which measures the amount of oxygen in the blood. In the hospital, if you have had or are having a heart attack, doctors will work quickly to restore blood flow to your heart and continuously monitor your vital signs to detect and treat complications. Restoring blood flow to the heart can prevent or limit damage to the heart muscle and help prevent another heart attack. Doctors may use clot-busting drugs called thrombolytics and procedures such as angioplasty. - Clot-busters or thrombolytic drugs are used to dissolve blood clots that are blocking blood flow to the heart. When given soon after a heart attack begins, these drugs can limit or prevent permanent damage to the heart. To be most effective, these drugs must be given within one hour after the start of heart attack symptoms. - Angioplasty procedures are used to open blocked or narrowed coronary arteries. A stent, which is a tiny metal mesh tube, may be placed in the artery to help keep it open. Some stents are coated with medicines that help prevent the artery from becoming blocked again. - Coronary artery bypass surgery uses arteries or veins from other areas in your body to bypass your blocked coronary arteries. Clot-busters or thrombolytic drugs are used to dissolve blood clots that are blocking blood flow to the heart. When given soon after a heart attack begins, these drugs can limit or prevent permanent damage to the heart. To be most effective, these drugs must be given within one hour after the start of heart attack symptoms. Angioplasty procedures are used to open blocked or narrowed coronary arteries. A stent, which is a tiny metal mesh tube, may be placed in the artery to help keep it open. Some stents are coated with medicines that help prevent the artery from becoming blocked again. Coronary artery bypass surgery uses arteries or veins from other areas in your body to bypass your blocked coronary arteries. Drug Treatments Many medications are used to treat heart attacks. They include beta blockers, ACE inhibitors, nitrates, anticoagulants, antiplatelet medications, and medications to relieve pain and anxiety. - Beta blockers slow your heart rate and reduce your heart's need for blood and oxygen. As a result, your heart beats with less force, and your blood pressure falls. Beta blockers are also used to relieve angina and prevent second heart attacks and correct an irregular heartbeat. - Angiotensin-converting enzyme or ACE inhibitors lower your blood pressure and reduce the strain on your heart. They are used in some patients after a heart attack to help prevent further weakening of the heart and increase the chances of survival. - Nitrates, such as nitroglycerin, relax blood vessels and relieve chest pain. Anticoagulants, such as heparin and warfarin, thin the blood and prevent clots from forming in your arteries. - >Antiplatelet medications, such as aspirin and clopidogrel, stop platelets from clumping together to form clots. They are given to people who have had a heart attack, have angina, or have had an angioplasty. - Glycoprotein llb-llla inhibitors are potent antiplatelet medications given intravenously to prevent clots from forming in your arteries. Beta blockers slow your heart rate and reduce your heart's need for blood and oxygen. As a result, your heart beats with less force, and your blood pressure falls. Beta blockers are also used to relieve angina and prevent second heart attacks and correct an irregular heartbeat. Angiotensin-converting enzyme or ACE inhibitors lower your blood pressure and reduce the strain on your heart. They are used in some patients after a heart attack to help prevent further weakening of the heart and increase the chances of survival. Nitrates, such as nitroglycerin, relax blood vessels and relieve chest pain. Anticoagulants, such as heparin and warfarin, thin the blood and prevent clots from forming in your arteries. >Antiplatelet medications, such as aspirin and clopidogrel, stop platelets from clumping together to form clots. They are given to people who have had a heart attack, have angina, or have had an angioplasty. Glycoprotein llb-llla inhibitors are potent antiplatelet medications given intravenously to prevent clots from forming in your arteries. Doctors may also prescribe medications to relieve pain and anxiety, or to treat irregular heart rhythms which often occur during a heart attack. Echocardiogram and Stress Tests While you are still in the hospital or after you go home, your doctor may order other tests, such as an echocardiogram. An echocardiogram uses ultrasound to make an image of the heart which can be seen on a video monitor. It shows how well the heart is filling with blood and pumping it to the rest of the body. Your doctor may also order a stress test to see how well your heart works when it has a heavy workload. You run on a treadmill or pedal a bicycle or receive medicine through a vein in your arm to make your heart work harder. EKG and blood pressure readings are taken before, during, and after the test to see how your heart responds. Often, an echocardiogram or nuclear scan of the heart is performed before and after exercise or intravenous medication. The test is stopped if chest pain or a very sharp rise or fall in blood pressure occurs. Monitoring continues for 10 to 15 minutes after the test or until your heart rate returns to baseline.",
+    "http://nihseniorhealth.gov/heartattack/toc.html"
+  ],
+  [
+    "Heart attack - what to ask your doctor (Summary): A heart attack occurs when blood flow to a part of your heart is blocked for a period of time and a part of the heart muscle is damaged. It is also called a myocardial infarction (MI). Watch this video about: Coronary artery disease Angina is pain or pressure in the chest. It occurs when your heart muscle is not getting enough blood or oxygen. You may feel angina in your neck or jaw. Sometimes you may notice that you are short of breath. Below are some questions you may want to ask your health care provider to help you take care of yourself after a heart attack.",
+    "https://medlineplus.gov/ency/patientinstructions/000231.htm"
+  ],
+  [
+    "What are the treatments for Heart Attack?: There are many medicines that are used to treat a heart attack. - Clot-busters or thrombolytic drugs dissolve blood clots that are blocking blood flow to the heart. - Beta blockers decrease the workload on your heart by slowing your heart rate. - Angiotensin-converting enzyme (ACE) inhibitors lower your blood pressure and reduce the strain on your heart. - Nitrates, such as nitroglycerin relax blood vessels and relieve chest pain. - Anticoagulants thin the blood and prevent clots from forming in your arteries. - Antiplatelet medications, such as aspirin and clopidogrel, stop platelets from clumping together to form clots. These medications are given to people who have had a heart attack, have angina, or have had angioplasty. Clot-busters or thrombolytic drugs dissolve blood clots that are blocking blood flow to the heart. Beta blockers decrease the workload on your heart by slowing your heart rate. Angiotensin-converting enzyme (ACE) inhibitors lower your blood pressure and reduce the strain on your heart. Nitrates, such as nitroglycerin relax blood vessels and relieve chest pain. Anticoagulants thin the blood and prevent clots from forming in your arteries. Antiplatelet medications, such as aspirin and clopidogrel, stop platelets from clumping together to form clots. These medications are given to people who have had a heart attack, have angina, or have had angioplasty. Doctors may also prescribe medicines to relieve pain and anxiety, or to treat irregular heart rhythms which often occur during a heart attack.",
+    "http://nihseniorhealth.gov/heartattack/toc.html"
+  ],
+  [
+    "What are the treatments for Heart Attack?: After a heart attack, many people worry about having another heart attack. They often feel depressed and may have trouble adjusting to a new lifestyle. You should discuss your feelings with your doctor. Your doctor can give you medication for anxiety or depression and may recommend professional counseling. Spend time with family, friends, and even pets. Affection can make you feel better and less lonely. Most people stop feeling depressed after they have fully recovered.",
+    "http://nihseniorhealth.gov/heartattack/toc.html"
+  ],
+  [
+    "Heart Attack (Signs and Symptoms): Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. In one study, for example, one-third of the patients who had heart attacks had no chest pain. These patients were more likely to be older, female, or diabetic. The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one. It is important for you to know the most common symptoms of a heart attack and also remember these facts: Heart attacks can start slowly and cause only mild pain or discomfort. Symptoms can be mild or more intense and sudden. Symptoms also may come and go over several hours. People who have high blood sugar (diabetes) may have no symptoms or very mild ones. The most common symptom, in both men and women, is chest pain or discomfort. Women are somewhat more likely to have shortness of breath, nausea and vomiting, unusual tiredness (sometimes for days), and pain in the back, shoulders, and jaw. Some people don't have symptoms at all. Heart attacks that occur without any symptoms or with very mild symptoms are called silent heart attacks. Most Common Symptoms The most common warning symptoms of a heart attack for both men and women are: Chest pain or discomfort.\u00a0Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion. The feeling can be mild or severe. Upper body discomfort.\u00a0You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button). Shortness of breath.\u00a0This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity. The symptoms of angina (an-JI-nuh or AN-juh-nuh) can be similar to the symptoms of a heart attack. Angina is chest pain that occurs in people who have coronary heart disease, usually when they're active. Angina pain usually lasts for only a few minutes and goes away with rest. Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack. All chest pain should be checked by a doctor. Other Common Signs and Symptoms Pay attention to these other possible symptoms of a heart attack: Breaking out in a cold sweat Feeling unusually tired for no reason, sometimes for days (especially if you are a woman) Nausea (feeling sick to the stomach) and vomiting Light-headedness or sudden dizziness Any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual) Not everyone having a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. However, some people may have a pattern of symptoms that recur. The more signs and symptoms you have, the more likely it is that you're having a heart attack. Quick Action Can Save Your Life: Call 9\u20131\u20131\u00a0 The signs and symptoms of a heart attack can develop suddenly. However, they also can develop slowly\u2014sometimes within hours, days, or weeks of a heart attack. Any time you think you might be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9\u20131\u20131 for emergency medical care, even if you are not sure whether you're having a heart attack. Here's why: Acting fast can save your life. An ambulance is the best and safest way to get to the hospital. Emergency medical services (EMS) personnel can check how you are doing and start life-saving medicines and other treatments right away. People who arrive by ambulance often receive faster treatment at the hospital.\u00a0 The 9\u20131\u20131 operator or EMS technician can give you advice. You might be told to crush or chew an aspirin if you're not allergic, unless there is a medical reason for you not to take one. Aspirin taken during a heart attack can limit the damage to your heart and save your life. Every minute matters. Never delay calling 9\u20131\u20131 to take aspirin or do anything else you think might help.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack"
+  ],
+  [
+    "Heart attack: A heart attack occurs when the flow of blood to the heart is blocked, most often by a build-up of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries). The interrupted blood flow can damage or destroy part of the heart muscle. A heart attack, also called a myocardial infarction, can be fatal, but treatment has improved dramatically over the years. It's crucial to call 911 or emergency medical help if you think you might be having a heart attack. Common heart attack signs and symptoms include: - Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back - Nausea, indigestion, heartburn or abdominal pain - Shortness of breath - Cold sweat - Fatigue - Lightheadedness or sudden dizziness Heart attack symptoms vary Not all people who have heart attacks have the same symptoms or have the same severity of symptoms. Some people have mild pain; others have more severe pain. Some people have no symptoms, while for others, the first sign may be sudden cardiac arrest. However, the more signs and symptoms you have, the greater the likelihood you're having a heart attack. Some heart attacks strike suddenly, but many people have warning signs and symptoms hours, days or weeks in advance. The earliest warning may be recurrent chest pain (angina) that's triggered by exertion and relieved by rest. Angina is caused by a temporary decrease in blood flow to the heart. A heart attack differs from a condition in which your heart suddenly stops (sudden cardiac arrest, which occurs when an electrical disturbance disrupts your heart's pumping action and causes blood to stop flowing to the rest of your body). A heart attack can cause cardiac arrest, but it's not the only cause. When to see a doctor Act immediately. Some people wait too long because they don't recognize the important signs and symptoms. Take these steps: - Call for emergency medical help. If you suspect you're having a heart attack, don't hesitate. Immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only if there are no other options. Because your condition can worsen, driving yourself puts you and others at risk. - Take nitroglycerin, if prescribed to you by a doctor. Take it as instructed while awaiting emergency help. - Take aspirin, if recommended. Taking aspirin during a heart attack could reduce heart damage by helping to keep your blood from clotting. Aspirin can interact with other medications, however, so don't take an aspirin unless your doctor or emergency medical personnel recommend it. Don't delay calling 911 to take an aspirin. Call for emergency help first. What to do if you see someone having a heart attack If you encounter someone who is unconscious, first call for emergency medical help. Then begin CPR to keep blood flowing. Push hard and fast on the person's chest in a fairly rapid rhythm - about 100 to 120 compressions a minute. It's not necessary to check the person's airway or deliver rescue breaths unless you've been trained in CPR. A heart attack occurs when one or more of your coronary arteries become blocked. Over time, a coronary artery can narrow from the buildup of various substances, including cholesterol (atherosclerosis). This condition, known as coronary artery disease, causes most heart attacks. During a heart attack, one of these plaques can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If large enough, the clot can completely block the flow of blood through the coronary artery. Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Use of tobacco and of illicit drugs, such as cocaine, can cause a life-threatening spasm. A heart attack can also occur due to a tear in the heart artery (spontaneous coronary artery dissection). Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body. You can improve or eliminate many of these risk factors to reduce your chances of having a first or subsequent heart attack. Heart attack risk factors include: - Age. Men age 45 or older and women age 55 or older are more likely to have a heart attack than are younger men and women. - Tobacco. Smoking and long-term exposure to secondhand smoke increase the risk of a heart attack. - High blood pressure. Over time, high blood pressure can damage arteries that feed your heart by accelerating atherosclerosis. High blood pressure that occurs with obesity, smoking, high cholesterol or diabetes increases your risk even more. - High blood cholesterol or triglyceride levels. A high level of low-density lipoprotein (LDL) cholesterol (the \"bad\" cholesterol) is most likely to narrow arteries. A high level of triglycerides, a type of blood fat related to your diet, also ups your risk of heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol (the \"good\" cholesterol) lowers your risk of heart attack. - Diabetes. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, a form of sugar. Having diabetes - not producing enough insulin or not responding to insulin properly - causes your body's blood sugar levels to rise. Diabetes, especially uncontrolled, increases your risk of a heart attack. - Family history of heart attack. If your siblings, parents or grandparents have had early heart attacks (by age 55 for male relatives and by age 65 for female relatives), you may be at increased risk. - Lack of physical activity. An inactive lifestyle contributes to high blood cholesterol levels and obesity. People who get regular aerobic exercise have better cardiovascular fitness, which decreases their overall risk of heart attack. Exercise is also beneficial in lowering high blood pressure. - Obesity. Obesity is associated with high blood cholesterol levels, high triglyceride levels, high blood pressure and diabetes. Losing just 10 percent of your body weight can lower this risk, however. - Stress. You may respond to stress in ways that can increase your risk of a heart attack. - Illegal drug use. Using stimulant drugs, such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack. - A history of preeclampsia. This condition causes high blood pressure during pregnancy and increases the lifetime risk of heart disease. - A history of an autoimmune condition, such as rheumatoid arthritis or lupus. Conditions such as rheumatoid arthritis, lupus and other autoimmune conditions can increase your risk of having a heart attack. Complications are often related to the damage done to your heart during an attack. Damage can lead to: - Abnormal heart rhythms (arrhythmias). Electrical \"short circuits\" can develop, resulting in abnormal heart rhythms, some of which can be serious, even fatal. - Heart failure. An attack may damage so much heart tissue that the remaining heart muscle can't adequately pump blood out of your heart. Heart failure may be temporary, or it can be a chronic condition resulting from extensive and permanent damage to your heart. - Heart rupture. Areas of heart muscle weakened by a heart attack can rupture, leaving a hole in part of the heart. This rupture is often fatal. - Valve problems. Heart valves damaged during a heart attack may develop severe leakage problems. Ideally, your doctor should screen you during regular physical exams for risk factors that can lead to a heart attack. If you're in an emergency setting for symptoms of a heart attack, you'll be asked to describe your symptoms and have your blood pressure, pulse and temperature checked. You'll be hooked up to a heart monitor and will almost immediately have tests to see if you're having a heart attack. Tests will help check if your signs and symptoms, such as chest pain, indicate a heart attack or another condition. These tests include: - Electrocardiogram (ECG). This first test done to diagnose a heart attack records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as waves displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress. - Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Emergency room doctors will take samples of your blood to test for the presence of these enzymes. Additional tests If you've had a heart attack or one is occurring, doctors will take immediate steps to treat your condition. You may also undergo these additional tests: - Chest X-ray. An X-ray image of your chest allows your doctor to check the size of your heart and its blood vessels and to look for fluid in your lungs. - Echocardiogram. During this test, sound waves directed at your heart from a wandlike device (transducer) held on your chest bounce off your heart and are processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged by a heart attack and isn't pumping normally or at peak capacity. - Coronary catheterization (angiogram). A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg or groin, to the arteries in your heart. The dye makes the arteries visible on X-ray, revealing areas of blockage. - Exercise stress test. In the days or weeks after your heart attack, you may also undergo a stress test. Stress tests measure how your heart and blood vessels respond to exertion. You may walk on a treadmill or pedal a stationary bike while attached to an ECG machine. Or you may receive a drug intravenously that stimulates your heart similar to exercise. Your doctor may also order a nuclear stress test, which is similar to an exercise stress test, but uses an injected dye and special imaging techniques to produce detailed images of your heart while you're exercising. These tests can help determine your long-term treatment. - Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). These tests can be used to diagnose heart problems, including the extent of damage from heart attacks. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. In a cardiac MRI, you lie on a table inside a long tubelike machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. The signals create images of your heart. Heart attack treatment at a hospital With each passing minute after a heart attack, more heart tissue loses oxygen and deteriorates or dies. The main way to prevent heart damage is to restore blood flow quickly. Medications Medications given to treat a heart attack include: - Aspirin. The 911 operator may instruct you to take aspirin, or emergency medical personnel may give you aspirin immediately. Aspirin reduces blood clotting, thus helping maintain blood flow through a narrowed artery. - Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you'll survive and with less heart damage. - Antiplatelet agents. Emergency room doctors may give you other drugs to help prevent new clots and keep existing clots from getting larger. These include medications, such as clopidogrel (Plavix) and others, called platelet aggregation inhibitors. - Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood less \"sticky\" and less likely to form clots. Heparin is given intravenously or by an injection under your skin. - Pain relievers. You may receive a pain reliever, such as morphine, to ease your discomfort. - Nitroglycerin. This medication, used to treat chest pain (angina), can help improve blood flow to the heart by widening (dilating) the blood vessels. - Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure, making your heart's job easier. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks. - ACE inhibitors. These drugs lower blood pressure and reduce stress on the heart. Surgical and other procedures In addition to medications, you may undergo one of the following procedures to treat your heart attack: - Coronary angioplasty and stenting. Doctors insert a long, thin tube (catheter) that's passed through an artery, usually in your leg or groin, to a blocked artery in your heart. If you've had a heart attack, this procedure is often done immediately after a cardiac catheterization, a procedure used to locate blockages. This catheter is equipped with a special balloon that, once in position, is briefly inflated to open a blocked coronary artery. A metal mesh stent may be inserted into the artery to keep it open long term, restoring blood flow to the heart. Depending on your condition, your doctor may opt to place a stent coated with a slow-releasing medication to help keep your artery open. - Coronary artery bypass surgery. In some cases, doctors may perform emergency bypass surgery at the time of a heart attack. If possible, your doctor may suggest that you have bypass surgery after your heart has had time - about three to seven days - to recover from your heart attack. Bypass surgery involves sewing veins or arteries in place beyond a blocked or narrowed coronary artery, allowing blood flow to the heart to bypass the narrowed section. Once blood flow to your heart is restored and your condition is stable, you're likely to remain in the hospital for several days. Your lifestyle affects your heart health. The following steps can help you not only prevent but also recover from a heart attack: - Avoid smoke. The most important thing you can do to improve your heart's health is to not smoke. Also, avoid being around secondhand smoke. If you need to quit, ask your doctor for help. - Control your blood pressure and cholesterol levels. If one or both of these is high, your doctor can prescribe changes to your diet and medications. Ask your doctor how often you need to have your blood pressure and cholesterol levels monitored. - Get regular medical checkups. Some of the major risk factors for heart attack - high blood cholesterol, high blood pressure and diabetes - cause no symptoms early on. Your doctor can perform tests to check for these conditions and help you manage them, if necessary. - Exercise regularly. Regular exercise helps improve heart muscle function after a heart attack and helps prevent a heart attack by helping you to control your weight, diabetes, cholesterol and blood pressure. Exercise needn't be vigorous. Walking 30 minutes a day, five days a week can improve your health. - Maintain a healthy weight. Excess weight strains your heart and can contribute to high cholesterol, high blood pressure and diabetes. - Eat a heart-healthy diet. Saturated fat, trans fats and cholesterol in your diet can narrow arteries to your heart, and too much salt can raise blood pressure. Eat a heart-healthy diet that includes lean proteins, such as fish and beans, plenty of fruits and vegetables and whole grains. - Manage diabetes. High blood sugar is damaging to your heart. Regular exercise, eating well and losing weight all help to keep blood sugar levels at more-desirable levels. Many people also need medication to manage their diabetes. - Control stress. Reduce stress in your day-to-day activities. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events in your life. - If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and men older than age 65, and up to two drinks a day for men age 65 and younger.",
+    "https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106"
+  ],
+  [
+    "Heart attack (Diagnosis): Ideally, your doctor should screen you during regular physical exams for risk factors that can lead to a heart attack. If you're in an emergency setting for symptoms of a heart attack, you'll be asked to describe your symptoms and have your blood pressure, pulse and temperature checked. You'll be hooked up to a heart monitor and will almost immediately have tests to see if you're having a heart attack. Tests will help check if your signs and symptoms, such as chest pain, indicate a heart attack or another condition. These tests include: - Electrocardiogram (ECG). This first test done to diagnose a heart attack records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as waves displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress. - Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Emergency room doctors will take samples of your blood to test for the presence of these enzymes. Additional tests If you've had a heart attack or one is occurring, doctors will take immediate steps to treat your condition. You may also undergo these additional tests: - Chest X-ray. An X-ray image of your chest allows your doctor to check the size of your heart and its blood vessels and to look for fluid in your lungs. - Echocardiogram. During this test, sound waves directed at your heart from a wandlike device (transducer) held on your chest bounce off your heart and are processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged by a heart attack and isn't pumping normally or at peak capacity. - Coronary catheterization (angiogram). A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg or groin, to the arteries in your heart. The dye makes the arteries visible on X-ray, revealing areas of blockage. - Exercise stress test. In the days or weeks after your heart attack, you may also undergo a stress test. Stress tests measure how your heart and blood vessels respond to exertion. You may walk on a treadmill or pedal a stationary bike while attached to an ECG machine. Or you may receive a drug intravenously that stimulates your heart similar to exercise. Your doctor may also order a nuclear stress test, which is similar to an exercise stress test, but uses an injected dye and special imaging techniques to produce detailed images of your heart while you're exercising. These tests can help determine your long-term treatment. - Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). These tests can be used to diagnose heart problems, including the extent of damage from heart attacks. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. In a cardiac MRI, you lie on a table inside a long tubelike machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. The signals create images of your heart.",
+    "https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106"
+  ],
+  [
+    "How to diagnose Heart Attack?: Your doctor will diagnose a heart attack based on your signs and symptoms, your medical and family histories, and test results. Diagnostic Tests EKG (Electrocardiogram) An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart. An EKG can show signs of heart damage due to coronary heart disease (CHD) and signs of a previous or current heart attack. Blood Tests During a heart attack, heart muscle cells die and release proteins into the bloodstream. Blood tests can measure the amount of these proteins in the bloodstream. Higher than normal levels of these proteins suggest a heart attack. Commonly used blood tests include troponin tests, CK or CKMB tests, and serum myoglobin tests. Blood tests often are repeated to check for changes over time. Coronary Angiography Coronary angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the insides of your coronary arteries. This test often is done during a heart attack to help find blockages in the coronary arteries. To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-e-ter-ih-ZA-shun). A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through the coronary arteries. The dye lets your doctor study the flow of blood through the heart and blood vessels. If your doctor finds a blockage, he or she may recommend a procedure calledpercutaneous (per-ku-TA-ne-us) coronary intervention (PCI), sometimes referred to ascoronary angioplasty(AN-jee-oh-plas-tee). This procedure can help restore blood flow through a blocked artery. Sometimes a small mesh tube called a stent is placed in the artery to help prevent blockages after the procedure.",
+    "http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack"
+  ],
+  [
+    "How to diagnose Heart Attack?: If You Have Symptoms, Call 9-1-1 Diagnosis and treatment of a heart attack can begin when emergency personnel arrive after you call 9-1-1. Do not put off calling 9-1-1 because you are not sure that you are having a heart attack. Call within 5 minutes of the start of symptoms. At the hospital emergency room, doctors will work fast to find out if you are having or have had a heart attack. They will consider your symptoms, medical and family history, and test results. Initial tests will be quickly followed by treatment if you are having a heart attack. Diagnostic Tests - an electrocardiogram - blood tests - nuclear heart scan - cardiac catheterization - and coronary angiography. an electrocardiogram blood tests nuclear heart scan cardiac catheterization and coronary angiography. The electrocardiogram, also known as ECG or EKG, is used to measure the rate and regularity of your heartbeat. Blood tests are also used in diagnosing a heart attack. When cells in the heart die, they release enzymes into the blood. They are called markers or biomarkers. Measuring the amount of these markers in the blood can show how much damage was done to your heart. Doctors often repeat these tests to check for changes. The nuclear heart scan uses radioactive tracers to outline the heart chambers and major blood vessels leading to and from the heart. A nuclear heart scan shows any damage to your heart muscle as well as how well blood flows to and from the heart. In cardiac catheterization, a thin, flexible tube is passed through an artery in your groin or arm to reach the coronary arteries. This test allows your doctor to - determine blood pressure and flow in the heart's chambers - collect blood samples from the heart, and - examine the arteries of the heart by x-ray. determine blood pressure and flow in the heart's chambers collect blood samples from the heart, and examine the arteries of the heart by x-ray. Coronary angiography is usually done with the cardiac catheterization. A dye that can be seen on an x-ray is injected through the catheter into the coronary arteries. It shows where there are blockages and how severe they are.",
+    "http://nihseniorhealth.gov/heartattack/toc.html"
+  ],
+  [
+    "Heart attack - what to ask your doctor (Summary): A heart attack occurs when blood flow to a part of your heart is blocked for a period of time and a part of the heart muscle is damaged. It is also called a myocardial infarction (MI). Watch this video about: Coronary artery disease Angina is pain or pressure in the chest. It occurs when your heart muscle is not getting enough blood or oxygen. You may feel angina in your neck or jaw. Sometimes you may notice that you are short of breath. Below are some questions you may want to ask your health care provider to help you take care of yourself after a heart attack.",
+    "https://medlineplus.gov/ency/patientinstructions/000231.htm"
+  ],
+  [
+    "How to diagnose Heart Attack?: Several tests are used to diagnose a heart attack. - An electrocardiogram, also called an EKG, measures the rate and regularity of your heartbeat. - Blood tests identify and measure markers in the blood that can show how much damage was done to your heart. These tests are often repeated at specific time periods to check for changes. - A nuclear heart scan uses radioactive tracers to show damage to heart chambers and major blood vessels. - Cardiac catheterization involves passing a thin flexible tube through an artery in your groin or arm to look at your coronary arteries. It allows your doctor to examine the blood flow in your heart's chambers. - Cardiac angiography is usually performed along with cardiac catheterization, using a dye injected through the cardiac catheter. The dye allows the doctor to see where there may be blockages in the coronary arteries. An electrocardiogram, also called an EKG, measures the rate and regularity of your heartbeat. Blood tests identify and measure markers in the blood that can show how much damage was done to your heart. These tests are often repeated at specific time periods to check for changes. A nuclear heart scan uses radioactive tracers to show damage to heart chambers and major blood vessels. Cardiac catheterization involves passing a thin flexible tube through an artery in your groin or arm to look at your coronary arteries. It allows your doctor to examine the blood flow in your heart's chambers. Cardiac angiography is usually performed along with cardiac catheterization, using a dye injected through the cardiac catheter. The dye allows the doctor to see where there may be blockages in the coronary arteries.",
+    "http://nihseniorhealth.gov/heartattack/toc.html"
+  ],
+  [
+    "Heart Attack (Treatments): Early treatment for a heart attack can pr event or limit damage to the heart muscle. Acting fast, by calling 9\u20131\u20131 at the first symptoms of a heart attack, can save your life. Medical personnel can begin diagnosis and treatment even before you get to the hospital. Immediate Treatment Certain treatments usually are started right away if a heart attack is suspected, even before the diagnosis is confirmed. These include: Aspirin to prevent further blood clotting Nitroglycerin to reduce your heart\u2019s workload and improve blood flow through the coronary arteries Oxygen therapy Treatment for chest pain Once the diagnosis of a heart attack is confirmed or strongly suspected, doctors start treatments promptly to try to restore blood flow through the blood vessels supplying the heart. The two main treatments are clot-busting medicines and percutaneous coronary intervention, also known as coronary angioplasty, a procedure used to open blocked coronary arteries. Clot-Busting Medicines Thrombolytic medicines, also called clot busters, are used to dissolve blood clots that are blocking the coronary arteries. To work best, these medicines must be given within several hours of the start of heart attack symptoms. Ideally, the medicine should be given as soon as possible. Percutaneous Coronary Intervention Percutaneous coronary intervention is a nonsurgical procedure that opens blocked or narrowed coronary arteries. A thin, flexible tube (catheter) with a balloon or other device on the end is threaded through a blood vessel, usually in the groin (upper thigh), to the narrowed or blocked coronary artery. Once in place, the balloon located at the tip of the catheter is inflated to compress the plaque and related clot against the wall of the artery. This restores blood flow through the artery. During the procedure, the doctor may put a small mesh tube called a stent in the artery. The stent helps to keep the blood vessel open to prevent blockages in the artery in the months or years after the procedure. Other Treatments for Heart Attack Other treatments for heart attack include: Medicines Medical procedures Heart-healthy lifestyle changes Cardiac rehabilitation Medicines Your doctor may prescribe one or more of the following medicines. ACE inhibitors. ACE inhibitors lower blood pressure and reduce strain on your heart. They also help slow down further weakening of the heart muscle. Anticlotting medicines. Anticlotting medicines stop platelets from clumping together and forming unwanted blood clots. Examples of anticlotting medicines include aspirin and clopidogrel. Anticoagulants. Anticoagulants, or blood thinners, prevent blood clots from forming in your arteries. These medicines also keep existing clots from getting larger. Beta blockers. Beta blockers decrease your heart\u2019s workload. These medicines also are used to relieve chest pain and discomfort and to help prevent another heart attack. Beta blockers also are used to treat arrhythmias (irregular heartbeats). Statin medicines. Statins control or lower your blood cholesterol. By lowering your blood cholesterol level, you can decrease your chance of having another heart attack or\u00a0stroke. You also may be given medicines to relieve pain and anxiety, and treat arrhythmias.\u00a0Take all medicines regularly, as your doctor prescribes. Don\u2019t change the amount of your medicine or skip a dose unless your doctor tells you to.\u00a0 Medical Procedures Coronary artery bypass grafting also may be used to treat a heart attack. During coronary artery bypass grafting, a surgeon removes a healthy artery or vein from your body. The artery or vein is then connected, or grafted, to bypass the blocked section of the coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This provides a new route for blood to flow to the heart muscle. Heart-Healthy Lifestyle Changes Treatment for a heart attack usually includes making heart-healthy lifestyle changes. Your doctor also may recommend: Heart-healthy eating Aiming for healthy weight Managing stress Physical activity Quitting smoking Taking these steps can lower your chances of having another heart attack. Cardiac Rehabilitation Your doctor may recommend cardiac rehabilitation (cardiac rehab) to help you recover from a heart attack and to help prevent another heart attack. Nearly everyone who has had a heart attack can benefit from rehab. Cardiac rehab is a medically supervised program that may help improve the health and well-being of people who have heart problems. The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists. Rehab has two parts: Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to reduce your risk for future heart problems. The rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and how to deal with your fears about the future. Exercise training. This part helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your personal abilities, needs, and interests.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack"
+  ],
+  [
+    "Heart attack: A heart attack occurs when the flow of blood to the heart is blocked, most often by a build-up of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries). The interrupted blood flow can damage or destroy part of the heart muscle. A heart attack, also called a myocardial infarction, can be fatal, but treatment has improved dramatically over the years. It's crucial to call 911 or emergency medical help if you think you might be having a heart attack. Common heart attack signs and symptoms include: - Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back - Nausea, indigestion, heartburn or abdominal pain - Shortness of breath - Cold sweat - Fatigue - Lightheadedness or sudden dizziness Heart attack symptoms vary Not all people who have heart attacks have the same symptoms or have the same severity of symptoms. Some people have mild pain; others have more severe pain. Some people have no symptoms, while for others, the first sign may be sudden cardiac arrest. However, the more signs and symptoms you have, the greater the likelihood you're having a heart attack. Some heart attacks strike suddenly, but many people have warning signs and symptoms hours, days or weeks in advance. The earliest warning may be recurrent chest pain (angina) that's triggered by exertion and relieved by rest. Angina is caused by a temporary decrease in blood flow to the heart. A heart attack differs from a condition in which your heart suddenly stops (sudden cardiac arrest, which occurs when an electrical disturbance disrupts your heart's pumping action and causes blood to stop flowing to the rest of your body). A heart attack can cause cardiac arrest, but it's not the only cause. When to see a doctor Act immediately. Some people wait too long because they don't recognize the important signs and symptoms. Take these steps: - Call for emergency medical help. If you suspect you're having a heart attack, don't hesitate. Immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only if there are no other options. Because your condition can worsen, driving yourself puts you and others at risk. - Take nitroglycerin, if prescribed to you by a doctor. Take it as instructed while awaiting emergency help. - Take aspirin, if recommended. Taking aspirin during a heart attack could reduce heart damage by helping to keep your blood from clotting. Aspirin can interact with other medications, however, so don't take an aspirin unless your doctor or emergency medical personnel recommend it. Don't delay calling 911 to take an aspirin. Call for emergency help first. What to do if you see someone having a heart attack If you encounter someone who is unconscious, first call for emergency medical help. Then begin CPR to keep blood flowing. Push hard and fast on the person's chest in a fairly rapid rhythm - about 100 to 120 compressions a minute. It's not necessary to check the person's airway or deliver rescue breaths unless you've been trained in CPR. A heart attack occurs when one or more of your coronary arteries become blocked. Over time, a coronary artery can narrow from the buildup of various substances, including cholesterol (atherosclerosis). This condition, known as coronary artery disease, causes most heart attacks. During a heart attack, one of these plaques can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If large enough, the clot can completely block the flow of blood through the coronary artery. Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Use of tobacco and of illicit drugs, such as cocaine, can cause a life-threatening spasm. A heart attack can also occur due to a tear in the heart artery (spontaneous coronary artery dissection). Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body. You can improve or eliminate many of these risk factors to reduce your chances of having a first or subsequent heart attack. Heart attack risk factors include: - Age. Men age 45 or older and women age 55 or older are more likely to have a heart attack than are younger men and women. - Tobacco. Smoking and long-term exposure to secondhand smoke increase the risk of a heart attack. - High blood pressure. Over time, high blood pressure can damage arteries that feed your heart by accelerating atherosclerosis. High blood pressure that occurs with obesity, smoking, high cholesterol or diabetes increases your risk even more. - High blood cholesterol or triglyceride levels. A high level of low-density lipoprotein (LDL) cholesterol (the \"bad\" cholesterol) is most likely to narrow arteries. A high level of triglycerides, a type of blood fat related to your diet, also ups your risk of heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol (the \"good\" cholesterol) lowers your risk of heart attack. - Diabetes. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, a form of sugar. Having diabetes - not producing enough insulin or not responding to insulin properly - causes your body's blood sugar levels to rise. Diabetes, especially uncontrolled, increases your risk of a heart attack. - Family history of heart attack. If your siblings, parents or grandparents have had early heart attacks (by age 55 for male relatives and by age 65 for female relatives), you may be at increased risk. - Lack of physical activity. An inactive lifestyle contributes to high blood cholesterol levels and obesity. People who get regular aerobic exercise have better cardiovascular fitness, which decreases their overall risk of heart attack. Exercise is also beneficial in lowering high blood pressure. - Obesity. Obesity is associated with high blood cholesterol levels, high triglyceride levels, high blood pressure and diabetes. Losing just 10 percent of your body weight can lower this risk, however. - Stress. You may respond to stress in ways that can increase your risk of a heart attack. - Illegal drug use. Using stimulant drugs, such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack. - A history of preeclampsia. This condition causes high blood pressure during pregnancy and increases the lifetime risk of heart disease. - A history of an autoimmune condition, such as rheumatoid arthritis or lupus. Conditions such as rheumatoid arthritis, lupus and other autoimmune conditions can increase your risk of having a heart attack. Complications are often related to the damage done to your heart during an attack. Damage can lead to: - Abnormal heart rhythms (arrhythmias). Electrical \"short circuits\" can develop, resulting in abnormal heart rhythms, some of which can be serious, even fatal. - Heart failure. An attack may damage so much heart tissue that the remaining heart muscle can't adequately pump blood out of your heart. Heart failure may be temporary, or it can be a chronic condition resulting from extensive and permanent damage to your heart. - Heart rupture. Areas of heart muscle weakened by a heart attack can rupture, leaving a hole in part of the heart. This rupture is often fatal. - Valve problems. Heart valves damaged during a heart attack may develop severe leakage problems. Ideally, your doctor should screen you during regular physical exams for risk factors that can lead to a heart attack. If you're in an emergency setting for symptoms of a heart attack, you'll be asked to describe your symptoms and have your blood pressure, pulse and temperature checked. You'll be hooked up to a heart monitor and will almost immediately have tests to see if you're having a heart attack. Tests will help check if your signs and symptoms, such as chest pain, indicate a heart attack or another condition. These tests include: - Electrocardiogram (ECG). This first test done to diagnose a heart attack records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as waves displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress. - Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Emergency room doctors will take samples of your blood to test for the presence of these enzymes. Additional tests If you've had a heart attack or one is occurring, doctors will take immediate steps to treat your condition. You may also undergo these additional tests: - Chest X-ray. An X-ray image of your chest allows your doctor to check the size of your heart and its blood vessels and to look for fluid in your lungs. - Echocardiogram. During this test, sound waves directed at your heart from a wandlike device (transducer) held on your chest bounce off your heart and are processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged by a heart attack and isn't pumping normally or at peak capacity. - Coronary catheterization (angiogram). A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg or groin, to the arteries in your heart. The dye makes the arteries visible on X-ray, revealing areas of blockage. - Exercise stress test. In the days or weeks after your heart attack, you may also undergo a stress test. Stress tests measure how your heart and blood vessels respond to exertion. You may walk on a treadmill or pedal a stationary bike while attached to an ECG machine. Or you may receive a drug intravenously that stimulates your heart similar to exercise. Your doctor may also order a nuclear stress test, which is similar to an exercise stress test, but uses an injected dye and special imaging techniques to produce detailed images of your heart while you're exercising. These tests can help determine your long-term treatment. - Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). These tests can be used to diagnose heart problems, including the extent of damage from heart attacks. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. In a cardiac MRI, you lie on a table inside a long tubelike machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. The signals create images of your heart. Heart attack treatment at a hospital With each passing minute after a heart attack, more heart tissue loses oxygen and deteriorates or dies. The main way to prevent heart damage is to restore blood flow quickly. Medications Medications given to treat a heart attack include: - Aspirin. The 911 operator may instruct you to take aspirin, or emergency medical personnel may give you aspirin immediately. Aspirin reduces blood clotting, thus helping maintain blood flow through a narrowed artery. - Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you'll survive and with less heart damage. - Antiplatelet agents. Emergency room doctors may give you other drugs to help prevent new clots and keep existing clots from getting larger. These include medications, such as clopidogrel (Plavix) and others, called platelet aggregation inhibitors. - Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood less \"sticky\" and less likely to form clots. Heparin is given intravenously or by an injection under your skin. - Pain relievers. You may receive a pain reliever, such as morphine, to ease your discomfort. - Nitroglycerin. This medication, used to treat chest pain (angina), can help improve blood flow to the heart by widening (dilating) the blood vessels. - Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure, making your heart's job easier. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks. - ACE inhibitors. These drugs lower blood pressure and reduce stress on the heart. Surgical and other procedures In addition to medications, you may undergo one of the following procedures to treat your heart attack: - Coronary angioplasty and stenting. Doctors insert a long, thin tube (catheter) that's passed through an artery, usually in your leg or groin, to a blocked artery in your heart. If you've had a heart attack, this procedure is often done immediately after a cardiac catheterization, a procedure used to locate blockages. This catheter is equipped with a special balloon that, once in position, is briefly inflated to open a blocked coronary artery. A metal mesh stent may be inserted into the artery to keep it open long term, restoring blood flow to the heart. Depending on your condition, your doctor may opt to place a stent coated with a slow-releasing medication to help keep your artery open. - Coronary artery bypass surgery. In some cases, doctors may perform emergency bypass surgery at the time of a heart attack. If possible, your doctor may suggest that you have bypass surgery after your heart has had time - about three to seven days - to recover from your heart attack. Bypass surgery involves sewing veins or arteries in place beyond a blocked or narrowed coronary artery, allowing blood flow to the heart to bypass the narrowed section. Once blood flow to your heart is restored and your condition is stable, you're likely to remain in the hospital for several days. Your lifestyle affects your heart health. The following steps can help you not only prevent but also recover from a heart attack: - Avoid smoke. The most important thing you can do to improve your heart's health is to not smoke. Also, avoid being around secondhand smoke. If you need to quit, ask your doctor for help. - Control your blood pressure and cholesterol levels. If one or both of these is high, your doctor can prescribe changes to your diet and medications. Ask your doctor how often you need to have your blood pressure and cholesterol levels monitored. - Get regular medical checkups. Some of the major risk factors for heart attack - high blood cholesterol, high blood pressure and diabetes - cause no symptoms early on. Your doctor can perform tests to check for these conditions and help you manage them, if necessary. - Exercise regularly. Regular exercise helps improve heart muscle function after a heart attack and helps prevent a heart attack by helping you to control your weight, diabetes, cholesterol and blood pressure. Exercise needn't be vigorous. Walking 30 minutes a day, five days a week can improve your health. - Maintain a healthy weight. Excess weight strains your heart and can contribute to high cholesterol, high blood pressure and diabetes. - Eat a heart-healthy diet. Saturated fat, trans fats and cholesterol in your diet can narrow arteries to your heart, and too much salt can raise blood pressure. Eat a heart-healthy diet that includes lean proteins, such as fish and beans, plenty of fruits and vegetables and whole grains. - Manage diabetes. High blood sugar is damaging to your heart. Regular exercise, eating well and losing weight all help to keep blood sugar levels at more-desirable levels. Many people also need medication to manage their diabetes. - Control stress. Reduce stress in your day-to-day activities. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events in your life. - If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and men older than age 65, and up to two drinks a day for men age 65 and younger.",
+    "https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106"
+  ],
+  [
+    "Heart Attack (Signs and Symptoms): Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. In one study, for example, one-third of the patients who had heart attacks had no chest pain. These patients were more likely to be older, female, or diabetic. The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one. It is important for you to know the most common symptoms of a heart attack and also remember these facts: Heart attacks can start slowly and cause only mild pain or discomfort. Symptoms can be mild or more intense and sudden. Symptoms also may come and go over several hours. People who have high blood sugar (diabetes) may have no symptoms or very mild ones. The most common symptom, in both men and women, is chest pain or discomfort. Women are somewhat more likely to have shortness of breath, nausea and vomiting, unusual tiredness (sometimes for days), and pain in the back, shoulders, and jaw. Some people don't have symptoms at all. Heart attacks that occur without any symptoms or with very mild symptoms are called silent heart attacks. Most Common Symptoms The most common warning symptoms of a heart attack for both men and women are: Chest pain or discomfort.\u00a0Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion. The feeling can be mild or severe. Upper body discomfort.\u00a0You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button). Shortness of breath.\u00a0This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity. The symptoms of angina (an-JI-nuh or AN-juh-nuh) can be similar to the symptoms of a heart attack. Angina is chest pain that occurs in people who have coronary heart disease, usually when they're active. Angina pain usually lasts for only a few minutes and goes away with rest. Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack. All chest pain should be checked by a doctor. Other Common Signs and Symptoms Pay attention to these other possible symptoms of a heart attack: Breaking out in a cold sweat Feeling unusually tired for no reason, sometimes for days (especially if you are a woman) Nausea (feeling sick to the stomach) and vomiting Light-headedness or sudden dizziness Any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual) Not everyone having a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. However, some people may have a pattern of symptoms that recur. The more signs and symptoms you have, the more likely it is that you're having a heart attack. Quick Action Can Save Your Life: Call 9\u20131\u20131\u00a0 The signs and symptoms of a heart attack can develop suddenly. However, they also can develop slowly\u2014sometimes within hours, days, or weeks of a heart attack. Any time you think you might be having heart attack symptoms or a heart attack, don't ignore it or feel embarrassed to call for help. Call 9\u20131\u20131 for emergency medical care, even if you are not sure whether you're having a heart attack. Here's why: Acting fast can save your life. An ambulance is the best and safest way to get to the hospital. Emergency medical services (EMS) personnel can check how you are doing and start life-saving medicines and other treatments right away. People who arrive by ambulance often receive faster treatment at the hospital.\u00a0 The 9\u20131\u20131 operator or EMS technician can give you advice. You might be told to crush or chew an aspirin if you're not allergic, unless there is a medical reason for you not to take one. Aspirin taken during a heart attack can limit the damage to your heart and save your life. Every minute matters. Never delay calling 9\u20131\u20131 to take aspirin or do anything else you think might help.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack"
+  ],
+  [
+    "Heart Attack (Prevention): Lowering your risk factors for coronary heart disease can help you prevent a heart attack. Even if you already have coronary heart disease, you still can take steps to lower your risk for a heart attack. These steps involve making heart-healthy lifestyle changes\u00a0and getting ongoing\u00a0medical care for related conditions that make heart attack more likely. Talk to your doctor about whether you may benefit from aspirin primary prevention, or using aspirin to help prevent your first heart attack. Heart-Healthy Lifestyle Changes A heart-healthy lifestyle can help prevent a heart attack and includes heart-healthy eating, being physically active, quitting smoking, managing stress, and managing your weight. Ongoing Care Treat Related Conditions Treating conditions that make a heart attack more likely also can help lower your risk for a heart attack. These conditions may include: Diabetes (high blood sugar). If you have diabetes, try to control your blood sugar level through diet and physical activity (as your doctor recommends). If needed, take medicine as prescribed. High blood cholesterol. Your doctor may prescribe a statin medicine to lower your cholesterol if diet and exercise aren\u2019t enough. High blood pressure. Your doctor may prescribe medicine to keep your blood pressure under control. Chronic kidney disease. Your doctor may prescribe medicines to control your high blood pressure or high blood sugar levels. Peripheral artery disease. Your doctor may recommend surgery or procedures to unblock the affected arteries. Have an Emergency Action Plan Make sure that you have an emergency action plan in case you or someone in your family has a heart attack. This is very important if you\u2019re at high risk for, or have already had, a heart attack. Write down a list of medicines you are taking, medicines you are allergic to, your health care provider\u2019s phone numbers (both during and after office hours), and contact information for a friend or relative. Keep the list in a handy place (for example, fill out this wallet card) to share in a medical emergency. Talk with your doctor about the signs and symptoms of a heart attack, when you should call 9\u20131\u20131, and steps you can take while waiting for medical help to arrive.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/heartattack"
+  ],
+  [
+    "Dementia (WHAT IS DEMENTIA?): Dementia is the loss of cognitive functioning-thinking, remembering, and reasoning-and behavioral abilities to such an extent that it interferes with a person's daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person's functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.Signs and symptoms of dementia result when once-healthy neurons (nerve cells) in the brain stop working, lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience far greater loss.While dementia is more common as people grow older (up to half of all people age 85 or older may have some form of dementia), it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia. One type of dementia, frontotemporal disorders, is more common in middle-aged than older adults.Memory loss, though common, is not the only sign of dementia. For a person to have dementia, he or she must have:- Two or more core mental functions that are impaired. These functions include memory, language skills, visual perception, and the ability to focus and pay attention. These also include cognitive skills such as the ability to reason and solve problems. - A loss of brain function severe enough that a person cannot do normal, everyday tasksIn addition, some people with dementia cannot control their emotions. Their personalities may change. They can have delusions, which are strong beliefs without proof, such as the idea that someone is stealing from them. They also may hallucinate, seeing or otherwise experiencing things that are not real.The causes of dementia can vary, depending on the types of brain changes that may be taking place. Other dementias include Lewy body dementia, frontotemporal disorders, and vascular dementia. It is common for people to have mixed dementia-a combination of two or more disorders, at least one of which is dementia. For example, some people have both Alzheimer's disease and vascular dementia.Learn more about dementia from MedlinePlus.",
+    "https://www.nia.nih.gov/health/topics/dementia"
+  ],
+  [
+    "What is Dementia?: Dementia is not a specific disease. It is a descriptive term for a collection of symptoms that can be caused by a number of disorders that affect the brain. People with dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships. They also lose their ability to solve problems and maintain emotional control, and they may experience personality changes and behavioral problems, such as agitation, delusions, and hallucinations. While memory loss is a common symptom of dementia, memory loss by itself does not mean that a person has dementia. Doctors diagnose dementia only if two or more brain functions - such as memory and language skills -- are significantly impaired without loss of consciousness. Some of the diseases that can cause symptoms of dementia are Alzheimers disease, vascular dementia, Lewy body dementia, frontotemporal dementia, Huntingtons disease, and Creutzfeldt-Jakob disease. Doctors have identified other conditions that can cause dementia or dementia-like symptoms including reactions to medications, metabolic problems and endocrine abnormalities, nutritional deficiencies, infections, poisoning, brain tumors, anoxia or hypoxia (conditions in which the brains oxygen supply is either reduced or cut off entirely), and heart and lung problems. Although it is common in very elderly individuals, dementia is not a normal part of the aging process.",
+    "http://www.ninds.nih.gov/disorders/dementias/dementia.htm"
+  ],
+  [
+    "What is Dementia?: Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000739.htm"
+  ],
+  [
+    "Dementia: Dementia isn't a specific disease. Instead, dementia describes a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with daily functioning. Though dementia generally involves memory loss, memory loss has different causes. So memory loss alone doesn't mean you have dementia. Alzheimer's disease is the most common cause of a progressive dementia in older adults, but there are a number of causes of dementia. Depending on the cause, some dementia symptoms can be reversed. Dementia care at Mayo Clinic Dementia symptoms vary depending on the cause, but common signs and symptoms include: Cognitive changes - Memory loss, which is usually noticed by a spouse or someone else - Difficulty communicating or finding words - Difficulty reasoning or problem-solving - Difficulty handling complex tasks - Difficulty with planning and organizing - Difficulty with coordination and motor functions - Confusion and disorientation Psychological changes - Personality changes - Depression - Anxiety - Inappropriate behavior - Paranoia - Agitation - Hallucinations When to see a doctor See a doctor if you or a loved one has memory problems or other dementia symptoms. Some treatable medical conditions can cause dementia symptoms, so it's important to determine the underlying cause. Dementia involves damage of nerve cells in the brain, which can occur in several areas of the brain. Dementia affects people differently, depending on the area of the brain affected. Dementias are often grouped by what they have in common, such as the part of the brain that's affected or whether they worsen over time (progressive dementias). Some dementias, such as those caused by a reaction to medications or vitamin deficiencies, might improve with treatment. Progressive dementias Types of dementias that progress and aren't reversible include: - Alzheimer's disease. In people age 65 and older, Alzheimer's disease is the most common cause of dementia. Although the cause of Alzheimer's disease isn't known, plaques and tangles are often found in the brains of people with Alzheimer's. Plaques are clumps of a protein called beta-amyloid, and tangles are fibrous tangles made up of tau protein. Certain genetic factors might make it more likely that people will develop Alzheimer's. - Vascular dementia. This second most common type of dementia occurs as a result of damage to the vessels that supply blood to your brain. Blood vessel problems can be caused by stroke or other blood vessel conditions. - Lewy body dementia. Lewy bodies are abnormal clumps of protein that have been found in the brains of people with Lewy body dementia, Alzheimer's disease and Parkinson's disease. This is one of the more common types of progressive dementia. - Frontotemporal dementia. This is a group of diseases characterized by the breakdown (degeneration) of nerve cells in the frontal and temporal lobes of the brain, the areas generally associated with personality, behavior and language. As with other dementias, the cause isn't known. - Mixed dementia. Autopsy studies of the brains of people 80 and older who had dementia indicate that many had a combination of Alzheimer's disease, vascular dementia and Lewy body dementia. Studies are ongoing to determine how having mixed dementia affects symptoms and treatments. Other disorders linked to dementia - Huntington's disease. Caused by a genetic mutation, this disease causes certain nerve cells in your brain and spinal cord to waste away. Signs and symptoms, including a severe decline in thinking (cognitive) skills usually appear around age 30 or 40. - Traumatic brain injury. This condition is caused by repetitive head trauma, such as experienced by boxers, football players or soldiers. Depending on the part of the brain that's injured, this condition can cause dementia signs and symptoms, such as depression, explosiveness, memory loss, uncoordinated movement and impaired speech, as well as slow movement, tremors and rigidity (parkinsonism). Symptoms might not appear until years after the trauma. - Creutzfeldt-Jakob disease. This rare brain disorder usually occurs in people without known risk factors. This condition might be due to an abnormal form of a protein. Creutzfeldt-Jakob disease can be inherited or caused by exposure to diseased brain or nervous system tissue. Signs and symptoms of this fatal condition usually appear around age 60. - Parkinson's disease. Many people with Parkinson's disease eventually develop dementia symptoms (Parkinson's disease dementia). Dementia-like conditions that can be reversed Some causes of dementia or dementia-like symptoms can be reversed with treatment. They include: - Infections and immune disorders. Dementia-like symptoms can result from fever or other side effects of your body's attempt to fight off an infection. Conditions such as multiple sclerosis that result from the body's immune system attacking nerve cells also can cause dementia. - Metabolic problems and endocrine abnormalities. People with thyroid problems, low blood sugar (hypoglycemia), too little or too much sodium or calcium, or an impaired ability to absorb vitamin B-12 can develop dementia-like symptoms or other personality changes. - Nutritional deficiencies. Not drinking enough liquids (dehydration); not getting enough thiamin (vitamin B-1), which is common in people with chronic alcoholism; and not getting enough vitamins B-6 and B-12 in your diet can cause dementia-like symptoms. - Reactions to medications. A reaction to a medication or an interaction of several medications can cause dementia-like symptoms. - Subdural hematomas. Bleeding between the surface of the brain and the covering over the brain, which is common in the elderly after a fall, can cause symptoms similar to dementia. - Poisoning. Exposure to heavy metals, such as lead, and other poisons, such as pesticides, as well as alcohol abuse or recreational drug use can lead to symptoms of dementia. Symptoms might resolve with treatment. - Brain tumors. Rarely, dementia can result from damage caused by a brain tumor. - Anoxia. This condition, also called hypoxia, occurs when organ tissues aren't getting enough oxygen. Anoxia can occur due to severe asthma, heart attack, carbon monoxide poisoning or other causes. - Normal-pressure hydrocephalus. This condition, which is caused by enlarged ventricles in the brain, can cause walking problems, urinary difficulty and memory loss. Many factors can eventually lead to dementia. Some factors, such as age, can't be changed. Others can be addressed to reduce your risk. Risk factors that can't be changed - Age. The risk rises as you age, especially after age 65. However, dementia isn't a normal part of aging, and dementia can occur in younger people. - Family history. Having a family history of dementia puts you at greater risk of developing the condition. However, many people with a family history never develop symptoms, and many people without a family history do. Tests to determine whether you have certain genetic mutations are available. - Down syndrome. By middle age, many people with Down syndrome develop early-onset Alzheimer's disease. - Mild cognitive impairment. This involves difficulties with memory but without loss of daily function. It puts people at higher risk of dementia. Risk factors you can change You might be able to control the following risk factors of dementia. - Heavy alcohol use. If you drink large amounts of alcohol, you might have a higher risk of dementia. Some studies, however, have shown that moderate amounts of alcohol might have a protective effect. - Cardiovascular risk factors. These include high blood pressure (hypertension), high cholesterol, buildup of fats in your artery walls (atherosclerosis) and obesity. - Depression. Although not yet well-understood, late-life depression might indicate the development of dementia. - Diabetes. If you have diabetes, you might have an increased risk of dementia, especially if it's poorly controlled. - Smoking. Smoking might increase your risk of developing dementia and blood vessel (vascular) diseases. - Sleep apnea. People who snore and have episodes where they frequently stop breathing while asleep may have reversible memory loss. Dementia can affect many body systems and, therefore, the ability to function. Dementia can lead to: - Inadequate nutrition. Many people with dementia eventually reduce or stop their intake of nutrients. Ultimately, they may be unable to chew and swallow. - Pneumonia. Difficulty swallowing increases the risk of choking or aspirating food into the lungs, which can block breathing and cause pneumonia. - Inability to perform self-care tasks. As dementia progresses, it can interfere with bathing, dressing, brushing hair or teeth, using the toilet independently and taking medications accurately. - Personal safety challenges. Some day-to-day situations can present safety issues for people with dementia, including driving, cooking and walking alone. - Death. Late-stage dementia results in coma and death, often from infection. Diagnosing dementia and determining what type it is can be challenging. A diagnosis of dementia requires that at least two core mental functions be impaired enough to interfere with daily living. They are memory, language skills, ability to focus and pay attention, ability to reason and problem-solve, and visual perception. Your doctor will review your medical history and symptoms and conduct a physical examination. He or she will likely ask someone close to you about your symptoms, as well. No single test can diagnose dementia, so doctors are likely to run a number of tests that can help pinpoint the problem. Cognitive and neuropsychological tests Doctors will evaluate your thinking (cognitive) function. A number of tests measure thinking skills such as memory, orientation, reasoning and judgment, language skills, and attention. Neurological evaluation Doctors evaluate your memory, language, visual perception, attention, problem-solving, movement, senses, balance, reflexes and other areas. Brain scans - CT or MRI. These scans can check for evidence of stroke or bleeding or tumor or hydrocephalus. - PET scans. These can show patterns of brain activity and if the amyloid protein, a hallmark of Alzheimer's disease, has been deposited in the brain. Laboratory tests Simple blood tests can detect physical problems that can affect brain function, such as vitamin B-12 deficiency or an underactive thyroid gland. Sometimes the spinal fluid is examined for infection, inflammation or markers of some degenerative diseases. Psychiatric evaluation A mental health professional can determine whether depression or another mental health condition is contributing to your symptoms. Most types of dementia can't be cured, but there are ways to manage your symptoms. Medications The following are used to temporarily improve dementia symptoms. - Cholinesterase inhibitors. These medications - including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) - work by boosting levels of a chemical messenger involved in memory and judgment. Although primarily used to treat Alzheimer's disease, these medications might also be prescribed for other dementias, including vascular dementia, Parkinson's disease dementia and Lewy body dementia. Side effects can include nausea, vomiting and diarrhea. - Memantine. Memantine (Namenda) works by regulating the activity of glutamate, another chemical messenger involved in brain functions, such as learning and memory. In some cases, memantine is prescribed with a cholinesterase inhibitor. A common side effect of memantine is dizziness. - Other medications. Your doctor might prescribe medications to treat other symptoms or conditions, such as depression, sleep disturbances or agitation. Therapies Several dementia symptoms and behavior problems might be treated initially using nondrug approaches, such as: - Occupational therapy. An occupational therapist can show you how to make your home safer and teach coping behaviors. The purpose is to prevent accidents, such as falls; manage behavior; and prepare you for the dementia progression. - Modifying the environment. Reducing clutter and noise can make it easier for someone with dementia to focus and function. You might need to hide objects that can threaten safety, such as knives and car keys. Monitoring systems can alert you if the person with dementia wanders. - Modifying tasks. Break tasks into easier steps and focus on success, not failure. Structure and routine also help reduce confusion in people with dementia. Dementia symptoms and behavior problems will progress over time. Caregivers might try the following suggestions: - Enhance communication. When talking with your loved one, maintain eye contact. Speak slowly in simple sentences, and don't rush the response. Present one idea or instruction at a time. Use gestures and cues, such as pointing to objects. - Encourage exercise. Exercise benefits everyone, including people with dementia. The main benefits of exercise include improved strength and cardiovascular health. There is growing evidence that exercise also protects the brain from dementia, especially when combined with a healthy diet and treatment for risk factors for cardiovascular disease. Some research also shows physical activity might slow the progression of impaired thinking in people with Alzheimer's disease. And it can lessen symptoms of depression. - Encourage activity. Plan activities the person with dementia enjoys and can do. Dancing, painting, gardening, cooking, singing and others can be fun, can help you connect with your loved one, and can help your loved one focus on what he or she can still do. - Establish a nighttime ritual. Behavior is often worse at night. Try to establish going-to-bed rituals that are calming and away from the noise of television, meal cleanup and active family members. Leave nightlights on in the bedroom, hall and bathroom to prevent disorientation. Limiting caffeine, discouraging napping and offering opportunities for exercise during the day might ease nighttime restlessness. - Encourage keeping a calendar. A calendar might help your loved one remember upcoming events, daily activities and medication schedules. Consider sharing a calendar with your loved one. - Plan for the future. Develop a plan with your loved one while he or she is able to participate that identifies goals for future care. Support groups, legal advisers, family members and others might be able to help. You'll need to consider financial and legal issues, safety and daily living concerns, and long-term care options. Several dietary supplements, herbal remedies and therapies have been studied for people with dementia. Some may be beneficial. Use caution when considering taking dietary supplements, vitamins or herbal remedies, especially if you're taking other medications. These remedies aren't regulated, and claims about their benefits aren't always based on scientific research. Some alternative medicines for Alzheimer's disease and other forms of dementia that have been studied include: - Vitamin E. Evidence for taking vitamin E to slow Alzheimer disease is soft. Doctors warn against taking large doses of vitamin E because it may have a higher risk of mortality, especially in people with heart disease. - Omega-3 fatty acids. There is some evidence that eating fish three times a week might lower your risk of dementia. However, in clinical studies, omega-3 fatty acids haven't significantly slowed cognitive decline in mild to moderate Alzheimer's disease. More research is needed. - Ginkgo. Although ginkgo is considered safe, study results have been inconsistent in determining whether ginkgo helps people with dementia. The following techniques may help reduce agitation and promote relaxation in people with dementia. - Music therapy, which involves listening to soothing music - Pet therapy, which involves use of animals, such as visits from dogs, to promote improved moods and behaviors in people with dementia - Aromatherapy, which uses fragrant plant oils - Massage therapy - Art therapy, which involves creating art, focusing on the process rather than the outcome Other therapies The following techniques may help reduce agitation and promote relaxation in people with dementia. - Music therapy, which involves listening to soothing music - Pet therapy, which involves use of animals, such as visits from dogs, to promote improved moods and behaviors in people with dementia - Aromatherapy, which uses fragrant plant oils - Massage therapy - Art therapy, which involves creating art, focusing on the process rather than the outcome",
+    "https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013"
+  ],
+  [
+    "What is Dementia?: Dementia is the name for a group of symptoms caused by disorders that affect the brain. It is not a specific disease. People with dementia may not be able to think well enough to do normal activities, such as getting dressed or eating. They may lose their ability to solve problems or control their emotions. Their personalities may change. They may become agitated or see things that are not there. Memory loss is a common symptom of dementia. However, memory loss by itself does not mean you have dementia. People with dementia have serious problems with two or more brain functions, such as memory and language. Although dementia is common in very elderly people, it is not part of normal aging. Many different diseases can cause dementia, including Alzheimer's disease and stroke. Drugs are available to treat some of these diseases. While these drugs cannot cure dementia or repair brain damage, they may improve symptoms or slow down the disease. NIH: National Institute of Neurological Disorders and Stroke",
+    "https://www.nlm.nih.gov/medlineplus/dementia.html"
+  ],
+  [
+    "Dementia: Vascular dementia, the second most common form of dementia in older adults after Alzheimer's disease, and vascular cognitive impairment (VCI) result from injuries to vessels that supply blood to the brain, often after a stroke or series of strokes. The symptoms of vascular dementia can be similar to those of Alzheimer's, and both conditions can occur at the same time (a condition called \"mixed dementia\"). Symptoms of vascular dementia and VCI can begin suddenly and worsen or improve over time.Caregivers of people with vascular dementia or VCI face a variety of challenges. Learning more about these disorders can help. This resource list is a place to start. All resources on this list are available free online.The items on this list are in three categories:- Vascular Dementia and Vascular Cognitive Impairment - CADASIL-a rare, inherited form of vascular dementia - Binswanger's Disease-also called Subcortical Vascular Dementia Vascular dementia, the second most common form of dementia in older adults after Alzheimer's disease, and vascular cognitive impairment (VCI) result from injuries to vessels that supply blood to the brain, often after a stroke or series of strokes. The symptoms of vascular dementia can be similar to those of Alzheimer's, and both conditions can occur at the same time (a condition called \"mixed dementia\"). Symptoms of vascular dementia and VCI can begin suddenly and worsen or improve over time.Caregivers of people with vascular dementia or VCI face a variety of challenges. Learning more about these disorders can help. This resource list is a place to start. All resources on this list are available free online.The items on this list are in three categories:- Vascular Dementia and Vascular Cognitive Impairment - CADASIL-a rare, inherited form of vascular dementia - Binswanger's Disease-also called Subcortical Vascular Dementia The Brain Needs Blood (February-March 2013)This Neurology Now magazine article offers an overview of the relationship between vascular events or disease (including stroke and mini-stroke) and cognitive impairment. Using a patient case study, it describes the differences between VCI and Alzheimer's disease. The article also discusses lesser known, possible risk factors for VCI, such as depression and sleep disorders, as well as treatment strategies.Published by the American Academy of Neurology. Free online access.The Dementias: Hope Through Research (2013)This booklet from the National Institute on Aging and the National Institute of Neurological Disorders and Stroke describes different kinds of dementia, including vascular dementia. It discusses brain changes, symptoms, and treatments for many dementias, as well as risk factors and diagnosis for dementia generally. It also summarizes dementia research supported by the National Institutes of Health. The booklet includes a glossary and list of resources.Published by the National Institutes of Health. Available from the National Institute on Aging Alzheimer's and related Dementias Education and Referral (ADEAR) Center. Phone: 1-800-438-4380. Email: adear@nia.nih.gov. Free online access.Vascular Cognitive Impairment (undated)This article notes the varied definitions of VCI. It describes symptoms, including problems with memory and executive function, and risk factors such as diabetes and high blood pressure. The article also gives information about diagnostic tests and treatments, as well as lifestyle changes that may reduce the risk of VCI.Published by the University of Cincinnati Memory Disorders Center. Phone: 1-866-941-8264. Free online access.Vascular Dementia (2015)In this fact sheet, vascular dementia is defined as a decline in thinking skills caused by a major stroke or multiple minor strokes. The fact sheet notes that vascular brain changes often coexist with changes linked to other types of dementia, including Alzheimer's disease. The fact sheet lists symptoms, such as confusion and trouble speaking, and discusses diagnosis, risk factors, and treatment.Published by the Alzheimer's Association. Phone: 1-800-272-3900. Email: info@alz.org. Free online access.Vascular Dementia (2014)This web module offers an overview of vascular dementia. It discusses causes and risk factors, as well as symptoms, which can vary depending on the part of the brain where blood flow is impaired. The module also gives tips for preparing for a doctor's appointment and describes diagnostic tests, treatments, coping mechanisms for patients and caregivers, and prevention.Published by MayoClinic.com. Free online access.Vascular Dementia (undated)This fact sheet discusses vascular dementia as a common after-stroke problem that makes it difficult to process information. The condition can lead to memory loss, confusion, decreased attention span, other cognitive symptoms, and movement symptoms. The fact sheet offers practical tips for managing the disease and for caring for someone with vascular dementia.Published by the National Stroke Association. Phone: 1-800-787-6537. Free online access.Vascular Dementia (2015)In this overview, vascular dementia (sometimes called multi-infarct dementia) is described as dementia resulting from a series of small strokes. The article lists other risk factors, such as diabetes and smoking, and symptoms, which grow worse as the disease progresses. Also discussed are diagnosis, treatment, and possible complications.Published by the National Library of Medicine. Free online access.Multi-Infarct Dementia Information Page (2017)This web page provides an overview of multi-infarct dementia, a type of vascular dementia caused by multiple, often \"silent\" strokes. It describes symptoms, the difficulty of diagnosis, and treatment by preventing or controlling risk factors such as high cholesterol.Published by the National Institute of Neurological Disorders and Stroke. Phone: 1-800-352-9424. Free online access.What Is Vascular Dementia? (2014)This detailed fact sheet explains that vascular dementia has several types, including post-stroke, single-infarct, and subcortical dementias. It describes their separate, but related, causes and how symptoms change over time. Possible ways to stop the disease from progressing, such as controlling underlying conditions, are noted.Available from the Alzheimer's Society, London. E-mail: enquiries@alzheimers.org.uk. CADASIL stands for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. It is a rare, inherited disorder that affects the small blood vessels in the brain and leads to vascular dementia or vascular cognitive impairment and other symptoms.CADASIL (2015)This overview explains the acronym CADASIL and describes the hallmark symptoms caused by damage to small blood vessels. It also explains that a mutation of the NOTCH3 gene causes CADASIL and discusses related disorders. The web page includes resources and references.Published by the National Organization for Rare Disorders. Phone: 1-800-999-6673. Free online access.CADASIL Information Page (2017)This web page describes CADASIL as an inherited disease caused by a genetic mutation that typically leads to cognitive problems and dementia by age 65. Symptoms and disease onset vary widely, but CADASIL often begins in a person's mid-30s. There is no cure, though drugs may alleviate some symptoms.Published by the National Institute of Neurological Disorders and Stroke. Phone: 1-800-352-9424. Free online access.Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (reviewed 2013)This web page answers questions about CADASIL-what it is, how people inherit it, and more. It explains that although the condition causes strokes, it is not associated with common risk factors for stroke such as high blood pressure. Rather, an inherited genetic mutation (in the NOTCH3 gene) affecting small blood vessels is the cause of several symptoms, including migraines and dementia. The web page includes a glossary and list of online resources.Published by the National Library of Medicine. Phone: 1-888-346-3656. Free online access.Understanding CADASIL (undated)This brief guide explains the brain changes resulting from the NOTCH3 gene mutation that causes CADASIL. It focuses on stroke and transient ischemic attack (common symptoms of CADASIL) and their effects, including cognitive impairment. It also lists medical treatments and tests to avoid because they can increase the risk of certain symptoms.Published by CADASIL Together We Have Hope. Phone: 1-877-519-4673. Email: info@cadasilfoundation.org. Free online access. As they reach the end of life, people suffering from dementia can present special challenges for caregivers. People can live with diseases such as Alzheimer's or Parkinson's dementia for years, so it can be hard to think of these as terminal diseases. But, they do cause death. As they reach the end of life, people suffering from dementia can present special challenges for caregivers. People can live with diseases such as Alzheimer's or Parkinson's dementia for years, so it can be hard to think of these as terminal diseases. But, they do cause death. Dementia causes the gradual loss of thinking, remembering, and reasoning abilities, making it difficult for those who want to provide supportive care at the end of life to know what is needed. Because people with advanced dementia can no longer communicate clearly, they cannot share their concerns. Is Uncle Bert refusing food because he's not hungry or because he's confused? Why does Grandma Sakura seem agitated? Is she in pain and needs medication to relieve it, but can't tell you?As these conditions progress, caregivers may find it hard to provide emotional or spiritual comfort. How can you let Grandpa know how much his life has meant to you? How do you make peace with your mother if she no longer knows who you are? Someone who has severe memory loss might not take spiritual comfort from sharing family memories or understand when others express what an important part of their life this person has been. Palliative care or hospice can be helpful in many ways to families of people with dementia.Sensory connections-targeting someone's senses, like hearing, touch, or sight-can bring comfort. Being touched or massaged can be soothing. Listening to music, white noise, or sounds from nature seem to relax some people and lessen their agitation.When a dementia like Alzheimer's disease is first diagnosed, if everyone understands that there is no cure, then plans for the end of life can be made before thinking and speaking abilities fail and the person with Alzheimer's can no longer legally complete documents like advance directives.Learn more about legal and financial planning for people with Alzheimer's disease.End-of-life care decisions are more complicated for caregivers if the dying person has not expressed the kind of care he or she would prefer. Someone newly diagnosed with Alzheimer's disease might not be able to imagine the later stages of the disease. Quality of life is an important issue when making healthcare decisions for people with dementia. For example, medicines are available that may delay or keep symptoms from becoming worse for a little while. Medicines also may help control some behavioral symptoms in people with mild-to-moderate Alzheimer's disease.However, some caregivers might not want drugs prescribed for people in the later stages of Alzheimer's. They may believe that the person's quality of life is already so poor that the medicine is unlikely to make a difference. If the drug has serious side effects, they may be even more likely to decide against it.When making care decisions for someone else near the end of life, consider the goals of care and weigh the benefits, risks, and side effects of the treatment. You may have to make a treatment decision based on the person's comfort at one end of the spectrum and extending life or maintaining abilities for a little longer at the other.With dementia, a person's body may continue to be physically healthy while his or her thinking and memory are deteriorating. This means that caregivers and family members may be faced with very difficult decisions about how treatments that maintain physical health, such as installing a pacemaker, fit within the care goals. Dementia often progresses slowly and unpredictably. Experts suggest that signs of the final stage of Alzheimer's disease include some of the following:- Being unable to move around on one's own - Being unable to speak or make oneself understood - Needing help with most, if not all, daily activities, such as eating and self-care - Eating problems such as difficulty swallowingBecause of their unique experience with what happens at the end of life, hospice and palliative care experts might be able to help identify when someone in the final stage of Alzheimer's disease is in the last days or weeks of life. Caring for people with Alzheimer's or other dementias at home can be demanding and stressful for the family caregiver. Depression is a problem for some family caregivers, as is fatigue, because many feel they are always on call. Family caregivers may have to cut back on work hours or leave work altogether because of their caregiving responsibilities.Many family members taking care of a person with advanced dementia at home feel relief when death happens-for themselves and for the person who died. It is important to realize such feelings are normal. Hospice-whether used at home or in a facility (such as a nursing home)-gives family caregivers needed support near the end of life, as well as help with their grief, both before and after their family member dies.Caregivers, ask for help when you need it. Learn about respite care.Questions to Ask About End-of-Life Care for a Person with Dementia You will want to understand how the available medical options presented by the healthcare team fit into your family's particular needs. You might want to ask questions such as: - How will the approach the doctor is suggesting affect your relative's quality of life? Will it make a difference in comfort and well-being? - If considering home hospice for your relative with dementia, what will be needed to care for him or her? Does the facility have special experience with people with dementia? - What can I expect as the disease gets worse?Read about this topic in Spanish. Lea sobre este tema en espanol. It is common for people to have mixed dementia-a combination of two or more disorders, at least one of which is dementia. A number of combinations are possible. For example, some people have both Alzheimer's disease and vascular dementia.Some studies indicate that mixed dementia is the most common cause of dementia in the elderly. For example, autopsy studies looking at the brains of people who had dementia indicate that most people age 80 and older had mixed dementia-a combination of brain changes related to Alzheimer's disease (amyloid and tau), cerebrovascular disease (such as stroke), and, in some instances, Lewy body dementia (Lewy bodies). These studies suggest that mixed dementia is caused by both Alzheimer's-related neurodegenerative processes and vascular disease-related processes.In a person with mixed dementia, it may not be clear exactly how many of a person's symptoms are due to Alzheimer's or another type of dementia. In one study, approximately 40 percent of people who were thought to have Alzheimer's were found after autopsy to also have some form of cerebrovascular disease. In addition, several studies have found that many of the major risk factors for vascular disease also may be risk factors for Alzheimer's disease.Researchers are still working to understand how underlying disease processes in mixed dementia influence each other. It is not clear, for example, if symptoms are likely to be worse when a person has brain changes reflecting multiple types of dementia. Nor do we know if a person with multiple dementias can benefit from treating one type, for example, when a person with Alzheimer's controls high blood pressure and other vascular disease risk factors. It is common for people to have mixed dementia-a combination of two or more disorders, at least one of which is dementia. A number of combinations are possible. For example, some people have both Alzheimer's disease and vascular dementia.Some studies indicate that mixed dementia is the most common cause of dementia in the elderly. For example, autopsy studies looking at the brains of people who had dementia indicate that most people age 80 and older had mixed dementia-a combination of brain changes related to Alzheimer's disease (amyloid and tau), cerebrovascular disease (such as stroke), and, in some instances, Lewy body dementia (Lewy bodies). These studies suggest that mixed dementia is caused by both Alzheimer's-related neurodegenerative processes and vascular disease-related processes.In a person with mixed dementia, it may not be clear exactly how many of a person's symptoms are due to Alzheimer's or another type of dementia. In one study, approximately 40 percent of people who were thought to have Alzheimer's were found after autopsy to also have some form of cerebrovascular disease. In addition, several studies have found that many of the major risk factors for vascular disease also may be risk factors for Alzheimer's disease.Researchers are still working to understand how underlying disease processes in mixed dementia influence each other. It is not clear, for example, if symptoms are likely to be worse when a person has brain changes reflecting multiple types of dementia. Nor do we know if a person with multiple dementias can benefit from treating one type, for example, when a person with Alzheimer's controls high blood pressure and other vascular disease risk factors. It is common for people to have mixed dementia-a combination of two or more disorders, at least one of which is dementia. A number of combinations are possible. For example, some people have both Alzheimer's disease and vascular dementia.Some studies indicate that mixed dementia is the most common cause of dementia in the elderly. For example, autopsy studies looking at the brains of people who had dementia indicate that most people age 80 and older had mixed dementia-a combination of brain changes related to Alzheimer's disease (amyloid and tau), cerebrovascular disease (such as stroke), and, in some instances, Lewy body dementia (Lewy bodies). These studies suggest that mixed dementia is caused by both Alzheimer's-related neurodegenerative processes and vascular disease-related processes.In a person with mixed dementia, it may not be clear exactly how many of a person's symptoms are due to Alzheimer's or another type of dementia. In one study, approximately 40 percent of people who were thought to have Alzheimer's were found after autopsy to also have some form of cerebrovascular disease. In addition, several studies have found that many of the major risk factors for vascular disease also may be risk factors for Alzheimer's disease.Researchers are still working to understand how underlying disease processes in mixed dementia influence each other. It is not clear, for example, if symptoms are likely to be worse when a person has brain changes reflecting multiple types of dementia. Nor do we know if a person with multiple dementias can benefit from treating one type, for example, when a person with Alzheimer's controls high blood pressure and other vascular disease risk factors. Vascular dementia, considered the second most common form of dementia after Alzheimer's disease, and vascular cognitive impairment (VCI) result from injuries to the vessels supplying blood to the brain, often after a stroke or series of strokes. Vascular dementia and VCI arise as a result of risk factors that similarly increase the risk for cerebrovascular disease (such as stroke), including atrial fibrillation, hypertension (high blood pressure), diabetes, and high cholesterol. The symptoms of vascular dementia can be similar to those of Alzheimer's, and both conditions can occur at the same time. Symptoms of vascular dementia can begin suddenly and worsen or improve during one's lifetime.This type of dementia is often managed with drugs to prevent strokes. The aim is to reduce the risk of additional brain damage. Some studies suggest that drugs that improve memory in Alzheimer's disease might benefit people with early vascular dementia. Interventions that address risk factors may be incorporated into the management of vascular dementia.Some types of vascular dementia include:Multi-infarct dementia. This type of dementia occurs when a person has had many small strokes that damage brain cells. One side of the body may be disproportionally affected, and multi-infarct dementia may impair language or other functions, depending on the region of the brain that is affected. When the strokes occur on both sides of the brain, dementia is more likely than when stroke occurs on one side of the brain. In some cases, a single stroke can damage the brain enough to cause dementia. This so-called single-infarct dementia is more common when stroke affects the left side of the brain-where speech centers are located-and/or when it involves the hippocampus, the part of the brain that is vital for memory.Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). This inherited form of cardiovascular disease results in a thickening of the walls of small- and medium-sized blood vessels, eventually stemming the flow of blood to the brain. It is associated with mutations of a gene called Notch3. CADASIL is associated with multi-infarct dementia, stroke, migraine with aura (migraine preceded by visual symptoms), and mood disorders. The first symptoms can appear in people between ages 20 and 40. Many people with CADASIL are undiagnosed. People with first-degree relatives who have CADASIL can be tested for genetic mutations to the Notch3 gene to determine their own risk of developing CADASIL.Subcortical vascular dementia, also called Binswanger's disease. This rare form of dementia involves extensive damage to the small blood vessels and nerve fibers that make up white matter, the \"network\" part of the brain believed to be critical for relaying messages between regions. The symptoms of Binswanger's are related to the disruption of subcortical neural circuits involving short-term memory, organization, mood, attention, decision making, and appropriate behavior. A characteristic feature of this disease is psychomotor slowness, such as an increase in the time it takes for a person to think of a letter and then write it on a piece of paper.For more information about vascular dementia and VCI, see NIA's list of resources. Vascular dementia, considered the second most common form of dementia after Alzheimer's disease, and vascular cognitive impairment (VCI) result from injuries to the vessels supplying blood to the brain, often after a stroke or series of strokes. Vascular dementia and VCI arise as a result of risk factors that similarly increase the risk for cerebrovascular disease (such as stroke), including atrial fibrillation, hypertension (high blood pressure), diabetes, and high cholesterol. The symptoms of vascular dementia can be similar to those of Alzheimer's, and both conditions can occur at the same time. Symptoms of vascular dementia can begin suddenly and worsen or improve during one's lifetime.This type of dementia is often managed with drugs to prevent strokes. The aim is to reduce the risk of additional brain damage. Some studies suggest that drugs that improve memory in Alzheimer's disease might benefit people with early vascular dementia. Interventions that address risk factors may be incorporated into the management of vascular dementia.Some types of vascular dementia include:Multi-infarct dementia. This type of dementia occurs when a person has had many small strokes that damage brain cells. One side of the body may be disproportionally affected, and multi-infarct dementia may impair language or other functions, depending on the region of the brain that is affected. When the strokes occur on both sides of the brain, dementia is more likely than when stroke occurs on one side of the brain. In some cases, a single stroke can damage the brain enough to cause dementia. This so-called single-infarct dementia is more common when stroke affects the left side of the brain-where speech centers are located-and/or when it involves the hippocampus, the part of the brain that is vital for memory.Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). This inherited form of cardiovascular disease results in a thickening of the walls of small- and medium-sized blood vessels, eventually stemming the flow of blood to the brain. It is associated with mutations of a gene called Notch3. CADASIL is associated with multi-infarct dementia, stroke, migraine with aura (migraine preceded by visual symptoms), and mood disorders. The first symptoms can appear in people between ages 20 and 40. Many people with CADASIL are undiagnosed. People with first-degree relatives who have CADASIL can be tested for genetic mutations to the Notch3 gene to determine their own risk of developing CADASIL.Subcortical vascular dementia, also called Binswanger's disease. This rare form of dementia involves extensive damage to the small blood vessels and nerve fibers that make up white matter, the \"network\" part of the brain believed to be critical for relaying messages between regions. The symptoms of Binswanger's are related to the disruption of subcortical neural circuits involving short-term memory, organization, mood, attention, decision making, and appropriate behavior. A characteristic feature of this disease is psychomotor slowness, such as an increase in the time it takes for a person to think of a letter and then write it on a piece of paper.For more information about vascular dementia and VCI, see NIA's list of resources. Vascular dementia, considered the second most common form of dementia after Alzheimer's disease, and vascular cognitive impairment (VCI) result from injuries to the vessels supplying blood to the brain, often after a stroke or series of strokes. Vascular dementia and VCI arise as a result of risk factors that similarly increase the risk for cerebrovascular disease (such as stroke), including atrial fibrillation, hypertension (high blood pressure), diabetes, and high cholesterol. The symptoms of vascular dementia can be similar to those of Alzheimer's, and both conditions can occur at the same time. Symptoms of vascular dementia can begin suddenly and worsen or improve during one's lifetime.This type of dementia is often managed with drugs to prevent strokes. The aim is to reduce the risk of additional brain damage. Some studies suggest that drugs that improve memory in Alzheimer's disease might benefit people with early vascular dementia. Interventions that address risk factors may be incorporated into the management of vascular dementia.Some types of vascular dementia include:Multi-infarct dementia. This type of dementia occurs when a person has had many small strokes that damage brain cells. One side of the body may be disproportionally affected, and multi-infarct dementia may impair language or other functions, depending on the region of the brain that is affected. When the strokes occur on both sides of the brain, dementia is more likely than when stroke occurs on one side of the brain. In some cases, a single stroke can damage the brain enough to cause dementia. This so-called single-infarct dementia is more common when stroke affects the left side of the brain-where speech centers are located-and/or when it involves the hippocampus, the part of the brain that is vital for memory.Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). This inherited form of cardiovascular disease results in a thickening of the walls of small- and medium-sized blood vessels, eventually stemming the flow of blood to the brain. It is associated with mutations of a gene called Notch3. CADASIL is associated with multi-infarct dementia, stroke, migraine with aura (migraine preceded by visual symptoms), and mood disorders. The first symptoms can appear in people between ages 20 and 40. Many people with CADASIL are undiagnosed. People with first-degree relatives who have CADASIL can be tested for genetic mutations to the Notch3 gene to determine their own risk of developing CADASIL.Subcortical vascular dementia, also called Binswanger's disease. This rare form of dementia involves extensive damage to the small blood vessels and nerve fibers that make up white matter, the \"network\" part of the brain believed to be critical for relaying messages between regions. The symptoms of Binswanger's are related to the disruption of subcortical neural circuits involving short-term memory, organization, mood, attention, decision making, and appropriate behavior. A characteristic feature of this disease is psychomotor slowness, such as an increase in the time it takes for a person to think of a letter and then write it on a piece of paper.For more information about vascular dementia and VCI, see NIA's list of resources. Some caregivers need help when the person is in the early stages of Alzheimer's disease. Other caregivers look for help when the person is in the later stages of Alzheimer's. It's okay to seek help whenever you need it.As the person moves through the stages of Alzheimer's, he or she will need more care. One reason is that medicines used to treat Alzheimer's disease can only control symptoms; they cannot cure the disease. Symptoms, such as memory loss and confusion, will get worse over time.Because of this, you will need more help. You may feel that asking for help shows weakness or a lack of caring, but the opposite is true. Asking for help shows your strength. It means you know your limits and when to seek support. Some caregivers need help when the person is in the early stages of Alzheimer's disease. Other caregivers look for help when the person is in the later stages of Alzheimer's. It's okay to seek help whenever you need it.As the person moves through the stages of Alzheimer's, he or she will need more care. One reason is that medicines used to treat Alzheimer's disease can only control symptoms; they cannot cure the disease. Symptoms, such as memory loss and confusion, will get worse over time.Because of this, you will need more help. You may feel that asking for help shows weakness or a lack of caring, but the opposite is true. Asking for help shows your strength. It means you know your limits and when to seek support. According to many caregivers, building a local support system is a key way to get help. Your support system might include a caregiver support group, the local chapter of the Alzheimer's Association, family, friends, and faith groups. Here are some places that can give you support and advice:NIA Alzheimer's and related Dementias Education and Referral (ADEAR) Center Email: adear@nia.nih.gov Phone: 1-800-438-4380 www.nia.nih.gov/alzheimers The ADEAR Center offers information on diagnosis, treatment, patient care, caregiver needs, long-term care, and research and clinical trials related to Alzheimer's disease. Staff can refer you to local and national resources, or you can search for information on the website. The Center is a service of the National Institute on Aging (NIA), part of the Federal Government's National Institutes of Health. They have information to help you understand Alzheimer's disease. You can also get hints on other subjects, including:- Talking with the doctor - Financial and legal planning - Medicines - Comfort care at the end of life - Paying for careAlzheimer's Association Phone: 1-800-272-3900 www.alz.orgThe Alzheimer's Association offers information, a help line, and support services to people with Alzheimer's and their caregivers. Local chapters across the country offer support groups, including many that help with early-stage Alzheimer's disease. Call or go online to find out where to get help in your area. The Association also funds Alzheimer's research.Alzheimer's Foundation of America Phone: 1-866-232-8484 www.alzfdn.orgThe Alzheimer's Foundation of America provides information about how to care for people with Alzheimer's, as well as a list of services for people with the disease. It also offers information for caregivers and their families through member organizations. Services include a toll-free hotline, publications, and other educational materials.Eldercare Locator Phone: 1-800-677-1116 www.eldercare.govCaregivers often need information about community resources, such as home care, adult day care, and nursing homes. Contact the Eldercare Locator to find these resources in your area. The Eldercare Locator is a service of the Administration on Aging. The Federal Government funds this service.National Institute on Aging Information Center Email: niaic@nia.nih.gov Phone: 1-800-222-2225 TTY: 1-800-222-4225 www.nia.nih.gov/healthThe NIA Information Center offers free publications about aging. Many of these publications are in both English and Spanish. They can be viewed, printed, and ordered online. Various disorders and factors contribute to the development of dementia. Neurodegenerative disorders result in a progressive and irreversible loss of neurons and brain functioning. Currently, there are no cures for these types of disorders. They include:- Alzheimer's disease - Frontotemporal disorders - Lewy body dementiaOther types of progressive brain disease include:- Vascular dementia and vascular cognitive impairment - Mixed dementia, a combination of two or more disorders, at least one of which is dementiaOther types of dementia can often be halted or even reversed with treatment. For example, normal pressure hydrocephalus, an abnormal buildup of cerebrospinal fluid in the brain, often resolves with treatment.In addition, certain medical conditions can cause serious memory problems that resemble dementia. These problems should go away once the conditions are treated. These conditions include:- Side effects of certain medicines - Depression - Certain vitamin deficiencies - Drinking too much alcohol - Blood clots or tumors in the brain - Head injury, such as a concussion from a fall or accident - Thyroid, kidney, or liver problemsDoctors have identified many other conditions that can cause dementia or dementia-like symptoms. These conditions include:- Creutzfeldt-Jakob disease, a rare brain disorder - Huntington's disease, a hereditary disorder caused by a faulty gene - Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury - Subdural hematoma, bleeding between the brain's surface and its outer coveringThe overlap in symptoms of various dementias can make it hard to get an accurate diagnosis. But a proper diagnosis is important to get the right treatment. Seek help from a neurologist-a doctor who specializes in disorders of the brain and nervous system-or other medical specialist who knows about dementia.Learn more about dementia from MedlinePlus. Various disorders and factors contribute to the development of dementia. Neurodegenerative disorders result in a progressive and irreversible loss of neurons and brain functioning. Currently, there are no cures for these types of disorders. They include:- Alzheimer's disease - Frontotemporal disorders - Lewy body dementiaOther types of progressive brain disease include:- Vascular dementia and vascular cognitive impairment - Mixed dementia, a combination of two or more disorders, at least one of which is dementiaOther types of dementia can often be halted or even reversed with treatment. For example, normal pressure hydrocephalus, an abnormal buildup of cerebrospinal fluid in the brain, often resolves with treatment.In addition, certain medical conditions can cause serious memory problems that resemble dementia. These problems should go away once the conditions are treated. These conditions include:- Side effects of certain medicines - Depression - Certain vitamin deficiencies - Drinking too much alcohol - Blood clots or tumors in the brain - Head injury, such as a concussion from a fall or accident - Thyroid, kidney, or liver problemsDoctors have identified many other conditions that can cause dementia or dementia-like symptoms. These conditions include:- Creutzfeldt-Jakob disease, a rare brain disorder - Huntington's disease, a hereditary disorder caused by a faulty gene - Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury - Subdural hematoma, bleeding between the brain's surface and its outer coveringThe overlap in symptoms of various dementias can make it hard to get an accurate diagnosis. But a proper diagnosis is important to get the right treatment. Seek help from a neurologist-a doctor who specializes in disorders of the brain and nervous system-or other medical specialist who knows about dementia.Learn more about dementia from MedlinePlus. Various disorders and factors contribute to the development of dementia. Neurodegenerative disorders result in a progressive and irreversible loss of neurons and brain functioning. Currently, there are no cures for these types of disorders. They include:- Alzheimer's disease - Frontotemporal disorders - Lewy body dementiaOther types of progressive brain disease include:- Vascular dementia and vascular cognitive impairment - Mixed dementia, a combination of two or more disorders, at least one of which is dementiaOther types of dementia can often be halted or even reversed with treatment. For example, normal pressure hydrocephalus, an abnormal buildup of cerebrospinal fluid in the brain, often resolves with treatment.In addition, certain medical conditions can cause serious memory problems that resemble dementia. These problems should go away once the conditions are treated. These conditions include:- Side effects of certain medicines - Depression - Certain vitamin deficiencies - Drinking too much alcohol - Blood clots or tumors in the brain - Head injury, such as a concussion from a fall or accident - Thyroid, kidney, or liver problemsDoctors have identified many other conditions that can cause dementia or dementia-like symptoms. These conditions include:- Creutzfeldt-Jakob disease, a rare brain disorder - Huntington's disease, a hereditary disorder caused by a faulty gene - Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury - Subdural hematoma, bleeding between the brain's surface and its outer coveringThe overlap in symptoms of various dementias can make it hard to get an accurate diagnosis. But a proper diagnosis is important to get the right treatment. Seek help from a neurologist-a doctor who specializes in disorders of the brain and nervous system-or other medical specialist who knows about dementia.Learn more about dementia from MedlinePlus. Dementia is the loss of cognitive functioning-thinking, remembering, and reasoning-and behavioral abilities to such an extent that it interferes with a person's daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person's functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.Signs and symptoms of dementia result when once-healthy neurons (nerve cells) in the brain stop working, lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience far greater loss.While dementia is more common as people grow older (up to half of all people age 85 or older may have some form of dementia), it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia. One type of dementia, frontotemporal disorders, is more common in middle-aged than older adults.Memory loss, though common, is not the only sign of dementia. For a person to have dementia, he or she must have:- Two or more core mental functions that are impaired. These functions include memory, language skills, visual perception, and the ability to focus and pay attention. These also include cognitive skills such as the ability to reason and solve problems. - A loss of brain function severe enough that a person cannot do normal, everyday tasksIn addition, some people with dementia cannot control their emotions. Their personalities may change. They can have delusions, which are strong beliefs without proof, such as the idea that someone is stealing from them. They also may hallucinate, seeing or otherwise experiencing things that are not real.The causes of dementia can vary, depending on the types of brain changes that may be taking place. Other dementias include Lewy body dementia, frontotemporal disorders, and vascular dementia. It is common for people to have mixed dementia-a combination of two or more disorders, at least one of which is dementia. For example, some people have both Alzheimer's disease and vascular dementia.Learn more about dementia from MedlinePlus. Dementia is the loss of cognitive functioning-thinking, remembering, and reasoning-and behavioral abilities to such an extent that it interferes with a person's daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person's functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.Signs and symptoms of dementia result when once-healthy neurons (nerve cells) in the brain stop working, lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience far greater loss.While dementia is more common as people grow older (up to half of all people age 85 or older may have some form of dementia), it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia. One type of dementia, frontotemporal disorders, is more common in middle-aged than older adults.Memory loss, though common, is not the only sign of dementia. For a person to have dementia, he or she must have:- Two or more core mental functions that are impaired. These functions include memory, language skills, visual perception, and the ability to focus and pay attention. These also include cognitive skills such as the ability to reason and solve problems. - A loss of brain function severe enough that a person cannot do normal, everyday tasksIn addition, some people with dementia cannot control their emotions. Their personalities may change. They can have delusions, which are strong beliefs without proof, such as the idea that someone is stealing from them. They also may hallucinate, seeing or otherwise experiencing things that are not real.The causes of dementia can vary, depending on the types of brain changes that may be taking place. Other dementias include Lewy body dementia, frontotemporal disorders, and vascular dementia. It is common for people to have mixed dementia-a combination of two or more disorders, at least one of which is dementia. For example, some people have both Alzheimer's disease and vascular dementia.Learn more about dementia from MedlinePlus. Dementia is the loss of cognitive functioning-thinking, remembering, and reasoning-and behavioral abilities to such an extent that it interferes with a person's daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person's functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.Signs and symptoms of dementia result when once-healthy neurons (nerve cells) in the brain stop working, lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience far greater loss.While dementia is more common as people grow older (up to half of all people age 85 or older may have some form of dementia), it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia. One type of dementia, frontotemporal disorders, is more common in middle-aged than older adults.Memory loss, though common, is not the only sign of dementia. For a person to have dementia, he or she must have:- Two or more core mental functions that are impaired. These functions include memory, language skills, visual perception, and the ability to focus and pay attention. These also include cognitive skills such as the ability to reason and solve problems. - A loss of brain function severe enough that a person cannot do normal, everyday tasksIn addition, some people with dementia cannot control their emotions. Their personalities may change. They can have delusions, which are strong beliefs without proof, such as the idea that someone is stealing from them. They also may hallucinate, seeing or otherwise experiencing things that are not real.The causes of dementia can vary, depending on the types of brain changes that may be taking place. Other dementias include Lewy body dementia, frontotemporal disorders, and vascular dementia. It is common for people to have mixed dementia-a combination of two or more disorders, at least one of which is dementia. For example, some people have both Alzheimer's disease and vascular dementia.Learn more about dementia from MedlinePlus. If you do not see an aging friend or relative often, changes in his or her health may seem dramatic. In contrast, the primary caregiver might not notice such changes or realize that more help, medical treatment, or supervision is needed. Or, the primary caregiver might not want to accept the fact that the health of his or her spouse or parent is failing. Sometimes a geriatric care manager or other professional is the first to notice changes.For families dealing with Alzheimer's disease or another dementia, it can be easier to cover for the person-doing things for him or her, filling in information in conversations, and so on-than to acknowledge what is happening.As a caregiver, you can provide support by helping an aging friend or relative get the care they need.A few good questions to help you start the conversation with the primary caregiver are:- If you thought there might be a change in Aunt Joan's condition, whose opinion would you seek? - I didn't notice Dad repeating himself so much the last time I was here. Do you remember when it started?Some changes may not be what you think. Occasional forgetfulness does not necessarily indicate dementia. Before you raise the issue of what needs to be done, talk to your parent and the primary caregiver about your concerns.Try not to sound critical when you raise the subject. Instead, mention your particular worry, for example, \"Mom, it looks like you don't have much food in the house-are you having trouble getting to the store?\" and explain why you are asking. Listen to what the primary caregiver says about the situation and whether he or she believes there are problems.Discuss what you think could be done. For example, you could ask:- Would you like me to arrange to have groceries delivered on a regular basis? - Do we need to get a second opinion about the diagnosis? - Can you follow the medication schedule? - Would you like some help with housework?Try to follow your suggestions with practical help, and give specific examples of what you can do. For example, you might arrange to have a personal or home health aide come in once a week. You might schedule doctors' appointments or arrange for transportation.In some cases, you may have to be forceful, especially if you feel that the situation is unhealthy or unsafe. Do not leave a frail adult at risk. If you have to act against the wishes of your parent or the primary caregiver, be direct and explain what you are going to do. Discuss your plan, and say why you are taking action.Find more tips for long-distance caregivers. If you do not see an aging friend or relative often, changes in his or her health may seem dramatic. In contrast, the primary caregiver might not notice such changes or realize that more help, medical treatment, or supervision is needed. Or, the primary caregiver might not want to accept the fact that the health of his or her spouse or parent is failing. Sometimes a geriatric care manager or other professional is the first to notice changes.For families dealing with Alzheimer's disease or another dementia, it can be easier to cover for the person-doing things for him or her, filling in information in conversations, and so on-than to acknowledge what is happening.As a caregiver, you can provide support by helping an aging friend or relative get the care they need.A few good questions to help you start the conversation with the primary caregiver are:- If you thought there might be a change in Aunt Joan's condition, whose opinion would you seek? - I didn't notice Dad repeating himself so much the last time I was here. Do you remember when it started?Some changes may not be what you think. Occasional forgetfulness does not necessarily indicate dementia. Before you raise the issue of what needs to be done, talk to your parent and the primary caregiver about your concerns.Try not to sound critical when you raise the subject. Instead, mention your particular worry, for example, \"Mom, it looks like you don't have much food in the house-are you having trouble getting to the store?\" and explain why you are asking. Listen to what the primary caregiver says about the situation and whether he or she believes there are problems.Discuss what you think could be done. For example, you could ask:- Would you like me to arrange to have groceries delivered on a regular basis? - Do we need to get a second opinion about the diagnosis? - Can you follow the medication schedule? - Would you like some help with housework?Try to follow your suggestions with practical help, and give specific examples of what you can do. For example, you might arrange to have a personal or home health aide come in once a week. You might schedule doctors' appointments or arrange for transportation.In some cases, you may have to be forceful, especially if you feel that the situation is unhealthy or unsafe. Do not leave a frail adult at risk. If you have to act against the wishes of your parent or the primary caregiver, be direct and explain what you are going to do. Discuss your plan, and say why you are taking action.Find more tips for long-distance caregivers. To diagnose dementia, doctors first assess whether a person has an underlying treatable condition such as depression, abnormal thyroid function, normal pressure hydrocephalus, or vitamin B12 deficiency. Early diagnosis is important, as some causes for symptoms can be treated. In many cases, the specific type of dementia a person has may not be confirmed until after the person has died and the brain is examined.A medical assessment for dementia generally includes:- Patient history. Typical questions about a person's medical and family history might include asking about whether dementia runs in the family, how and when symptoms began, changes in behavior and personality, and if the person is taking certain medications that might cause or worsen symptoms. - Physical exam. Measuring blood pressure and other vital signs may help physicians detect conditions that might cause or occur with dementia. Such conditions may be treatable. - Neurological tests. Assessing balance, sensory function, reflexes, vision, eye movements, and other cognitive functions helps identify conditions that may affect the diagnosis or are treatable with drugs. To diagnose dementia, doctors first assess whether a person has an underlying treatable condition such as depression, abnormal thyroid function, normal pressure hydrocephalus, or vitamin B12 deficiency. Early diagnosis is important, as some causes for symptoms can be treated. In many cases, the specific type of dementia a person has may not be confirmed until after the person has died and the brain is examined.A medical assessment for dementia generally includes:- Patient history. Typical questions about a person's medical and family history might include asking about whether dementia runs in the family, how and when symptoms began, changes in behavior and personality, and if the person is taking certain medications that might cause or worsen symptoms. - Physical exam. Measuring blood pressure and other vital signs may help physicians detect conditions that might cause or occur with dementia. Such conditions may be treatable. - Neurological tests. Assessing balance, sensory function, reflexes, vision, eye movements, and other cognitive functions helps identify conditions that may affect the diagnosis or are treatable with drugs. The following procedures also may be used to diagnose dementia:- Cognitive and neuropsychological tests. These tests measure memory, problem solving, attention, counting, language skills, and other abilities related to mental functioning. - Laboratory tests. Blood and urine tests can help find or rule out possible causes of symptoms. - Brain scans. These tests can identify strokes, tumors, and other problems that can cause dementia. Scans also identify changes in the brain's structure and function. The most common scans are: - Computed tomography (CT), which uses X-rays to produce images of the brain and other organs - Magnetic resonance imaging (MRI), which uses magnetic fields and radio waves to produce detailed images of body structures, including tissues, organs, bones, and nerves - Positron emission tomography (PET), which uses radiation to provide pictures of brain activity - Psychiatric evaluation. This evaluation will help determine if depression or another mental health condition is causing or contributing to a person's symptoms. - Genetic tests. Some dementias are caused by a known gene defect. In these cases, a genetic test can help people know if they are at risk for dementia. People should talk with family members, a primary care doctor, and a genetic counselor before getting tested. Visiting a family doctor is often the first step for people who are experiencing changes in thinking, movement, or behavior. However, neurologists-doctors who specialize in disorders of the brain and nervous system-generally have the expertise needed to diagnose dementia. Geriatric psychiatrists, neuropsychologists, and geriatricians may also be skilled in diagnosing the condition.If a specialist cannot be found in your community, ask the neurology department of the nearest medical school for a referral. A hospital affiliated with a medical school may also have a dementia or movement disorders clinic that provides expert evaluation.",
+    "https://www.nia.nih.gov/health/topics/dementia"
+  ],
+  [
+    "Dementia - home care: Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, and behavior. A loved one with dementia will need support in the home as the disease gets worse. You can help by trying to understand how the person with dementia perceives his or her world. Give the person a chance to talk about any challenges and take part in his or her own daily care. Start by talking with your loved one's health care provider. Ask how you can: - Help the person stay calm and oriented - Make dressing and grooming easier - Talk to the person - Help with memory loss - Manage behavior and sleep problems Tips for reducing confusion in people with dementia include: - Have familiar objects and people around. - Keep lights on at night. - Use reminders, notes, lists of routine tasks, or directions for daily activities. - Stick to a simple activity schedule. Taking regular walks with a caregiver can help improve communication skills and prevent wandering. Calming music may reduce wandering and restlessness, ease anxiety, and improve sleep and behavior. People with dementia should have their eyes and ears checked. If problems are found, hearing aids, glasses, or cataract surgery may be needed. People with dementia should also have regular driving tests. At some point, it won't be safe for them to continue to drive. This may not be an easy conversation, so seek help from their provider and other family members. State laws vary on the ability of a person with dementia to continue to drive. Supervised meals can help with feeding. People with dementia often forget to eat and drink, and can become dehydrated as a result. Talk to the provider about the need for extra calories due to increased physical activity from restlessness and wandering. Also talk to the provider about: - Watching for risk of choking and what to do if choking occurs - How to increase safety in the home - How to prevent falls - Ways to improve bathroom safety The Alzheimer's Association's Safe Return Program requires people with dementia to wear an identification bracelet. If they wander, their caregiver can contact the police and the national Safe Return office, where information about them is stored and shared nationwide. Eventually, people with dementia may need 24-hour monitoring and assistance to provide a safe environment, control aggressive or agitated behavior, and meet their needs. LONG-TERM CARE A person with dementia may need monitoring and help at home or in an institution. Possible options include: - Adult day care - Boarding homes - Nursing homes - In-home care Many organizations are available to help you care for a person with dementia. They include: - Adult protective services - Community resources - Local or state government departments of aging - Visiting nurses or aides - Volunteer services In some communities, dementia-related support groups may be available. Family counseling can help family members cope with home care. Advance directives, power of attorney, and other legal actions may make it easier to decide on care for the person with dementia. Seek legal advice early, before the person is unable to make these decisions. There are support groups that can provide information and resources for people with Alzheimer disease and their caregivers. Updated by: Daniel Kantor, MD, Kantor Neurology, Coconut Creek, FL and Immediate Past President of the Florida Society of Neurology (FSN). Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007428.htm"
+  ],
+  [
+    "Dementia (TYPES OF DEMENTIA): Various disorders and factors contribute to the development of dementia. Neurodegenerative disorders result in a progressive and irreversible loss of neurons and brain functioning. Currently, there are no cures for these types of disorders. They include:- Alzheimer's disease - Frontotemporal disorders - Lewy body dementiaOther types of progressive brain disease include:- Vascular dementia and vascular cognitive impairment - Mixed dementia, a combination of two or more disorders, at least one of which is dementiaOther types of dementia can often be halted or even reversed with treatment. For example, normal pressure hydrocephalus, an abnormal buildup of cerebrospinal fluid in the brain, often resolves with treatment.In addition, certain medical conditions can cause serious memory problems that resemble dementia. These problems should go away once the conditions are treated. These conditions include:- Side effects of certain medicines - Depression - Certain vitamin deficiencies - Drinking too much alcohol - Blood clots or tumors in the brain - Head injury, such as a concussion from a fall or accident - Thyroid, kidney, or liver problemsDoctors have identified many other conditions that can cause dementia or dementia-like symptoms. These conditions include:- Creutzfeldt-Jakob disease, a rare brain disorder - Huntington's disease, a hereditary disorder caused by a faulty gene - Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury - Subdural hematoma, bleeding between the brain's surface and its outer coveringThe overlap in symptoms of various dementias can make it hard to get an accurate diagnosis. But a proper diagnosis is important to get the right treatment. Seek help from a neurologist-a doctor who specializes in disorders of the brain and nervous system-or other medical specialist who knows about dementia.Learn more about dementia from MedlinePlus.",
+    "https://www.nia.nih.gov/health/topics/dementia"
+  ],
+  [
+    "Dementia (DIAGNOSING DEMENTIA): To diagnose dementia, doctors first assess whether a person has an underlying treatable condition such as depression, abnormal thyroid function, normal pressure hydrocephalus, or vitamin B12 deficiency. Early diagnosis is important, as some causes for symptoms can be treated. In many cases, the specific type of dementia a person has may not be confirmed until after the person has died and the brain is examined.A medical assessment for dementia generally includes:- Patient history. Typical questions about a person's medical and family history might include asking about whether dementia runs in the family, how and when symptoms began, changes in behavior and personality, and if the person is taking certain medications that might cause or worsen symptoms. - Physical exam. Measuring blood pressure and other vital signs may help physicians detect conditions that might cause or occur with dementia. Such conditions may be treatable. - Neurological tests. Assessing balance, sensory function, reflexes, vision, eye movements, and other cognitive functions helps identify conditions that may affect the diagnosis or are treatable with drugs.",
+    "https://www.nia.nih.gov/health/topics/dementia"
+  ],
+  [
+    "Etiology: Etiology describes the cause or causes of a disease. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002356.htm"
+  ],
+  [
+    "What causes Dementia?: Dementia usually occurs in older age. It is rare in people under age 60. The risk of dementia increases as a person gets older. Most types of dementia are nonreversible (degenerative). Nonreversible means the changes in the brain that are causing the dementia cannot be stopped or turned back. Alzheimer disease is the most common type of dementia. Another common type of dementia is vascular dementia. It is caused by many small strokes. Lewy body disease is a common cause of dementia in the elderly. People with this condition have abnormal protein structures in certain areas of the brain. The following medical conditions can also lead to dementia: - Huntington disease - Brain injury - Multiple sclerosis - Infections such as HIV/AIDS, syphilis,and Lyme disease - Parkinson disease - Pick disease - Progressive supranuclear palsy Some causes of dementia may be stopped or reversed if they are found soon enough, including: - Brain injury - Brain tumors - Chronic alcohol abuse - Changes in blood sugar, sodium, and calcium levels (dementia due to metabolic causes) - Low vitamin B12 level - Normal pressure hydrocephalus - Use of certain medicines, including cimetidine and some cholesterol drugs",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000739.htm"
+  ],
+  [
+    "Dementia - home care (Information): A loved one with dementia will need support in the home as the disease gets worse. You can help by trying to understand how the person with dementia perceives his or her world. Give the person a chance to talk about any challenges and take part in his or her own daily care. Start by talking with your loved one's health care provider. Ask how you can: - Help the person stay calm and oriented - Make dressing and grooming easier - Talk to the person - Help with memory loss - Manage behavior and sleep problems Tips for reducing confusion in people with dementia include: - Have familiar objects and people around. - Keep lights on at night. - Use reminders, notes, lists of routine tasks, or directions for daily activities. - Stick to a simple activity schedule. Taking regular walks with a caregiver can help improve communication skills and prevent wandering. Calming music may reduce wandering and restlessness, ease anxiety, and improve sleep and behavior. People with dementia should have their eyes and ears checked. If problems are found, hearing aids, glasses, or cataract surgery may be needed. People with dementia should also have regular driving tests. At some point, it won't be safe for them to continue to drive. This may not be an easy conversation, so seek help from their provider and other family members. State laws vary on the ability of a person with dementia to continue to drive. Supervised meals can help with feeding. People with dementia often forget to eat and drink, and can become dehydrated as a result. Talk to the provider about the need for extra calories due to increased physical activity from restlessness and wandering. Also talk to the provider about: - Watching for risk of choking and what to do if choking occurs - How to increase safety in the home - How to prevent falls - Ways to improve bathroom safety The Alzheimer's Association's Safe Return Program requires people with dementia to wear an identification bracelet. If they wander, their caregiver can contact the police and the national Safe Return office, where information about them is stored and shared nationwide. Eventually, people with dementia may need 24-hour monitoring and assistance to provide a safe environment, control aggressive or agitated behavior, and meet their needs. LONG-TERM CARE A person with dementia may need monitoring and help at home or in an institution. Possible options include: - Adult day care - Boarding homes - Nursing homes - In-home care Many organizations are available to help you care for a person with dementia. They include: - Adult protective services - Community resources - Local or state government departments of aging - Visiting nurses or aides - Volunteer services In some communities, dementia-related support groups may be available. Family counseling can help family members cope with home care. Advance directives, power of attorney, and other legal actions may make it easier to decide on care for the person with dementia. Seek legal advice early, before the person is unable to make these decisions. There are support groups that can provide information and resources for people with Alzheimer disease and their caregivers.",
+    "https://medlineplus.gov/ency/article/007428.htm"
+  ],
+  [
+    "Dementia - home care: Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, and behavior. A loved one with dementia will need support in the home as the disease gets worse. You can help by trying to understand how the person with dementia perceives his or her world. Give the person a chance to talk about any challenges and take part in his or her own daily care. Start by talking with your loved one's health care provider. Ask how you can: - Help the person stay calm and oriented - Make dressing and grooming easier - Talk to the person - Help with memory loss - Manage behavior and sleep problems Tips for reducing confusion in people with dementia include: - Have familiar objects and people around. - Keep lights on at night. - Use reminders, notes, lists of routine tasks, or directions for daily activities. - Stick to a simple activity schedule. Taking regular walks with a caregiver can help improve communication skills and prevent wandering. Calming music may reduce wandering and restlessness, ease anxiety, and improve sleep and behavior. People with dementia should have their eyes and ears checked. If problems are found, hearing aids, glasses, or cataract surgery may be needed. People with dementia should also have regular driving tests. At some point, it won't be safe for them to continue to drive. This may not be an easy conversation, so seek help from their provider and other family members. State laws vary on the ability of a person with dementia to continue to drive. Supervised meals can help with feeding. People with dementia often forget to eat and drink, and can become dehydrated as a result. Talk to the provider about the need for extra calories due to increased physical activity from restlessness and wandering. Also talk to the provider about: - Watching for risk of choking and what to do if choking occurs - How to increase safety in the home - How to prevent falls - Ways to improve bathroom safety The Alzheimer's Association's Safe Return Program requires people with dementia to wear an identification bracelet. If they wander, their caregiver can contact the police and the national Safe Return office, where information about them is stored and shared nationwide. Eventually, people with dementia may need 24-hour monitoring and assistance to provide a safe environment, control aggressive or agitated behavior, and meet their needs. LONG-TERM CARE A person with dementia may need monitoring and help at home or in an institution. Possible options include: - Adult day care - Boarding homes - Nursing homes - In-home care Many organizations are available to help you care for a person with dementia. They include: - Adult protective services - Community resources - Local or state government departments of aging - Visiting nurses or aides - Volunteer services In some communities, dementia-related support groups may be available. Family counseling can help family members cope with home care. Advance directives, power of attorney, and other legal actions may make it easier to decide on care for the person with dementia. Seek legal advice early, before the person is unable to make these decisions. There are support groups that can provide information and resources for people with Alzheimer disease and their caregivers. Updated by: Daniel Kantor, MD, Kantor Neurology, Coconut Creek, FL and Immediate Past President of the Florida Society of Neurology (FSN). Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007428.htm"
+  ],
+  [
+    "Frontotemporal dementia (Related Diseases): The following diseases are related to Frontotemporal dementia. If you have a question about any of these diseases, you can contact GARD. Pick's disease Primary progressive aphasia Semantic dementia",
+    "https://rarediseases.info.nih.gov/diseases/8436/frontotemporal-dementia"
+  ],
+  [
+    "Dementia (Overview): Dementia isn't a specific disease. Instead, dementia describes a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with daily functioning. Though dementia generally involves memory loss, memory loss has different causes. So memory loss alone doesn't mean you have dementia. Alzheimer's disease is the most common cause of a progressive dementia in older adults, but there are a number of causes of dementia. Depending on the cause, some dementia symptoms can be reversed. Dementia care at Mayo Clinic",
+    "https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013"
+  ],
+  [
+    "Dementia (WHAT IS DEMENTIA?): Dementia is the loss of cognitive functioning-thinking, remembering, and reasoning-and behavioral abilities to such an extent that it interferes with a person's daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person's functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.Signs and symptoms of dementia result when once-healthy neurons (nerve cells) in the brain stop working, lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience far greater loss.While dementia is more common as people grow older (up to half of all people age 85 or older may have some form of dementia), it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia. One type of dementia, frontotemporal disorders, is more common in middle-aged than older adults.Memory loss, though common, is not the only sign of dementia. For a person to have dementia, he or she must have:- Two or more core mental functions that are impaired. These functions include memory, language skills, visual perception, and the ability to focus and pay attention. These also include cognitive skills such as the ability to reason and solve problems. - A loss of brain function severe enough that a person cannot do normal, everyday tasksIn addition, some people with dementia cannot control their emotions. Their personalities may change. They can have delusions, which are strong beliefs without proof, such as the idea that someone is stealing from them. They also may hallucinate, seeing or otherwise experiencing things that are not real.The causes of dementia can vary, depending on the types of brain changes that may be taking place. Other dementias include Lewy body dementia, frontotemporal disorders, and vascular dementia. It is common for people to have mixed dementia-a combination of two or more disorders, at least one of which is dementia. For example, some people have both Alzheimer's disease and vascular dementia.Learn more about dementia from MedlinePlus.",
+    "https://www.nia.nih.gov/health/topics/dementia"
+  ],
+  [
+    "Dementia (Definition): Dementia is not a specific disease. It is a descriptive term for a collection of symptoms that can be caused by a number of disorders that affect the brain. People with dementia have significantly impaired intellectual functioning that interferes with normal activities and relationships. They also lose their ability to solve problems and maintain emotional control, and they may experience personality changes and behavioral problems, such as agitation, delusions, and hallucinations. While memory loss is a common symptom of dementia, memory loss by itself does not mean that a person has dementia. Doctors diagnose dementia only if two or more brain functions - such as memory and language skills -- are significantly impaired without loss of consciousness.\u00a0 Some of the diseases that can cause symptoms of dementia are Alzheimer\u2019s disease, vascular dementia, Lewy body dementia, frontotemporal dementia, Huntington\u2019s disease, and Creutzfeldt-Jakob disease.\u00a0 Doctors have identified other conditions that can cause dementia or dementia-like symptoms including reactions to medications, metabolic problems and endocrine abnormalities, nutritional deficiencies, infections, poisoning, brain tumors, anoxia or hypoxia (conditions in which the brain\u2019s oxygen supply is either reduced or cut off entirely), and heart and lung problems.\u00a0 Although it is common in very elderly individuals, dementia is not a normal part of the aging process.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Dementia-Information-Page"
+  ],
+  [
+    "Dementia (VASCULAR DEMENTIA AND VASCULAR COGNITIVE IMPAIRMENT: A RESOURCE LIST): Vascular dementia, the second most common form of dementia in older adults after Alzheimer's disease, and vascular cognitive impairment (VCI) result from injuries to vessels that supply blood to the brain, often after a stroke or series of strokes. The symptoms of vascular dementia can be similar to those of Alzheimer's, and both conditions can occur at the same time (a condition called \"mixed dementia\"). Symptoms of vascular dementia and VCI can begin suddenly and worsen or improve over time.Caregivers of people with vascular dementia or VCI face a variety of challenges. Learning more about these disorders can help. This resource list is a place to start. All resources on this list are available free online.The items on this list are in three categories:- Vascular Dementia and Vascular Cognitive Impairment - CADASIL-a rare, inherited form of vascular dementia - Binswanger's Disease-also called Subcortical Vascular Dementia",
+    "https://www.nia.nih.gov/health/topics/dementia"
+  ],
+  [
+    "Dementia (Symptoms): Dementia symptoms include difficulty with many areas of mental function, including: - Emotional behavior or personality - Language - Memory - Perception - Thinking and judgment (cognitive skills) Dementia usually first appears as forgetfulness. Mild cognitive impairment (MCI) is the stage between normal forgetfulness due to aging and the development of dementia. People with MCI have mild problems with thinking and memory that do not interfere with daily activities. They often know about their forgetfulness. Not everyone with MCI develops dementia. Symptoms of MCI include: - Difficulty doing more than one task at a time - Difficulty solving problems or making decisions - Forgetting recent events or conversations - Taking longer to do more difficult mental activities Early symptoms of dementia can include: - Difficulty with tasks that take some thought, but that used to come easily, such as balancing a checkbook, playing games (such as bridge), and learning new information or routines - Getting lost on familiar routes - Language problems, such as trouble with the names of familiar objects - Losing interest in things previously enjoyed, flat mood - Misplacing items - Personality changes and loss of social skills, which can lead to inappropriate behaviors As dementia becomes worse, symptoms are more obvious and interfere with the ability to take care of oneself. Symptoms may include: - Change in sleep patterns, often waking up at night - Difficulty with basic tasks, such as preparing meals, choosing proper clothing, or driving - Forgetting details about current events - Forgetting events in one's own life history, losing self-awareness - Having hallucinations, arguments, striking out, and violent behavior - Having delusions, depression, agitation - More difficulty reading or writing - Poor judgment and loss of ability to recognize danger - Using the wrong word, not pronouncing words correctly, speaking in confusing sentences - Withdrawing from social contact People with severe dementia can no longer: - Perform basic activities of daily living, such as eating, dressing, and bathing - Recognize family members - Understand language Other symptoms that may occur with dementia: - Problems controlling bowel movements or urine - Swallowing problems",
+    "https://medlineplus.gov/ency/article/000739.htm"
+  ],
+  [
+    "Myopathy with extrapyramidal signs (Symptoms): The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Ataxia Occasional Microcephaly Occasional Ophthalmoplegia Occasional Optic atrophy Occasional Peripheral axonal neuropathy Occasional Ptosis Occasional Abnormality of extrapyramidal motor function Very rare Chorea Very rare Dystonia Very rare Orofacial dyskinesia Very rare Proximal muscle weakness Very rare Specific learning disability Very rare Tremor Very rare Autosomal recessive inheritance - Difficulty running - Difficulty walking - Elevated serum creatine phosphokinase - Motor delay - View complete list of signs and symptoms...",
+    "https://rarediseases.info.nih.gov/diseases/12978/myopathy-with-extrapyramidal-signs"
+  ],
+  [
+    "Dementia (Symptoms): Dementia symptoms vary depending on the cause, but common signs and symptoms include: Cognitive changes - Memory loss, which is usually noticed by a spouse or someone else - Difficulty communicating or finding words - Difficulty reasoning or problem-solving - Difficulty handling complex tasks - Difficulty with planning and organizing - Difficulty with coordination and motor functions - Confusion and disorientation Psychological changes - Personality changes - Depression - Anxiety - Inappropriate behavior - Paranoia - Agitation - Hallucinations When to see a doctor See a doctor if you or a loved one has memory problems or other dementia symptoms. Some treatable medical conditions can cause dementia symptoms, so it's important to determine the underlying cause.",
+    "https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013"
+  ],
+  [
+    "Vascular dementia (Symptoms): Symptoms of VaD may develop gradually or may progress after each small stroke. Symptoms may begin suddenly after each stroke. Some people with VaD may improve for short periods, but decline after having more silent strokes. Early symptoms of dementia can include: - Difficulty performing tasks that used to come easily, such as balancing a checkbook, playing games (such as bridge), and learning new information or routines - Getting lost on familiar routes - Language problems, such as trouble finding the name of familiar objects - Losing interest in things you previously enjoyed, flat mood - Misplacing items - Personality changes and loss of social skills As dementia worsens, symptoms are more obvious and the ability to take care of oneself declines. Symptoms may include: - Change in sleep patterns, often waking up at night - Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, or driving - Forgetting details about current events - Forgetting events in your own life history, losing awareness of who you are - Having delusions, depression, or agitation - Having hallucinations, arguments, striking out, or violent behavior - Having more difficulty reading or writing - Having poor judgment and loss of ability to recognize danger - Using the wrong word, not pronouncing words correctly, or speaking in confusing sentences - Withdrawing from social contact Nervous system (neurologic) problems that occur with a stroke may also be present.",
+    "https://medlineplus.gov/ency/article/000746.htm"
+  ],
+  [
+    "Vascular dementia (Symptoms): Vascular dementia symptoms vary, depending on the part of your brain where blood flow is impaired. Symptoms often overlap with those of other types of dementia, especially Alzheimer's disease. Vascular dementia symptoms may be most clear-cut when they occur suddenly following a stroke. When changes in your thinking and reasoning seem clearly linked to a stroke, this condition is sometimes called post-stroke dementia. Another characteristic pattern of vascular dementia symptoms sometimes follows a series of strokes or mini strokes. In this pattern, changes in your thought processes occur in noticeable steps downward from your previous level of function, unlike the gradual, steady decline that typically occurs in Alzheimer's disease. But vascular dementia can also develop very gradually, just like Alzheimer's disease. What's more, vascular dementia and Alzheimer's often occur together. Studies show that people with dementia symptoms usually have brain changes typical of more than one type. Some doctors call this condition mixed dementia. Vascular dementia symptoms include: - Confusion - Trouble paying attention and concentrating - Reduced ability to organize thoughts or actions - Decline in ability to analyze a situation, develop an effective plan and communicate that plan to others - Difficulty deciding what to do next - Problems with memory - Restlessness and agitation - Unsteady gait - Sudden or frequent urge to urinate or inability to control passing urine - Depression",
+    "https://www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793"
+  ],
+  [
+    "Frontotemporal dementia (Symptoms): Identifying precisely which diseases fall into the category of frontotemporal dementia presents a particular challenge to scientists. The signs and symptoms may vary greatly from one individual to the next. Researchers have identified several clusters of symptoms that tend to occur together and are dominant in subgroups of people with the disorder. More than one symptom cluster may be apparent in the same person. The signs and symptoms of frontotemporal dementia progressively worsen with time, almost always over years. Eventually, people require 24-hour care. The most common signs and symptoms of frontotemporal dementia involve extreme changes in behavior and personality. These include: - Increasingly inappropriate actions - Loss of empathy and other interpersonal skills - Lack of judgment and inhibition - Apathy - Repetitive compulsive behavior - A decline in personal hygiene - Changes in eating habits, predominantly overeating - Oral exploration and consumption of inedible objects - Lack of awareness of thinking or behavioral changes Some subtypes of frontotemporal dementia are marked by the impairment or loss of speech and language difficulties. Two types of primary progressive aphasia are considered frontotemporal dementia. Primary progressive aphasia is characterized by an increasing difficulty in using and understanding written and spoken language. For example, people may have trouble finding the right word to use in speech or naming objects. Semantic dementia is one type of primary progressive aphasia. It's also known as semantic variant primary progressive aphasia. Individuals with semantic dementia have prominent difficulty naming (anomia) and may replace a specific word with a more general word such as \"it\" for pen. They may also lose knowledge of word meaning. Progressive agrammatic (nonfluent) aphasia is another type of primary progressive aphasia characterized by nonfluent and hesitant speech. Speech may sound telegraphic with misuse of pronouns and errors in sentence construction. Rarer subtypes of frontotemporal dementia are characterized by problems with movement, similar to those associated with Parkinson's disease or amyotrophic lateral sclerosis. Movement-related signs and symptoms may include: - Tremor - Rigidity - Muscle spasms - Poor coordination - Difficulty swallowing - Muscle weakness",
+    "https://www.mayoclinic.org/diseases-conditions/frontotemporal-dementia/symptoms-causes/syc-20354737"
+  ],
+  [
+    "Symptoms and Causes of Diabetes (What are the symptoms of diabetes?): Symptoms of diabetes includeincreased thirst and urination increased hunger fatigue blurred vision numbness or tingling in the feet or hands sores that do not heal unexplained weight lossSymptoms of type 1 diabetes can start quickly, in a matter of weeks. Symptoms of type 2 diabetes often develop slowly\u2014over the course of several years\u2014and can be so mild that you might not even notice them. Many people with type 2 diabetes have no symptoms. Some people do not find out they have the disease until they have diabetes-related health problems, such as blurred vision or heart trouble.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes"
+  ],
+  [
+    "Vital signs: Vital signs reflect essential body functions, including your heartbeat, breathing rate, temperature, and blood pressure. Your health care provider may watch, measure, or monitor your vital signs to check your level of physical functioning. Normal vital signs change with age, sex, weight, exercise capability, and overall health. Normal vital sign ranges for the average healthy adult while resting are: - Blood pressure: 90/60 mm Hg to 120/80 mm Hg - Breathing: 12 to 18 breaths per minute - Pulse: 60 to 100 beats per minute - Temperature: 97.8\u00b0F to 99.1\u00b0F (36.5\u00b0C to 37.3\u00b0C)/average 98.6\u00b0F (37\u00b0C) Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002341.htm"
+  ],
+  [
+    "Myopathy with extrapyramidal signs: Myopathy with extrapyramidal signs is a disorder characterized by early childhood onset of proximal muscle weakness (muscles closest to the body\u2019s midline) and learning disabilities. The muscle weakness does not progress, but most patients develop progressive atypical involuntary muscle contractions that influence gait, movement, and posture (extrapyramidal signs) that may be disabling. Signs and symptoms are variable and include brief, repetitive, jerky and uncontrolled movements caused by muscle contractions ( chorea), tremor, abnormal posturing, and involuntary repetitive movements of the mouth and face. [1] \u00a0Other symptoms may include uncoordinated movements ( ataxia ), a very small head ( microcephaly ), drooping of the eyelids, wasting of the eye nerve ( optic atrophy), and axonal peripheral neuropathy. It is caused by changes ( mutations ) in the MICU1 gene and is inherited in an autosomal recessive \u00a0 pattern. [1] [2] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Ataxia Occasional Microcephaly Occasional Ophthalmoplegia Occasional Optic atrophy Occasional Peripheral axonal neuropathy Occasional Ptosis Occasional Abnormality of extrapyramidal motor function Very rare Chorea Very rare Dystonia Very rare Orofacial dyskinesia Very rare Proximal muscle weakness Very rare Specific learning disability Very rare Tremor Very rare Autosomal recessive inheritance - Difficulty running - Difficulty walking - Elevated serum creatine phosphokinase - Motor delay - View complete list of signs and symptoms...",
+    "https://rarediseases.info.nih.gov/diseases/12978/myopathy-with-extrapyramidal-signs"
+  ],
+  [
+    "Dementia (Treatment): Most types of dementia can't be cured, but there are ways to manage your symptoms. Medications The following are used to temporarily improve dementia symptoms. - Cholinesterase inhibitors. These medications - including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) - work by boosting levels of a chemical messenger involved in memory and judgment. Although primarily used to treat Alzheimer's disease, these medications might also be prescribed for other dementias, including vascular dementia, Parkinson's disease dementia and Lewy body dementia. Side effects can include nausea, vomiting and diarrhea. - Memantine. Memantine (Namenda) works by regulating the activity of glutamate, another chemical messenger involved in brain functions, such as learning and memory. In some cases, memantine is prescribed with a cholinesterase inhibitor. A common side effect of memantine is dizziness. - Other medications. Your doctor might prescribe medications to treat other symptoms or conditions, such as depression, sleep disturbances or agitation. Therapies Several dementia symptoms and behavior problems might be treated initially using nondrug approaches, such as: - Occupational therapy. An occupational therapist can show you how to make your home safer and teach coping behaviors. The purpose is to prevent accidents, such as falls; manage behavior; and prepare you for the dementia progression. - Modifying the environment. Reducing clutter and noise can make it easier for someone with dementia to focus and function. You might need to hide objects that can threaten safety, such as knives and car keys. Monitoring systems can alert you if the person with dementia wanders. - Modifying tasks. Break tasks into easier steps and focus on success, not failure. Structure and routine also help reduce confusion in people with dementia.",
+    "https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013"
+  ],
+  [
+    "What are the treatments for Dementia?: Drugs to specifically treat Alzheimers disease and some other progressive dementias are now available. Although these drugs do not halt the disease or reverse existing brain damage, they can improve symptoms and slow the progression of the disease. This may improve an individuals quality of life, ease the burden on caregivers, or delay admission to a nursing home. Many researchers are also examining whether these drugs may be useful for treating other types of dementia. Many people with dementia, particularly those in the early stages, may benefit from practicing tasks designed to improve performance in specific aspects of cognitive functioning. For example, people can sometimes be taught to use memory aids, such as mnemonics, computerized recall devices, or note taking.",
+    "http://www.ninds.nih.gov/disorders/dementias/dementia.htm"
+  ],
+  [
+    "What are the treatments for Dementia?: Treatment depends on the condition causing the dementia. Some people may need to stay in the hospital for a short time. Sometimes, dementia medicine can make a patient's confusion worse. Stopping or changing these medicines is part of the treatment. Certain mental exercises can help with dementia. Treating conditions that can lead to confusion often greatly improve mental function. Such conditions include: - Anemia - Congestive heart failure - Decreased blood oxygen (hypoxia) - Depression - Heart failure - Infections - Nutritional disorders - Thyroid disorders Medicines may be used to: - Slow the rate at which symptoms get worse, though improvement with these drugs may be small - Control problems with behavior, such as loss of judgment or confusion Someone with dementia will need support in the homeas the disease gets worse. Family members or other caregivers can help by helping the person cope with memory lossand behavior and sleep problems. It is important to make sure the homes of people who have dementia are safe for them.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000739.htm"
+  ],
+  [
+    "Frontotemporal dementia (Treatment): Frontotemporal dementia can't be cured. There is no effective way to slow its progression. Treatment involves managing the symptoms. Medications - Antidepressants. Some types of antidepressants, such as trazodone, may reduce the behavioral problems associated with frontotemporal dementia. Selective serotonin reuptake inhibitors (SSRIs) - such as sertraline (Zoloft) or fluvoxamine (Luvox) - also have been effective in some people. - Antipsychotics. Antipsychotic medications, such as olanzapine (Zyprexa) or quetiapine (Seroquel), are sometimes used to combat the behavioral problems of frontotemporal dementia. However, these medications must be used with caution because the side effects include an increased risk of death in dementia patients. Therapy People experiencing language difficulties may benefit from speech therapy to learn alternate strategies for communication.",
+    "https://www.mayoclinic.org/diseases-conditions/frontotemporal-dementia/symptoms-causes/syc-20354737"
+  ],
+  [
+    "Lewy body dementia (Treatment): Treatment can be challenging, and there's no cure for Lewy body dementia. Doctors treat the individual symptoms. Medications - Cholinesterase inhibitors. These Alzheimer's disease medications, such as rivastigmine (Exelon), work by increasing the levels of chemical messengers believed to be important for memory, thought and judgment (neurotransmitters) in the brain. This can help improve alertness and cognition, and may help reduce hallucinations and other behavioral problems. Possible side effects may include gastrointestinal upset, excessive salivation and tearing, and frequent urination. These are not FDA approved for Lewy body dementia. - Parkinson's disease medications. These medications, such as carbidopa-levodopa (Sinemet) may help reduce parkinsonian symptoms, such as rigid muscles and slow movement. However, these medications may also increase confusion, hallucinations and delusions. - Medications to treat other symptoms. Your doctor may prescribe medications to treat other symptoms associated with Lewy body dementia, such as sleep or movement problems. If possible, avoid medications with anticholinergic properties, which can worsen cognition or dopamine agonists, which can cause hallucinations. First-generation antipsychotic medications, such as haloperidol (Haldol), should not be used to treat Lewy body dementia. They may cause severe confusion, severe Parkinsonism, sedation and sometimes even death. Very rarely, certain second-generation antipsychotics may be prescribed for a short time at a low dose but only if the benefits outweigh the risks. Therapies Because antipsychotic drugs can worsen Lewy body dementia symptoms, it might be helpful to initially try nondrug approaches, such as: - Tolerating the behavior. Many times a person with Lewy body dementia isn't distressed by the hallucinations. In these cases, the side effects of medication may be worse than the hallucinations themselves. - Modifying the environment. Reducing clutter and distracting noise can make it easier for someone with dementia to function. - Offering soothing responses. A caregiver's response may worsen behavior. Avoid correcting and quizzing a person with dementia. Offer reassurance and validation of his or her concerns. - Creating daily routines and keeping tasks simple. Break tasks into easier steps and focus on successes, not failures. Structure and routine during the day can be less confusing.",
+    "https://www.mayoclinic.org/diseases-conditions/lewy-body-dementia/symptoms-causes/syc-20352025"
+  ],
+  [
+    "Vascular dementia (Treatment): Controlling underlying conditions and risk factors Controlling conditions that affect the underlying health of your heart and blood vessels can sometimes slow the rate at which vascular dementia gets worse, and may also sometimes prevent further decline. Depending on your individual situation, your doctor may prescribe medications to: - Lower your blood pressure - Reduce your cholesterol level - Prevent your blood from clotting and keep your arteries clear - Help control your blood sugar if you have diabetes Alzheimer's medications The Food and Drug Administration (FDA) has not approved any drugs specifically to treat changes in judgment, planning, memory and other thought processes caused by vascular dementia. However, certain medications approved by the FDA to treat these symptoms in Alzheimer's disease may also help people with vascular dementia to the same modest extent they help those with Alzheimer's. Doctors may prescribe one or both types of the following Alzheimer's drugs: - Cholinesterase inhibitors - including donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon) - work by boosting levels of a brain cell chemical messenger involved in memory and judgment. Side effects can include nausea, vomiting, muscle cramps and diarrhea. - Memantine (Namenda) regulates another brain cell chemical messenger important for information processing, storage and retrieval. Side effects can include headache, constipation, confusion and dizziness.",
+    "https://www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793"
+  ],
+  [
+    "Insulin, Medicines, and Other Diabetes Treatments (Do I have other treatment options for my diabetes?): When medicines and lifestyle changes are not enough to manage your diabetes, a less common treatment may be an option. Other treatments include bariatric surgery for certain people with type 1 or type 2 diabetes, and an \"artificial pancreas\" and\u00a0pancreatic islet transplantation for some people with type 1 diabetes.Bariatric surgeryAlso called weight-loss surgery or metabolic surgery, bariatric surgery may help some people with obesity and type 2 diabetes lose a large amount of weight and regain normal blood glucose levels. Some people with diabetes may no longer need their diabetes medicine after bariatric surgery. Whether and for how long blood glucose levels improve seems to vary by the patient, type of weight-loss surgery, and amount of weight the person loses. Other factors include how long someone has had diabetes and whether or not the person uses insulin.1Recent research suggests that weight-loss surgery also may help improve blood glucose control in people with type 1 diabetes who are obese.2Researchers are studying the long-term results of bariatric surgery in people with type 1 and type 2 diabetes.Artificial PancreasThe NIDDK has played an important role in developing \u201cartificial pancreas\u201d technology. An artificial pancreas replaces manual blood glucose testing and the use of insulin shots or a pump. A single system monitors blood glucose levels around the clock and provides insulin or a combination of insulin and a second hormone, glucagon, automatically. The system can also be monitored remotely, for example by parents or medical staff.In 2016, the FDA approved a type of artificial pancreas system called a hybrid closed-loop system. This system tests your glucose level every 5 minutes throughout the day and night, and automatically gives you the right amount of insulin.You still need to manually adjust the amount of insulin the pump delivers at mealtimes. But, the artificial pancreas may free you from some of the daily tasks needed to keep your blood glucose stable\u2014or help you sleep through the night without the need to wake and test your glucose or take medicine.The hybrid closed-loop system is expected to be available in the U.S. in 2017. Talk with your health care provider about whether this system might be right for you.The NIDDK has funded several important studies on different types of artificial pancreas devices to better help people with type 1 diabetes manage their disease. The devices may also help people with type 2 diabetes and gestational diabetes.Pancreatic islet transplantationPancreatic islet transplantation is an experimental treatment for poorly controlled type 1 diabetes. Pancreatic islets are clusters of cells in the pancreas that make the hormone insulin. In type 1 diabetes, the body\u2019s immune system attacks these cells. A pancreatic islet transplant replaces destroyed islets with new ones that make and release insulin. This procedure takes islets from the pancreas of an organ donor and transfers them to a person with type 1 diabetes. Because researchers are still studying pancreatic islet transplantation, the procedure is only available to people enrolled in research studies. Learn more about islet transplantation studies.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/insulin-medicines-treatments"
+  ],
+  [
+    "Vascular dementia (Treatment): There is no treatment to turn back damage to the brain caused by small strokes. An important goal is to control symptoms and correct the risk factors. To prevent future strokes: - Avoid fatty foods. Follow a healthy, low-fat diet. - DO NOT drink more than 1 to 2 alcoholic drinks a day. - Keep blood pressure lower than 130/80 mm/Hg. Ask your doctor what your blood pressure should be. - Keep LDL \"bad\" cholesterol lower than 70 mg/dL. - Do not smoke. - The doctor may suggest blood thinners, such as aspirin, to help prevent blood clots from forming in the arteries. DO NOT start taking aspirin or stop taking it without talking to your doctor first. The goals of helping someone with dementia in the home are to: - Manage behavior problems, confusion, sleep problems, and agitation - Remove safety hazards in the home - Support family members and other caregivers Medicines may be needed to control aggressive, agitated, or dangerous behaviors. Medicines used to treat Alzheimer disease have not been shown to work for VaD.",
+    "https://medlineplus.gov/ency/article/000746.htm"
+  ],
+  [
+    "Pick disease (Treatment): There is no specific treatment for Pick disease. Medicines may help manage mood swings. Sometimes, people with Pick disease take the same medicines used to treat other types of dementia. In some cases, stopping or changing medicines that worsen confusion or that are not needed can improve thinking and other mental functions. Medicines include: - Analgesics - Anticholinergics - Central nervous system depressants - Cimetidine - Lidocaine It is important to treat any disorders that can cause confusion. These include: - Anemia - Decreased oxygen (hypoxia) level - Heart failure - High carbon dioxide level - Infections - Kidney failure - Liver failure - Nutritional disorders - Thyroid disorders - Mood disorders, such as depression Medicines may be needed to control aggressive, dangerous, or agitated behaviors. Behavior modification can help some people control unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (when it is safe to do so). Talk therapy (psychotherapy) does not always work. This is because it can cause further confusion or disorientation. Reality orientation, which reinforces environmental and other cues, may help reduce disorientation. Depending on the symptoms and severity of the disease, monitoring and help with personal hygiene and self-care may be needed. Eventually, there may be a need for 24-hour care and monitoring at home or in a special facility. Family counseling can help the person cope with the changes needed for home care. Care may include: - Adult protective services - Community resources - Homemakers - Visiting nurses or aides - Volunteer services People with Pick disease and their family may need to seek legal advice early in the course of the disorder. Advance care directive, power of attorney, and other legal actions can make it easier to make decisions regarding the care of the person with Pick disease.",
+    "https://medlineplus.gov/ency/article/000744.htm"
+  ],
+  [
+    "Dementia (Diagnosis): Diagnosing dementia and determining what type it is can be challenging. A diagnosis of dementia requires that at least two core mental functions be impaired enough to interfere with daily living. They are memory, language skills, ability to focus and pay attention, ability to reason and problem-solve, and visual perception. Your doctor will review your medical history and symptoms and conduct a physical examination. He or she will likely ask someone close to you about your symptoms, as well. No single test can diagnose dementia, so doctors are likely to run a number of tests that can help pinpoint the problem. Cognitive and neuropsychological tests Doctors will evaluate your thinking (cognitive) function. A number of tests measure thinking skills such as memory, orientation, reasoning and judgment, language skills, and attention. Neurological evaluation Doctors evaluate your memory, language, visual perception, attention, problem-solving, movement, senses, balance, reflexes and other areas. Brain scans - CT or MRI. These scans can check for evidence of stroke or bleeding or tumor or hydrocephalus. - PET scans. These can show patterns of brain activity and if the amyloid protein, a hallmark of Alzheimer's disease, has been deposited in the brain. Laboratory tests Simple blood tests can detect physical problems that can affect brain function, such as vitamin B-12 deficiency or an underactive thyroid gland. Sometimes the spinal fluid is examined for infection, inflammation or markers of some degenerative diseases. Psychiatric evaluation A mental health professional can determine whether depression or another mental health condition is contributing to your symptoms.",
+    "https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013"
+  ],
+  [
+    "How to diagnose Dementia?: A skilled health care provider can often diagnose dementia using the following: - Complete physical exam, including nervous system exam - Asking about the person's medical history and symptoms - Mental function tests (mental status examination) Other tests may be ordered to find out if other problems may be causing dementia or making it worse. These conditions include: - Anemia - Brain tumor - Chronic infection - Intoxication from medicines - Severe depression - Thyroid disease - Vitamin deficiency The following tests and procedures may be done: - B12 level - Blood ammonia levels - Blood chemistry (chem-20) - Blood gas analysis - Cerebrospinal fluid (CSF) analysis - Drug or alcohol levels (toxicology screen) - Electroencephalograph (EEG) - Head CT - Mental status test - MRI of head - Thyroid function tests, including thyroid stimulating hormone (TSH) - Thyroid stimulating hormone level - Urinalysis",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000739.htm"
+  ],
+  [
+    "Lewy body dementia (Diagnosis): A progressive decline in your ability to think is required to diagnose Lewy body dementia. In addition, two of the following core symptoms must be present: - Fluctuating and unpredictable alertness and thinking (cognitive) function - Repeated visual hallucinations - Parkinsonian symptoms - REM sleep behavior disorder, in which people act out their dreams during sleep In addition to the core symptoms of Lewy body dementia, tests for certain biomarkers can further support a diagnosis of Lewy body dementia. Biomarkers are substances in the blood that indicate the presence of a disease, such as Lewy body dementia. Right now there are no biomarkers to definitively diagnose Lewy body dementia, but some biomarkers support it. Biomarkers alone, without symptoms, aren't enough for a diagnosis. Biomarker tests to support Lewy body dementia diagnosis include: - Nuclear imaging tests such as single-photon emission computerized tomography (SPECT) and positron emission tomography (PET) - Tests that measure check nerve function of the heart's blood vessels (iodine-MIBG myocardial scintigraphy) - Sleep studies that examine brain wave activity Your doctor may also diagnose Lewy body dementia based on the presence of one core symptom and one or more of these biomarkers that support the diagnosis: - Autonomic dysfunction, which involves instability in blood pressure and heart rate, poor regulation of body temperature, sweating, and related symptoms - Feeling excessively sleepy during the daytime - Loss of the sense of smell There are several combinations of symptoms, features and biomarkers that help doctors diagnose Lewy body dementia. Depending on the combination, the diagnosis may be considered probable or possible. Doctors may also try to rule out other conditions that may cause similar signs and symptoms to support a diagnosis of Lewy body dementia. Tests may include: Neurological and physical examination Your doctor may check for signs of Parkinson's disease, strokes, tumors or other medical conditions that can affect the brain and physical function. The neurological examination may test: - Reflexes - Strength - Walking - Muscle tone - Eye movements - Balance - Sense of touch Assessment of mental abilities A short form of this test, which assesses your memory and thinking skills, can be done in less than 10 minutes in your doctor's office. It's not generally useful in distinguishing Lewy body dementia from Alzheimer's disease but can indicate dementia. Longer tests can take several hours, but help identify Lewy body dementia. Your doctor will compare your test results with those of people from a similar age and education level. This can help distinguish normal from abnormal cognitive aging, and may help diagnose the condition. Blood tests These can rule out physical problems that can affect brain function, such as vitamin B-12 deficiency or an underactive thyroid gland. Brain scans Your doctor may order an MRI, PET or CT scan to identify a stroke or bleeding, and to rule out the possibility of a tumor. While dementias are diagnosed based on the history and physical examination, certain features on imaging studies can suggest different types of dementia, such as Alzheimer's or Lewy body dementia. Your doctor may order a sleep evaluation to check for REM sleep behavior disorder or an autonomic function test to look for signs of heart rate and blood pressure instability.",
+    "https://www.mayoclinic.org/diseases-conditions/lewy-body-dementia/symptoms-causes/syc-20352025"
+  ],
+  [
+    "Frontotemporal dementia (Diagnosis): No single test can identify frontotemporal dementia, so doctors attempt to identify certain characteristic features while excluding other possible causes. The disorder can be especially challenging to diagnose in the early stages, as symptoms of frontotemporal dementia often overlap with those of other conditions. Blood tests To see if your symptoms are being caused by a different condition, such as liver or kidney disease, your doctor may order blood tests. Neuropsychological testing Sometimes doctors undertake a more extensive assessment of reasoning and memory skills. This type of testing is especially helpful in determining the type of dementia at an early stage. Brain scans By looking at images of the brain, doctors may be able to pinpoint any visible abnormalities - such as clots, bleeding or tumors - that may be causing signs and symptoms. - Magnetic resonance imaging (MRI). An MRI machine uses radio waves and a strong magnetic field to produce detailed images of your brain. - Positron emission tomography (PET). PET scans use a small amount of low-dose radioactive material that's injected into a vein to help visualize blood sugar metabolism in the brain, which can help identify frontal or temporal lobe brain abnormalities.",
+    "https://www.mayoclinic.org/diseases-conditions/frontotemporal-dementia/symptoms-causes/syc-20354737"
+  ],
+  [
+    "Vascular dementia (Diagnosis): Doctors can nearly always determine that you have dementia, but there's no specific test that confirms you have vascular dementia. Your doctor will make a judgment about whether vascular dementia is the most likely cause of your symptoms based on the information you provide, your medical history for stroke or disorders of the heart and blood vessels, and results of tests that may help clarify your diagnosis. Lab tests If your medical record doesn't include recent values for key indicators of the health of your heart and blood vessels, your doctor will test your: - Blood pressure - Cholesterol - Blood sugar He or she may also order tests to rule out other potential causes of memory loss and confusion, such as: - Thyroid disorders - Vitamin deficiencies Neurological exam Your doctor is likely to check your overall neurological health by testing your: - Reflexes - Muscle tone and strength, and how strength on one side of your body compares with the other side - Ability to get up from a chair and walk across the room - Sense of touch and sight - Coordination - Balance Brain imaging Images of your brain can pinpoint visible abnormalities caused by strokes, blood vessel diseases, tumors or trauma that may cause changes in thinking and reasoning. A brain-imaging study can help your doctor zero in on more likely causes for your symptoms and rule out other causes. Brain-imaging procedures your doctor may recommend to help diagnose vascular dementia include: - Computerized tomography (CT) scan. For a CT scan, you'll lie on a narrow table that slides into a small chamber. X-rays pass through your body from various angles, and a computer uses this information to create detailed cross-sectional images (slices) of your brain. This test is painless and takes about 20 minutes. A CT scan can provide information about your brain's structure; tell whether any regions show shrinkage; and detect evidence of strokes, mini strokes (transient ischemic attacks), blood vessel changes or tumors. Sometimes you'll receive an intravenous (IV) injection of a contrast agent that will help highlight certain brain tissues. - Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to produce detailed images of your brain. You lie on a narrow table that slides into a tube-shaped MRI machine, which makes loud banging noises while it produces images. The entire procedure can take an hour or more. MRIs are painless, but some people feel claustrophobic inside the machine and are disturbed by the noise. MRIs can provide even more detail than CT scans about strokes, mini strokes and blood vessel abnormalities. Carotid ultrasound This procedure uses high-frequency sound waves to determine whether your carotid arteries - which run up through either side of your neck to supply blood to brain - show signs of narrowing as a result of plaque deposits or structural problems. Your test may include a Doppler ultrasound, which shows the movement of blood through your arteries in addition to structural features. Neuropsychological tests This type of exam assesses your ability to: - Speak, write and understand language - Work with numbers - Learn and remember information - Develop a plan of attack and solve a problem - Respond effectively to hypothetical situations Neuropsychological tests sometimes show characteristic results for people with different types of dementia. People with vascular dementia may have an exceptionally hard time analyzing a problem and developing an effective solution. They may be less likely to have trouble learning new information and remembering than are people with Alzheimer's unless their blood vessel problems affect specific brain regions important for memory. However, there's often a lot of overlap in exam results for people with vascular dementia and people who have Alzheimer's disease.",
+    "https://www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793"
+  ],
+  [
+    "Frontotemporal dementia (Diagnosis): Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. Orphanet lists international laboratories offering diagnostic testing for this condition.",
+    "https://rarediseases.info.nih.gov/diseases/8436/frontotemporal-dementia"
+  ],
+  [
+    "Binswanger's disease (Diagnosis): A diagnosis of Binswanger's disease is often suspected based on the presence of characteristic signs and symptoms. Additional testing can then be ordered to confirm the diagnosis. This generally consists of imaging studies of the brain (i.e. CT scan and/or MRI scan). [1] [2]",
+    "https://rarediseases.info.nih.gov/diseases/5925/binswangers-disease"
+  ],
+  [
+    "COPD: Espa\u00f1ol \u00a0 Also known as chronic obstructive pulmonary disease; chronic bronchitis; or emphysema. COPD, or chronic obstructive pulmonary disease, is a progressive disease that makes it hard to breathe. Progressive means the disease gets worse over time. COPD can cause\u00a0coughing\u00a0that produces large amounts of a slimy substance called mucus, wheezing, shortness of breath, chest tightness, and other symptoms. Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. However, up to 25 percent of people with COPD never smoked. Long-term exposure to other lung irritants\u2014such as air pollution, chemical fumes, or dusts\u2014also may contribute to COPD. A rare genetic condition called alpha-1 antitrypsin (AAT) deficiency can also cause the disease. Overview To understand COPD, it helps to understand\u00a0how the lungs work. The air that you breathe goes down your windpipe into tubes in your lungs called bronchial tubes or airways. Within the lungs, your bronchial tubes branch many times into thousands of smaller, thinner tubes called bronchioles. These tubes end in bunches of tiny round air sacs called alveoli. Small blood vessels called capillaries run along the walls of the air sacs. When air reaches the air sacs, oxygen passes through the air sac walls into the blood in the capillaries. At the same time, a waste product, called carbon dioxide (CO2) gas, moves from the capillaries into the air sacs. This process, called gas exchange, brings in oxygen for the body to use for vital functions and removes the CO2. The airways and air sacs are elastic or stretchy. When you breathe in, each air sac fills up with air, like a small balloon. When you breathe out, the air sacs deflate and the air goes out. In COPD, less air flows in and out of the airways because of one or more of the following: The airways and air sacs lose their elastic quality. The walls between many of the air sacs are destroyed. The walls of the airways become thick and inflamed. The airways make more mucus than usual and can become clogged. Normal Lungs and Lungs With COPD In the United States, the term COPD includes two main conditions\u2014emphysema\u00a0and chronic\u00a0bronchitis. In emphysema, the walls between many of the air sacs are damaged. As a result, the air sacs lose their shape and become floppy. This damage also can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones. If this happens, the amount of gas exchange in the lungs is reduced. In chronic bronchitis, the lining of the airways stays constantly irritated and inflamed, and this causes the lining to swell. Lots of thick mucus forms in the airways, making it hard to breathe. Most people who have COPD have both emphysema and chronic bronchitis, but the severity of each condition varies from person to person. Thus, the general term COPD is more accurate. Outlook COPD is a major cause of disability, and it is the third leading cause of death in the United States. Currently, 16 million people are diagnosed with COPD. Many more people may have the disease and not even know it. COPD develops slowly. Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself. Most of the time, COPD is diagnosed in middle-aged or older adults. The disease is not contagious, meaning it cannot be passed from person to person. COPD has no cure yet, and doctors do not know how to reverse the damage to the lungs. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/copd"
+  ],
+  [
+    "What is COPD?: Chronic obstructive pulmonary disease, or COPD, is a progressive lung disease in which the airways of the lungs become damaged, making it hard to breathe. You may also have heard COPD called other names, like emphysema or chronic bronchitis. In people who have COPD, the airways that carry air in and out of the lungs are partially blocked, making it difficult to get air in and out. COPD is a major cause of death and illness throughout the world. It kills more than 120,000 Americans each year. That's one death every 4 minutes. How COPD Affects Airways The \"airways\" are the tubes that carry air in and out of the lungs through the nose and mouth. The airways of the lungs branch out like an upside-down tree. At the end of each branch are many small, balloon-like air sacs. In healthy people, the airways and air sacs are elastic (stretchy). When you breathe in, each air sac fills up with air, like a small balloon, and when you breathe out, the balloon deflates and the air goes out. In people with COPD, the airways and air sacs lose their shape and become floppy. Less air gets in and less air goes out of the airways because - The airways and air sacs lose their elasticity like an old rubber band. - The walls between many of the air sacs are destroyed. - The walls of the airways become thick and inflamed or swollen. - Cells in the airways make more mucus or sputum than usual, which tends to clog the airways. The airways and air sacs lose their elasticity like an old rubber band. The walls between many of the air sacs are destroyed. The walls of the airways become thick and inflamed or swollen. Cells in the airways make more mucus or sputum than usual, which tends to clog the airways. COPD Develops Slowly, Has No Cure When COPD is severe, shortness of breath and other symptoms of COPD can get in the way of even the most basic tasks, such as doing light housework, taking a walk, even washing and dressing. COPD develops slowly, and it may be many years before you notice symptoms like feeling short of breath. Most of the time, COPD is diagnosed in middle-aged or older people. There is no cure for COPD. The damage to your airways and lungs cannot be reversed, but there are things you can do to control the disabling effects of the disease. COPD is not contagious. You cannot catch it from someone else.",
+    "http://nihseniorhealth.gov/copd/toc.html"
+  ],
+  [
+    "COPD: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It's caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions. Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It's characterized by daily cough and mucus (sputum) production. Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter. COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions. COPD care at Mayo Clinic COPD symptoms often don't appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues. For chronic bronchitis, the main symptom is a daily cough and mucus (sputum) production at least three months a year for two consecutive years. Other signs and symptoms of COPD may include: - Shortness of breath, especially during physical activities - Wheezing - Chest tightness - Having to clear your throat first thing in the morning, due to excess mucus in your lungs - A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish - Blueness of the lips or fingernail beds (cyanosis) - Frequent respiratory infections - Lack of energy - Unintended weight loss (in later stages) - Swelling in ankles, feet or legs People with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than usual day-to-day variation and persist for at least several days. The main cause of COPD in developed countries is tobacco smoking. In the developing world, COPD often occurs in people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes. Only about 20 to 30 percent of chronic smokers may develop clinically apparent COPD, although many smokers with long smoking histories may develop reduced lung function. Some smokers develop less common lung conditions. They may be misdiagnosed as having COPD until a more thorough evaluation is performed. Air travels down your windpipe (trachea) and into your lungs through two large tubes (bronchi). Inside your lungs, these tubes divide many times - like the branches of a tree - into many smaller tubes (bronchioles) that end in clusters of tiny air sacs (alveoli). The air sacs have very thin walls full of tiny blood vessels (capillaries). The oxygen in the air you inhale passes into these blood vessels and enters your bloodstream. At the same time, carbon dioxide - a gas that is a waste product of metabolism - is exhaled. Your lungs rely on the natural elasticity of the bronchial tubes and air sacs to force air out of your body. COPD causes them to lose their elasticity and overexpand, which leaves some air trapped in your lungs when you exhale. Causes of airway obstruction include: - Emphysema. This lung disease causes destruction of the fragile walls and elastic fibers of the alveoli. Small airways collapse when you exhale, impairing airflow out of your lungs. - Chronic bronchitis. In this condition, your bronchial tubes become inflamed and narrowed and your lungs produce more mucus, which can further block the narrowed tubes. You develop a chronic cough trying to clear your airways. In the vast majority of cases, the lung damage that leads to COPD is caused by long-term cigarette smoking. But there are likely other factors at play in the development of COPD, such as a genetic susceptibility to the disease, because only about 20 to 30 percent of smokers may develop COPD. Other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe smoke, air pollution and workplace exposure to dust, smoke or fumes. In about 1 percent of people with COPD, the disease results from a genetic disorder that causes low levels of a protein called alpha-1-antitrypsin. Alpha-1-antitrypsin (AAt) is made in the liver and secreted into the bloodstream to help protect the lungs. Alpha-1-antitrypsin deficiency can affect the liver as well as the lungs. Damage to the lung can occur in infants and children, not only adults with long smoking histories. For adults with COPD related to AAt deficiency, treatment options include those used for people with more-common types of COPD. In addition, some people can be treated by replacing the missing AAt protein, which may prevent further damage to the lungs. Risk factors for COPD include: - Exposure to tobacco smoke. The most significant risk factor for COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers and marijuana smokers also may be at risk, as well as people exposed to large amounts of secondhand smoke. - People with asthma who smoke. The combination of asthma, a chronic inflammatory airway disease, and smoking increases the risk of COPD even more. - Occupational exposure to dusts and chemicals. Long-term exposure to chemical fumes, vapors and dusts in the workplace can irritate and inflame your lungs. - Exposure to fumes from burning fuel. In the developing world, people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes are at higher risk of developing COPD. - Age. COPD develops slowly over years, so most people are at least 40 years old when symptoms begin. - Genetics. The uncommon genetic disorder alpha-1-antitrypsin deficiency is the cause of some cases of COPD. Other genetic factors likely make certain smokers more susceptible to the disease. COPD can cause many complications, including: - Respiratory infections. People with COPD are more likely to catch colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue. An annual flu vaccination and regular vaccination against pneumococcal pneumonia can prevent some infections. - Heart problems. For reasons that aren't fully understood, COPD can increase your risk of heart disease, including heart attack. Quitting smoking may reduce this risk. - Lung cancer. People with COPD have a higher risk of developing lung cancer. Quitting smoking may reduce this risk. - High blood pressure in lung arteries. COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension). - Depression. Difficulty breathing can keep you from doing activities that you enjoy. And dealing with serious illness can contribute to development of depression. Talk to your doctor if you feel sad or helpless or think that you may be experiencing depression. COPD is commonly misdiagnosed - former smokers may sometimes be told they have COPD, when in reality they may have simple deconditioning or another less common lung condition. Likewise, many people who have COPD may not be diagnosed until the disease is advanced and interventions are less effective. To diagnose your condition, your doctor will review your signs and symptoms, discuss your family and medical history, and discuss any exposure you've had to lung irritants - especially cigarette smoke. Your doctor may order several tests to diagnose your condition. Tests may include: - Lung (pulmonary) function tests. Pulmonary function tests measure the amount of air you can inhale and exhale, and if your lungs are delivering enough oxygen to your blood. Spirometry is the most common lung function test. During this test, you'll be asked to blow into a large tube connected to a small machine called a spirometer. This machine measures how much air your lungs can hold and how fast you can blow the air out of your lungs. Spirometry can detect COPD even before you have symptoms of the disease. It can also be used to track the progression of disease and to monitor how well treatment is working. Spirometry often includes measurement of the effect of bronchodilator administration. Other lung function tests include measurement of lung volumes, diffusing capacity and pulse oximetry. - Chest X-ray. A chest X-ray can show emphysema, one of the main causes of COPD. An X-ray can also rule out other lung problems or heart failure. - CT scan. A CT scan of your lungs can help detect emphysema and help determine if you might benefit from surgery for COPD. CT scans can also be used to screen for lung cancer. - Arterial blood gas analysis. This blood test measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide. - Laboratory tests. Laboratory tests aren't used to diagnose COPD, but they may be used to determine the cause of your symptoms or rule out other conditions. For example, laboratory tests may be used to determine if you have the genetic disorder alpha-1-antitrypsin (AAt) deficiency, which may be the cause of some cases of COPD. This test may be done if you have a family history of COPD and develop COPD at a young age, such as under age 45. A diagnosis of COPD is not the end of the world. Most people have mild forms of the disease for which little therapy is needed other than smoking cessation. Even for more advanced stages of disease, effective therapy is available that can control symptoms, reduce your risk of complications and exacerbations, and improve your ability to lead an active life. Smoking cessation The most essential step in any treatment plan for COPD is to stop all smoking. It's the only way to keep COPD from getting worse - which can eventually reduce your ability to breathe. But quitting smoking isn't easy. And this task may seem particularly daunting if you've tried to quit and have been unsuccessful. Talk to your doctor about nicotine replacement products and medications that might help, as well as how to handle relapses. Your doctor may also recommend a support group for people who want to quit smoking. It's also a good idea to avoid secondhand smoke exposure whenever possible. Medications Doctors use several kinds of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed. These medications - which usually come in an inhaler - relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day or both. Short-acting bronchodilators include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex HFA), and ipratropium (Atrovent). The long-acting bronchodilators include tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil, Perforomist), arformoterol (Brovana), indacaterol (Arcapta) and aclidinium (Tudorza). Inhaled corticosteroid medications can reduce airway inflammation and help prevent exacerbations. Side effects may include bruising, oral infections and hoarseness. These medications are useful for people with frequent exacerbations of COPD. Fluticasone (Flovent HFA, Flonase, others) and budesonide (Pulmicort Flexhaler, Uceris, others) are examples of inhaled steroids. Some medications combine bronchodilators and inhaled steroids. Salmeterol and fluticasone (Advair) and formoterol and budesonide (Symbicort) are examples of combination inhalers. For people who have a moderate or severe acute exacerbation, short courses (for example, five days) of oral corticosteroids prevent further worsening of COPD. However, long-term use of these medications can have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection. A new type of medication approved for people with severe COPD and symptoms of chronic bronchitis is roflumilast (Daliresp), a phosphodiesterase-4 inhibitor. This drug decreases airway inflammation and relaxes the airways. Common side effects include diarrhea and weight loss. This very inexpensive medication may help improve breathing and prevent exacerbations. Side effects may include nausea, headache, fast heartbeat and tremor. Side effects are dose related, and low doses are recommended. Respiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate COPD symptoms. Antibiotics help treat acute exacerbations, but they aren't generally recommended for prevention. However, a recent study shows that the antibiotic azithromycin prevents exacerbations, but it isn't clear whether this is due to its antibiotic effect or its anti-inflammatory properties. Lung therapies Doctors often use these additional therapies for people with moderate or severe COPD: - Oxygen therapy. If there isn't enough oxygen in your blood, you may need supplemental oxygen. There are several devices to deliver oxygen to your lungs, including lightweight, portable units that you can take with you to run errands and get around town. Some people with COPD use oxygen only during activities or while sleeping. Others use oxygen all the time. Oxygen therapy can improve quality of life and is the only COPD therapy proven to extend life. Talk to your doctor about your needs and options. - Pulmonary rehabilitation program. These programs generally combine education, exercise training, nutrition advice and counseling. You'll work with a variety of specialists, who can tailor your rehabilitation program to meet your needs. Pulmonary rehabilitation may shorten hospitalizations, increase your ability to participate in everyday activities and improve your quality of life. Talk to your doctor about referral to a program. Managing exacerbations Even with ongoing treatment, you may experience times when symptoms become worse for days or weeks. This is called an acute exacerbation, and it may lead to lung failure if you don't receive prompt treatment. Exacerbations may be caused by a respiratory infection, air pollution or other triggers of inflammation. Whatever the cause, it's important to seek prompt medical help if you notice a sustained increase in coughing, a change in your mucus or if you have a harder time breathing. When exacerbations occur, you may need additional medications (such as antibiotics, steroids or both), supplemental oxygen or treatment in the hospital. Once symptoms improve, your doctor will talk with you about measures to prevent future exacerbations, such as quitting smoking, taking inhaled steroids, long-acting bronchodilators or other medications, getting your annual flu vaccine, and avoiding air pollution whenever possible. Surgery Surgery is an option for some people with some forms of severe emphysema who aren't helped sufficiently by medications alone. Surgical options include: - Lung volume reduction surgery. In this surgery, your surgeon removes small wedges of damaged lung tissue from the upper lungs. This creates extra space in your chest cavity so that the remaining healthier lung tissue can expand and the diaphragm can work more efficiently. In some people, this surgery can improve quality of life and prolong survival. - Lung transplant. Lung transplantation may be an option for certain people who meet specific criteria. Transplantation can improve your ability to breathe and to be active. However, it's a major operation that has significant risks, such as organ rejection, and it's necessary to take lifelong immune-suppressing medications. - Bullectomy. Large air spaces (bullae) form in the lungs when the walls of the air sacs are destroyed. These bullae can become very large and cause breathing problems. In a bullectomy, doctors remove bullae from the lungs to help improve air flow. If you have COPD, you can take steps to feel better and slow the damage to your lungs: - Control your breathing. Talk to your doctor or respiratory therapist about techniques for breathing more efficiently throughout the day. Also be sure to discuss breathing positions and relaxation techniques that you can use when you're short of breath. - Clear your airways. With COPD, mucus tends to collect in your air passages and can be difficult to clear. Controlled coughing, drinking plenty of water and using a humidifier may help. - Exercise regularly. It may seem difficult to exercise when you have trouble breathing, but regular exercise can improve your overall strength and endurance and strengthen your respiratory muscles. Discuss with your doctor which activities are appropriate for you. - Eat healthy foods. A healthy diet can help you maintain your strength. If you're underweight, your doctor may recommend nutritional supplements. If you're overweight, losing weight can significantly help your breathing, especially during times of exertion. - Avoid smoke and air pollution. In addition to quitting smoking, it's important to avoid places where others smoke. Secondhand smoke may contribute to further lung damage. Other types of air pollution also can irritate your lungs. - See your doctor regularly. Stick to your appointment schedule, even if you're feeling fine. It's important to steadily monitor your lung function. And be sure to get your annual flu vaccine in the fall to help prevent infections that can worsen your COPD. Ask your doctor when you need the pneumococcal vaccine. Let your doctor know if you have worsening symptoms or you notice signs of infection.",
+    "https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679"
+  ],
+  [
+    "What is COPD?: More information on COPD is available at: What is COPD? and at the Learn More, Breathe Better Campaign For information on quitting smoking, visit http://www.surgeongeneral.gov/tobacco/ or Smokefree.gov. For information on the H1N1 flu and COPD, go to The Centers for Disease Control and Prevention.",
+    "http://nihseniorhealth.gov/copd/toc.html"
+  ],
+  [
+    "Smoking and COPD: Smoking is the leading cause of COPD. Smoking is also a trigger for COPD flare-ups. Smoking damages the air sacs, airways, and the lining of your lungs. Injured lungs have trouble moving enough air in and out, so it's hard to breathe. Things that make chronic obstructive pulmonary disease (COPD) symptoms worse are called triggers. Knowing what your triggers are and how to avoid them can help you feel better. Smoking is a trigger for many people who have COPD. Smoking can cause an exacerbation, or flare-up, of your symptoms. You do not have to be a smoker for smoking to cause harm. Exposure to someone else's smoking (called secondhand smoke) is also a trigger for COPD flare-ups. Smoking damages your lungs. When you have COPD and smoke, your lungs will get damaged more rapidly than if you were to stop smoking. Quitting smoking is the best thing you can do to protect your lungs and keep your COPD symptoms from getting worse. This can help you stay more active and enjoy life. Tell your friends and family about your goal to quit. Take a break from people and situations that make you want to smoke. Keep busy with other things. Take it 1 day at a time. Ask your health care provider to help you quit. There are many ways to quit smoking, including: - Medicines - Nicotine replacement therapy - Support groups, counseling, or stop-smoking classes in person or online It is not easy, but anyone can quit. Newer medicines and programs can be very helpful. List the reasons you want to quit. Then set a quit date. You may need to try quitting more than once. And that's OK. Keep trying if you do not succeed at first. The more times you try to quit, the more likely you are to be successful. Secondhand smoke will trigger more COPD flare-ups and cause more damage to your lungs. So you need to take steps to avoid secondhand smoke. - Make your home and car smoke-free zones. Tell others you are with to follow this rule. Take ashtrays out of your home. - Choose smoke-free restaurants, bars, and workplaces (if possible). - Avoid public places that allow smoking. Setting these rules can: - Reduce the amount of secondhand smoke you and your family breathe in - Help you quit smoking and stay smoke-free If there are smokers at your workplace, ask someone about policies regarding if and where smoking is allowed. Tips to help with secondhand smoke at work are: - Make sure there are proper containers for smokers to throw away their cigarette butts and matches. - Ask coworkers who smoke to keep their coats away from work areas. - Use a fan and keep windows open, if possible. - Use an alternative exit to avoid smokers outside the building. Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000696.htm"
+  ],
+  [
+    "What is COPD?: COPD (chronic obstructive pulmonary disease) makes it hard for you to breathe. The two main types are chronic bronchitis and emphysema. The main cause of COPD is long-term exposure to substances that irritate and damage the lungs. This is usually cigarette smoke. Air pollution, chemical fumes, or dust can also cause it. At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. They include - A cough that produces a lot of mucus - Shortness of breath, especially with physical activity - Wheezing - Chest tightness Doctors use lung function tests, imaging tests, and blood tests to diagnose COPD. There is no cure. Treatments may relieve symptoms. They include medicines, oxygen therapy, surgery, or a lung transplant. Quitting smoking is the most important step you can take to treat COPD. NIH: National Heart, Lung, and Blood Institute",
+    "https://www.nlm.nih.gov/medlineplus/copd.html"
+  ],
+  [
+    "COPD and other health problems: If you have COPD, you are more likely to have other health problems, too. These are called comorbidities. People with COPD tend to have more health problems than people who do not have COPD. Having other health problems can affect your symptoms and treatments. You may need to visit your doctor more often. You also may need to have more tests or treatments. Having COPD is a lot to manage. But try to stay positive. You can protect your health by understanding why you are at risk for certain conditions and learning how to prevent them. If you have chronic obstructive pulmonary disease (COPD), you are more likely to have: - Repeat infections, such as pneumonia. COPD increases your risk of complications from colds and the flu. It increases your risk of needing to be hospitalized due to lung infection. - High blood pressure in the lungs. COPD may cause high blood pressure in the arteries that bring blood to your lungs. This is called pulmonary hypertension. - Heart disease. COPD increases your risk of heart attack, heart failure, chest pain, irregular heartbeat, and blood clots. - Diabetes. Having COPD increases this risk. Also, some COPD medicines can cause high blood sugar. - Osteoporosis (weak bones). People with COPD often have low levels of vitamin D, are inactive, and smoke. These factors increase your risk of bone loss and weak bones. Certain COPD medicines also may cause bone loss. - Depression and anxiety. It is common for people with COPD to feel depressed or anxious. Being breathless can cause anxiety. Plus, having symptoms slows you down so you can't do as much as you used to. - Heartburn and gastroesophageal reflux disease (GERD). GERD and heartburn can lead to more COPD symptoms and flare-ups. - Lung cancer. Continuing to smoke increases this risk. Many factors play a role in why people with COPD often have other health problems. Smoking is one of the biggest culprits. Smoking is a risk factor for most of the problems above. - COPD usually develops in middle age. And people tend to have more health problems as they age. - COPD makes it hard to breathe, which can make it hard to get enough exercise. Being inactive can lead to bone and muscle loss and increase your risk for other health problems. - Certain COPD medicines can increase your risk of other conditions such as bone loss, heart conditions, diabetes, and high blood pressure. Work closely with your doctor to keep COPD and other medical problems under control. Taking the following steps can also help protect your health: - Take medicines and treatments as directed. - If you smoke, quit. Also avoid secondhand smoke. Avoiding smoke is the best way to slow down damage to your lungs. Ask your doctor about stop-smoking programs and other options, such as nicotine replacement therapy and tobacco cessation medicines. - Discuss the risks and side effects of your medicines with your doctor. There may be better options available or things you can do to reduce or offset the harms. Tell your doctor if you notice any side effects. - Have a yearly flu vaccine and a\u00a0pneumonia vaccine to help guard against infections. Wash your hands often. Stay away from people with colds or other infections. - Stay as active as possible. Try short walks and light weight training. Talk with your doctor about ways to get exercise. - Eat a healthy diet rich in lean proteins, fish, whole grains, fruits, and vegetables. Eating several small healthy meals a day can give you the nutrients you need without feeling bloated. An overfull belly can make it hard to breathe. - Talk with your doctor if you feel sad, helpless, or worried. There are programs and medicines that can help you feel more positive and hopeful. Remember that you are not alone. Your doctor will work with you to help you stay as healthy and active as possible. You should call your doctor when: - You have new signs or symptoms that concern you. - You are having trouble managing one or more of your health conditions. - You have concerns about your health problems and treatments. - You feel hopeless, sad, or anxious. - You notice medicine side effects that bother you. Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000701.htm"
+  ],
+  [
+    "COPD - managing stress and your mood (COPD and Your Emotions): Having chronic obstructive pulmonary disease (COPD) can affect your mood and emotions for several reasons: - You cannot do all the things you used to do. - You may need to do things much slower than you used to. - You may often feel tired. - You may have a hard time sleeping. - You may feel ashamed or blame yourself for having COPD. - You may be more isolated from others because it is harder to get out to do things. - Breathing problems can be stressful and scary. All of these factors can make you feel stressed, anxious, or depressed.",
+    "https://medlineplus.gov/ency/patientinstructions/000700.htm"
+  ],
+  [
+    "COPD - how to use a nebulizer: A nebulizer turns your COPD medicine into a mist. It is easier to breathe the medicine into your lungs this way. If you use a nebulizer, your COPD medicines will come in liquid form. With a nebulizer, you will sit with your machine and use a mouthpiece. Medicine goes into your lungs as you take slow, deep breaths for 10 to 15 minutes. Many people with chronic obstructive pulmonary disease (COPD) do not need to use a nebulizer. Another way to get your medicine is with an inhaler, which is usually just as effective. Nebulizers can deliver medicine with less effort than inhalers. You and your doctor can decide if a nebulizer is the best way to get the medicine you need. The choice of device may be based on whether you find a nebulizer easier to use and what type of medicine you take. Most nebulizers use air compressors. Some use sound vibrations. These are called \"ultrasonic nebulizers.\" They are quieter, but they cost more. Follow these steps to set up and use your nebulizer: - Connect the hose to the air compressor. - Fill the medicine cup with your prescription. To avoid spills, close the medicine cup tightly and always hold the mouthpiece straight up and down. - Attach the other end of the hose to the mouthpiece and medicine cup. - Turn on the nebulizer machine. - Place the mouthpiece in your mouth. Keep your lips firm around the mouthpiece so that all of the medicine goes into your lungs. - Breathe through your mouth until all the medicine is used. This usually takes 10 to 15 minutes. Some people use a nose clip to help them breathe only through their mouth. - Turn off the machine when you are done. You will need to clean your nebulizer to prevent bacteria from growing in it, since bacteria can cause a lung infection. It takes some time to clean your nebulizer and keep it working properly. Be sure to unplug the machine before cleaning. After each use: - Wash the medicine cup and mouthpiece with warm running water. - Let them air dry on clean paper towels. - Later, hook up the nebulizer and run air through the machine for 20 seconds to make sure all of the parts are dry. - Take apart and store the machine in a covered area until the next use. Once per day, you may add a mild dish soap to the cleaning routine above. Once or twice each week: - You may add a soaking step to the cleaning routine above. - Soak the cup and mouthpiece in 1 part distilled white vinegar, 2 parts warm water solution. You may clean the outside of your machine with a warm, damp cloth as necessary. Never wash the hose or tubing. You will also need to change the filter. The instructions that come with your nebulizer will tell you when you should change the filter. Most nebulizers are small, so they are easy to transport. You may carry your nebulizer in your carry-on luggage when traveling by plane. - Keep your nebulizer covered and packed in a safe place. - Pack your medicines in a cool, dry place when traveling. Call your doctor if you are having trouble using your nebulizer. You should also call if you have any of these problems while using your nebulizer: - Anxiety - Feeling that your heart is racing or pounding (palpitations) - Shortness of breath - Feeling very excited These may be signs that you are getting too much medicine. Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000699.htm"
+  ],
+  [
+    "COPD - managing stress and your mood (How Your Emotions can Affect COPD): Having COPD can change how you feel about yourself. And how you feel about yourself can affect COPD symptoms and how well you care for yourself. People with COPD who are depressed may have more COPD flare-ups and may have to go to the hospital more often. Depression saps your energy and motivation. When you are depressed, you may be less likely to: - Eat well and exercise. - Take your medicines as directed. - Follow your treatment plan. - Get enough rest. Or, you may get too much rest. Stress is a known COPD trigger. When you feel stressed and anxious, you may breathe faster, which can make you feel short of breath. When it is harder to breathe, you feel more anxious, and the cycle continues, leading you to feel even worse.",
+    "https://medlineplus.gov/ency/patientinstructions/000700.htm"
+  ],
+  [
+    "COPD (Causes): Long-term exposure to lung irritants that damage the lungs and the airways usually is the cause of COPD. In the United States, the most common irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled. Breathing in secondhand smoke, which is in the air from other people smoking; air pollution; or chemical fumes or dusts from the environment or workplace also can contribute to COPD. Rarely, a genetic condition called\u00a0alpha-1 antitrypsin deficiency\u00a0may play a role in causing COPD. People who have this condition have low blood levels of alpha-1 antitrypsin (AAT)\u2014a protein made in the liver. Having a low level of the AAT protein can lead to lung damage and COPD if you are exposed to smoke or other lung irritants. If you have alpha-1 antitrypsin deficiency and also smoke, COPD can worsen very quickly. Some people who have\u00a0asthma\u00a0can develop COPD. Asthma is a chronic lung disease that inflames and narrows the airways. Treatment usually can reverse the inflammation and narrowing that occurs in asthma.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/copd"
+  ],
+  [
+    "What causes COPD?: COPD is a disease that slowly worsens over time, especially if you continue to smoke. If you have COPD, you are more likely to have lung infections, which can be fatal. If the lungs are severely damaged, the heart may be affected. A person with COPD dies when the lungs and heart are unable to function and get oxygen to the body's organs and tissues, or when a complication, such as a severe infection, occurs. Treatment for COPD may help prevent complications, prolong life, and improve a person's quality of life.",
+    "http://nihseniorhealth.gov/copd/toc.html"
+  ],
+  [
+    "COPD (More Information): NHLBI resources Alpha-1 Antitrypsin Deficiency Asthma Breathing Better With a COPD Diagnosis\u00a0(also available in\u00a0Spanish) Bronchitis\u00a0 COPD: Are You at Risk?\u00a0(also available in\u00a0Spanish) Chest X Ray Chest CT Scan COPD Learn More Breathe Better\u00ae COPD National Action Plan Cough Fact Sheet:\u00a0Long-Term Oxygen Treatment Trial (LOTT) Frequently Asked Questions How the Lungs Work\u00a0 Lung Transplant Oxygen Therapy\u00a0 Pneumonia Pulmonary Function Tests\u00a0 Pulmonary Rehabilitation\u00a0 Smoking and Your Heart Story of Success: COPD Your Guide to a Healthy Heart Other resources Chronic Bronchitis\u00a0(National Library of Medicine [NLM] MedlinePlus) COPD\u00a0(NLM MedlinePlus) Emphysema\u00a0(NLM MedlinePlus) Smokefree.gov (National Cancer Institute [NCI]) Quitlines and the Expansion of Smoking Cessation Support (NCI) ____________________ \u00ae COPD Learn More Breathe Better is a registered trademark of the U.S. Department of Health and Human Services.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/copd"
+  ],
+  [
+    "COPD (Prevention): You can take steps to prevent COPD before it starts. If you already have COPD, you can take steps to prevent complications and slow the progression of the disease. Prevent COPD Before It Starts The best way to prevent COPD is to not start smoking or to quit smoking. Smoking is the leading cause of COPD. If you smoke, talk with your doctor about programs and products that can help you quit. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit. Also, try to avoid lung irritants that can contribute to COPD, such as air pollution, chemical fumes, dusts, and secondhand smoke, which is smoke in the air from other people smoking. For more information about how to quit smoking, go to the Health Topics\u00a0Smoking and Your Heart\u00a0article and the National Heart, Lung, and Blood Institute's Your Guide to a Healthy Heart.\u00a0Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute\u2019s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848). Prevent Complications and Slow the Progression of COPD If you have COPD, the most important step you can take is to quit smoking. Quitting can help prevent complications and slow the progression of the disease. You also should avoid exposure to the lung irritants mentioned above. Follow your treatments for COPD exactly as your doctor prescribes. They can help you breathe easier, stay more active, and avoid or manage severe symptoms. Talk with your doctor about whether and when you should get flu, or influenza, and\u00a0pneumonia\u00a0vaccines. These vaccines can lower your chances of getting these illnesses, which are major health risks for people who have COPD.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/copd"
+  ],
+  [
+    "COPD: Espa\u00f1ol \u00a0 Also known as chronic obstructive pulmonary disease; chronic bronchitis; or emphysema. COPD, or chronic obstructive pulmonary disease, is a progressive disease that makes it hard to breathe. Progressive means the disease gets worse over time. COPD can cause\u00a0coughing\u00a0that produces large amounts of a slimy substance called mucus, wheezing, shortness of breath, chest tightness, and other symptoms. Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. However, up to 25 percent of people with COPD never smoked. Long-term exposure to other lung irritants\u2014such as air pollution, chemical fumes, or dusts\u2014also may contribute to COPD. A rare genetic condition called alpha-1 antitrypsin (AAT) deficiency can also cause the disease. Overview To understand COPD, it helps to understand\u00a0how the lungs work. The air that you breathe goes down your windpipe into tubes in your lungs called bronchial tubes or airways. Within the lungs, your bronchial tubes branch many times into thousands of smaller, thinner tubes called bronchioles. These tubes end in bunches of tiny round air sacs called alveoli. Small blood vessels called capillaries run along the walls of the air sacs. When air reaches the air sacs, oxygen passes through the air sac walls into the blood in the capillaries. At the same time, a waste product, called carbon dioxide (CO2) gas, moves from the capillaries into the air sacs. This process, called gas exchange, brings in oxygen for the body to use for vital functions and removes the CO2. The airways and air sacs are elastic or stretchy. When you breathe in, each air sac fills up with air, like a small balloon. When you breathe out, the air sacs deflate and the air goes out. In COPD, less air flows in and out of the airways because of one or more of the following: The airways and air sacs lose their elastic quality. The walls between many of the air sacs are destroyed. The walls of the airways become thick and inflamed. The airways make more mucus than usual and can become clogged. Normal Lungs and Lungs With COPD In the United States, the term COPD includes two main conditions\u2014emphysema\u00a0and chronic\u00a0bronchitis. In emphysema, the walls between many of the air sacs are damaged. As a result, the air sacs lose their shape and become floppy. This damage also can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones. If this happens, the amount of gas exchange in the lungs is reduced. In chronic bronchitis, the lining of the airways stays constantly irritated and inflamed, and this causes the lining to swell. Lots of thick mucus forms in the airways, making it hard to breathe. Most people who have COPD have both emphysema and chronic bronchitis, but the severity of each condition varies from person to person. Thus, the general term COPD is more accurate. Outlook COPD is a major cause of disability, and it is the third leading cause of death in the United States. Currently, 16 million people are diagnosed with COPD. Many more people may have the disease and not even know it. COPD develops slowly. Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself. Most of the time, COPD is diagnosed in middle-aged or older adults. The disease is not contagious, meaning it cannot be passed from person to person. COPD has no cure yet, and doctors do not know how to reverse the damage to the lungs. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/copd"
+  ],
+  [
+    "COPD (Signs and Symptoms): At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. Common signs and symptoms of COPD include: An ongoing\u00a0cough\u00a0or a cough that produces a lot of mucus; this is often called smoker's cough. Shortness of breath, especially with physical activity Wheezing or a whistling or squeaky sound when you breathe Chest tightness If you have COPD, you also may often have colds or other respiratory infections such as the flu, or influenza. Not everyone who has the symptoms described above has COPD. Likewise, not everyone who has COPD has these symptoms. Some of the symptoms of COPD are similar to the symptoms of other diseases and conditions. Your doctor can determine if you have COPD. If your symptoms are mild, you may not notice them, or you may adjust your lifestyle to make breathing easier. For example, you may take the elevator instead of the stairs. Over time, symptoms may become severe enough to cause you to see a doctor. For example, you may become short of breath during physical exertion. The severity of your symptoms will depend on how much lung damage you have. If you keep smoking, the damage will occur faster than if you stop smoking. Severe COPD can cause other symptoms, such as swelling in your ankles, feet, or legs; weight loss; and lower muscle endurance. Some severe symptoms may require treatment in a hospital. You\u2014or, if you are unable, family members or friends\u2014should seek emergency care if you are experiencing the following: You are having a hard time catching your breath or talking. Your lips or fingernails turn blue or gray, a sign of a low oxygen level in your blood. People around you notice that you are not mentally alert. Your heartbeat is very fast. The recommended treatment for symptoms that are getting worse is not working.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/copd"
+  ],
+  [
+    "COPD (Diagnosis): COPD is commonly misdiagnosed - former smokers may sometimes be told they have COPD, when in reality they may have simple deconditioning or another less common lung condition. Likewise, many people who have COPD may not be diagnosed until the disease is advanced and interventions are less effective. To diagnose your condition, your doctor will review your signs and symptoms, discuss your family and medical history, and discuss any exposure you've had to lung irritants - especially cigarette smoke. Your doctor may order several tests to diagnose your condition. Tests may include: - Lung (pulmonary) function tests. Pulmonary function tests measure the amount of air you can inhale and exhale, and if your lungs are delivering enough oxygen to your blood. Spirometry is the most common lung function test. During this test, you'll be asked to blow into a large tube connected to a small machine called a spirometer. This machine measures how much air your lungs can hold and how fast you can blow the air out of your lungs. Spirometry can detect COPD even before you have symptoms of the disease. It can also be used to track the progression of disease and to monitor how well treatment is working. Spirometry often includes measurement of the effect of bronchodilator administration. Other lung function tests include measurement of lung volumes, diffusing capacity and pulse oximetry. - Chest X-ray. A chest X-ray can show emphysema, one of the main causes of COPD. An X-ray can also rule out other lung problems or heart failure. - CT scan. A CT scan of your lungs can help detect emphysema and help determine if you might benefit from surgery for COPD. CT scans can also be used to screen for lung cancer. - Arterial blood gas analysis. This blood test measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide. - Laboratory tests. Laboratory tests aren't used to diagnose COPD, but they may be used to determine the cause of your symptoms or rule out other conditions. For example, laboratory tests may be used to determine if you have the genetic disorder alpha-1-antitrypsin (AAt) deficiency, which may be the cause of some cases of COPD. This test may be done if you have a family history of COPD and develop COPD at a young age, such as under age 45.",
+    "https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679"
+  ],
+  [
+    "COPD (Summary): Summary COPD (chronic obstructive pulmonary disease) makes it hard for you to breathe. The two main types are chronic bronchitis and emphysema. The main cause of COPD is long-term exposure to substances that irritate and damage the lungs. This is usually cigarette smoke. Air pollution, chemical fumes, or dust can also cause it. At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. They include - A cough that produces a lot of mucus - Shortness of breath, especially with physical activity - Wheezing - Chest tightness Doctors use lung function tests, imaging tests, and blood tests to diagnose COPD. There is no cure. Treatments may relieve symptoms. They include medicines, oxygen therapy, surgery, or a lung transplant. Quitting smoking is the most important step you can take to treat COPD. NIH: National Heart, Lung, and Blood Institute",
+    "#"
+  ],
+  [
+    "COPD (Overview): Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It's caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions. Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It's characterized by daily cough and mucus (sputum) production. Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter. COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions. COPD care at Mayo Clinic",
+    "https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679"
+  ],
+  [
+    "COPD (Signs and Symptoms): At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. Common signs and symptoms of COPD include: An ongoing\u00a0cough\u00a0or a cough that produces a lot of mucus; this is often called smoker's cough. Shortness of breath, especially with physical activity Wheezing or a whistling or squeaky sound when you breathe Chest tightness If you have COPD, you also may often have colds or other respiratory infections such as the flu, or influenza. Not everyone who has the symptoms described above has COPD. Likewise, not everyone who has COPD has these symptoms. Some of the symptoms of COPD are similar to the symptoms of other diseases and conditions. Your doctor can determine if you have COPD. If your symptoms are mild, you may not notice them, or you may adjust your lifestyle to make breathing easier. For example, you may take the elevator instead of the stairs. Over time, symptoms may become severe enough to cause you to see a doctor. For example, you may become short of breath during physical exertion. The severity of your symptoms will depend on how much lung damage you have. If you keep smoking, the damage will occur faster than if you stop smoking. Severe COPD can cause other symptoms, such as swelling in your ankles, feet, or legs; weight loss; and lower muscle endurance. Some severe symptoms may require treatment in a hospital. You\u2014or, if you are unable, family members or friends\u2014should seek emergency care if you are experiencing the following: You are having a hard time catching your breath or talking. Your lips or fingernails turn blue or gray, a sign of a low oxygen level in your blood. People around you notice that you are not mentally alert. Your heartbeat is very fast. The recommended treatment for symptoms that are getting worse is not working.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/copd"
+  ],
+  [
+    "What are the symptoms of COPD?: Common Symptoms The most common symptoms of COPD are - a cough that does not go away - coughing up lots of sputum (mucus). a cough that does not go away coughing up lots of sputum (mucus). These symptoms often start years before the flow of air in and out of the lungs is reduced. Not everyone who has a cough and sputum goes on to develop COPD. Other common symptoms of COPD include - shortness of breath while doing activities you used to be able to do - wheezing (a whistling sound when you breathe) - tightness in the chest. shortness of breath while doing activities you used to be able to do wheezing (a whistling sound when you breathe) tightness in the chest. Getting a Diagnosis Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results. If your doctor thinks you may have COPD, he or she will examine you, listen to your lungs, and ask you questions about your medical history, and what lung irritants you may have been around for long periods of time. The Spirometry Test To confirm a diagnosis of COPD, your doctor will use a breathing test called spirometry. The test is easy and painless and shows how much air you can breathe out and measures how fast you can breathe it out. In a spirometry test, you breathe hard into a large hose connected to a machine called a spirometer. When you breathe out, the spirometer measures how much air your lungs can hold and how fast you can blow air out of your lungs. Spirometry can detect COPD before symptoms develop. Your doctor also might use the test results to find out how severe your COPD is and to help set your treatment goals. The test results also may help find out whether another condition, such as asthma or heart failure, is causing your symptoms. Determining COPD Severity Based on this test, your doctor can determine if you have COPD and how severe it is. There are four levels of severity for COPD: - people at risk for COPD - people with mild COPD - people with moderate COPD - people with severe COPD. people at risk for COPD people with mild COPD people with moderate COPD people with severe COPD. People at risk for developing COPD have a normal breathing test and mild symptoms such as chronic cough and sputum (mucus) production. People with mild COPD have mild breathing limitation. Symptoms may include a chronic cough and sputum (mucus) production. At this stage, you may not be aware that airflow in your lungs is reduced. People with moderate COPD have a breathing test that shows worsening airflow blockages. Symptoms may be worse than with mild COPD and you may experience shortness of breath while working hard, walking fast, or doing brisk activity. At this stage, you would seek medical attention. People with severe COPD have a breathing test that shows severe limitation of the airflow. People with severe COPD will be short of breath after just a little activity. In very severe COPD, complications like respiratory failure or signs of heart failure may develop. At this stage, quality of life is impaired and worsening symptoms may be life-threatening. Other Tests Other tests are used to rule out other causes of the symptoms. - Bronchodilator reversibility testing uses the spirometer and medications called bronchodilators to assess whether breathing problems may be caused by asthma. Bronchodilator reversibility testing uses the spirometer and medications called bronchodilators to assess whether breathing problems may be caused by asthma. - A chest X-ray or a chest CT scan may also be ordered by your doctor. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms. A chest X-ray or a chest CT scan may also be ordered by your doctor. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms. - An arterial blood gas test is another test that is used. This blood test shows the oxygen level in the blood to see how severe your COPD is and whether you need oxygen therapy. An arterial blood gas test is another test that is used. This blood test shows the oxygen level in the blood to see how severe your COPD is and whether you need oxygen therapy.",
+    "http://nihseniorhealth.gov/copd/toc.html"
+  ],
+  [
+    "COPD (Symptoms): COPD symptoms often don't appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues. For chronic bronchitis, the main symptom is a daily cough and mucus (sputum) production at least three months a year for two consecutive years. Other signs and symptoms of COPD may include: - Shortness of breath, especially during physical activities - Wheezing - Chest tightness - Having to clear your throat first thing in the morning, due to excess mucus in your lungs - A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish - Blueness of the lips or fingernail beds (cyanosis) - Frequent respiratory infections - Lack of energy - Unintended weight loss (in later stages) - Swelling in ankles, feet or legs People with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than usual day-to-day variation and persist for at least several days.",
+    "https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679"
+  ],
+  [
+    "Myopathy with extrapyramidal signs (Symptoms): The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Ataxia Occasional Microcephaly Occasional Ophthalmoplegia Occasional Optic atrophy Occasional Peripheral axonal neuropathy Occasional Ptosis Occasional Abnormality of extrapyramidal motor function Very rare Chorea Very rare Dystonia Very rare Orofacial dyskinesia Very rare Proximal muscle weakness Very rare Specific learning disability Very rare Tremor Very rare Autosomal recessive inheritance - Difficulty running - Difficulty walking - Elevated serum creatine phosphokinase - Motor delay - View complete list of signs and symptoms...",
+    "https://rarediseases.info.nih.gov/diseases/12978/myopathy-with-extrapyramidal-signs"
+  ],
+  [
+    "What are the symptoms of COPD?: Call your doctor right away if your symptoms worsen suddenly. People with COPD may have symptoms that suddenly get worse. When this happens, you have a much harder time catching your breath. Symptoms that worsen suddenly can include sudden chest tightness, more coughing, a change in your sputum (mucus), or fever. Your doctor will look at things that may be causing these sudden symptoms. Sometimes the symptoms are caused by a lung infection.",
+    "http://nihseniorhealth.gov/copd/toc.html"
+  ],
+  [
+    "Symptoms and Causes of Diabetes (What are the symptoms of diabetes?): Symptoms of diabetes includeincreased thirst and urination increased hunger fatigue blurred vision numbness or tingling in the feet or hands sores that do not heal unexplained weight lossSymptoms of type 1 diabetes can start quickly, in a matter of weeks. Symptoms of type 2 diabetes often develop slowly\u2014over the course of several years\u2014and can be so mild that you might not even notice them. Many people with type 2 diabetes have no symptoms. Some people do not find out they have the disease until they have diabetes-related health problems, such as blurred vision or heart trouble.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes"
+  ],
+  [
+    "Vital signs: Vital signs reflect essential body functions, including your heartbeat, breathing rate, temperature, and blood pressure. Your health care provider may watch, measure, or monitor your vital signs to check your level of physical functioning. Normal vital signs change with age, sex, weight, exercise capability, and overall health. Normal vital sign ranges for the average healthy adult while resting are: - Blood pressure: 90/60 mm Hg to 120/80 mm Hg - Breathing: 12 to 18 breaths per minute - Pulse: 60 to 100 beats per minute - Temperature: 97.8\u00b0F to 99.1\u00b0F (36.5\u00b0C to 37.3\u00b0C)/average 98.6\u00b0F (37\u00b0C) Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002341.htm"
+  ],
+  [
+    "Myopathy with extrapyramidal signs: Myopathy with extrapyramidal signs is a disorder characterized by early childhood onset of proximal muscle weakness (muscles closest to the body\u2019s midline) and learning disabilities. The muscle weakness does not progress, but most patients develop progressive atypical involuntary muscle contractions that influence gait, movement, and posture (extrapyramidal signs) that may be disabling. Signs and symptoms are variable and include brief, repetitive, jerky and uncontrolled movements caused by muscle contractions ( chorea), tremor, abnormal posturing, and involuntary repetitive movements of the mouth and face. [1] \u00a0Other symptoms may include uncoordinated movements ( ataxia ), a very small head ( microcephaly ), drooping of the eyelids, wasting of the eye nerve ( optic atrophy), and axonal peripheral neuropathy. It is caused by changes ( mutations ) in the MICU1 gene and is inherited in an autosomal recessive \u00a0 pattern. [1] [2] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Ataxia Occasional Microcephaly Occasional Ophthalmoplegia Occasional Optic atrophy Occasional Peripheral axonal neuropathy Occasional Ptosis Occasional Abnormality of extrapyramidal motor function Very rare Chorea Very rare Dystonia Very rare Orofacial dyskinesia Very rare Proximal muscle weakness Very rare Specific learning disability Very rare Tremor Very rare Autosomal recessive inheritance - Difficulty running - Difficulty walking - Elevated serum creatine phosphokinase - Motor delay - View complete list of signs and symptoms...",
+    "https://rarediseases.info.nih.gov/diseases/12978/myopathy-with-extrapyramidal-signs"
+  ],
+  [
+    "Warning signs and symptoms of heart disease: Heart disease often develops over time. You may have early signs or symptoms long before you have serious heart problems. Or you may not realize you are developing heart disease. The warning signs of heart disease may not be obvious. Also, not every person has the same symptoms. Certain symptoms, such as chest pain, ankle swelling, and shortness of breath may be signals that something is wrong. Learning the warning signs can help you get treatment and help prevent a heart attack or stroke. Chest pain is discomfort or pain that you feel along the front of your body, between your neck and upper abdomen. There are many causes of chest pain that have nothing to do with your heart. But chest pain is still the most common symptom of poor blood flow to the heart or a heart attack. This type of chest pain is called angina. Chest pain can occur when the heart is not getting enough blood or oxygen. The amount and type of pain can vary from person to person. The intensity of the pain does not always relate to how severe the problem is. - Some people may feel a crushing pain, while others feel only mild discomfort. - Your chest may feel heavy or like someone is squeezing your heart. You may also feel a sharp, burning pain in your chest. - You may feel the pain under your breastbone (sternum), or in your neck, arms, stomach, jaw, or upper back. - Chest pain from angina often occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin. - Bad indigestion can also cause chest pain. Women, older adults, and people with diabetes may have little or no chest pain. They are more likely to have symptoms other than chest pain, such as: - Fatigue - Shortness of breath - General weakness - Change in skin color or greyish pallor (episodes of change in skin color associated with weakness) Other symptoms of a heart attack can include: - Extreme anxiety - Fainting or loss of consciousness - Lightheadedness or dizziness - Nausea or vomiting - Palpitations (feeling like your heart is beating too fast or irregularly) - Shortness of breath - Sweating, which may be very heavy When the heart can't pump blood as well as it should, blood backs up in the veins that go from the lungs to the heart. Fluid leaks into the lungs and causes shortness of breath. This is a symptom of heart failure. You may notice shortness of breath: - During activity - While you're resting - When you're lying flat on your back -- it may even wake you from sleep Coughing or wheezing that doesn't go away can be another sign that fluid is building up in your lungs. You may also cough up mucus that is pink or bloody. Swelling (edema) in your lower legs is another sign of a heart problem. When your heart doesn't work as well, blood flow slows and backs up in the veins in your legs. This causes fluid to build up in your tissues. You may also have swelling in your stomach or notice some weight gain. Narrowing of the blood vessels that bring blood to other parts of the body may mean you have a much higher risk for heart attack. It can occur when cholesterol and other fatty material (plaque) build up on the walls of your arteries. Poor blood supply to the legs may lead to: - Pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs. - Symptoms that often appear during walking or exercise, and go away after several minutes of rest. - Numbness in your legs or feet when you are at rest. Your legs may also feel cool to the touch, and the skin may look pale. A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a \"brain attack.\" Symptoms of stroke can include difficulty moving the limbs on one side of your body, one side of the face drooping, difficulty with speaking or understanding language. Tiredness can have many causes. Often it simply means that you need more rest. But feeling run down can be a sign of a more serious problem. Fatigue may be a sign of heart trouble when: - You feel much more tired than normal. It's common for women to feel severely tired before or during a heart attack. - You feel so tired that you can't do your normal daily activities. - You have sudden, severe weakness. If your heart can't pump blood as well, it may beat faster to try to keep up. You may feel your heart racing or throbbing. A fast or uneven heartbeat can also be the sign of an arrhythmia. This is a problem with your heart rate or rhythm. If you have any signs of heart disease, call your health care provider right away. Don't wait to see if the symptoms go away or dismiss them as nothing. Call your local emergency number (such as 911) if: - You have chest pain or other symptoms of a heart attack - If you know you have angina and have chest pain that doesn't go away after 5 minutes of rest or after taking nitroglycerine - If you think you may be having a heart attack - If you become extremely short of breath - If you think you may have lost consciousness Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000775.htm"
+  ],
+  [
+    "COPD (Diagnosis): Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results. Your doctor may ask whether you smoke or have had contact with lung irritants, such as secondhand smoke, air pollution, chemical fumes, or dusts. If you have an ongoing\u00a0cough, let your doctor know how long you've had it, how much you cough, and how much mucus comes up when you cough. Also, let your doctor know whether you have a family history of COPD. Your doctor will examine you and use a stethoscope to listen for wheezing or other abnormal chest sounds. He or she also may recommend one or more tests to diagnose COPD. Pulmonary Function Tests Pulmonary function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. The main test for COPD is spirometry. Other lung function tests, such as a lung diffusion capacity test, also might be used. Read\u00a0Pulmonary Function Tests\u00a0for more information. Spirometry During this painless test, a technician will ask you to take a deep breath in. Then, you'll blow as hard as you can into a tube connected to a small machine. The machine is called a spirometer. The machine measures how much air you breathe out. It also measures how fast you can blow air out. Spirometry Your doctor may have you inhale, or breathe in, medicine that helps open your airways and then blow into the tube again. He or she can then compare your test results before and after taking the medicine. Spirometry can detect COPD before symptoms develop. Your doctor also might use the test results to find out how severe your COPD is and to help set your treatment goals. The test results also may help find out whether another condition, such as\u00a0asthma\u00a0or\u00a0heart failure, is causing your symptoms. Other Tests Your doctor may recommend other tests, such as: A\u00a0chest x ray\u00a0or\u00a0chest CT scan. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms. An arterial blood gas test. This blood test measures the oxygen level in your blood using a sample of blood taken from an artery. The results from this test can show how severe your COPD is and whether you need\u00a0oxygen therapy.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/copd"
+  ],
+  [
+    "COPD (Treatment): COPD has no cure yet. However, lifestyle changes and treatments can help you feel better, stay more active, and slow the progress of the disease. The goals of COPD treatment include: Relieving your symptoms Slowing the progress of the disease Improving your exercise tolerance or your ability to stay active Preventing and treating complications Improving your overall health To assist with your treatment, your family doctor may advise you to see a pulmonologist. This is a doctor who specializes in treating lung disorders. Lifestyle Changes Quit Smoking and Avoid Lung Irritants Quitting smoking is the most important step you can take to treat COPD. Talk with your doctor about programs and products that can help you quit. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit. Also, try to avoid secondhand smoke and places with dusts, fumes, or other toxic substances that you may inhale. For more information about how to quit smoking, read Smoking and Your Heart and the National Heart, Lung, and Blood Institute's\u00a0Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute\u2019s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848). Other Lifestyle Changes If you have COPD, especially more severe forms, you may have trouble eating enough because of symptoms such as shortness of breath and fatigue. As a result, you may not get all of the calories and nutrients you need, which can worsen your symptoms and raise your risk for infections. Talk with your doctor about following an eating plan that will meet your nutritional needs. Your doctor may suggest eating smaller, more frequent meals; resting before eating; and taking vitamins or nutritional supplements. Also, talk with your doctor about what types of activity are safe for you. You may find it hard to remain active with your symptoms. However, physical activity can strengthen the muscles that help you breathe and improve your overall wellness. Medicines Bronchodilators Bronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier. Depending on the severity of your COPD, your doctor may prescribe short-acting or long-acting bronchodilators. Short-acting bronchodilators last about 4\u20136 hours and should be used only when needed. Long-acting bronchodilators last about 12 hours or more and are used every day. Most bronchodilators are taken using a device called an inhaler. This device allows the medicine to go straight to your lungs. Not all inhalers are used the same way. Ask your health care providers to show you the correct way to use your inhaler. If your COPD is mild, your doctor may only prescribe a short-acting inhaled bronchodilator. In this case, you may use the medicine only when symptoms occur. If your COPD is moderate or severe, your doctor may prescribe regular treatment with short- and long-acting bronchodilators. Combination Bronchodilators Plus Inhaled Glucocorticosteroids (Steroids) In general, using inhaled steroids alone is not a preferred treatment. If your COPD is more severe, or if your symptoms flare up often, your doctor may prescribe a combination of medicines that includes a bronchodilator and an inhaled steroid. Steroids help reduce airway inflammation.\u00a0 Your doctor may ask you to try inhaled steroids with the bronchodilator for a trial period of 6\u00a0weeks to 3\u00a0months to see whether the addition of the steroid helps relieve your breathing problems. Vaccines Flu Shots The flu, or influenza, can cause serious problems for people who have COPD. Flu shots can reduce your risk of getting the flu. Talk with your doctor about getting a yearly flu shot. Pneumococcal Vaccine This vaccine lowers your risk for pneumococcal\u00a0pneumonia\u00a0and its complications. People who have COPD are at higher risk for pneumonia than people who do not have COPD. Talk with your doctor about whether you should get this vaccine. Pulmonary Rehabilitation Pulmonary rehabilitation\u00a0or rehab is a broad program that helps improve the well-being of people who have chronic breathing problems. Rehab may include an exercise program, disease management training, and nutritional and psychological counseling. The program's goal is to help you stay active and carry out your daily activities. Your rehab team may include doctors, nurses, physical therapists, respiratory therapists, exercise specialists, and dietitians. These health professionals will create a program that meets your needs. Oxygen Therapy If you have severe COPD and low levels of oxygen in your blood,\u00a0oxygen therapy\u00a0can help you breathe better. For this treatment, oxygen is delivered through nasal prongs or a mask. You may need extra oxygen all the time or only at certain times. For some people who have severe COPD, using extra oxygen for most of the day can help them: Do tasks or activities while experiencing fewer symptoms Protect their hearts and other organs from damage Sleep more during the night and improve alertness during the day Live longer Surgery Surgery may benefit some people who have COPD. Surgery usually is a last resort for people who have severe symptoms that have not improved from taking medicines. Surgeries for people who have COPD that is mainly related to\u00a0emphysema\u00a0include bullectomy and lung volume reduction surgery (LVRS). A\u00a0lung transplant\u00a0might be an option for people who have very severe COPD. Bullectomy When the walls of the air sacs are destroyed, larger air spaces called bullae form. These air spaces can become so large that they interfere with breathing. In a bullectomy, doctors remove one or more very large bullae from the lungs. Lung Volume Reduction Surgery In LVRS, surgeons remove damaged tissue from the lungs. This helps the lungs work better. In carefully selected patients, LVRS can improve breathing and quality of life. Lung Transplant During a lung transplant, doctors remove your damaged lung and replace it with a healthy lung from a donor. A lung transplant can improve your lung function and quality of life. However, lung transplants have many risks, such as infections and rejection of the transplanted lung. If you have very severe COPD, talk with your doctor about whether a lung transplant is an option. Ask your doctor about the benefits and risks of this type of surgery. Managing Complications COPD symptoms usually worsen slowly over time. However, they can worsen suddenly. For instance, a cold, flu, or lung infection may cause your symptoms to quickly worsen. You may have a much harder time catching your breath. You also may have chest tightness, more\u00a0coughing, changes in the color or amount of your sputum or spit, and a fever. Call your doctor right away if your symptoms worsen suddenly. He or she may prescribe antibiotics to treat the infection, along with other medicines, such as bronchodilators and inhaled steroids, to help you breathe. Some severe symptoms may require treatment in a hospital. For more information, read\u00a0Signs and Symptoms.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/copd"
+  ],
+  [
+    "What are the treatments for COPD?: Treatment for COPD can be different for each person and is based on whether symptoms are mild, moderate or severe. Treatments include medication, pulmonary or lung rehabilitation, oxygen treatment, and surgery. There are also treatments to manage complications or a sudden onset of symptoms.",
+    "http://nihseniorhealth.gov/copd/toc.html"
+  ],
+  [
+    "COPD (Treatment): A diagnosis of COPD is not the end of the world. Most people have mild forms of the disease for which little therapy is needed other than smoking cessation. Even for more advanced stages of disease, effective therapy is available that can control symptoms, reduce your risk of complications and exacerbations, and improve your ability to lead an active life. Smoking cessation The most essential step in any treatment plan for COPD is to stop all smoking. It's the only way to keep COPD from getting worse - which can eventually reduce your ability to breathe. But quitting smoking isn't easy. And this task may seem particularly daunting if you've tried to quit and have been unsuccessful. Talk to your doctor about nicotine replacement products and medications that might help, as well as how to handle relapses. Your doctor may also recommend a support group for people who want to quit smoking. It's also a good idea to avoid secondhand smoke exposure whenever possible. Medications Doctors use several kinds of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed. These medications - which usually come in an inhaler - relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day or both. Short-acting bronchodilators include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex HFA), and ipratropium (Atrovent). The long-acting bronchodilators include tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil, Perforomist), arformoterol (Brovana), indacaterol (Arcapta) and aclidinium (Tudorza). Inhaled corticosteroid medications can reduce airway inflammation and help prevent exacerbations. Side effects may include bruising, oral infections and hoarseness. These medications are useful for people with frequent exacerbations of COPD. Fluticasone (Flovent HFA, Flonase, others) and budesonide (Pulmicort Flexhaler, Uceris, others) are examples of inhaled steroids. Some medications combine bronchodilators and inhaled steroids. Salmeterol and fluticasone (Advair) and formoterol and budesonide (Symbicort) are examples of combination inhalers. For people who have a moderate or severe acute exacerbation, short courses (for example, five days) of oral corticosteroids prevent further worsening of COPD. However, long-term use of these medications can have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection. A new type of medication approved for people with severe COPD and symptoms of chronic bronchitis is roflumilast (Daliresp), a phosphodiesterase-4 inhibitor. This drug decreases airway inflammation and relaxes the airways. Common side effects include diarrhea and weight loss. This very inexpensive medication may help improve breathing and prevent exacerbations. Side effects may include nausea, headache, fast heartbeat and tremor. Side effects are dose related, and low doses are recommended. Respiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate COPD symptoms. Antibiotics help treat acute exacerbations, but they aren't generally recommended for prevention. However, a recent study shows that the antibiotic azithromycin prevents exacerbations, but it isn't clear whether this is due to its antibiotic effect or its anti-inflammatory properties. Lung therapies Doctors often use these additional therapies for people with moderate or severe COPD: - Oxygen therapy. If there isn't enough oxygen in your blood, you may need supplemental oxygen. There are several devices to deliver oxygen to your lungs, including lightweight, portable units that you can take with you to run errands and get around town. Some people with COPD use oxygen only during activities or while sleeping. Others use oxygen all the time. Oxygen therapy can improve quality of life and is the only COPD therapy proven to extend life. Talk to your doctor about your needs and options. - Pulmonary rehabilitation program. These programs generally combine education, exercise training, nutrition advice and counseling. You'll work with a variety of specialists, who can tailor your rehabilitation program to meet your needs. Pulmonary rehabilitation may shorten hospitalizations, increase your ability to participate in everyday activities and improve your quality of life. Talk to your doctor about referral to a program. Managing exacerbations Even with ongoing treatment, you may experience times when symptoms become worse for days or weeks. This is called an acute exacerbation, and it may lead to lung failure if you don't receive prompt treatment. Exacerbations may be caused by a respiratory infection, air pollution or other triggers of inflammation. Whatever the cause, it's important to seek prompt medical help if you notice a sustained increase in coughing, a change in your mucus or if you have a harder time breathing. When exacerbations occur, you may need additional medications (such as antibiotics, steroids or both), supplemental oxygen or treatment in the hospital. Once symptoms improve, your doctor will talk with you about measures to prevent future exacerbations, such as quitting smoking, taking inhaled steroids, long-acting bronchodilators or other medications, getting your annual flu vaccine, and avoiding air pollution whenever possible. Surgery Surgery is an option for some people with some forms of severe emphysema who aren't helped sufficiently by medications alone. Surgical options include: - Lung volume reduction surgery. In this surgery, your surgeon removes small wedges of damaged lung tissue from the upper lungs. This creates extra space in your chest cavity so that the remaining healthier lung tissue can expand and the diaphragm can work more efficiently. In some people, this surgery can improve quality of life and prolong survival. - Lung transplant. Lung transplantation may be an option for certain people who meet specific criteria. Transplantation can improve your ability to breathe and to be active. However, it's a major operation that has significant risks, such as organ rejection, and it's necessary to take lifelong immune-suppressing medications. - Bullectomy. Large air spaces (bullae) form in the lungs when the walls of the air sacs are destroyed. These bullae can become very large and cause breathing problems. In a bullectomy, doctors remove bullae from the lungs to help improve air flow.",
+    "https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679"
+  ],
+  [
+    "What are the treatments for COPD?: Bronchodilators and inhaled steroids are two medications used to treat COPD. Bronchodilators work by relaxing the muscles around the airways, opening them and making it easier to breathe. People with mild COPD take bronchodilators using an inhaler only when needed. Those with moderate or severe COPD may need more regular treatment. Inhaled steroids also are used for people with moderate or severe COPD in order to reduce swelling in the airways.",
+    "http://nihseniorhealth.gov/copd/toc.html"
+  ],
+  [
+    "COPD and other health problems (Summary): If you have COPD, you are more likely to have other health problems, too. These are called comorbidities. People with COPD tend to have more health problems than people who do not have COPD. Having other health problems can affect your symptoms and treatments. You may need to visit your doctor more often. You also may need to have more tests or treatments. Having COPD is a lot to manage. But try to stay positive. You can protect your health by understanding why you are at risk for certain conditions and learning how to prevent them.",
+    "https://medlineplus.gov/ency/patientinstructions/000701.htm"
+  ],
+  [
+    "COPD (Prevention): You can take steps to prevent COPD before it starts. If you already have COPD, you can take steps to prevent complications and slow the progression of the disease. Prevent COPD Before It Starts The best way to prevent COPD is to not start smoking or to quit smoking. Smoking is the leading cause of COPD. If you smoke, talk with your doctor about programs and products that can help you quit. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit. Also, try to avoid lung irritants that can contribute to COPD, such as air pollution, chemical fumes, dusts, and secondhand smoke, which is smoke in the air from other people smoking. For more information about how to quit smoking, go to the Health Topics\u00a0Smoking and Your Heart\u00a0article and the National Heart, Lung, and Blood Institute's Your Guide to a Healthy Heart.\u00a0Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute\u2019s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848). Prevent Complications and Slow the Progression of COPD If you have COPD, the most important step you can take is to quit smoking. Quitting can help prevent complications and slow the progression of the disease. You also should avoid exposure to the lung irritants mentioned above. Follow your treatments for COPD exactly as your doctor prescribes. They can help you breathe easier, stay more active, and avoid or manage severe symptoms. Talk with your doctor about whether and when you should get flu, or influenza, and\u00a0pneumonia\u00a0vaccines. These vaccines can lower your chances of getting these illnesses, which are major health risks for people who have COPD.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/copd"
+  ],
+  [
+    "Insulin, Medicines, and Other Diabetes Treatments (Do I have other treatment options for my diabetes?): When medicines and lifestyle changes are not enough to manage your diabetes, a less common treatment may be an option. Other treatments include bariatric surgery for certain people with type 1 or type 2 diabetes, and an \"artificial pancreas\" and\u00a0pancreatic islet transplantation for some people with type 1 diabetes.Bariatric surgeryAlso called weight-loss surgery or metabolic surgery, bariatric surgery may help some people with obesity and type 2 diabetes lose a large amount of weight and regain normal blood glucose levels. Some people with diabetes may no longer need their diabetes medicine after bariatric surgery. Whether and for how long blood glucose levels improve seems to vary by the patient, type of weight-loss surgery, and amount of weight the person loses. Other factors include how long someone has had diabetes and whether or not the person uses insulin.1Recent research suggests that weight-loss surgery also may help improve blood glucose control in people with type 1 diabetes who are obese.2Researchers are studying the long-term results of bariatric surgery in people with type 1 and type 2 diabetes.Artificial PancreasThe NIDDK has played an important role in developing \u201cartificial pancreas\u201d technology. An artificial pancreas replaces manual blood glucose testing and the use of insulin shots or a pump. A single system monitors blood glucose levels around the clock and provides insulin or a combination of insulin and a second hormone, glucagon, automatically. The system can also be monitored remotely, for example by parents or medical staff.In 2016, the FDA approved a type of artificial pancreas system called a hybrid closed-loop system. This system tests your glucose level every 5 minutes throughout the day and night, and automatically gives you the right amount of insulin.You still need to manually adjust the amount of insulin the pump delivers at mealtimes. But, the artificial pancreas may free you from some of the daily tasks needed to keep your blood glucose stable\u2014or help you sleep through the night without the need to wake and test your glucose or take medicine.The hybrid closed-loop system is expected to be available in the U.S. in 2017. Talk with your health care provider about whether this system might be right for you.The NIDDK has funded several important studies on different types of artificial pancreas devices to better help people with type 1 diabetes manage their disease. The devices may also help people with type 2 diabetes and gestational diabetes.Pancreatic islet transplantationPancreatic islet transplantation is an experimental treatment for poorly controlled type 1 diabetes. Pancreatic islets are clusters of cells in the pancreas that make the hormone insulin. In type 1 diabetes, the body\u2019s immune system attacks these cells. A pancreatic islet transplant replaces destroyed islets with new ones that make and release insulin. This procedure takes islets from the pancreas of an organ donor and transfers them to a person with type 1 diabetes. Because researchers are still studying pancreatic islet transplantation, the procedure is only available to people enrolled in research studies. Learn more about islet transplantation studies.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/insulin-medicines-treatments"
+  ],
+  [
+    "Chronic obstructive pulmonary disease (Treatment): There is no cure for COPD. But there are many things you can do to relieve symptoms and keep the disease from getting worse. If you smoke, now is the time to quit. This is the best way to slow lung damage. Medicines used to treat COPD include: - Inhalers (bronchodilators) COPD -- quick-relief drugs to help open the airways - Inhaled COPD -- control drugs or oral steroids to reduce lung inflammation - Anti-inflammatory drugs to reduce swelling in the airways - Certain long-term antibiotics In severe cases or during flare-ups, you may need to receive: - Steroids by mouth or through a vein (intravenously) - Bronchodilators through a nebulizer - Oxygen therapy - Assistance from a machine to help breathing by using a mask, BiPAP, or through the use of an endotracheal tube Your health care provider may prescribe antibiotics during symptom flare-ups, because an infection can make COPD worse. You may need oxygen therapy at home if you have a low level of oxygen in your blood. Pulmonary rehabilitation does not cure COPD. But it can teach you to breathe in a different way so you can stay active and feel better. LIVING WITH COPD You can do things every day to keep COPD from getting worse, protect your lungs, and stay healthy. Walk to build up strength: - Ask the provider or therapist how far to walk. - Slowly increase how far you walk. - Avoid talking if you get short of breath when you walk. - Use pursed lip breathing when you breathe out, to empty your lungs before the next breath. Things you can do to make it easier for yourself around the home include: - Avoid very cold air or very hot weather - Make sure no one smokes in your home - Reduce air pollution by not using the fireplace and getting rid of other irritants - Manage stress in your mood Eat healthy foods, including fish, poultry, and lean meat, as well as fruits and vegetables. If it is hard to keep your weight up, talk to a provider or dietitian about eating foods with more calories. Surgery may be used to treat COPD. Only a few people benefit from these surgical treatments: - Surgery to remove parts of the diseased lung, which can help less-diseased parts work better in some people with emphysema - Lung transplant for a small number of very severe cases",
+    "https://medlineplus.gov/ency/article/000091.htm"
+  ],
+  [
+    "COPD (Summary): Summary COPD (chronic obstructive pulmonary disease) makes it hard for you to breathe. The two main types are chronic bronchitis and emphysema. The main cause of COPD is long-term exposure to substances that irritate and damage the lungs. This is usually cigarette smoke. Air pollution, chemical fumes, or dust can also cause it. At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. They include - A cough that produces a lot of mucus - Shortness of breath, especially with physical activity - Wheezing - Chest tightness Doctors use lung function tests, imaging tests, and blood tests to diagnose COPD. There is no cure. Treatments may relieve symptoms. They include medicines, oxygen therapy, surgery, or a lung transplant. Quitting smoking is the most important step you can take to treat COPD. NIH: National Heart, Lung, and Blood Institute",
+    "#"
+  ],
+  [
+    "COPD - managing stress and your mood (How to Manage Stress and Avoid Depression): There are things you can and should do to protect your emotional health. While you cannot get rid of all the stress in your life, you can learn how to manage it. These suggestions may help you relieve stress and stay positive. - Identify the people, places, and situations that cause stress. Knowing what causes you stress can help you avoid or manage it. - Try to avoid things that make you anxious. For example, DO NOT spend time with people who stress you out. Instead, seek out people who nurture and support you. Go shopping during quieter times when there's less traffic and fewer people around. - Practice relaxation exercises. Deep breathing, visualization, letting go of negative thoughts, and muscle relaxation exercises are all simple ways to release tension and reduce stress. - DO NOT take on too much. Take care of yourself by letting go and learning to say no. For example, perhaps you typically host 25 people for Thanksgiving dinner. Cut it back to 8. Or better yet, ask someone else to host. If you work, talk with your boss about ways to manage your workload so you do not feel overwhelmed. - Stay involved. DO NOT isolate yourself. Make time every week to spend time with friends or attend social events. - Practice positive daily health habits. Get up and get dressed every morning. Move your body every day. Exercise is one of the best stress busters and mood boosters around. Eat a healthy diet and get enough sleep every night. - Talk it out. Share your feelings with trusted family or friends. Or talk with a clergy member. DO NOT keep things bottled up inside. - Follow your treatment plan. When your COPD is well-managed, you will have more energy for the things you enjoy. - DO NOT delay. Get help for depression. Feeling angry, upset, sad, or anxious at times is understandable. Having COPD changes your life, and it can be hard to accept a new way of living. However, depression is more than occasional sadness or frustration. Symptoms of depression include: - Low mood most of the time - Frequent irritability - Not enjoying your usual activities - Trouble sleeping, or sleeping too much - A big change in appetite, often with weight gain or loss - Increased tiredness and lack of energy - Feelings of worthlessness, self-hate, and guilt - Trouble concentrating - Feeling hopeless or helpless - Repeated thoughts of death or suicide If you have symptoms of depression that last for 2 weeks or more, call your doctor. You do not have to live with these feelings. Treatment can help you feel better.",
+    "https://medlineplus.gov/ency/patientinstructions/000700.htm"
+  ],
+  [
+    "COPD (Diagnosis): Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results. Your doctor may ask whether you smoke or have had contact with lung irritants, such as secondhand smoke, air pollution, chemical fumes, or dusts. If you have an ongoing\u00a0cough, let your doctor know how long you've had it, how much you cough, and how much mucus comes up when you cough. Also, let your doctor know whether you have a family history of COPD. Your doctor will examine you and use a stethoscope to listen for wheezing or other abnormal chest sounds. He or she also may recommend one or more tests to diagnose COPD. Pulmonary Function Tests Pulmonary function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. The main test for COPD is spirometry. Other lung function tests, such as a lung diffusion capacity test, also might be used. Read\u00a0Pulmonary Function Tests\u00a0for more information. Spirometry During this painless test, a technician will ask you to take a deep breath in. Then, you'll blow as hard as you can into a tube connected to a small machine. The machine is called a spirometer. The machine measures how much air you breathe out. It also measures how fast you can blow air out. Spirometry Your doctor may have you inhale, or breathe in, medicine that helps open your airways and then blow into the tube again. He or she can then compare your test results before and after taking the medicine. Spirometry can detect COPD before symptoms develop. Your doctor also might use the test results to find out how severe your COPD is and to help set your treatment goals. The test results also may help find out whether another condition, such as\u00a0asthma\u00a0or\u00a0heart failure, is causing your symptoms. Other Tests Your doctor may recommend other tests, such as: A\u00a0chest x ray\u00a0or\u00a0chest CT scan. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms. An arterial blood gas test. This blood test measures the oxygen level in your blood using a sample of blood taken from an artery. The results from this test can show how severe your COPD is and whether you need\u00a0oxygen therapy.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/copd"
+  ],
+  [
+    "How to diagnose COPD?: To confirm a COPD diagnosis, a doctor will use a breathing test called spirometry. The test is easy and painless. It shows how well the lungs are working. The spirometer measures how much air the lungs can hold and how fast air is blown out of the lungs. Other tests, such as bronchodilator reversibility testing, a chest X-ray, and arterial blood gas test, may be ordered.",
+    "http://nihseniorhealth.gov/copd/toc.html"
+  ],
+  [
+    "COPD (Diagnosis): COPD is commonly misdiagnosed - former smokers may sometimes be told they have COPD, when in reality they may have simple deconditioning or another less common lung condition. Likewise, many people who have COPD may not be diagnosed until the disease is advanced and interventions are less effective. To diagnose your condition, your doctor will review your signs and symptoms, discuss your family and medical history, and discuss any exposure you've had to lung irritants - especially cigarette smoke. Your doctor may order several tests to diagnose your condition. Tests may include: - Lung (pulmonary) function tests. Pulmonary function tests measure the amount of air you can inhale and exhale, and if your lungs are delivering enough oxygen to your blood. Spirometry is the most common lung function test. During this test, you'll be asked to blow into a large tube connected to a small machine called a spirometer. This machine measures how much air your lungs can hold and how fast you can blow the air out of your lungs. Spirometry can detect COPD even before you have symptoms of the disease. It can also be used to track the progression of disease and to monitor how well treatment is working. Spirometry often includes measurement of the effect of bronchodilator administration. Other lung function tests include measurement of lung volumes, diffusing capacity and pulse oximetry. - Chest X-ray. A chest X-ray can show emphysema, one of the main causes of COPD. An X-ray can also rule out other lung problems or heart failure. - CT scan. A CT scan of your lungs can help detect emphysema and help determine if you might benefit from surgery for COPD. CT scans can also be used to screen for lung cancer. - Arterial blood gas analysis. This blood test measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide. - Laboratory tests. Laboratory tests aren't used to diagnose COPD, but they may be used to determine the cause of your symptoms or rule out other conditions. For example, laboratory tests may be used to determine if you have the genetic disorder alpha-1-antitrypsin (AAt) deficiency, which may be the cause of some cases of COPD. This test may be done if you have a family history of COPD and develop COPD at a young age, such as under age 45.",
+    "https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679"
+  ],
+  [
+    "How to diagnose COPD?: If you have not been exercising regularly, you should get the advice of your doctor before starting. The symptoms of COPD are different for each person. People with mild COPD may not have much difficulty walking or exercising. As the symptoms of COPD get worse over time, a person may have more difficulty with walking and exercising. You should talk to your doctor about exercising and whether you would benefit from a pulmonary or lung rehabilitation program.",
+    "http://nihseniorhealth.gov/copd/toc.html"
+  ],
+  [
+    "COPD (Summary): Summary COPD (chronic obstructive pulmonary disease) makes it hard for you to breathe. The two main types are chronic bronchitis and emphysema. The main cause of COPD is long-term exposure to substances that irritate and damage the lungs. This is usually cigarette smoke. Air pollution, chemical fumes, or dust can also cause it. At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. They include - A cough that produces a lot of mucus - Shortness of breath, especially with physical activity - Wheezing - Chest tightness Doctors use lung function tests, imaging tests, and blood tests to diagnose COPD. There is no cure. Treatments may relieve symptoms. They include medicines, oxygen therapy, surgery, or a lung transplant. Quitting smoking is the most important step you can take to treat COPD. NIH: National Heart, Lung, and Blood Institute",
+    "#"
+  ],
+  [
+    "COPD (More Information): NHLBI resources Alpha-1 Antitrypsin Deficiency Asthma Breathing Better With a COPD Diagnosis\u00a0(also available in\u00a0Spanish) Bronchitis\u00a0 COPD: Are You at Risk?\u00a0(also available in\u00a0Spanish) Chest X Ray Chest CT Scan COPD Learn More Breathe Better\u00ae COPD National Action Plan Cough Fact Sheet:\u00a0Long-Term Oxygen Treatment Trial (LOTT) Frequently Asked Questions How the Lungs Work\u00a0 Lung Transplant Oxygen Therapy\u00a0 Pneumonia Pulmonary Function Tests\u00a0 Pulmonary Rehabilitation\u00a0 Smoking and Your Heart Story of Success: COPD Your Guide to a Healthy Heart Other resources Chronic Bronchitis\u00a0(National Library of Medicine [NLM] MedlinePlus) COPD\u00a0(NLM MedlinePlus) Emphysema\u00a0(NLM MedlinePlus) Smokefree.gov (National Cancer Institute [NCI]) Quitlines and the Expansion of Smoking Cessation Support (NCI) ____________________ \u00ae COPD Learn More Breathe Better is a registered trademark of the U.S. Department of Health and Human Services.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/copd"
+  ],
+  [
+    "COPD: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It's caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions. Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It's characterized by daily cough and mucus (sputum) production. Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter. COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions. COPD care at Mayo Clinic COPD symptoms often don't appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues. For chronic bronchitis, the main symptom is a daily cough and mucus (sputum) production at least three months a year for two consecutive years. Other signs and symptoms of COPD may include: - Shortness of breath, especially during physical activities - Wheezing - Chest tightness - Having to clear your throat first thing in the morning, due to excess mucus in your lungs - A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish - Blueness of the lips or fingernail beds (cyanosis) - Frequent respiratory infections - Lack of energy - Unintended weight loss (in later stages) - Swelling in ankles, feet or legs People with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than usual day-to-day variation and persist for at least several days. The main cause of COPD in developed countries is tobacco smoking. In the developing world, COPD often occurs in people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes. Only about 20 to 30 percent of chronic smokers may develop clinically apparent COPD, although many smokers with long smoking histories may develop reduced lung function. Some smokers develop less common lung conditions. They may be misdiagnosed as having COPD until a more thorough evaluation is performed. Air travels down your windpipe (trachea) and into your lungs through two large tubes (bronchi). Inside your lungs, these tubes divide many times - like the branches of a tree - into many smaller tubes (bronchioles) that end in clusters of tiny air sacs (alveoli). The air sacs have very thin walls full of tiny blood vessels (capillaries). The oxygen in the air you inhale passes into these blood vessels and enters your bloodstream. At the same time, carbon dioxide - a gas that is a waste product of metabolism - is exhaled. Your lungs rely on the natural elasticity of the bronchial tubes and air sacs to force air out of your body. COPD causes them to lose their elasticity and overexpand, which leaves some air trapped in your lungs when you exhale. Causes of airway obstruction include: - Emphysema. This lung disease causes destruction of the fragile walls and elastic fibers of the alveoli. Small airways collapse when you exhale, impairing airflow out of your lungs. - Chronic bronchitis. In this condition, your bronchial tubes become inflamed and narrowed and your lungs produce more mucus, which can further block the narrowed tubes. You develop a chronic cough trying to clear your airways. In the vast majority of cases, the lung damage that leads to COPD is caused by long-term cigarette smoking. But there are likely other factors at play in the development of COPD, such as a genetic susceptibility to the disease, because only about 20 to 30 percent of smokers may develop COPD. Other irritants can cause COPD, including cigar smoke, secondhand smoke, pipe smoke, air pollution and workplace exposure to dust, smoke or fumes. In about 1 percent of people with COPD, the disease results from a genetic disorder that causes low levels of a protein called alpha-1-antitrypsin. Alpha-1-antitrypsin (AAt) is made in the liver and secreted into the bloodstream to help protect the lungs. Alpha-1-antitrypsin deficiency can affect the liver as well as the lungs. Damage to the lung can occur in infants and children, not only adults with long smoking histories. For adults with COPD related to AAt deficiency, treatment options include those used for people with more-common types of COPD. In addition, some people can be treated by replacing the missing AAt protein, which may prevent further damage to the lungs. Risk factors for COPD include: - Exposure to tobacco smoke. The most significant risk factor for COPD is long-term cigarette smoking. The more years you smoke and the more packs you smoke, the greater your risk. Pipe smokers, cigar smokers and marijuana smokers also may be at risk, as well as people exposed to large amounts of secondhand smoke. - People with asthma who smoke. The combination of asthma, a chronic inflammatory airway disease, and smoking increases the risk of COPD even more. - Occupational exposure to dusts and chemicals. Long-term exposure to chemical fumes, vapors and dusts in the workplace can irritate and inflame your lungs. - Exposure to fumes from burning fuel. In the developing world, people exposed to fumes from burning fuel for cooking and heating in poorly ventilated homes are at higher risk of developing COPD. - Age. COPD develops slowly over years, so most people are at least 40 years old when symptoms begin. - Genetics. The uncommon genetic disorder alpha-1-antitrypsin deficiency is the cause of some cases of COPD. Other genetic factors likely make certain smokers more susceptible to the disease. COPD can cause many complications, including: - Respiratory infections. People with COPD are more likely to catch colds, the flu and pneumonia. Any respiratory infection can make it much more difficult to breathe and could cause further damage to lung tissue. An annual flu vaccination and regular vaccination against pneumococcal pneumonia can prevent some infections. - Heart problems. For reasons that aren't fully understood, COPD can increase your risk of heart disease, including heart attack. Quitting smoking may reduce this risk. - Lung cancer. People with COPD have a higher risk of developing lung cancer. Quitting smoking may reduce this risk. - High blood pressure in lung arteries. COPD may cause high blood pressure in the arteries that bring blood to your lungs (pulmonary hypertension). - Depression. Difficulty breathing can keep you from doing activities that you enjoy. And dealing with serious illness can contribute to development of depression. Talk to your doctor if you feel sad or helpless or think that you may be experiencing depression. COPD is commonly misdiagnosed - former smokers may sometimes be told they have COPD, when in reality they may have simple deconditioning or another less common lung condition. Likewise, many people who have COPD may not be diagnosed until the disease is advanced and interventions are less effective. To diagnose your condition, your doctor will review your signs and symptoms, discuss your family and medical history, and discuss any exposure you've had to lung irritants - especially cigarette smoke. Your doctor may order several tests to diagnose your condition. Tests may include: - Lung (pulmonary) function tests. Pulmonary function tests measure the amount of air you can inhale and exhale, and if your lungs are delivering enough oxygen to your blood. Spirometry is the most common lung function test. During this test, you'll be asked to blow into a large tube connected to a small machine called a spirometer. This machine measures how much air your lungs can hold and how fast you can blow the air out of your lungs. Spirometry can detect COPD even before you have symptoms of the disease. It can also be used to track the progression of disease and to monitor how well treatment is working. Spirometry often includes measurement of the effect of bronchodilator administration. Other lung function tests include measurement of lung volumes, diffusing capacity and pulse oximetry. - Chest X-ray. A chest X-ray can show emphysema, one of the main causes of COPD. An X-ray can also rule out other lung problems or heart failure. - CT scan. A CT scan of your lungs can help detect emphysema and help determine if you might benefit from surgery for COPD. CT scans can also be used to screen for lung cancer. - Arterial blood gas analysis. This blood test measures how well your lungs are bringing oxygen into your blood and removing carbon dioxide. - Laboratory tests. Laboratory tests aren't used to diagnose COPD, but they may be used to determine the cause of your symptoms or rule out other conditions. For example, laboratory tests may be used to determine if you have the genetic disorder alpha-1-antitrypsin (AAt) deficiency, which may be the cause of some cases of COPD. This test may be done if you have a family history of COPD and develop COPD at a young age, such as under age 45. A diagnosis of COPD is not the end of the world. Most people have mild forms of the disease for which little therapy is needed other than smoking cessation. Even for more advanced stages of disease, effective therapy is available that can control symptoms, reduce your risk of complications and exacerbations, and improve your ability to lead an active life. Smoking cessation The most essential step in any treatment plan for COPD is to stop all smoking. It's the only way to keep COPD from getting worse - which can eventually reduce your ability to breathe. But quitting smoking isn't easy. And this task may seem particularly daunting if you've tried to quit and have been unsuccessful. Talk to your doctor about nicotine replacement products and medications that might help, as well as how to handle relapses. Your doctor may also recommend a support group for people who want to quit smoking. It's also a good idea to avoid secondhand smoke exposure whenever possible. Medications Doctors use several kinds of medications to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed. These medications - which usually come in an inhaler - relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day or both. Short-acting bronchodilators include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex HFA), and ipratropium (Atrovent). The long-acting bronchodilators include tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil, Perforomist), arformoterol (Brovana), indacaterol (Arcapta) and aclidinium (Tudorza). Inhaled corticosteroid medications can reduce airway inflammation and help prevent exacerbations. Side effects may include bruising, oral infections and hoarseness. These medications are useful for people with frequent exacerbations of COPD. Fluticasone (Flovent HFA, Flonase, others) and budesonide (Pulmicort Flexhaler, Uceris, others) are examples of inhaled steroids. Some medications combine bronchodilators and inhaled steroids. Salmeterol and fluticasone (Advair) and formoterol and budesonide (Symbicort) are examples of combination inhalers. For people who have a moderate or severe acute exacerbation, short courses (for example, five days) of oral corticosteroids prevent further worsening of COPD. However, long-term use of these medications can have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection. A new type of medication approved for people with severe COPD and symptoms of chronic bronchitis is roflumilast (Daliresp), a phosphodiesterase-4 inhibitor. This drug decreases airway inflammation and relaxes the airways. Common side effects include diarrhea and weight loss. This very inexpensive medication may help improve breathing and prevent exacerbations. Side effects may include nausea, headache, fast heartbeat and tremor. Side effects are dose related, and low doses are recommended. Respiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate COPD symptoms. Antibiotics help treat acute exacerbations, but they aren't generally recommended for prevention. However, a recent study shows that the antibiotic azithromycin prevents exacerbations, but it isn't clear whether this is due to its antibiotic effect or its anti-inflammatory properties. Lung therapies Doctors often use these additional therapies for people with moderate or severe COPD: - Oxygen therapy. If there isn't enough oxygen in your blood, you may need supplemental oxygen. There are several devices to deliver oxygen to your lungs, including lightweight, portable units that you can take with you to run errands and get around town. Some people with COPD use oxygen only during activities or while sleeping. Others use oxygen all the time. Oxygen therapy can improve quality of life and is the only COPD therapy proven to extend life. Talk to your doctor about your needs and options. - Pulmonary rehabilitation program. These programs generally combine education, exercise training, nutrition advice and counseling. You'll work with a variety of specialists, who can tailor your rehabilitation program to meet your needs. Pulmonary rehabilitation may shorten hospitalizations, increase your ability to participate in everyday activities and improve your quality of life. Talk to your doctor about referral to a program. Managing exacerbations Even with ongoing treatment, you may experience times when symptoms become worse for days or weeks. This is called an acute exacerbation, and it may lead to lung failure if you don't receive prompt treatment. Exacerbations may be caused by a respiratory infection, air pollution or other triggers of inflammation. Whatever the cause, it's important to seek prompt medical help if you notice a sustained increase in coughing, a change in your mucus or if you have a harder time breathing. When exacerbations occur, you may need additional medications (such as antibiotics, steroids or both), supplemental oxygen or treatment in the hospital. Once symptoms improve, your doctor will talk with you about measures to prevent future exacerbations, such as quitting smoking, taking inhaled steroids, long-acting bronchodilators or other medications, getting your annual flu vaccine, and avoiding air pollution whenever possible. Surgery Surgery is an option for some people with some forms of severe emphysema who aren't helped sufficiently by medications alone. Surgical options include: - Lung volume reduction surgery. In this surgery, your surgeon removes small wedges of damaged lung tissue from the upper lungs. This creates extra space in your chest cavity so that the remaining healthier lung tissue can expand and the diaphragm can work more efficiently. In some people, this surgery can improve quality of life and prolong survival. - Lung transplant. Lung transplantation may be an option for certain people who meet specific criteria. Transplantation can improve your ability to breathe and to be active. However, it's a major operation that has significant risks, such as organ rejection, and it's necessary to take lifelong immune-suppressing medications. - Bullectomy. Large air spaces (bullae) form in the lungs when the walls of the air sacs are destroyed. These bullae can become very large and cause breathing problems. In a bullectomy, doctors remove bullae from the lungs to help improve air flow. If you have COPD, you can take steps to feel better and slow the damage to your lungs: - Control your breathing. Talk to your doctor or respiratory therapist about techniques for breathing more efficiently throughout the day. Also be sure to discuss breathing positions and relaxation techniques that you can use when you're short of breath. - Clear your airways. With COPD, mucus tends to collect in your air passages and can be difficult to clear. Controlled coughing, drinking plenty of water and using a humidifier may help. - Exercise regularly. It may seem difficult to exercise when you have trouble breathing, but regular exercise can improve your overall strength and endurance and strengthen your respiratory muscles. Discuss with your doctor which activities are appropriate for you. - Eat healthy foods. A healthy diet can help you maintain your strength. If you're underweight, your doctor may recommend nutritional supplements. If you're overweight, losing weight can significantly help your breathing, especially during times of exertion. - Avoid smoke and air pollution. In addition to quitting smoking, it's important to avoid places where others smoke. Secondhand smoke may contribute to further lung damage. Other types of air pollution also can irritate your lungs. - See your doctor regularly. Stick to your appointment schedule, even if you're feeling fine. It's important to steadily monitor your lung function. And be sure to get your annual flu vaccine in the fall to help prevent infections that can worsen your COPD. Ask your doctor when you need the pneumococcal vaccine. Let your doctor know if you have worsening symptoms or you notice signs of infection.",
+    "https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679"
+  ],
+  [
+    "COPD: Espa\u00f1ol \u00a0 Also known as chronic obstructive pulmonary disease; chronic bronchitis; or emphysema. COPD, or chronic obstructive pulmonary disease, is a progressive disease that makes it hard to breathe. Progressive means the disease gets worse over time. COPD can cause\u00a0coughing\u00a0that produces large amounts of a slimy substance called mucus, wheezing, shortness of breath, chest tightness, and other symptoms. Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke. However, up to 25 percent of people with COPD never smoked. Long-term exposure to other lung irritants\u2014such as air pollution, chemical fumes, or dusts\u2014also may contribute to COPD. A rare genetic condition called alpha-1 antitrypsin (AAT) deficiency can also cause the disease. Overview To understand COPD, it helps to understand\u00a0how the lungs work. The air that you breathe goes down your windpipe into tubes in your lungs called bronchial tubes or airways. Within the lungs, your bronchial tubes branch many times into thousands of smaller, thinner tubes called bronchioles. These tubes end in bunches of tiny round air sacs called alveoli. Small blood vessels called capillaries run along the walls of the air sacs. When air reaches the air sacs, oxygen passes through the air sac walls into the blood in the capillaries. At the same time, a waste product, called carbon dioxide (CO2) gas, moves from the capillaries into the air sacs. This process, called gas exchange, brings in oxygen for the body to use for vital functions and removes the CO2. The airways and air sacs are elastic or stretchy. When you breathe in, each air sac fills up with air, like a small balloon. When you breathe out, the air sacs deflate and the air goes out. In COPD, less air flows in and out of the airways because of one or more of the following: The airways and air sacs lose their elastic quality. The walls between many of the air sacs are destroyed. The walls of the airways become thick and inflamed. The airways make more mucus than usual and can become clogged. Normal Lungs and Lungs With COPD In the United States, the term COPD includes two main conditions\u2014emphysema\u00a0and chronic\u00a0bronchitis. In emphysema, the walls between many of the air sacs are damaged. As a result, the air sacs lose their shape and become floppy. This damage also can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones. If this happens, the amount of gas exchange in the lungs is reduced. In chronic bronchitis, the lining of the airways stays constantly irritated and inflamed, and this causes the lining to swell. Lots of thick mucus forms in the airways, making it hard to breathe. Most people who have COPD have both emphysema and chronic bronchitis, but the severity of each condition varies from person to person. Thus, the general term COPD is more accurate. Outlook COPD is a major cause of disability, and it is the third leading cause of death in the United States. Currently, 16 million people are diagnosed with COPD. Many more people may have the disease and not even know it. COPD develops slowly. Symptoms often worsen over time and can limit your ability to do routine activities. Severe COPD may prevent you from doing even basic activities like walking, cooking, or taking care of yourself. Most of the time, COPD is diagnosed in middle-aged or older adults. The disease is not contagious, meaning it cannot be passed from person to person. COPD has no cure yet, and doctors do not know how to reverse the damage to the lungs. However, treatments and lifestyle changes can help you feel better, stay more active, and slow the progress of the disease. Long-term exposure to lung irritants that damage the lungs and the airways usually is the cause of COPD. In the United States, the most common irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled. Breathing in secondhand smoke, which is in the air from other people smoking; air pollution; or chemical fumes or dusts from the environment or workplace also can contribute to COPD. Rarely, a genetic condition called\u00a0alpha-1 antitrypsin deficiency\u00a0may play a role in causing COPD. People who have this condition have low blood levels of alpha-1 antitrypsin (AAT)\u2014a protein made in the liver. Having a low level of the AAT protein can lead to lung damage and COPD if you are exposed to smoke or other lung irritants. If you have alpha-1 antitrypsin deficiency and also smoke, COPD can worsen very quickly. Some people who have\u00a0asthma\u00a0can develop COPD. Asthma is a chronic lung disease that inflames and narrows the airways. Treatment usually can reverse the inflammation and narrowing that occurs in asthma.\u00a0 The main risk factor for COPD is smoking. Up to 75 percent of people who have COPD smoke or used to smoke. People who have a family history of COPD are more likely to develop the disease if they smoke. Long-term exposure to other lung irritants also is a risk factor for COPD. Examples of other lung irritants include air pollution, chemical fumes and dusts from the environment or workplace, and secondhand smoke, which is smoke in the air from other people smoking. Most people who have COPD are at least 40 years old when symptoms begin. Although uncommon, people younger than 40 can have COPD. This may occur, for example, if a person has a predisposing health issue, such as the genetic condition known as\u00a0alpha-1 antitrypsin deficiency. At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. Common signs and symptoms of COPD include: An ongoing\u00a0cough\u00a0or a cough that produces a lot of mucus; this is often called smoker's cough. Shortness of breath, especially with physical activity Wheezing or a whistling or squeaky sound when you breathe Chest tightness If you have COPD, you also may often have colds or other respiratory infections such as the flu, or influenza. Not everyone who has the symptoms described above has COPD. Likewise, not everyone who has COPD has these symptoms. Some of the symptoms of COPD are similar to the symptoms of other diseases and conditions. Your doctor can determine if you have COPD. If your symptoms are mild, you may not notice them, or you may adjust your lifestyle to make breathing easier. For example, you may take the elevator instead of the stairs. Over time, symptoms may become severe enough to cause you to see a doctor. For example, you may become short of breath during physical exertion. The severity of your symptoms will depend on how much lung damage you have. If you keep smoking, the damage will occur faster than if you stop smoking. Severe COPD can cause other symptoms, such as swelling in your ankles, feet, or legs; weight loss; and lower muscle endurance. Some severe symptoms may require treatment in a hospital. You\u2014or, if you are unable, family members or friends\u2014should seek emergency care if you are experiencing the following: You are having a hard time catching your breath or talking. Your lips or fingernails turn blue or gray, a sign of a low oxygen level in your blood. People around you notice that you are not mentally alert. Your heartbeat is very fast. The recommended treatment for symptoms that are getting worse is not working. Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results. Your doctor may ask whether you smoke or have had contact with lung irritants, such as secondhand smoke, air pollution, chemical fumes, or dusts. If you have an ongoing\u00a0cough, let your doctor know how long you've had it, how much you cough, and how much mucus comes up when you cough. Also, let your doctor know whether you have a family history of COPD. Your doctor will examine you and use a stethoscope to listen for wheezing or other abnormal chest sounds. He or she also may recommend one or more tests to diagnose COPD. Pulmonary Function Tests Pulmonary function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. The main test for COPD is spirometry. Other lung function tests, such as a lung diffusion capacity test, also might be used. Read\u00a0Pulmonary Function Tests\u00a0for more information. Spirometry During this painless test, a technician will ask you to take a deep breath in. Then, you'll blow as hard as you can into a tube connected to a small machine. The machine is called a spirometer. The machine measures how much air you breathe out. It also measures how fast you can blow air out. Spirometry Your doctor may have you inhale, or breathe in, medicine that helps open your airways and then blow into the tube again. He or she can then compare your test results before and after taking the medicine. Spirometry can detect COPD before symptoms develop. Your doctor also might use the test results to find out how severe your COPD is and to help set your treatment goals. The test results also may help find out whether another condition, such as\u00a0asthma\u00a0or\u00a0heart failure, is causing your symptoms. Other Tests Your doctor may recommend other tests, such as: A\u00a0chest x ray\u00a0or\u00a0chest CT scan. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms. An arterial blood gas test. This blood test measures the oxygen level in your blood using a sample of blood taken from an artery. The results from this test can show how severe your COPD is and whether you need\u00a0oxygen therapy. COPD has no cure yet. However, lifestyle changes and treatments can help you feel better, stay more active, and slow the progress of the disease. The goals of COPD treatment include: Relieving your symptoms Slowing the progress of the disease Improving your exercise tolerance or your ability to stay active Preventing and treating complications Improving your overall health To assist with your treatment, your family doctor may advise you to see a pulmonologist. This is a doctor who specializes in treating lung disorders. Lifestyle Changes Quit Smoking and Avoid Lung Irritants Quitting smoking is the most important step you can take to treat COPD. Talk with your doctor about programs and products that can help you quit. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit. Also, try to avoid secondhand smoke and places with dusts, fumes, or other toxic substances that you may inhale. For more information about how to quit smoking, read Smoking and Your Heart and the National Heart, Lung, and Blood Institute's\u00a0Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute\u2019s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848). Other Lifestyle Changes If you have COPD, especially more severe forms, you may have trouble eating enough because of symptoms such as shortness of breath and fatigue. As a result, you may not get all of the calories and nutrients you need, which can worsen your symptoms and raise your risk for infections. Talk with your doctor about following an eating plan that will meet your nutritional needs. Your doctor may suggest eating smaller, more frequent meals; resting before eating; and taking vitamins or nutritional supplements. Also, talk with your doctor about what types of activity are safe for you. You may find it hard to remain active with your symptoms. However, physical activity can strengthen the muscles that help you breathe and improve your overall wellness. Medicines Bronchodilators Bronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier. Depending on the severity of your COPD, your doctor may prescribe short-acting or long-acting bronchodilators. Short-acting bronchodilators last about 4\u20136 hours and should be used only when needed. Long-acting bronchodilators last about 12 hours or more and are used every day. Most bronchodilators are taken using a device called an inhaler. This device allows the medicine to go straight to your lungs. Not all inhalers are used the same way. Ask your health care providers to show you the correct way to use your inhaler. If your COPD is mild, your doctor may only prescribe a short-acting inhaled bronchodilator. In this case, you may use the medicine only when symptoms occur. If your COPD is moderate or severe, your doctor may prescribe regular treatment with short- and long-acting bronchodilators. Combination Bronchodilators Plus Inhaled Glucocorticosteroids (Steroids) In general, using inhaled steroids alone is not a preferred treatment. If your COPD is more severe, or if your symptoms flare up often, your doctor may prescribe a combination of medicines that includes a bronchodilator and an inhaled steroid. Steroids help reduce airway inflammation.\u00a0 Your doctor may ask you to try inhaled steroids with the bronchodilator for a trial period of 6\u00a0weeks to 3\u00a0months to see whether the addition of the steroid helps relieve your breathing problems. Vaccines Flu Shots The flu, or influenza, can cause serious problems for people who have COPD. Flu shots can reduce your risk of getting the flu. Talk with your doctor about getting a yearly flu shot. Pneumococcal Vaccine This vaccine lowers your risk for pneumococcal\u00a0pneumonia\u00a0and its complications. People who have COPD are at higher risk for pneumonia than people who do not have COPD. Talk with your doctor about whether you should get this vaccine. Pulmonary Rehabilitation Pulmonary rehabilitation\u00a0or rehab is a broad program that helps improve the well-being of people who have chronic breathing problems. Rehab may include an exercise program, disease management training, and nutritional and psychological counseling. The program's goal is to help you stay active and carry out your daily activities. Your rehab team may include doctors, nurses, physical therapists, respiratory therapists, exercise specialists, and dietitians. These health professionals will create a program that meets your needs. Oxygen Therapy If you have severe COPD and low levels of oxygen in your blood,\u00a0oxygen therapy\u00a0can help you breathe better. For this treatment, oxygen is delivered through nasal prongs or a mask. You may need extra oxygen all the time or only at certain times. For some people who have severe COPD, using extra oxygen for most of the day can help them: Do tasks or activities while experiencing fewer symptoms Protect their hearts and other organs from damage Sleep more during the night and improve alertness during the day Live longer Surgery Surgery may benefit some people who have COPD. Surgery usually is a last resort for people who have severe symptoms that have not improved from taking medicines. Surgeries for people who have COPD that is mainly related to\u00a0emphysema\u00a0include bullectomy and lung volume reduction surgery (LVRS). A\u00a0lung transplant\u00a0might be an option for people who have very severe COPD. Bullectomy When the walls of the air sacs are destroyed, larger air spaces called bullae form. These air spaces can become so large that they interfere with breathing. In a bullectomy, doctors remove one or more very large bullae from the lungs. Lung Volume Reduction Surgery In LVRS, surgeons remove damaged tissue from the lungs. This helps the lungs work better. In carefully selected patients, LVRS can improve breathing and quality of life. Lung Transplant During a lung transplant, doctors remove your damaged lung and replace it with a healthy lung from a donor. A lung transplant can improve your lung function and quality of life. However, lung transplants have many risks, such as infections and rejection of the transplanted lung. If you have very severe COPD, talk with your doctor about whether a lung transplant is an option. Ask your doctor about the benefits and risks of this type of surgery. Managing Complications COPD symptoms usually worsen slowly over time. However, they can worsen suddenly. For instance, a cold, flu, or lung infection may cause your symptoms to quickly worsen. You may have a much harder time catching your breath. You also may have chest tightness, more\u00a0coughing, changes in the color or amount of your sputum or spit, and a fever. Call your doctor right away if your symptoms worsen suddenly. He or she may prescribe antibiotics to treat the infection, along with other medicines, such as bronchodilators and inhaled steroids, to help you breathe. Some severe symptoms may require treatment in a hospital. For more information, read\u00a0Signs and Symptoms. \u00a0 You can take steps to prevent COPD before it starts. If you already have COPD, you can take steps to prevent complications and slow the progression of the disease. Prevent COPD Before It Starts The best way to prevent COPD is to not start smoking or to quit smoking. Smoking is the leading cause of COPD. If you smoke, talk with your doctor about programs and products that can help you quit. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit. Also, try to avoid lung irritants that can contribute to COPD, such as air pollution, chemical fumes, dusts, and secondhand smoke, which is smoke in the air from other people smoking. For more information about how to quit smoking, go to the Health Topics\u00a0Smoking and Your Heart\u00a0article and the National Heart, Lung, and Blood Institute's Your Guide to a Healthy Heart.\u00a0Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute\u2019s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848). Prevent Complications and Slow the Progression of COPD If you have COPD, the most important step you can take is to quit smoking. Quitting can help prevent complications and slow the progression of the disease. You also should avoid exposure to the lung irritants mentioned above. Follow your treatments for COPD exactly as your doctor prescribes. They can help you breathe easier, stay more active, and avoid or manage severe symptoms. Talk with your doctor about whether and when you should get flu, or influenza, and\u00a0pneumonia\u00a0vaccines. These vaccines can lower your chances of getting these illnesses, which are major health risks for people who have COPD. COPD has no cure yet. However, you can take steps to manage your symptoms and slow the progression of the disease. Avoid lung irritants. Get ongoing care. Manage the disease and its symptoms. Prepare for emergencies. Avoid Lung Irritants If you smoke, quit. Smoking is the leading cause of COPD. Talk with your doctor about programs and products that can help you quit. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit. For more information about how to quit smoking, go to the Health Topics\u00a0Smoking and Your Heart\u00a0article and the National Heart, Lung, and Blood Institute's\u00a0Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute\u2019s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848). Also, try to avoid lung irritants that can contribute to COPD, such as air pollution, chemical fumes, dusts, and secondhand smoke, which is smoke in the air from other people smoking. Keep these irritants out of your home. If you are getting your home painted or sprayed for insects, have it done when you can stay away for a while. If possible, keep your windows closed and stay at home when there is a lot of air pollution or dusts outside. Get Ongoing Care If you have COPD, it is important to get ongoing medical care. Take all your medicines as your doctor prescribes. Make sure to refill your prescriptions before they run out. Bring a list of all the medicines you are taking when you have medical checkups. Talk with your doctor about whether and when you should get flu, or influenza, and\u00a0pneumonia\u00a0vaccines. Also, ask him or her about other diseases for which COPD may increase your risk, such as heart disease, lung cancer, and pneumonia. Manage COPD and Its Symptoms You can do things to help manage COPD and its symptoms. For example: Do activities slowly. Put items you use often in one easy-to-reach place. Find simple ways to cook, clean, and do other chores. For example, you might want to use a small table or cart with wheels to move things around and a pole or tongs with long handles to reach things. Ask for help in making things more accessible in your house so that you won't need to climb stairs as often. Keep your clothes loose, and wear clothes and shoes that are easy to put on and take off. Depending on how severe your disease is, you may want to ask your family and friends for help with daily tasks. Prepare for Emergencies If you have COPD, know when and where to seek help for your symptoms. You should get emergency care if you have severe symptoms, such as trouble catching your breath or talking. For more information on severe symptoms of COPD, read\u00a0Signs and Symptoms. Call your doctor if you notice that your symptoms are worsening or if you have signs of an infection, such as a fever. Your doctor may change or adjust your treatments to relieve and treat symptoms. Keep phone numbers handy for your doctor, hospital, and someone who can take you for medical care. You also should have on hand directions to the doctor's office and hospital and a list of all the medicines you are taking. Emotional Issues and Support Living with COPD may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also might help. If you are depressed, your doctor may recommend medicines or other treatments that can improve your quality of life. Joining a patient support group may help you adjust to living with COPD. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center. Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you. NHLBI resources Alpha-1 Antitrypsin Deficiency Asthma Breathing Better With a COPD Diagnosis\u00a0(also available in\u00a0Spanish) Bronchitis\u00a0 COPD: Are You at Risk?\u00a0(also available in\u00a0Spanish) Chest X Ray Chest CT Scan COPD Learn More Breathe Better\u00ae COPD National Action Plan Cough Fact Sheet:\u00a0Long-Term Oxygen Treatment Trial (LOTT) Frequently Asked Questions How the Lungs Work\u00a0 Lung Transplant Oxygen Therapy\u00a0 Pneumonia Pulmonary Function Tests\u00a0 Pulmonary Rehabilitation\u00a0 Smoking and Your Heart Story of Success: COPD Your Guide to a Healthy Heart Other resources Chronic Bronchitis\u00a0(National Library of Medicine [NLM] MedlinePlus) COPD\u00a0(NLM MedlinePlus) Emphysema\u00a0(NLM MedlinePlus) Smokefree.gov (National Cancer Institute [NCI]) Quitlines and the Expansion of Smoking Cessation Support (NCI) ____________________ \u00ae COPD Learn More Breathe Better is a registered trademark of the U.S. Department of Health and Human Services.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/copd"
+  ],
+  [
+    "COPD (Causes): Long-term exposure to lung irritants that damage the lungs and the airways usually is the cause of COPD. In the United States, the most common irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled. Breathing in secondhand smoke, which is in the air from other people smoking; air pollution; or chemical fumes or dusts from the environment or workplace also can contribute to COPD. Rarely, a genetic condition called\u00a0alpha-1 antitrypsin deficiency\u00a0may play a role in causing COPD. People who have this condition have low blood levels of alpha-1 antitrypsin (AAT)\u2014a protein made in the liver. Having a low level of the AAT protein can lead to lung damage and COPD if you are exposed to smoke or other lung irritants. If you have alpha-1 antitrypsin deficiency and also smoke, COPD can worsen very quickly. Some people who have\u00a0asthma\u00a0can develop COPD. Asthma is a chronic lung disease that inflames and narrows the airways. Treatment usually can reverse the inflammation and narrowing that occurs in asthma.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/copd"
+  ],
+  [
+    "COPD (Prevention): You can take steps to prevent COPD before it starts. If you already have COPD, you can take steps to prevent complications and slow the progression of the disease. Prevent COPD Before It Starts The best way to prevent COPD is to not start smoking or to quit smoking. Smoking is the leading cause of COPD. If you smoke, talk with your doctor about programs and products that can help you quit. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit. Also, try to avoid lung irritants that can contribute to COPD, such as air pollution, chemical fumes, dusts, and secondhand smoke, which is smoke in the air from other people smoking. For more information about how to quit smoking, go to the Health Topics\u00a0Smoking and Your Heart\u00a0article and the National Heart, Lung, and Blood Institute's Your Guide to a Healthy Heart.\u00a0Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute\u2019s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848). Prevent Complications and Slow the Progression of COPD If you have COPD, the most important step you can take is to quit smoking. Quitting can help prevent complications and slow the progression of the disease. You also should avoid exposure to the lung irritants mentioned above. Follow your treatments for COPD exactly as your doctor prescribes. They can help you breathe easier, stay more active, and avoid or manage severe symptoms. Talk with your doctor about whether and when you should get flu, or influenza, and\u00a0pneumonia\u00a0vaccines. These vaccines can lower your chances of getting these illnesses, which are major health risks for people who have COPD.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/copd"
+  ],
+  [
+    "Obesity: Obesity is a complex disorder involving an excessive amount of body fat. Obesity isn't just a cosmetic concern. It increases your risk of diseases and health problems, such as heart disease, diabetes and high blood pressure. Being extremely obese means you are especially likely to have health problems related to your weight. The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. Dietary changes, increased physical activity and behavior changes can help you lose weight. Prescription medications and weight-loss surgery are additional options for treating obesity. Obesity is diagnosed when your body mass index (BMI) is 30 or higher. Your body mass index is calculated by dividing your weight in kilograms (kg) by your height in meters (m) squared. For most people, BMI provides a reasonable estimate of body fat. However, BMI doesn't directly measure body fat, so some people, such as muscular athletes, may have a BMI in the obese category even though they don't have excess body fat. Ask your doctor if your BMI is a problem. When to see a doctor If you think you may be obese, and especially if you're concerned about weight-related health problems, see your doctor or health care provider. You and your provider can evaluate your health risks and discuss your weight-loss options. Although there are genetic, behavioral and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through exercise and normal daily activities. Your body stores these excess calories as fat. Obesity can sometimes be traced to a medical cause, such as Prader-Willi syndrome, Cushing's syndrome, and other diseases and conditions. However, these disorders are rare and, in general, the principal causes of obesity are: - Inactivity. If you're not very active, you don't burn as many calories. With a sedentary lifestyle, you can easily take in more calories every day than you use through exercise and normal daily activities. - Unhealthy diet and eating habits. Weight gain is inevitable if you regularly eat more calories than you burn. And most Americans' diets are too high in calories and are full of fast food and high-calorie beverages. Obesity usually results from a combination of causes and contributing factors, including: - Genetics. Your genes may affect the amount of body fat you store, and where that fat is distributed. Genetics may also play a role in how efficiently your body converts food into energy and how your body burns calories during exercise. - Family lifestyle. Obesity tends to run in families. If one or both of your parents are obese, your risk of being obese is increased. That's not just because of genetics. Family members tend to share similar eating and activity habits. - Inactivity. If you're not very active, you don't burn as many calories. With a sedentary lifestyle, you can easily take in more calories every day than you burn through exercise and routine daily activities. Having medical problems, such as arthritis, can lead to decreased activity, which contributes to weight gain. - Unhealthy diet. A diet that's high in calories, lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain. - Medical problems. In some people, obesity can be traced to a medical cause, such as Prader-Willi syndrome, Cushing's syndrome and other conditions. Medical problems, such as arthritis, also can lead to decreased activity, which may result in weight gain. - Certain medications. Some medications can lead to weight gain if you don't compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers. - Social and economic issues. Research has linked social and economic factors to obesity. Avoiding obesity is difficult if you don't have safe areas to exercise. Similarly, you may not have been taught healthy ways of cooking, or you may not have money to buy healthier foods. In addition, the people you spend time with may influence your weight - you're more likely to become obese if you have obese friends or relatives. - Age. Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your body tends to decrease with age. This lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs, and can make it harder to keep off excess weight. If you don't consciously control what you eat and become more physically active as you age, you'll likely gain weight. - Pregnancy. During pregnancy, a woman's weight necessarily increases. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women. - Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to enough weight gain that the person becomes obese. In the long run, however, quitting smoking is still a greater benefit to your health than continuing to smoke. - Lack of sleep. Not getting enough sleep or getting too much sleep can cause changes in hormones that increase your appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain. Even if you have one or more of these risk factors, it doesn't mean that you're destined to become obese. You can counteract most risk factors through diet, physical activity and exercise, and behavior changes. If you're obese, you're more likely to develop a number of potentially serious health problems, including: - High triglycerides and low high-density lipoprotein (HDL) cholesterol - Type 2 diabetes - High blood pressure - Metabolic syndrome - a combination of high blood sugar, high blood pressure, high triglycerides and low HDL cholesterol - Heart disease - Stroke - Cancer, including cancer of the uterus, cervix, endometrium, ovaries, breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney and prostate - Breathing disorders, including sleep apnea, a potentially serious sleep disorder in which breathing repeatedly stops and starts - Gallbladder disease - Gynecological problems, such as infertility and irregular periods - Erectile dysfunction and sexual health issues - Nonalcoholic fatty liver disease, a condition in which fat builds up in the liver and can cause inflammation or scarring - Osteoarthritis Quality of life When you're obese, your overall quality of life may be diminished. You may not be able to do things you used to do, such as participating in enjoyable activities. You may avoid public places. Obese people may even encounter discrimination. Other weight-related issues that may affect your quality of life include: - Depression - Disability - Sexual problems - Shame and guilt - Social isolation - Lower work achievement If your BMI is in the obese range, your health care provider will typically review your health history in detail, perform a physical exam and recommend some tests. These exams and tests generally include: - Taking your health history. Your doctor may review your weight history, weight-loss efforts, exercise habits, eating patterns, what other conditions you've had, medications, stress levels and other issues about your health. Your doctor may also review your family's health history to see if you may be predisposed to certain conditions. - A general physical exam. This includes also measuring your height; checking vital signs, such as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining your abdomen. - Calculating your BMI. Your doctor will check your body mass index (BMI) to determine your level of obesity. This should be done at least once a year. Your BMI also helps determine your overall health risk and what treatment may be appropriate. - Measuring your waist circumference. Fat stored around your waist, sometimes called visceral fat or abdominal fat, may further increase your risk of diseases, such as diabetes and heart disease. Women with a waist measurement (circumference) of more than 35 inches (80 centimeters, or cm) and men with a waist measurement of more than 40 inches (102 cm) may have more health risks than do people with smaller waist measurements. Like the BMI measurement, your waist circumference should be checked at least once a year. - Checking for other health problems. If you have known health problems, your doctor will evaluate them. Your doctor will also check for other possible health problems, such as high blood pressure and diabetes. - Blood tests. What tests you have depend on your health, risk factors and any current symptoms you may be having. Tests may include a cholesterol test, liver function tests, a fasting glucose, a thyroid test and others. Your doctor may also recommend certain heart tests, such as an electrocardiogram. Gathering all this information helps you and your doctor determine how much weight you need to lose and what health conditions or risks you already have. And this will guide treatment decisions. The goal of obesity treatment is to reach and stay at a healthy weight. You may need to work with a team of health professionals - including a dietitian, behavior counselor or an obesity specialist - to help you understand and make changes in your eating and activity habits. The initial treatment goal is usually a modest weight loss - 3 to 5 percent of your total weight. That means that if you weigh 200 pounds (91 kg) and are obese by BMI standards, you would need to lose only about 6 to 10 pounds (2.7 to 4.5 kg) for your health to begin to improve. However, the more weight you lose, the greater the benefits. All weight-loss programs require changes in your eating habits and increased physical activity. The treatment methods that are right for you depend on your level of obesity, your overall health and your willingness to participate in your weight-loss plan. Other treatment tools include: - Dietary changes - Exercise and activity - Behavior change - Prescription weight-loss medications - Weight-loss surgery Dietary changes Reducing calories and practicing healthier eating habits are vital to overcoming obesity. Although you may lose weight quickly at first, slow and steady weight loss over the long term is considered the safest way to lose weight and the best way to keep it off permanently. Avoid drastic and unrealistic diet changes, such as crash diets, because they're unlikely to help you keep excess weight off for the long term. Plan to participate in a comprehensive weight-loss program for at least six months and in the maintenance phase of a program for at least a year to boost your odds of weight-loss success. There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you. Dietary changes to treat obesity include: - Cutting calories. The key to weight loss is reducing how many calories you take in. You and your health care providers can review your typical eating and drinking habits to see how many calories you normally consume and where you can cut back. You and your doctor can decide how many calories you need to take in each day to lose weight, but a typical amount is 1,200 to 1,500 calories for women and 1,500 to 1,800 for men. - Feeling full on less. The concept of energy density can help you satisfy your hunger with fewer calories. All foods have a certain number of calories within a given amount (volume). Some foods - such as desserts, candies, fats and processed foods - are high in energy density. This means that a small volume of that food has a large number of calories. In contrast, other foods, such as fruits and vegetables, have lower energy density. These foods provide a larger portion size with a fewer number of calories. By eating larger portions of foods that have fewer calories, you reduce hunger pangs, take in fewer calories and feel better about your meal, which contributes to how satisfied you feel overall. - Making healthier choices. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole-grain carbohydrates. Also emphasize lean sources of protein - such as beans, lentils and soy - and lean meats. If you like fish, try to include fish twice a week. Limit salt and added sugar. Stick with low-fat dairy products. Eat small amounts of fats, and make sure they come from heart-healthy sources, such as olive, canola and nut oils. - Restricting certain foods. Certain diets limit the amount of a particular food group, such as high-carbohydrate or full-fat foods. Ask your doctor which diet plans have been found effective and which might be helpful for you. Drinking sugar-sweetened beverages is a sure way to consume more calories than you intended, and limiting these drinks or eliminating them altogether is a good place to start cutting calories. - Meal replacements. These plans suggest that you replace one or two meals with their products - such as low-calorie shakes or meal bars - and eat healthy snacks and a healthy, balanced third meal that's low in fat and calories. In the short term, this type of diet can help you lose weight. Keep in mind that these diets likely won't teach you how to change your overall lifestyle, though, so you may have to keep this up if you want to keep your weight off. Be wary of quick fixes. You may be tempted by fad diets that promise fast and easy weight loss. The reality, however, is that there are no magic foods or quick fixes. Fad diets may help in the short term, but the long-term results don't appear to be any better than other diets. Similarly, you may lose weight on a crash diet, but you're likely to regain it when you stop the diet. To lose weight - and keep it off - you have to adopt healthy-eating habits that you can maintain over time. Exercise and activity Increased physical activity or exercise is an essential part of obesity treatment. Most people who are able to maintain their weight loss for more than a year get regular exercise, even simply walking. To boost your activity level: - Exercise. People who are overweight or obese need to get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to maintain the loss of a modest amount of weight. To achieve more-significant weight loss, you may need to exercise 300 minutes or more a week. You probably will need to gradually increase the amount you exercise as your endurance and fitness improve. - Keep moving. Even though regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps burn calories. Making simple changes throughout your day can add up to big benefits. Park farther from store entrances, rev up your household chores, garden, get up and move around periodically, and wear a pedometer to track how many steps you actually take over the course of a day. Behavior changes A behavior modification program can help you make lifestyle changes and lose weight and keep it off. Steps to take include examining your current habits to find out what factors, stresses or situations may have contributed to your obesity. Everyone is different and has different obstacles to managing weight, such as a lack of time to exercise or late-night eating. Tailor your behavior changes to address your individual concerns. Behavior modification, sometimes called behavior therapy, can include: - Counseling. Therapy or interventions with trained mental health or other professionals can help you address emotional and behavioral issues related to eating. Therapy can help you understand why you overeat and learn healthy ways to cope with anxiety. You can also learn how to monitor your diet and activity, understand eating triggers, and cope with food cravings. Therapy can take place on both an individual and group basis. More-intensive programs - those that include 12 to 26 sessions a year - may be more helpful in achieving your weight-loss goals. - Support groups. You can find camaraderie and understanding in support groups where others share similar challenges with obesity. Check with your doctor, local hospitals or commercial weight-loss programs for support groups in your area, such as Weight Watchers. Prescription weight-loss medication Losing weight requires a healthy diet and regular exercise. But in certain situations, prescription weight-loss medication may help. Keep in mind, though, that weight-loss medication is meant to be used along with diet, exercise and behavior changes, not instead of them. If you don't make these other changes in your life, medication is unlikely to work. Your doctor may recommend weight-loss medication if other methods of weight loss haven't worked for you and you meet one of the following criteria: - Your body mass index (BMI) is 30 or greater - Your BMI is greater than 27, and you also have medical complications of obesity, such as diabetes, high blood pressure or sleep apnea Before selecting a medication for you, your doctor will consider your health history, as well as possible side effects. Some weight-loss medications can't be used by women who are pregnant, or people who take certain medications or have chronic health conditions. Commonly prescribed weight-loss medications include orlistat (Xenical), lorcaserin (Belviq), phentermine and topiramate (Qsymia), buproprion and naltrexone (Contrave), and liraglutide (Saxenda). You will need close medical monitoring while taking a prescription weight-loss medication. Also, keep in mind that a weight-loss medication may not work for everyone, and the effects may wane over time. When you stop taking a weight-loss medication, you may regain much or all of the weight you lost. Weight-loss surgery In some cases, weight-loss surgery, also called bariatric surgery, is an option. Weight-loss surgery limits the amount of food you're able to comfortably eat or decreases the absorption of food and calories or both. While weight-loss surgery offers the best chance of losing the most weight, it can pose serious risks. Weight-loss surgery for obesity may be considered if you have tried other methods to lose weight that haven't worked and: - You have extreme obesity (BMI of 40 or higher) - Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as diabetes or high blood pressure - You're committed to making the lifestyle changes that are necessary for surgery to work It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits. Common weight-loss surgeries include: - Gastric bypass surgery. In gastric bypass (Roux-en-Y gastric bypass), the surgeon creates a small pouch at the top of your stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of your stomach. - Laparoscopic adjustable gastric banding (LAGB). In this procedure, your stomach is separated into two pouches with an inflatable band. Pulling the band tight, like a belt, the surgeon creates a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently. - Biliopancreatic diversion with duodenal switch. This procedure begins with the surgeon removing a large part of the stomach. The surgeon leaves the valve that releases food to the small intestine and the first part of the small intestine (duodenum). Then the surgeon closes off the middle section of the intestine and attaches the last part directly to the duodenum. The separated section of the intestine is reattached to the end of the intestine to allow bile and digestive juices to flow into this part of the intestine. - Gastric sleeve. In this procedure, part of the stomach is removed, creating a smaller reservoir for food. It's a less complicated surgery than gastric bypass or biliopancreatic diversion with duodenal switch. Other treatments Vagal nerve blockade is another treatment for obesity. It involves implanting a device under the skin of the abdomen that sends intermittent electrical pulses to the abdominal vagus nerve, which tells the brain when the stomach feels empty or full. This new technology received FDA approval in 2014 for use by adults who have not been able to lose weight with a weight-loss program and who have a BMI of 35 to 45 with at least one obesity-related condition, such as type 2 diabetes. Preventing weight regain after obesity treatment Unfortunately, it's common to regain weight no matter what obesity treatment methods you try. If you take weight-loss medications, you'll probably regain weight when you stop taking them. You might even regain weight after weight-loss surgery if you continue to overeat or overindulge in high-calorie foods. But that doesn't mean your weight-loss efforts are futile. One of the best ways to prevent regaining the weight you've lost is to get regular physical activity. Aim for 60 minutes a day. Keep track of your physical activity if it helps you stay motivated and on course. As you lose weight and gain better health, talk to your doctor about what additional activities you might be able to do and, if appropriate, how to give your activity and exercise a boost. You may always have to remain vigilant about your weight. Combining a healthier diet and more activity in a practical and sustainable manner are the best ways to keep the weight you lost off for the long term. Take your weight loss and weight maintenance one day at a time and surround yourself with supportive resources to help ensure your success. Find a healthier way of living that you can stick with for the long term. Your effort to overcome obesity is more likely to be successful if you follow strategies at home in addition to your formal treatment plan. These can include: - Learning about your condition. Education about obesity can help you learn more about why you became obese and what you can do about it. You may feel more empowered to take control and stick to your treatment plan. Read reputable self-help books and consider talking about them with your doctor or therapist. - Setting realistic goals. When you have to lose a significant amount of weight, you may set goals that are unrealistic, such as trying to lose too much too fast. Don't set yourself up for failure. Set daily or weekly goals for exercise and weight loss. Make small changes in your diet instead of attempting drastic changes that you're not likely to stick with for the long haul. - Sticking to your treatment plan. Changing a lifestyle you may have lived with for many years can be difficult. Be honest with your doctor, therapist or other health care providers if you find your activity or eating goals slipping. You can work together to come up with new ideas or new approaches. - Enlisting support. Get your family and friends on board with your weight-loss goals. Surround yourself with people who will support you and help you, not sabotage your efforts. Make sure they understand how important weight loss is to your health. You might also want to join a weight-loss support group. - Keeping a record. Keep a food and activity log. This record can help you remain accountable for your eating and exercise habits. You can discover behavior that may be holding you back and, conversely, what works well for you. You can also use your log to track other important health parameters such as blood pressure and cholesterol levels and overall fitness. - Identifying and avoiding food triggers. Distract yourself from your desire to eat with something positive, such as calling a friend. Practice saying no to unhealthy foods and big portions. Eat when you're actually hungry - not simply when the clock says it's time to eat. - Taking your medications as directed. If you take weight-loss medications or medications to treat obesity-related conditions, such as high blood pressure or diabetes, take them exactly as prescribed. If you have a problem sticking with your medication regimen or have unpleasant side effects, talk to your doctor. Numerous dietary supplements that promise to help you shed weight quickly are available. The effectiveness, particularly the long-term effectiveness, and safety of these products are often questionable. Herbal remedies, vitamins and minerals, all considered dietary supplements by the Food and Drug Administration, don't have the same rigorous testing and labeling process as over-the-counter and prescription medications do. Yet some of these substances, including products labeled as \"natural,\" have drug-like effects that can be dangerous. Even some vitamins and minerals can cause problems when taken in excessive amounts. Ingredients may not be standard, and they can cause unpredictable and harmful side effects. Dietary supplements also can cause dangerous interactions with prescription medications you take. Talk to your doctor before taking any dietary supplements. Mind-body therapies - such as acupuncture, mindfulness meditation and yoga - may complement other obesity treatments. However, these therapies generally haven't been well-studied in the treatment of weight loss. Talk to your doctor if you're interested in adding a mind-body therapy to your treatment.",
+    "https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742"
+  ],
+  [
+    "What is Obesity?: Obesity means having too much body fat. It is not the same as being overweight, which means weighing too much. A person may be overweight from extra muscle or water, as well as from having too much fat. Both terms mean that a person's weight is higher than what is thought to be healthy for his or her height.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/007297.htm"
+  ],
+  [
+    "Overweight and Obesity: Espa\u00f1ol Also known as adiposity. Overweight and obesity are increasingly common conditions in the United States. They are caused by the increase in the size and the amount of fat cells in the body. Doctors measure body mass index (BMI) and waist circumference to screen and diagnose overweight and obesity. Obesity is a serious medical condition that can cause complications such as metabolic syndrome, high blood pressure, atherosclerosis, heart disease, diabetes, high blood cholesterol, cancers and sleep disorders. Treatment depends on the cause and severity of your condition and whether you have complications. Treatments include lifestyle changes, such as heart-healthy eating and increased physical activity, and Food and Drug Administration (FDA)-approved weight-loss medicines. For some people, surgery may be a treatment option. Explore this Health Topic to learn more about overweight and obesity, our role in research and clinical trials to improve health, and where to find more information.\u00a0 Energy imbalances, some genetic or endocrine medical conditions, and certain medicines are known to cause overweight or obesity. Energy imbalances cause the body to store fat Energy imbalances can cause overweight and obesity. An energy imbalance means that your energy IN does not equal your energy OUT. This energy is measured in calories. Energy IN is the amount of calories you get from food and drinks. Energy OUT is the amount of calories that your body uses for things such as breathing, digesting, being physically active, and regulating body temperature. Overweight and obesity develop over time when you take in more calories than you use, or when energy IN is more than your energy OUT. This type of energy imbalance causes your body to store fat. Your body uses certain nutrients such as carbohydrates or sugars, proteins, and fats from the foods you eat to: make energy for immediate use to power routine daily body functions and physical activity. store energy for future use by your body. Sugars are stored as glycogen in the liver and muscles. Fats are stored mainly as triglycerides in fat tissue. The amount of energy that your body gets from the food you eat depends on the type of foods you eat, how the food is prepared, and how long it has been since you last ate. Read more The body has three types of fat tissue\u2014white, brown, and beige\u2014that it uses to fuel itself, regulate its temperature in response to cold, and store energy for future use. Learn about the role of each fat type in maintaining energy balance in the body. White fat tissue can be found around the kidneys and under the skin in the buttocks, thighs, and abdomen. This fat type stores energy, makes hormones that control the way the body regulates urges to eat or stop eating, and makes inflammatory substances that can lead to complications. Brown fat tissue is located in the upper back area of human infants. This fat type releases stored energy as heat energy when a baby is cold. It also can make inflammatory substances. Brown fat can be seen in children and adults. Beige fat tissue is seen in the neck, shoulders, back, chest and abdomen of adults and resembles brown fat tissue. This fat type, which uses carbohydrates and fats to produce heat, increases when children and adults are exposed to cold. Medical conditions Some genetic syndromes and endocrine disorders can cause overweight or obesity. Genetic syndromes Several genetic syndromes are associated with overweight and obesity, including the following. Prader-Willi syndrome Bardet-Biedl syndrome Alstr\u00f6m syndrome Cohen syndrome The study of these genetic syndromes has helped researchers understand obesity. Endocrine disorders Because the endocrine system produces hormones that help maintain energy balances in the body, the following endocrine disorders or tumors affecting the endocrine system can cause overweight and obesity. Hypothyroidism. People with this condition have low levels of thyroid hormones. These low levels are associated with decreased metabolism and weight gain, even when food intake is reduced. People with hypothyroidism also produce less body heat, have a lower body temperature, and do not efficiently use stored fat for energy. Cushing\u2019s syndrome. People with this condition have high levels of glucocorticoids, such as cortisol, in the blood. High cortisol levels make the body feel like it is under chronic stress. As a result, people have an increase in appetite and the body will store more fat. Cushing\u2019s syndrome may develop after taking certain medicines or because the body naturally makes too much cortisol. Tumors. Some tumors, such as craneopharingioma, can cause severe obesity because the tumors develop near parts of the brain that control hunger. Medicines Medicines such as antipsychotics, antidepressants, antiepileptics, and antihyperglycemics can cause weight gain and lead to overweight and obesity. Talk to your doctor if you notice weight gain while you are using one of these medicines. Ask if there are other forms of the same medicine or other medicines that can treat your medical condition, but have less of an effect on your weight. Do not stop taking the medicine without talking to your doctor. Read more Several parts of your body, such as your stomach, intestines, pancreas, and fat tissue, use hormones to control how your brain decides if you are hungry or full. Some of these hormones are insulin, leptin, glucagon-like peptide (GLP-1), peptide YY, and ghrelin. Look for Research for Your Health\u00a0will explain how we are using current research and advancing research to understand, prevent and treat overweight and obesity. Risk Factors\u00a0will discuss family history, lifestyle, or other environmental factors that increase your risk of developing overweight and obesity. \u00a0 There are many risk factors for overweight and obesity. Some risk factors can be changed, such as unhealthy lifestyle habits and environments. Other risk factors, such as age, family history and genetics, race and ethnicity, and sex, cannot be changed. Heathy lifestyle changes\u00a0can decrease your risk for developing overweight and obesity. Unhealthy lifestyle habits Lack of physical activity, unhealthy eating patterns, not enough sleep, and high amounts of stress can increase your risk for overweight and obesity. Lack of physical activity Lack of physical activity due to high amounts of TV, computer, videogame or other screen usage has been associated with a high body mass index. Healthy lifestyle changes, such as being physically active and reducing screen time, can help you aim for a healthy weight. Unhealthy eating behaviors Some unhealthy eating behaviors can increase your risk for overweight and obesity. Eating more calories than you use. The amount of calories you need will vary based on your sex, age, and physical activity level. Find out your daily calorie needs or goals with the Body Weight Planner. Eating too much saturated and trans fats Eating foods high in added sugars Visit Heart-healthy eating for more information about healthy eating patterns. Not enough sleep Many studies have seen a high BMI in people who do not get enough sleep. Some studies have seen a relationship between sleep and the way our bodies use nutrients for energy and how lack of sleep can affect hormones that control hunger urges. Visit our Sleep Deprivation and Deficiency Health Topic for more information about lack of sleep. High amounts of stress Acute stress and chronic stress affect the brain and trigger the production of hormones, such as cortisol, that control our energy balances and hunger urges. Acute stress can trigger hormone changes that make you not want to eat. If the stress becomes chronic, hormone changes can make you eat more and store more fat. Age Childhood obesity remains a serious problem in the United States, and some populations are more at risk for childhood obesity than others. The risk of unhealthy weight gain increases as you age. Adults who have a healthy BMI often start to gain weight in young adulthood and continue to gain weight until 60 to 65 years old, when they tend to start losing weight. Unhealthy environments Many environmental factors can increase your risk for overweight and obesity: \u00a0 social factors such as having a low socioeconomic status or an unhealthy social or unsafe environment in the neighborhood\u00a0 built environment factors such as easy access to unhealthy fast foods, limited access to recreational facilities or parks, and few safe or easy ways to walk in your neighborhood exposure to chemicals known as obesogens that can change hormones and increase fatty tissue in our bodies Family history and genetics Genetic studies have found that overweight and obesity can run in families, so it is possible that our genes or DNA can cause these conditions. Research studies have found that certain DNA elements are associated with obesity. Read more Did you know obesity can change your DNA and the DNA you pass on to your children? Learn more about these DNA changes. Eating too much or eating too little during your pregnancy can change your baby\u2019s DNA and can affect how your child stores and uses fat later in life. Also, studies have shown that obese fathers have DNA changes in their sperm that can be passed on to their children. Race or ethnicity Overweight and obesity is highly prevalent in some racial and ethnic minority groups. Rates of obesity in American adults are highest in blacks, followed by Hispanics, then whites. This is true for men or women. While Asian men and women have the lowest rates of unhealthy BMIs, they may have high amounts of unhealthy fat in the abdomen. Samoans may be at risk for overweight and obesity because they may carry a DNA variant that is associated with increased BMI but not with common obesity-related complications. Sex In the United States, obesity is more common in black or Hispanic women than in black or Hispanic men. A person\u2019s sex may also affect the way the body stores fat. For example, women tend to store less unhealthy fat in the abdomen\u00a0than men do. Overweight and obesity is also common in women with polycystic ovary syndrome (PCOS). This is an endocrine condition that causes large ovaries and prevents proper ovulation, which can reduce fertility. \u00a0 \u00a0 Children and adults should be screened at least annually to see if they have a high or increasing body mass index (BMI), which allows doctors to recommend healthy lifestyle changes\u00a0to prevent overweight and obesity. Screening for a high or increasing body mass index (BMI) To screen for overweight and obesity, doctors measure BMI using calculations that depend on whether you are a child or an adult. After reading the information below, talk to your doctor or your child\u2019s doctor to determine if you or your child has a high or increasing BMI. Children: A healthy weight is usually when your child\u2019s BMI is at the 5th percentile up to the 85th percentile, based on growth charts for children who are the same age and sex. To figure out your child\u2019s BMI, use the Center for Disease Control and Prevention (CDC) BMI Percentile Calculator for Child and Teen and compare the BMI with the table below. Adults: A healthy weight for adults is usually when your BMI is 18.5 to less than 25. To figure out your BMI, use the National Heart, Lung, and Blood Institute\u2019s online BMI calculator and compare it with the table below.\u00a0You can also download the BMI calculator app for iPhone and Android. Healthy lifestyle changes to prevent overweight and obesity If your BMI indicates you are getting close to being overweight, or if you have certain risk factors, your doctor may recommend you adopt healthy lifestyle changes to prevent you from becoming overweight and obese. Changes include healthy eating, being physically active, aiming for a healthy weight,and getting healthy amounts of sleep. Read healthy lifestyle changes\u00a0for more information. Look for Diagnosis will explain tests and procedures that your doctor may use to diagnose overweight and obesity. Living With\u00a0will discuss what your doctor may recommend to monitor and prevent your condition from getting worse and to screen you for complications. Research for Your Health\u00a0will explain how we are using current research and advancing research to prevent overweight and obesity. Participate in NHLBI Clinical Trials will discuss our open clinical trials that are studying ways to prevent overweight and obesity. There are no specific symptoms of overweight and obesity. The signs of overweight and obesity include a high body mass index (BMI) and an unhealthy body fat distribution that can be estimated by measuring your waist circumference. Obesity can cause complications in many parts of your body.\u00a0\u00a0 High body mass index (BMI) A high BMI is the most common sign of overweight and obesity. Unhealthy body fat distribution Another sign of overweight and obesity is having an unhealthy body fat distribution. Fatty tissue is found in different parts of your body and has many functions. Having an increased waist circumference\u00a0suggests that you have increased amounts of fat in your abdomen. An increased waist circumference is a sign of obesity and can increase your risk for obesity-related complications. Read more Did you know that fatty tissue has different functions depending on its location in your body? Visceral fat\u00a0is the fatty tissue inside of your abdomen and organs. While we do not know what causes the body to create and store visceral fat, it is known that this type of fat interferes with the body\u2019s endocrine and immune systems and promotes chronic inflammation and contributes to obesity-related complications. Complications Obesity may cause the following complications: Metabolic Syndrome Type 2 diabetes High blood cholesterol and high triglyceride levels in the blood Diseases of the heart and blood vessels such as high blood pressure, atherosclerosis, heart attacks and stroke Respiratory problems such as obstructive sleep apnea , asthma, and obesity hypoventilation syndrome Back pain \u00a0 Non-alcoholic fatty liver disease (NAFLD) Osteoarthritis, a chronic inflammation that damages the cartilage and bone in or around the affected joint. It can cause mild or severe pain and usually affects weight-bearing joints in people who are obese. It is a major cause of knee replacement surgery in patients who are obese for a long time. Urinary incontinence, the unintentional leakage of urine. Chronic obesity can weaken pelvic muscles, making it harder to maintain bladder control. While it can happen to both sexes, it usually affects women as they age. Gallbladder disease Emotional health issues such as low self-esteem or depression. This may commonly occur in children. Cancers of the esophagus, pancreas, colon, rectum, kidney, endometrium, ovaries, gallbladder, breast, or liver. Read more Did you know inflammation is thought to play a role in the onset of certain obesity-related complications? Researchers now know more about visceral fat, which is deep in the abdomen of overweight and obese patients. Visceral fat releases factors that promote inflammation. Chronic obesity-related inflammation is thought to lead to insulin resistance and diabetes, changes in the liver or non-alcoholic fatty acid liver disease, and cancers. More research is needed to understand what triggers inflammation in some obese patients and to find new treatments. Look for Diagnosis\u00a0will explain tests and procedures used to detect signs of overweight and obesity and help rule our other conditions that may be causing weight gain. Treatment\u00a0will discuss treatment-related complications or side effects. Living With\u00a0will explain how doctors use waist circumference to monitor for disease severity and check for complications. \u00a0 Your doctor may diagnose overweight and obesity based on your medical history, physical exams that confirm you have a high body mass index (BMI) and possibly a high waist circumference, and tests to rule out other medical conditions. Confirming a high body mass index (BMI) To diagnose overweight and obesity, doctors measure BMI using calculations that depend on whether you are a child or an adult. Children: A healthy weight is usually when your child\u2019s BMI is at the 5th percentile up to less than the 85th percentile based on growth charts for children who are the same age and sex. To figure out your child\u2019s BMI, use the Center for Disease Control and Prevention (CDC) BMI Percentile Calculator for Child and Teen and compare the BMI with the table below. Adults: A healthy weight for adults is usually when your BMI is 18.5 to less than 25. To figure out your BMI, use the National Heart, Lung, and Blood Institute\u2019s online BMI calculator and compare it with the table below.\u00a0You can also download the BMI calculator app for iPhone and Android. Even if your BMI is in the healthy range, it is possible to be diagnosed as obese if you have a large waist circumference\u00a0that suggests increased amounts of fat in your abdomen that can lead to complications. Medical history Your doctor will ask about your eating and physical activity habits, family history, and will see if you have other\u00a0risk factors\u00a0Your doctor may ask if you have any other signs or symptoms. This information can help determine if you have other conditions that may be causing you to be overweight or obese or if you have\u00a0complications\u00a0from being overweight or obese. Physical exam During your physical exam, your doctor will measure your weight and height to calculate your BMI. Your doctor may also measure\u00a0your\u00a0waist circumference\u00a0to estimate the amount of\u00a0unhealthy fat\u00a0in your\u00a0abdomen.\u00a0In adults, a waist\u00a0circumference\u00a0over 35 inches for women who are not pregnant or 40 inches for men can help diagnose obesity and assess risk of future complications. If you are of South Asian or Central and South American descent, your doctor may use smaller waist circumference values to diagnose your obesity. People from these backgrounds often don\u2019t show signs of a large waist circumference even though they may have unhealthy amounts of fat deep in their abdomens and may be diagnosed with obesity. Visit\u00a0Assessing Your Weight\u00a0for more information. Read Living With\u00a0for more information about why it is important to monitor your waist circumference to assess your risk for complications. Tests to identify other medical conditions Your\u00a0doctor\u00a0may\u00a0order some\u00a0of the following tests to\u00a0identify\u00a0medical conditions that may be causing your\u00a0overweight and obesity. Blood tests. Blood tests that check your thyroid hormone levels can help rule out hypothyroidism as a cause of your overweight or obesity. Cortisol and adrenocorticotropic hormone (ACTH) tests can rule out Cushing\u2019s syndrome. Total testosterone and dehydroepiandrosterone sulphate (DHEAS) tests can help rule out polycystic ovary syndrome (PCOS). Pelvic ultrasound to examine the ovaries and detect cysts. This can rule out PCOS. Reminders Return to Risk Factors\u00a0to review family history, lifestyle, or other environmental factors that increase your risk of developing overweight and obesity. Return to Signs, Symptoms, and Complications\u00a0to review common signs and symptoms of overweight and obesity. Return to Screening and Prevention\u00a0to review how to screen for overweight and obesity. Treatment for overweight and obesity depends on the cause and severity of your condition. Possible treatments include healthy lifestyle changes, behavioral weight-loss treatment programs, medicines, and possibly surgery. You may need treatments for any complications that you have. Healthy lifestyle changes To help you aim for and maintain a healthy weight, your doctor may recommend that you adopt lifelong healthy lifestyle changes. Heart-healthy eating. Learn about which foods and nutrients are part of a healthy eating pattern. It\u2019s important to eat the right amount of calories to maintain a healthy weight. If you need to lose weight, try to reduce your total daily calories gradually. Use the Body Weight Planner to find out your daily calorie needs and to set goals. Visit healthy recipes and plan for success. Talk with your doctor before beginning any diet or eating plan. Visit Chose My Plate or 2015-2020 Dietary Guidelines for Americans for more information. Physical activity. Many health benefits are associated with physical activity and getting the recommended amount of physical activity needed each week. Physical activity is an important factor in determining whether a person can maintain a healthy body weight, lose excess body weight, or maintain successful weight loss. Before starting any exercise program, ask your doctor about what level of physical activity is right for you. Visit Physical Activity Has Many Health Benefits for more information. Healthy Sleep. Studies have shown some relationship between lack of sleep and obesity. Read Sleep Deprivation and Deficiency more information. Making lifelong healthy lifestyle changes, such as heart-healthy eating and physical activity, can help you modify your energy balance to help you aim for and maintain a healthy weight. For example: To aim for a healthy weight, or lose weight, you want your energy OUT to be more than your energy IN. To maintain weight loss you want your energy IN and energy OUT to be the same.\u00a0 Behavioral weight-loss programs Your doctor may recommend you enroll in individual or group behavioral weight-loss programs to treat your overweight and obesity. In these programs, a trained healthcare professional will customize a weight-loss plan for you. This plan will include a moderately-reduced calorie diet, physical activity goals, and behavioral strategies to help you make and maintain these lifestyle changes. Read Living With\u00a0for more information about required follow-up for these behavioral treatment programs. Read more Did you know your brain\u2019s pleasure and reward centers can be stimulated by food and the act of eating, making it harder to change eating patterns and lose weight? Researchers know that our brains can become patterned so that we feel pleasure or reward from eating. This can make us unconsciously crave food so our bodies feel that sense of pleasure. It can also make it hard to change our eating patterns, lose weight, or maintain a healthy weight. Researchers are studying whether cognitive behavioral therapies can be an effective treatment for overweight and obesity by retraining the brain to not associate pleasure with food and the act of eating. Medicines When healthy lifestyle changes are not enough, your doctor may treat your overweight and obesity with FDA-approved medicines. These medicines work in the following parts of your body. Brain. Several medicines change the way the brain regulates the urge to eat, which can help to decrease appetite. Some examples of these medicines are diethylpropion, phendimetrazine, lorcaserin, naltrexone/bupropion, and liraglutide. Gastrointestinal tract. Orlistat is the only available medicine. It blocks your intestines from absorbing fat from foods in your diet. Weight loss medicines are not recommended as a single treatment for weight loss. These medicines can help you lose weight but when combined with lifestyle changes may result in greater weight loss. Some of these medicines should not be used if you have certain conditions or are taking certain medicines. Also, these medicines have side effects. Talk to your doctor if you are pregnant, planning to get pregnant, breast feeding, or have a family history of cardiovascular diseases such as high blood pressure, heart attack, or stroke. Surgical procedures Some patients with obesity do not respond to healthy lifestyle changes and medicines. When these patients develop certain obesity-related complications, they may be eligible for the following surgeries. Gastric bypass surgery. A small part of the stomach is connected to the middle part of the intestine, bypassing the first part of intestine. This decreases the amount of food that you can eat and the amount of fat your body can take in and store. Gastrectomy. A big portion of the stomach is removed to decrease the amount of food that you can eat. Gastric banding. A hollow band is placed around the upper part of the stomach creating a smaller stomach. This decreases the amount of food you can eat. Talk to your doctor to learn more about the benefits and risks of each type of surgery. Possible complications include bleeding, infection, internal rupture of sutures, or even death. Read gastric bypass surgery for more information. Read more Interested in learning why these surgeries lead to weight loss in some patients? First, these surgeries reduce the amount of food stored in the stomach and the amount of calories your body can take in. This can help your body restore energy balance. Second, these surgeries change the levels of certain hormones and the way the brain responds to these hormones to control hunger urges. After surgery, some people are less interested in eating or they prefer to eat healthier foods. In some cases, genetic differences may affect how much weight loss patients experience after bariatric surgery. Look for Living With\u00a0will explain recommendations that your doctor may give, including lifelong healthy lifestyle changes and medical care to prevent your condition from recurring, getting worse, or causing complications. Research for Your Health\u00a0will explain how we are using current research and advancing research to treat people with overweight and obesity. Participate in NHLBI Clinical Trials\u00a0will discuss our ongoing clinical studies that are investigating treatments for overweight and obesity. If you have been diagnosed with overweight and obesity, it is important that you continue your treatment. Read about tips to help you aim for a healthy weight, the benefit of finding and continuing a behavioral weight-loss program, and ways your doctor may monitor if your condition is stable, worsening, or improving and assess your risk for complications. Tips to aim for a healthy weight Changing lifestyle habits takes time and patience. Follow these tips to help you maintain the healthy lifestyle changes your doctor recommended to aim for a healthy weight. Use our Daily Food and Activity Diary or the United States Department of Agriculture\u2019s online SuperTracker to record your daily food intake and physical activity. You, your doctor, or health care provider can use this diary to monitor your progress. Set specific goals. An example of a specific goal is to \u201cwalk 30 minutes, 5 days a week\". Be realistic about your time and abilities. Set doable goals that don\u2019t change too much at once. Consecutive goals that can move you ahead in small steps, are the best way to reach a distant point. When starting a new lifestyle, try to avoid changing too much at once. Slow changes lead to success. Remember, quick weight loss methods do not provide lasting results. Learn from your slips. Everyone slips, especially when learning something new. Don\u2019t worry if work, the weather, or your family causes you to have an occasional slip. Remember that changing your lifestyle is a long-term process. Find out what triggered the slip and restart your eating and physical activity plan. Celebrate your success. Reward yourself along the way as you meet your goals. Instead of eating out to celebrate your success, try a night at the movies, go shopping for workout clothes, visit the library or bookstore, or go on a hike. Identify temptations. Learn what environments or social activities, such as watching TV or going out with friends, may be keeping you from meeting your goals. Once you have identified them, use creative strategies to help keep you on track. \u00a0 Plan regular physical activity with a friend. Find a fun activity that you both enjoy, such as Zumba, jogging, biking or swimming. You are more likely to stick with that activity if you and a friend have committed to it. \u00a0 Visit More Information for important NHLBI resources to help you aim for a healthy weight. Find and continue a behavioral weight-loss program Some people find it is easier to aim and maintain a healthy weight when they have support from a weight-loss specialist or other individuals who also are trying to lose weight. Behavioral weight-loss programs can provide this support, and they can help you set goals that are specific to your needs. Your weight-loss specialist usually reviews or modifies your goals every six months based on your progress and overall health. When you are choosing a behavioral weight-loss program, you may want to consider whether the program should: offer the service of multiple professionals, such as registered dietitians, doctors, nurses, psychologists, and exercise physiologists. provide goals that have been customized for you that consider things such as the types of food you like, your schedule, your physical fitness, and your overall health. provide individual or group counseling to help you change your eating patterns and personal unhealthy habits. teach long-term strategies to deal with problems that can lead to future weight gain, such as stress or slipping back into unhealthy habits. When selecting a program, you may want to ask about: the percentage of people who complete the program. the average weight loss for people who finish the program. possible side effects. fees or costs for additional items such as dietary supplements. Monitoring your condition and its health risks You should visit your health care provider periodically to monitor for possible complications,\u00a0which if left untreated can be life-threatening. Your doctor may do any of the following to monitor your condition. Assess your weight loss since your last visit. A weight loss of approximately five percent in an overweight patient may improve the function of the fat tissue and help lower bad cholesterol and other substances that can predispose to complications. Measure your waist circumference\u00a0if you are an adult. If your waist circumference is greater than 35 inches for women or greater than 40 inches for men, you may be at risk for heart disease, stroke, or type 2 diabetes. South Asians and South and Central Americans have a higher risk of complications, so waist circumference should be smaller than 35 for man and 31 for women. To correctly measure your waist, stand and place a tape measure around your middle, just above your hip bones. Measure your waist just after you breathe out. Visit Assessing Your Weight for more information. Order blood tests to screen for complications. A lipid panel test can check if you have high cholesterol or triglyceride levels in your blood. A liver function test can determine if your liver is working properly. A fasting glucose test can find out if you have prediabetes or diabetes. \u00a0 The NHLBI is part of the U.S. Department of Health and Human Services\u2019 National Institutes of Health (NIH)\u2014the nation\u2019s biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders including overweight and obesity. Learn about the current and future NHLBI efforts to improve health through research and scientific discovery. Improving health with current research Learn about the following ways NHLBI continues to translate research and science into improved health for people who are overweight or obese. NHLBI Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. We support the development of guidelines based on up-to-date research to evaluate and manage risk of heart disease in children and adolescents, including overweight and obesity. Visit Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents for more information. NHLBI Systematic Evidence Reviews Support Development of Guidelines for Overweight and Obese Adults. We continue to perform systematic reviews of the latest science. These reviews help partner organizations update their clinical guidelines, which health professionals use to treat adults who are overweight or obese. Visit Managing Overweight and Obesity in Adults: Systematic Evidence Review from the Obesity Expert Panel for more information. NHLBI Obesity Education Initiative. We continue our 20-year long commitment to educating the public and high-risk populations about adopting heart-healthy eating and physical activity for life to prevent and treat overweight and obesity and their associated complications. Visit Obesity Education Initiative for more information. NIH Obesity Research Task Force and Strategic Plan. We continue to support this larger NIH task force, that is committed to capitalizing on scientific research discoveries to develop new prevention methods and treatments for overweight and obesity. Visit NIH Obesity Research, NHLBI Obesity Research and the Strategic Plan for NIH Obesity Research for more information. NIH task force to develop first nutrition strategic plan. We will collaborate with other institutes to develop a ten-year plan to increase research in nutrition, including experimental design and training. Visit NIH task force formed to develop first nutrition strategic plan for more information. Federal Dietary Guidelines for Americans. We continue to provide medical, nutritional, and other scientific expertise to the United States Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) that publish the 2015-2020 Dietary Guidelines for Americans with information about the latest science-based nutritional recommendations. Read more Learn about some of the pioneering research contributions we have made over the years that have improved clinical care. Association of obesity, high blood pressure and risk of disease of the blood vessels of the heart. NHLBI\u2019s multigenerational landmark Framingham Heart Study found that obesity increases the risk for high blood pressure, as well as heart and cardiovascular diseases. Visit the Framingham Heart Study for more information about all research activities and advances from this study. Evaluation of risks for heart disease in school children. The multigenerational Muscatine Heart Study followed children from 1970 to 1991 to study school-aged children for heart disease risk factors and to follow them throughout childhood into adulthood. The study continues to evaluate heart disease risk factors in the children of the initial study participants. Visit Muscatine Heart Study for more information about the results of this study. Association of invasive breast tumors in obese postmenopausal women. Through the landmark Women\u2019s Health Initiative, NHLBI is exploring tumor risk in obese women. While more research is needed, early findings show a possible association of invasive breast tumors in postmenopausal women who are obese. Visit the Women\u2019s Health Initiative for more information about all research activities and advances from this study. Community programs to prevent obesity. Based on the results of research studies, the NHLBI, with a multidisciplinary team of researchers, dieticians, public health experts and community center representatives, developed programs such as We Can!\u00ae and Aim for a Healthy Weight to promote a healthy lifestyle.\u00a0 Advancing research for improved health In support of our mission, we are committed to advancing overweight and obesity research in part through the following ways. We fund research. Our Division of Cardiovascular Sciences, which includes our Clinical Applications and Prevention Branch, funds research to understand how overweight and obesity relate to heart disease. Our Division of Lung Diseases funds research on the impact of overweight and obesity on sleep disordered breathing. The research we fund today will help improve our future health. Search the NIH Research Portfolio Online Reporting Tools (RePORT) to learn about research NHLBI is funding on overweight and obesity. We stimulate high-impact research. Our NHLBI Obesity Research continues discovering new insights about obesity that can lead to improved health care, practices, and policies to prevent or treat obesity and its heart, lung, and sleep consequences and translating research into practical strategies and tools for clinicians, patients, and the general public. Our Trans-Omics for Precision Medicine (TOPMed) Program includes participants with overweight and obesity, which may help us understand how genes contribute to overweight and obesity. The NHLBI Strategic Vision\u00a0highlights ways we may support research over the next decade, including new efforts for overweight and obesity. Read more Learn more about the exciting research areas we are exploring about overweight and obesity. Differences in gastrointestinal bacteria may contribute to overweight and obesity. NHLBI and other partners in the Trans-NIH Microbiome Working Group are investigating how different populations of bacteria in our gastrointestinal tracts may make people resistant or susceptible to obesity. Genetic variation affects how people metabolize dietary sugar and fats. NHLBI is mapping how genes determine the levels of sugar and fat in the blood. New interventions for childhood overweight and obesity. NHLBI is supporting new projects to prevent and treat childhood obesity. The NHLBI-Sponsored the COPTR program and the Healthy Communities Study to see how well programs were working to prevent childhood obesity in different populations. Obese parents can affect if their children become overweight or obese. A parent\u2019s weight can change the DNA their children have. NHLBI is interested in how these DNA changes affect whether the child grows up to be overweight or obese. Obesity-related inflammation may affect other medical conditions. Researchers know obesity causes inflammation in our bodies. NHLBI is interested in how obesity-related inflammation influences other conditions, such as cardiovascular diseases or asthma. Sleep-wake cycles can contribute to obesity. NHLBI continues funding studies to understand how the body\u2019s internal sleep-wake cycles influence sleep and eating behaviors in people who are obese. This may help discover new therapies. Look for Participate in NHLBI Clinical Trials\u00a0will discuss some of our overweight and obesity clinical trials that are open. \u00a0 After reading our overweight and obesity Health Topic, you may be interested in additional information found in the following resources. NHLBI resources Aim for a Healthy Weight BMI calculator for\u00a0Android and iPhone Daily Food and Activity Diary Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents Heart-Healthy Lifestyle Changes NHLBI Delicious Heart Healthy Recipes NHLBI Obesity Research The Practical Guide Identification, Evaluation, and Treatment of Overweight and Obesity in Adults We Can!\u00ae Other resources 2015-2020 Dietary Guidelines for Americans (HHS/USDA) BMI Percentile Calculator for Child and Teen\u00a0(CDC) ChoseMyPlate.gov (USDA) NIH Obesity Research (NIH) Nutrition and Physical activity (HHS) Obesogens (NIEHS) Overweight, Obesity and Weight loss (HHS) Overweight and Obesity (CDC) Overweight and Obesity (USDA) \u00a0 Physical Activity Guidelines for Americans (HHS) Weight-control Information Network (National Institute of Diabetes and Digestive and Kidney Diseases)",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/obe"
+  ],
+  [
+    "What is Obesity?: Obesity means having too much body fat. It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat, and/or body water. Both terms mean that a person's weight is greater than what's considered healthy for his or her height. Obesity occurs over time when you eat more calories than you use. The balance between calories-in and calories-out differs for each person. Factors that might affect your weight include your genetic makeup, overeating, eating high-fat foods, and not being physically active. Being obese increases your risk of diabetes, heart disease, stroke, arthritis, and some cancers. If you are obese, losing even 5 to 10 percent of your weight can delay or prevent some of these diseases. For example, that means losing 10 to 20 pounds if you weigh 200 pounds. NIH: National Institute of Diabetes and Digestive and Kidney Diseases",
+    "https://www.nlm.nih.gov/medlineplus/obesity.html"
+  ],
+  [
+    "Obesity and Overweight: Overweight and obesity mean that a person is in a weight range, given his or her height, that can cause health problems. Obesity causes even greater health risks than being overweight. The NICHD is one of many federal agencies and NIH Institutes working to understand overweight and obesity. The NICHD supports and conducts research on the causes of excess weight, how to prevent and treat obesity, and related topics, including conditions caused by obesity. What are obesity, overweight, and body composition? Body composition is a term that describes how much of a person\u2019s body is made up of bone, fat, water, and other substances. \u201cOverweight\u201d and \u201cobesity\u201d both mean that a person is at an unhealthy weight. An obese person has too much body fat. An overweight person weighs too much, but the extra weight may come from muscle, bone, body water, and/or fat. Health care providers often use body mass index (BMI) to determine if a person is overweight or obese. Adults who have a BMI between 25 and 29.9 are generally considered overweight. Adults who have a BMI of 30 or higher are considered obese. A child\u2019s weight status is determined using a special chart that takes into account the child\u2019s age and gender. Learn more about BMI and other measurements of overweight and obesity. How many people are affected/at risk? \u00bb More than 35% of U.S. adults are obese, and more than 34% are overweight. Obesity affects 17% of all children and adolescents in the United States, which is three times the prevalence from just one generation ago. Nearly 32% of children and adolescents are either overweight or obese. \u00ab Condition Information How are they diagnosed? \u00bb Using Body Mass Index The most common way to determine if a person is overweight or obese is to calculate body mass index (BMI). BMI is an estimate of body fat based on comparing a person\u2019s weight to his or her height. Health care providers also look at BMI, along with information about additional risk factors, to determine a person\u2019s risk for developing weight-related diseases. Usually, the higher a person\u2019s BMI, the higher the risk of disease. BMI for Adults An adult\u2019s BMI can be determined using a BMI calculator. Health care providers use BMI ranges to indicate a person's weight status. For adults, a BMI of: - 18.5 to 24.9 is considered normal weight - 25.0 to 29.9 is considered overweight - 30.0 to 39.9 is considered obese - 40.0 and higher is considered extremely obese It is important to remember that although BMI is generally a good way to estimate how much body fat a person has, it does not measure body fat directly and therefore is not reliable in all cases. For example, a person may weigh extra because he or she is athletic and has a lot of muscle, and not because he or she has excess body fat. BMI for Children and Teens For children age 2 and older and for teens, BMI uses weight and height, but adds sex and age into the calculation. Instead of using a specific number like the BMI charts for adults, the BMI for children and teens is listed as a percent. This percentage indicates a child\u2019s BMI in relation to the BMIs of other children of the same sex and age. A child and teen BMI calculator can provide a BMI. Children age 2 and older are considered: - At a healthy weight if their BMI falls between the 5th and the 85th percentiles - Overweight if their BMI is between the 85th and 95th percentiles - Obese if their BMI is at or higher than the 95th percentile Other Ways to Measure Body Fat Body fat can be measured in other ways in addition to BMI, including waist circumference, calculation of waist-to-hip circumference ratios, measuring the thickness of a skinfold (a pinch of skin and fat), and techniques such as ultrasound that are more precise than BMI. A health care provider can help determine if such tests are necessary. \u00ab How many people are affected/at risk? What are the treatments? \u00bb To maintain a healthy weight, it is important to create a balance between the calories eaten and the calories burned through physical activity and bodily functions. To lose weight, a person usually needs to reduce calories and increase physical activity. If lifestyle changes are not enough, medicines and weight-loss surgery also are options for some people who need to lose weight. What are some tips for healthy eating? - Emphasize fruits, vegetables, whole grains, and fat-free or low-fat milk and dairy products. - Include lean meats, poultry, fish, beans, eggs, and nuts. - Eat a diet low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars. - Drink more water instead of sugary drinks. How much physical activity does an adult need? Getting enough physical activity is an important way to help prevent or reduce overweight and obesity and related health problems. - Adults age 18 and older need at least 30 minutes of physical activity on 5 or more days of the week to be healthy. - Children and teens need at least 60 minutes of activity a day for their health. Learn more about weight-loss techniques, medications, and surgery options. \u00ab How are they diagnosed? What causes it? \u00bb A number of factors can play a role in weight gain. These include diet, lack of exercise, factors in a person\u2019s environment, and genetics. Some of these factors are discussed briefly below. The National Heart, Lung, and Blood Institute offers more information on the causes of overweight and obesity. Food and Activity People gain weight when they eat more calories than they burn through activity. This imbalance is the greatest contributor to weight gain. Environment The world around us influences our ability to maintain a healthy weight. For example: - Not having area parks, sidewalks, and affordable gyms makes it hard for people to be physically active. - Oversized food portions increase Americans\u2019 calorie intake, making even more physical activity necessary to maintain a healthy weight. - Some people don\u2019t have access to supermarkets that sell affordable healthy foods, such as fresh fruits and vegetables. - Food advertising encourages people to buy unhealthy foods, such as high-fat snacks and sugary drinks. Genetics Research shows that genetics plays a role in obesity. Genes can directly cause obesity in such disorders as Prader-Willi syndrome. Genes also may contribute to a person\u2019s susceptibility to weight gain. Scientists believe that genes may increase a person\u2019s likelihood of becoming obese but that outside factors, such as an abundant food supply or little physical activity, also may be required for a person to put on excess weight. Health Conditions and Medications Some hormone problems may cause overweight and obesity, such as underactive thyroid, Cushing syndrome and polycystic ovary syndrome (PCOS). Certain medicines also may cause weight gain, including some corticosteroids, antidepressants, and seizure medicines. Stress, Emotional Factors, and Poor Sleep Some people eat more than usual when they are bored, angry, upset, or stressed. Studies also have found that the less people sleep, the more likely they are to be overweight or obese. This is partly because hormones that are released during sleep control appetite and the body\u2019s use of energy. \u00ab What are the treatments? Other FAQs \u00bb Are there disorders or conditions associated with obesity and overweight? Can obesity and overweight affect fertility? Do obesity and overweight affect pregnancy? \u00ab What causes it? Are there associated conditions? \u00bb",
+    "https://www.nichd.nih.gov/health/topics/obesity"
+  ],
+  [
+    "Childhood obesity: Childhood obesity is a serious medical condition that affects children and adolescents. Children who are obese are above the normal weight for their age and height. Childhood obesity is particularly troubling because the extra pounds often start children on the path to health problems that were once considered adult problems - diabetes, high blood pressure and high cholesterol. Many obese children become obese adults, especially if one or both parents are obese. Childhood obesity can also lead to poor self-esteem and depression. One of the best strategies to reduce childhood obesity is to improve the eating and exercise habits of your entire family. Treating and preventing childhood obesity helps protect your child's health now and in the future. Not all children carrying extra pounds are overweight or obese. Some children have larger than average body frames. And children normally carry different amounts of body fat at the various stages of development. So you might not know just by looking at your child if weight is a health concern. The body mass index (BMI), which provides a guideline of weight in relation to height, is the accepted measure of overweight and obesity. Your child's doctor can help you figure out if your child's weight could pose health problems by using growth charts, the BMI and, if necessary, other tests. When to see a doctor If you're worried that your child is putting on too much weight, talk to his or her doctor. Your child's doctor will consider your child's history of growth and development, your family's weight-for-height history, and where your child lands on the growth charts. This can help determine if your child's weight is in an unhealthy range. Lifestyle issues - too little activity and too many calories from food and drinks - are the main contributors to childhood obesity. But genetic and hormonal factors might play a role as well. For example, recent research has found that changes in digestive hormones can affect the signals that let you know you're full. Many factors - usually working in combination - increase your child's risk of becoming overweight: - Diet. Regularly eating high-calorie foods, such as fast foods, baked goods and vending machine snacks, can easily cause your child to gain weight. Candy and desserts also can cause weight gain, and more and more evidence points to sugary drinks, including fruit juices, as culprits in obesity in some people. - Lack of exercise. Children who don't exercise much are more likely to gain weight because they don't burn as many calories. Too much time spent in sedentary activities, such as watching television or playing video games, also contributes to the problem. - Family factors. If your child comes from a family of overweight people, he or she may be more likely to put on weight. This is especially true in an environment where high-calorie foods are always available and physical activity isn't encouraged. - Psychological factors. Personal, parental and family stress can increase a child's risk of obesity. Some children overeat to cope with problems or to deal with emotions, such as stress, or to fight boredom. Their parents may have similar tendencies. - Socioeconomic factors. People in some communities have limited resources and limited access to supermarkets. As a result, they may opt for convenience foods that don't spoil quickly, such as frozen meals, crackers and cookies. In addition, people who live in lower income neighborhoods might not have access to a safe place to exercise. Childhood obesity can have complications for your child's physical, social and emotional well-being. Physical complications - Type 2 diabetes. This chronic condition affects the way your child's body uses sugar (glucose). Obesity and a sedentary lifestyle increase the risk of type 2 diabetes. - Metabolic syndrome. This cluster of conditions can put your child at risk of heart disease, diabetes or other health problems. Conditions include high blood pressure, high blood sugar, high triglycerides, low HDL (\"good\") cholesterol and excess abdominal fat. - High cholesterol and high blood pressure. A poor diet can cause your child to develop one or both of these conditions. These factors can contribute to the buildup of plaques in the arteries. These plaques can cause arteries to narrow and harden, which can lead to a heart attack or stroke later in life. - Asthma. Children who are overweight or obese might be more likely to have asthma. - Sleep disorders. Obstructive sleep apnea is a potentially serious disorder in which a child's breathing repeatedly stops and starts during sleep. - Nonalcoholic fatty liver disease (NAFLD). This disorder, which usually causes no symptoms, causes fatty deposits to build up in the liver. NAFLD can lead to scarring and liver damage. Social and emotional complications - Low self-esteem and being bullied. Children often tease or bully their overweight peers, who suffer a loss of self-esteem and an increased risk of depression as a result. - Behavior and learning problems. Overweight children tend to have more anxiety and poorer social skills than normal-weight children do. These problems might lead children who are overweight to act out and disrupt their classrooms at one extreme, or to withdraw socially at the other. - Depression. Low self-esteem can create overwhelming feelings of hopelessness, which can lead to depression in some children who are overweight. As part of regular well-child care, the doctor calculates your child's BMI and determines where it falls on the BMI-for-age growth chart. The BMI helps indicate if your child is overweight for his or her age and height. Using the growth chart, your doctor determines your child's percentile, meaning how your child compares with other children of the same sex and age. For example, if your child is in the 80th percentile, it means that compared with other children of the same sex and age, 80 percent have a lower weight or BMI. Cutoff points on these growth charts, established by the Centers for Disease Control and Prevention, help identify children who are overweight and obese: - BMI between 85th and 94th percentiles - overweight - BMI 95th percentile or above - obesity Because BMI doesn't consider things such as being muscular or having a larger than average body frame and because growth patterns vary greatly among children, your doctor also factors in your child's growth and development. This helps determine whether your child's weight is a health concern. In addition to BMI and charting weight on the growth charts, the doctor evaluates: - Your family's history of obesity and weight-related health problems, such as diabetes - Your child's eating habits - Your child's activity level - Other health conditions your child may have - Psychosocial history, including incidences of depression and sleep disturbances and sadness and whether your child has friends or is the target of bullying Blood tests Your child's doctor might order blood tests if he or she finds that your child is obese. These tests might include: - A cholesterol test - A blood sugar test - Other blood tests to check for hormone imbalances, vitamin D deficiency or other conditions associated with obesity Some of these tests require that your child not eat or drink anything before the test. Ask if your child needs to fast before a blood test and for how long. Treatment for childhood obesity is based on your child's age and if he or she has other medical conditions. Treatment usually includes changes in your child's eating habits and physical activity level. In certain circumstances, treatment might include medications or weight-loss surgery. Treatment for children who are overweight The American Academy of Pediatrics recommends that children older than 2 and adolescents whose weight falls in the overweight category be put on a weight-maintenance program to slow the progress of weight gain. This strategy allows the child to add inches in height but not pounds, causing BMI to drop over time into a healthier range. Treatment for children who are obese Children ages 6 to 11 who are obese might be encouraged to modify their eating habits for gradual weight loss of no more than 1 pound (or about 0.5 kilogram) a month. Older children and adolescents who are obese or severely obese might be encouraged to modify their eating habits to aim for weight loss of up to 2 pounds (or about 1 kilogram) a week. The methods for maintaining your child's current weight or losing weight are the same: Your child needs to eat a healthy diet - both in terms of type and amount of food - and increase physical activity. Success depends largely on your commitment to helping your child make these changes. Healthy eating Parents are the ones who buy groceries, cook meals and decide where the food is eaten. Even small changes can make a big difference in your child's health. - When food shopping, choose fruits and vegetables. Cut back on convenience foods - such as cookies, crackers and prepared meals - which are often high in sugar, fat and calories. Always have healthy snacks available. - Limit sweetened beverages. This includes those that contain fruit juice. These drinks provide little nutritional value in exchange for their high calories. They also can make your child feel too full to eat healthier foods. - Limit fast food. Many of the menu options are high in fat and calories. - Sit down together for family meals. Make it an event - a time to share news and tell stories. Discourage eating in front of a TV, computer or video game screen, which can lead to fast eating and lowered awareness of amount eaten. - Serve appropriate portion sizes. Children don't need as much food as adults do. Allow your child to eat until he or she is full, even if that means leaving food on the plate. And remember, when you eat out, restaurant portion sizes are often significantly oversized. Physical activity A critical part of achieving and maintaining a healthy weight, especially for children, is physical activity. It burns calories, strengthens bones and muscles, and helps children sleep well at night and stay alert during the day. Good habits established in childhood help adolescents maintain healthy weights despite the hormonal changes, rapid growth and social influences that often lead to overeating. And active children are more likely to become fit adults. To increase your child's activity level: - Limit TV and recreational computer time. Time spent watching television or using computers, smartphones or tablets is known as screen time. Children younger than 18 months should avoid all screen time, except for video-chatting with family and friends. For older preschooolers, limit screen use to 1 hour per day of high-quality programming. - Emphasize activity, not exercise. Children should be moderately to vigorously active for at least an hour a day. Your child's activity doesn't have to be a structured exercise program - the object is to get him or her moving. Free-play activities - such as playing hide-and-seek, tag or jump-rope - can be great for burning calories and improving fitness. - Find activities your child likes. For instance, if your child is artistically inclined, go on a nature hike to collect leaves and rocks that your child can use to make a collage. If your child likes to climb, head for the nearest neighborhood jungle gym or climbing wall. If your child likes to read, then walk or bike to the neighborhood library for a book. Medications Medication might be prescribed for some adolescents as part of an overall weight-loss plan. The risks of taking a prescription medication over the long term are unknown, and the medication's effect on weight loss and weight maintenance for adolescents is still in question. Weight-loss surgery Weight-loss surgery may be an option for severely obese adolescents who have been unable to lose weight through lifestyle changes. However, as with any type of surgery, there are potential risks and long-term complications. Also, the long-term effects of weight-loss surgery on future growth and development are largely unknown. Weight-loss surgery in adolescents is uncommon. But your doctor might recommend this surgery if your child's weight poses a greater health threat than do the potential risks of surgery. It's important that a child being considered for weight-loss surgery meet with a team of pediatric specialists, including a pediatric endocrinologist, psychologist and dietitian. Weight-loss surgery isn't a miracle cure. It doesn't guarantee that an adolescent will lose all of his or her excess weight or be able to keep it off long term. And surgery doesn't replace the need for a healthy diet and regular physical activity. Addressing a woman's health and weight before she conceives could lead to improvements in childhood obesity. If you're overweight and thinking of becoming pregnant, losing weight and eating well might affect your child's future. Eating well throughout pregnancy might also have a positive impact on your baby's later food choices. To give your infant a healthy start, the World Health Organization recommends exclusively breast-feeding for 6 months. If your child is overweight or obese, his or her best chance to achieve and maintain a healthy weight is to start eating a healthy diet and exercising more. Here are some steps you can take at home to help your child succeed: - Be a role model. Choose healthy foods and active pastimes for yourself. If you need to lose weight, doing so will motivate your child to do likewise. - Involve the whole family. Make healthy eating a priority and emphasize how important it is for everyone to be physically active. This avoids singling out the child who is overweight.",
+    "https://www.mayoclinic.org/diseases-conditions/childhood-obesity/symptoms-causes/syc-20354827"
+  ],
+  [
+    "Health risks of obesity: Obesity is a medical condition in which a high amount of body fat increases the chance of developing medical problems. People with obesity have a higher chance of developing these health problems: - High blood glucose (sugar) or diabetes. - High blood pressure (hypertension). - High blood cholesterol and triglycerides (dyslipidemia or high blood fats). - Heart attacks due to coronary heart disease, heart failure, and stroke. - Bone and joint problems, more weight puts pressure on the bones and joints. This can lead to osteoarthritis, a disease that causes joint pain and stiffness. - Stopping breathing during sleep (sleep apnea). This can cause daytime fatigue or sleepiness, poor attention, and problems at work. - Gallstones and liver problems. - Some cancers Three things can be used to determine if a person's body fat gives them a higher chance of developing obesity-related diseases: - Body mass index (BMI) - Waist size - Other risk factors the person has (a risk factor is anything that increases your chance of getting a disease.) Body mass index (BMI) is calculated using height and weight. It is used to estimate body fat. Starting at 25.0, the higher your BMI, the greater is your risk of developing obesity-related health problems. These ranges of BMI are used to describe levels of risk: - Overweight (not obese), if BMI is 25.0 to 29.9 - Class 1 (low-risk) obesity, if BMI is 30.0 to 34.9 - Class 2 (moderate-risk) obesity, if BMI is 35.0 to 39.9 - Class 3 (high-risk) obesity, if BMI is equal to or greater than 40.0 Women with a waist size greater than 35 inches (89 centimeters) and men with a waist size greater than 40 inches (102 centimeters) have an increased risk of heart disease and type 2 diabetes. People with \"apple-shaped\" bodies (waist is bigger than the hips) also have an increased risk of these conditions. Having a risk factor does not mean that you will get the disease. But it does increase the chance that you will. Some risk factors, like age, race, or family history cannot be changed. The more risk factors you have, the more likely it is that you will develop the disease or health problem. Your risk of developing health problems such as heart disease, stroke, and kidney problems increases if you are obese and have these risk factors: - High blood pressure (hypertension) - High blood cholesterol or triglycerides - High blood glucose (sugar), a sign of type 2 diabetes These other risk factors for heart disease and stroke are not caused by obesity: - Having a family member under the age of 50 with heart disease - Being physically inactive or having a sedentary lifestyle - Smoking or using tobacco products of any kind You can control many of these risk factors by changing your lifestyle. If you have obesity, your doctor can help you begin a weight-loss program. A starting goal of losing 5 to 10% of your current weight will reduce your risk of developing obesity-related diseases. Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in internal medicine and hospice and palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000348.htm"
+  ],
+  [
+    "Prescription Medications to Treat Overweight and Obesity (What are overweight and obesity?): Health care providers use the Body Mass Index (BMI), which is a measure of your weight in relation to your height, to define overweight and obesity. People who have a BMI between 25 and 30 are considered overweight. Obesity is defined as having a BMI of 30 or greater. You can calculate your BMI to learn if you are overweight or obese. Being overweight or obese may increase the risk of health problems. Your health care provider can assess your individual risk due to your weight.Obesity is a chronic condition that affects more than one in three adults in the United States. Another one in three adults is overweight. If you are struggling with your weight, you may find that a healthy eating plan and regular physical activity help you lose weight and keep it off over the long term. If these lifestyle changes are not enough to help you lose weight or maintain your weight loss, your doctor may prescribe medications as part of your weight-control program.",
+    "https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity"
+  ],
+  [
+    "Understanding Adult Overweight and Obesity (How are overweight and obesity treated?): The best way to control your weight may depend on how much excess weight you have, your overall health, and how ready you are to change your eating and physical activity habits. In some cases, if lifestyle changes do not lead to enough weight loss to improve your health, doctors may recommend additional treatment, including weight-loss drugs.In some cases of extreme obesity, doctors may recommend bariatric surgery. More information about bariatric surgery is provided in the NIDDK health topic, Bariatric Surgery for Severe Obesity.",
+    "https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-obesity"
+  ],
+  [
+    "Ayazi syndrome: The following summary is from Orphanet, a European reference portal for information on rare diseases and orphan drugs. Orpha Number: 1435 Disease definition Choroideremia-deafness-obesity syndrome is an X-linked retinal dystrophy characterized by choroideremia, causing in affected males progressive nyctalopia and eventual central blindness. Obesity, moderate intellectual disability and congenital mixed (sensorineural and conductive) deafness are also observed. Female carriers show typical retinal changes indicative of the choroideremia carrier state. Visit the Orphanet disease page for more resources. The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Chorioretinal degeneration Very frequent Choroideremia Very frequent Obesity Very frequent Sensorineural hearing impairment Very frequent Strabismus Occasional Chorioretinal atrophy - Conductive hearing impairment - Constriction of peripheral visual field - Contiguous gene syndrome - Intellectual disability - Nyctalopia - Progressive sensorineural hearing impairment - Progressive visual loss - X-linked recessive inheritance - View complete list of signs and symptoms...",
+    "https://rarediseases.info.nih.gov/diseases/369/ayazi-syndrome"
+  ],
+  [
+    "Etiology: Etiology describes the cause or causes of a disease. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002356.htm"
+  ],
+  [
+    "What causes Obesity?: Taking in more calories than your body burns can lead to obesity. This is because the body stores unused calories as fat. Obesity can be caused by: - Eating more food than your body can use - Drinking too much alcohol - Not getting enough exercise Many obese people who lose large amounts of weight and gain it back think it is their fault. They blame themselves for not having the willpower to keep the weight off. Many people regain more weight than they lost. Today, we know that biology is a big reason why some people cannot keep the weight off. Some people who live in the same place and eat the same foods become obese, while others do not. Our bodies have a complex system to keep our weight at a healthy level. In some people, this system does not work normally. The way we eat when we are children can affect the way we eat as adults. The way we eat over many years becomes a habit. It affects what we eat, when we eat, and how much we eat. We may feel that we are surrounded by things that make it easy to overeat and hard to stay active. - Many people feel they do not have time to plan and make healthy meals. - More people today work desk jobs compared to more active jobs in the past. - People with little free time may have less time to exercise. The term eating disorder means a group of medical conditions that have an unhealthy focus on eating, dieting, losing or gaining weight, and body image. A person may be obese, follow an unhealthy diet, and have an eating disorder all at the same time. Sometimes, medical problems or treatments cause weight gain, including: - Underactive thyroid (hypothyroidism) - Medicines such as birth control pills, antidepressants, and antipsychotics Other things that can cause weight gain are: - Quitting smoking. Many people who quit smoking gain 4 to 10 pounds in the first 6 months after quitting. - Stress, anxiety, feeling sad, or not sleeping well - Menopause. Women may gain 12 to 15 pounds during menopause. - Pregnancy. Women may not lose the weight they gained during pregnancy.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/007297.htm"
+  ],
+  [
+    "Obesity (Overview): Obesity is a complex disorder involving an excessive amount of body fat. Obesity isn't just a cosmetic concern. It increases your risk of diseases and health problems, such as heart disease, diabetes and high blood pressure. Being extremely obese means you are especially likely to have health problems related to your weight. The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. Dietary changes, increased physical activity and behavior changes can help you lose weight. Prescription medications and weight-loss surgery are additional options for treating obesity.",
+    "https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742"
+  ],
+  [
+    "Obesity (Summary): Summary Obesity means having too much body fat. It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat, and/or body water. Both terms mean that a person's weight is greater than what's considered healthy for his or her height. Obesity happens over time when you eat more calories than you use. The balance between calories-in and calories-out differs for each person. Factors that might affect your weight include your genetic makeup, overeating, eating high-fat foods, and not being physically active. Obesity increases your risk of diabetes, heart disease, stroke, arthritis, and some cancers. If you have obesity, losing even 5 to 10 percent of your weight can delay or prevent some of these diseases. For example, that means losing 10 to 20 pounds if you weigh 200 pounds. NIH: National Institute of Diabetes and Digestive and Kidney Diseases",
+    "#"
+  ],
+  [
+    "Obesity (Possible Complications): Obesity is a major health threat. The extra weight creates many risks to your health.",
+    "https://medlineplus.gov/ency/article/007297.htm"
+  ],
+  [
+    "Obesity (Causes): Although there are genetic, behavioral and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through exercise and normal daily activities. Your body stores these excess calories as fat. Obesity can sometimes be traced to a medical cause, such as Prader-Willi syndrome, Cushing's syndrome, and other diseases and conditions. However, these disorders are rare and, in general, the principal causes of obesity are: - Inactivity. If you're not very active, you don't burn as many calories. With a sedentary lifestyle, you can easily take in more calories every day than you use through exercise and normal daily activities. - Unhealthy diet and eating habits. Weight gain is inevitable if you regularly eat more calories than you burn. And most Americans' diets are too high in calories and are full of fast food and high-calorie beverages.",
+    "https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742"
+  ],
+  [
+    "Obesity (Risk factors): Obesity usually results from a combination of causes and contributing factors, including: - Genetics. Your genes may affect the amount of body fat you store, and where that fat is distributed. Genetics may also play a role in how efficiently your body converts food into energy and how your body burns calories during exercise. - Family lifestyle. Obesity tends to run in families. If one or both of your parents are obese, your risk of being obese is increased. That's not just because of genetics. Family members tend to share similar eating and activity habits. - Inactivity. If you're not very active, you don't burn as many calories. With a sedentary lifestyle, you can easily take in more calories every day than you burn through exercise and routine daily activities. Having medical problems, such as arthritis, can lead to decreased activity, which contributes to weight gain. - Unhealthy diet. A diet that's high in calories, lacking in fruits and vegetables, full of fast food, and laden with high-calorie beverages and oversized portions contributes to weight gain. - Medical problems. In some people, obesity can be traced to a medical cause, such as Prader-Willi syndrome, Cushing's syndrome and other conditions. Medical problems, such as arthritis, also can lead to decreased activity, which may result in weight gain. - Certain medications. Some medications can lead to weight gain if you don't compensate through diet or activity. These medications include some antidepressants, anti-seizure medications, diabetes medications, antipsychotic medications, steroids and beta blockers. - Social and economic issues. Research has linked social and economic factors to obesity. Avoiding obesity is difficult if you don't have safe areas to exercise. Similarly, you may not have been taught healthy ways of cooking, or you may not have money to buy healthier foods. In addition, the people you spend time with may influence your weight - you're more likely to become obese if you have obese friends or relatives. - Age. Obesity can occur at any age, even in young children. But as you age, hormonal changes and a less active lifestyle increase your risk of obesity. In addition, the amount of muscle in your body tends to decrease with age. This lower muscle mass leads to a decrease in metabolism. These changes also reduce calorie needs, and can make it harder to keep off excess weight. If you don't consciously control what you eat and become more physically active as you age, you'll likely gain weight. - Pregnancy. During pregnancy, a woman's weight necessarily increases. Some women find this weight difficult to lose after the baby is born. This weight gain may contribute to the development of obesity in women. - Quitting smoking. Quitting smoking is often associated with weight gain. And for some, it can lead to enough weight gain that the person becomes obese. In the long run, however, quitting smoking is still a greater benefit to your health than continuing to smoke. - Lack of sleep. Not getting enough sleep or getting too much sleep can cause changes in hormones that increase your appetite. You may also crave foods high in calories and carbohydrates, which can contribute to weight gain. Even if you have one or more of these risk factors, it doesn't mean that you're destined to become obese. You can counteract most risk factors through diet, physical activity and exercise, and behavior changes.",
+    "https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742"
+  ],
+  [
+    "Obesity (Summary): Obesity means having too much body fat. It is not the same as being overweight, which means weighing too much. A person may be overweight from extra muscle or water, as well as from having too much fat. Both terms mean that a person's weight is higher than what is thought to be healthy for his or her height.",
+    "https://medlineplus.gov/ency/article/007297.htm"
+  ],
+  [
+    "Obesity and Overweight (Overview): Overweight and obesity mean that a person is in a weight range, given his or her height, that can cause health problems. Obesity causes even greater health risks than being overweight. The NICHD is one of many federal agencies and NIH Institutes working to understand overweight and obesity. The NICHD supports and conducts research on the causes of excess weight, how to prevent and treat obesity, and related topics, including conditions caused by obesity.",
+    "https://www.nichd.nih.gov/health/topics/obesity"
+  ],
+  [
+    "Obesity and Overweight (Other FAQs): Are there disorders or conditions associated with obesity and overweight? Can obesity and overweight affect fertility? Do obesity and overweight affect pregnancy? \u00ab What causes it? Are there associated conditions? \u00bb",
+    "https://www.nichd.nih.gov/health/topics/obesity"
+  ],
+  [
+    "Obesity Hypoventilation Syndrome (Signs and Symptoms): Many of the signs and symptoms of obesity hypoventilation syndrome (OHS) are the same as those of obstructive sleep apnea. This is because many people who have OHS also have obstructive sleep apnea. One of the most common signs of obstructive sleep apnea is loud and chronic (ongoing) snoring. Pauses may occur in the snoring. Choking or gasping may follow the pauses. Other symptoms include: Daytime sleepiness Morning headaches Memory, learning, or concentration problems Feeling irritable or depressed, or having mood swings or personality changes You also may have rapid, shallow breathing. During a physical exam, your doctor might hear abnormal heart sounds while listening to your heart with a stethoscope. He or she also might notice that the opening to your throat is small and your neck is larger than normal. Complications of Obesity Hypoventilation Syndrome When left untreated, OHS can cause serious problems, such as: Leg edema, which is swelling in the legs caused by fluid in the body's tissues. Pulmonary hypertension, which is increased pressure in the pulmonary arteries. These arteries carry blood from your heart to your lungs to pick up oxygen. Cor pulmonale, which is failure of the right side of the heart. Secondary erythrocytosis, which is a condition in which the body makes too many red blood cells.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/ohs"
+  ],
+  [
+    "What are the symptoms of Overweight and Obesity?: Weight gain usually happens over time. Most people know when they've gained weight. Some of the signs of overweight or obesity include: Clothes feeling tight and needing a larger size. The scale showing that you've gained weight. Having extra fat around the waist. A higher than normal body mass index and waist circumference. (For more information, go to \"How Are Overweight and Obesity Diagnosed?\")",
+    "http://www.nhlbi.nih.gov/health/health-topics/topics/obe"
+  ],
+  [
+    "Myopathy with extrapyramidal signs (Symptoms): The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Ataxia Occasional Microcephaly Occasional Ophthalmoplegia Occasional Optic atrophy Occasional Peripheral axonal neuropathy Occasional Ptosis Occasional Abnormality of extrapyramidal motor function Very rare Chorea Very rare Dystonia Very rare Orofacial dyskinesia Very rare Proximal muscle weakness Very rare Specific learning disability Very rare Tremor Very rare Autosomal recessive inheritance - Difficulty running - Difficulty walking - Elevated serum creatine phosphokinase - Motor delay - View complete list of signs and symptoms...",
+    "https://rarediseases.info.nih.gov/diseases/12978/myopathy-with-extrapyramidal-signs"
+  ],
+  [
+    "Overweight and Obesity (Signs, Symptoms, and Complications): There are no specific symptoms of overweight and obesity. The signs of overweight and obesity include a high body mass index (BMI) and an unhealthy body fat distribution that can be estimated by measuring your waist circumference. Obesity can cause complications in many parts of your body.\u00a0\u00a0 High body mass index (BMI) A high BMI is the most common sign of overweight and obesity. Unhealthy body fat distribution Another sign of overweight and obesity is having an unhealthy body fat distribution. Fatty tissue is found in different parts of your body and has many functions. Having an increased waist circumference\u00a0suggests that you have increased amounts of fat in your abdomen. An increased waist circumference is a sign of obesity and can increase your risk for obesity-related complications. Read more Did you know that fatty tissue has different functions depending on its location in your body? Visceral fat\u00a0is the fatty tissue inside of your abdomen and organs. While we do not know what causes the body to create and store visceral fat, it is known that this type of fat interferes with the body\u2019s endocrine and immune systems and promotes chronic inflammation and contributes to obesity-related complications. Complications Obesity may cause the following complications: Metabolic Syndrome Type 2 diabetes High blood cholesterol and high triglyceride levels in the blood Diseases of the heart and blood vessels such as high blood pressure, atherosclerosis, heart attacks and stroke Respiratory problems such as obstructive sleep apnea , asthma, and obesity hypoventilation syndrome Back pain \u00a0 Non-alcoholic fatty liver disease (NAFLD) Osteoarthritis, a chronic inflammation that damages the cartilage and bone in or around the affected joint. It can cause mild or severe pain and usually affects weight-bearing joints in people who are obese. It is a major cause of knee replacement surgery in patients who are obese for a long time. Urinary incontinence, the unintentional leakage of urine. Chronic obesity can weaken pelvic muscles, making it harder to maintain bladder control. While it can happen to both sexes, it usually affects women as they age. Gallbladder disease Emotional health issues such as low self-esteem or depression. This may commonly occur in children. Cancers of the esophagus, pancreas, colon, rectum, kidney, endometrium, ovaries, gallbladder, breast, or liver. Read more Did you know inflammation is thought to play a role in the onset of certain obesity-related complications? Researchers now know more about visceral fat, which is deep in the abdomen of overweight and obese patients. Visceral fat releases factors that promote inflammation. Chronic obesity-related inflammation is thought to lead to insulin resistance and diabetes, changes in the liver or non-alcoholic fatty acid liver disease, and cancers. More research is needed to understand what triggers inflammation in some obese patients and to find new treatments. Look for Diagnosis\u00a0will explain tests and procedures used to detect signs of overweight and obesity and help rule our other conditions that may be causing weight gain. Treatment\u00a0will discuss treatment-related complications or side effects. Living With\u00a0will explain how doctors use waist circumference to monitor for disease severity and check for complications.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/obe"
+  ],
+  [
+    "Symptoms and Causes of Diabetes: Symptoms of diabetes includeincreased thirst and urination increased hunger fatigue blurred vision numbness or tingling in the feet or hands sores that do not heal unexplained weight lossSymptoms of type 1 diabetes can start quickly, in a matter of weeks. Symptoms of type 2 diabetes often develop slowly\u2014over the course of several years\u2014and can be so mild that you might not even notice them. Many people with type 2 diabetes have no symptoms. Some people do not find out they have the disease until they have diabetes-related health problems, such as blurred vision or heart trouble. Type 1 diabetes occurs when your immune system, the body\u2019s system for fighting infection, attacks and destroys the insulin-producing beta cells of the pancreas. Scientists think type 1 diabetes is caused by genes and environmental factors, such as viruses, that might trigger the disease. Studies such as TrialNet are working to pinpoint causes of type 1 diabetes and possible ways to prevent or slow the disease. Type 2 diabetes\u2014the most common form of diabetes\u2014is caused by several factors, including lifestyle factors and genes.Overweight, obesity, and physical inactivityYou are more likely to develop type 2 diabetes if you are not physically active and are overweight or obese. Extra weight sometimes causes insulin resistance and is common in people with type 2 diabetes. The location of body fat also makes a difference. Extra belly fat is linked to insulin resistance, type 2 diabetes, and heart and blood vessel disease. To see if your weight puts you at risk for type 2 diabetes, check out these Body Mass Index (BMI) charts.Insulin resistanceType 2 diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin well. As a result, your body needs more insulin to help glucose enter cells. At first, the pancreas makes more insulin to keep up with the added demand. Over time, the pancreas can\u2019t make enough insulin, and blood glucose levels rise.Genes and family historyAs in type 1 diabetes, certain genes may make you more likely to develop type 2 diabetes. The disease tends to run in families and occurs more often in these racial/ethnic groups:African Americans Alaska Natives American Indians Asian Americans Hispanics/Latinos Native Hawaiians Pacific IslandersGenes also can increase the risk of type 2 diabetes by increasing a person\u2019s tendency to become overweight or obese. Scientists believe gestational diabetes, a type of diabetes that develops during pregnancy, is caused by the hormonal changes of pregnancy along with genetic and lifestyle factors.Insulin resistanceHormones produced by the placenta contribute to insulin resistance, which occurs in all women during late pregnancy. Most pregnant women can produce enough insulin to overcome insulin resistance, but some cannot. Gestational diabetes occurs when the pancreas can\u2019t make enough insulin.As with type 2 diabetes, extra weight is linked to gestational diabetes. Women who are overweight or obese may already have insulin resistance when they become pregnant. Gaining too much weight during pregnancy may also be a factor.Hormonal changes, extra weight, and family history can contribute to gestational diabetes.Genes and family historyHaving a family history of diabetes makes it more likely that a woman will develop gestational diabetes, which suggests that genes play a role. Genes may also explain why the disorder occurs more often in African Americans, American Indians, Asians, and Hispanics/Latinas. Genetic mutations, other diseases, damage to the pancreas, and certain medicines may also cause diabetes.Genetic mutationsMonogenic diabetes is caused by mutations, or changes, in a single gene. These changes are usually passed through families, but sometimes the gene mutation happens on its own. Most of these gene mutations cause diabetes by making the pancreas less able to make insulin. The most common types of monogenic diabetes are neonatal diabetes and maturity-onset diabetes of the young (MODY). Neonatal diabetes occurs in the first 6 months of life. Doctors usually diagnose MODY during adolescence or early adulthood, but sometimes the disease is not diagnosed until later in life. Cystic fibrosis produces thick mucus that causes scarring in the pancreas. This scarring can prevent the pancreas from making enough insulin. Hemochromatosis causes the body to store too much iron. If the disease is not treated, iron can build up in and damage the pancreas and other organs.Hormonal diseasesSome hormonal diseases cause the body to produce too much of certain hormones, which sometimes cause insulin resistance and diabetes.Cushing\u2019s syndrome occurs when the body produces too much cortisol\u2014often called the \u201cstress hormone.\u201d Acromegaly occurs when the body produces too much growth hormone. Hyperthyroidism occurs when the thyroid gland produces too much thyroid hormone.Damage to or removal of the pancreasPancreatitis, pancreatic cancer, and trauma can all harm the beta cells or make them less able to produce insulin, resulting in diabetes. If the damaged pancreas is removed, diabetes will occur due to the loss of the beta cells.MedicinesSometimes certain medicines can harm beta cells or disrupt the way insulin works. These includeniacin, a type of vitamin B3 certain types of diuretics, also called water pills anti-seizure drugs psychiatric drugs drugs to treat human immunodeficiency virus (HIV) pentamidine, a drug used to treat a type of pneumonia glucocorticoids\u2014medicines used to treat inflammatory illnesses such as rheumatoid arthritis, asthma, lupus, and ulcerative colitis anti-rejection medicines, used to help stop the body from rejecting a transplanted organStatins, which are medicines to reduce LDL (\u201cbad\u201d) cholesterol levels, can slightly increase the chance that you\u2019ll develop diabetes. However, statins help protect you from heart disease and stroke. For this reason, the strong benefits of taking statins outweigh the small chance that you could develop diabetes.If you take any of these medicines and are concerned about their side effects, talk with your doctor.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes"
+  ],
+  [
+    "Vital signs: Vital signs reflect essential body functions, including your heartbeat, breathing rate, temperature, and blood pressure. Your health care provider may watch, measure, or monitor your vital signs to check your level of physical functioning. Normal vital signs change with age, sex, weight, exercise capability, and overall health. Normal vital sign ranges for the average healthy adult while resting are: - Blood pressure: 90/60 mm Hg to 120/80 mm Hg - Breathing: 12 to 18 breaths per minute - Pulse: 60 to 100 beats per minute - Temperature: 97.8\u00b0F to 99.1\u00b0F (36.5\u00b0C to 37.3\u00b0C)/average 98.6\u00b0F (37\u00b0C) Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002341.htm"
+  ],
+  [
+    "Myopathy with extrapyramidal signs: Myopathy with extrapyramidal signs is a disorder characterized by early childhood onset of proximal muscle weakness (muscles closest to the body\u2019s midline) and learning disabilities. The muscle weakness does not progress, but most patients develop progressive atypical involuntary muscle contractions that influence gait, movement, and posture (extrapyramidal signs) that may be disabling. Signs and symptoms are variable and include brief, repetitive, jerky and uncontrolled movements caused by muscle contractions ( chorea), tremor, abnormal posturing, and involuntary repetitive movements of the mouth and face. [1] \u00a0Other symptoms may include uncoordinated movements ( ataxia ), a very small head ( microcephaly ), drooping of the eyelids, wasting of the eye nerve ( optic atrophy), and axonal peripheral neuropathy. It is caused by changes ( mutations ) in the MICU1 gene and is inherited in an autosomal recessive \u00a0 pattern. [1] [2] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Ataxia Occasional Microcephaly Occasional Ophthalmoplegia Occasional Optic atrophy Occasional Peripheral axonal neuropathy Occasional Ptosis Occasional Abnormality of extrapyramidal motor function Very rare Chorea Very rare Dystonia Very rare Orofacial dyskinesia Very rare Proximal muscle weakness Very rare Specific learning disability Very rare Tremor Very rare Autosomal recessive inheritance - Difficulty running - Difficulty walking - Elevated serum creatine phosphokinase - Motor delay - View complete list of signs and symptoms...",
+    "https://rarediseases.info.nih.gov/diseases/12978/myopathy-with-extrapyramidal-signs"
+  ],
+  [
+    "Warning signs and symptoms of heart disease: Heart disease often develops over time. You may have early signs or symptoms long before you have serious heart problems. Or you may not realize you are developing heart disease. The warning signs of heart disease may not be obvious. Also, not every person has the same symptoms. Certain symptoms, such as chest pain, ankle swelling, and shortness of breath may be signals that something is wrong. Learning the warning signs can help you get treatment and help prevent a heart attack or stroke. Chest pain is discomfort or pain that you feel along the front of your body, between your neck and upper abdomen. There are many causes of chest pain that have nothing to do with your heart. But chest pain is still the most common symptom of poor blood flow to the heart or a heart attack. This type of chest pain is called angina. Chest pain can occur when the heart is not getting enough blood or oxygen. The amount and type of pain can vary from person to person. The intensity of the pain does not always relate to how severe the problem is. - Some people may feel a crushing pain, while others feel only mild discomfort. - Your chest may feel heavy or like someone is squeezing your heart. You may also feel a sharp, burning pain in your chest. - You may feel the pain under your breastbone (sternum), or in your neck, arms, stomach, jaw, or upper back. - Chest pain from angina often occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin. - Bad indigestion can also cause chest pain. Women, older adults, and people with diabetes may have little or no chest pain. They are more likely to have symptoms other than chest pain, such as: - Fatigue - Shortness of breath - General weakness - Change in skin color or greyish pallor (episodes of change in skin color associated with weakness) Other symptoms of a heart attack can include: - Extreme anxiety - Fainting or loss of consciousness - Lightheadedness or dizziness - Nausea or vomiting - Palpitations (feeling like your heart is beating too fast or irregularly) - Shortness of breath - Sweating, which may be very heavy When the heart can't pump blood as well as it should, blood backs up in the veins that go from the lungs to the heart. Fluid leaks into the lungs and causes shortness of breath. This is a symptom of heart failure. You may notice shortness of breath: - During activity - While you're resting - When you're lying flat on your back -- it may even wake you from sleep Coughing or wheezing that doesn't go away can be another sign that fluid is building up in your lungs. You may also cough up mucus that is pink or bloody. Swelling (edema) in your lower legs is another sign of a heart problem. When your heart doesn't work as well, blood flow slows and backs up in the veins in your legs. This causes fluid to build up in your tissues. You may also have swelling in your stomach or notice some weight gain. Narrowing of the blood vessels that bring blood to other parts of the body may mean you have a much higher risk for heart attack. It can occur when cholesterol and other fatty material (plaque) build up on the walls of your arteries. Poor blood supply to the legs may lead to: - Pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs. - Symptoms that often appear during walking or exercise, and go away after several minutes of rest. - Numbness in your legs or feet when you are at rest. Your legs may also feel cool to the touch, and the skin may look pale. A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a \"brain attack.\" Symptoms of stroke can include difficulty moving the limbs on one side of your body, one side of the face drooping, difficulty with speaking or understanding language. Tiredness can have many causes. Often it simply means that you need more rest. But feeling run down can be a sign of a more serious problem. Fatigue may be a sign of heart trouble when: - You feel much more tired than normal. It's common for women to feel severely tired before or during a heart attack. - You feel so tired that you can't do your normal daily activities. - You have sudden, severe weakness. If your heart can't pump blood as well, it may beat faster to try to keep up. You may feel your heart racing or throbbing. A fast or uneven heartbeat can also be the sign of an arrhythmia. This is a problem with your heart rate or rhythm. If you have any signs of heart disease, call your health care provider right away. Don't wait to see if the symptoms go away or dismiss them as nothing. Call your local emergency number (such as 911) if: - You have chest pain or other symptoms of a heart attack - If you know you have angina and have chest pain that doesn't go away after 5 minutes of rest or after taking nitroglycerine - If you think you may be having a heart attack - If you become extremely short of breath - If you think you may have lost consciousness Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000775.htm"
+  ],
+  [
+    "Common symptoms during pregnancy: Growing a baby is hard work. Your body will go through a lot of changes as your baby grows and your hormones change. Along with the aches and pains of pregnancy, you will feel other new or changing symptoms. Even so, many pregnant women say that they feel healthier than ever. Being tired is common during pregnancy. Most women feel tired the first few months, then again toward the end. Exercise, rest, and a proper diet can make you feel less tired. It may also help to take rest breaks or naps every day. Early on in the pregnancy, you will likely be making more trips to the bathroom. - As your uterus grows and rises higher in your abdomen (belly), the need to urinate often may lessen. - Even so, you will continue to urinate more throughout pregnancy. That means that you also need to drink more water, and may be thirstier than before you were pregnant. - As you get closer to delivery and your baby descends into your pelvis, you will need to pee much more, and the amount of urine passed at one time will be less (the bladder holds less due to pressure from the baby). If you have pain when you urinate or a change in urine odor or color, call your health care provider. These could be signs of a bladder infection. Some pregnant women also leak urine when they cough or sneeze. For most women, this goes away after the baby is born. If this happens to you, start doing Kegel exercises to strengthen the muscles of your pelvic floor. You may see more vaginal discharge while pregnant. Call your provider if the discharge: - Has a foul odor - Has a greenish color - Makes you feel itchy - Causes pain or soreness Having a hard time moving the bowels is normal during pregnancy. This is because: - Hormone changes during pregnancy slow down your digestive system. - Later in your pregnancy, the pressure from your uterus on your rectum may also worsen the problem. You can ease constipation by: - Eating raw fruits and vegetables, such as prunes, to get extra fiber. - Eating whole grain or bran cereals for more fiber. - Using a fiber supplement regularly. - Drinking plenty of water (8 to 9 cups daily). Ask your provider about trying a stool softener. Also ask before using laxatives during pregnancy. While you are pregnant, food stays in your stomach and bowels longer. This may cause heartburn (stomach acid moving back up into the esophagus). You can reduce heartburn by: - Eating small meals - Avoiding spicy and greasy foods - Not drinking large amounts of liquid before bedtime - Not exercising for at least 2 hours after you eat - Not lying down flat right after a meal If you continue to have heartburn, talk to your provider about medicines that can help. Some women have nose and gum bleeding while they are pregnant. This is because the tissues in their nose and gums get dry, and the blood vessels dilate and are closer to the surface. You can avoid or reduce this bleeding by: - Drinking lots of fluids - Getting lots of vitamin C, from orange juice or other fruits and juices - Using a humidifier (a device that puts water in the air) to decrease dryness of the nose or sinuses - Brushing your teeth with a soft toothbrush to decrease bleeding gums - Maintaining good dental hygiene and using floss every day to keep your gums healthy Swelling in your legs is common. You may see more swelling as you get closer to giving birth. The swelling is caused by your uterus pressing on the veins. - You may also notice that the veins in your lower body are becoming larger. - In the legs, these are called varicose veins. - You may also have veins close to your vulva and vagina that swell. - In your rectum, veins that swell are called hemorrhoids. To reduce swelling: - Raise your legs and rest your feet on a surface higher than your belly. - Lie on your side in bed. Lying on the left side is better if you can do it comfortably. It also provides better circulation for the baby. - Wear support pantyhose or compression stockings. - Limit salty foods. Salt works like a sponge and makes your body hold more water. - Try not to strain during bowel movements. This can worsen hemorrhoids. Leg swelling that occurs with headaches or high blood pressure can be a sign of a serious medical complication of pregnancy called preeclampsia. It is important to discuss leg swelling with your provider. Some women feel short of breath at times while they are pregnant. It happens more often in the early part of the pregnancy due to the changes in your hormones. It may also happen again toward the end of your pregnancy because of pressure from the baby. Mild shortness of breath from exercise that quickly gets better is not serious. Severe chest pain or shortness of breath that does not go away can be a sign of a serious medical complication. Call 911 or go to an emergency room right away if you have these symptoms. You may get short of breath again in the later weeks of pregnancy. This is because the uterus takes up so much room that your lungs do not have as much space to expand. Doing these things might help with shortness of breath: - Sitting up straight - Sleeping propped up on a pillow - Resting when you feel short of breath - Moving at a slower pace If you suddenly have a hard time breathing that is unusual for you, see your provider right away or go to the emergency room. Updated by: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000583.htm"
+  ],
+  [
+    "Overweight and Obesity (Treatment): Treatment for overweight and obesity depends on the cause and severity of your condition. Possible treatments include healthy lifestyle changes, behavioral weight-loss treatment programs, medicines, and possibly surgery. You may need treatments for any complications that you have. Healthy lifestyle changes To help you aim for and maintain a healthy weight, your doctor may recommend that you adopt lifelong healthy lifestyle changes. Heart-healthy eating. Learn about which foods and nutrients are part of a healthy eating pattern. It\u2019s important to eat the right amount of calories to maintain a healthy weight. If you need to lose weight, try to reduce your total daily calories gradually. Use the Body Weight Planner to find out your daily calorie needs and to set goals. Visit healthy recipes and plan for success. Talk with your doctor before beginning any diet or eating plan. Visit Chose My Plate or 2015-2020 Dietary Guidelines for Americans for more information. Physical activity. Many health benefits are associated with physical activity and getting the recommended amount of physical activity needed each week. Physical activity is an important factor in determining whether a person can maintain a healthy body weight, lose excess body weight, or maintain successful weight loss. Before starting any exercise program, ask your doctor about what level of physical activity is right for you. Visit Physical Activity Has Many Health Benefits for more information. Healthy Sleep. Studies have shown some relationship between lack of sleep and obesity. Read Sleep Deprivation and Deficiency more information. Making lifelong healthy lifestyle changes, such as heart-healthy eating and physical activity, can help you modify your energy balance to help you aim for and maintain a healthy weight. For example: To aim for a healthy weight, or lose weight, you want your energy OUT to be more than your energy IN. To maintain weight loss you want your energy IN and energy OUT to be the same.\u00a0 Behavioral weight-loss programs Your doctor may recommend you enroll in individual or group behavioral weight-loss programs to treat your overweight and obesity. In these programs, a trained healthcare professional will customize a weight-loss plan for you. This plan will include a moderately-reduced calorie diet, physical activity goals, and behavioral strategies to help you make and maintain these lifestyle changes. Read Living With\u00a0for more information about required follow-up for these behavioral treatment programs. Read more Did you know your brain\u2019s pleasure and reward centers can be stimulated by food and the act of eating, making it harder to change eating patterns and lose weight? Researchers know that our brains can become patterned so that we feel pleasure or reward from eating. This can make us unconsciously crave food so our bodies feel that sense of pleasure. It can also make it hard to change our eating patterns, lose weight, or maintain a healthy weight. Researchers are studying whether cognitive behavioral therapies can be an effective treatment for overweight and obesity by retraining the brain to not associate pleasure with food and the act of eating. Medicines When healthy lifestyle changes are not enough, your doctor may treat your overweight and obesity with FDA-approved medicines. These medicines work in the following parts of your body. Brain. Several medicines change the way the brain regulates the urge to eat, which can help to decrease appetite. Some examples of these medicines are diethylpropion, phendimetrazine, lorcaserin, naltrexone/bupropion, and liraglutide. Gastrointestinal tract. Orlistat is the only available medicine. It blocks your intestines from absorbing fat from foods in your diet. Weight loss medicines are not recommended as a single treatment for weight loss. These medicines can help you lose weight but when combined with lifestyle changes may result in greater weight loss. Some of these medicines should not be used if you have certain conditions or are taking certain medicines. Also, these medicines have side effects. Talk to your doctor if you are pregnant, planning to get pregnant, breast feeding, or have a family history of cardiovascular diseases such as high blood pressure, heart attack, or stroke. Surgical procedures Some patients with obesity do not respond to healthy lifestyle changes and medicines. When these patients develop certain obesity-related complications, they may be eligible for the following surgeries. Gastric bypass surgery. A small part of the stomach is connected to the middle part of the intestine, bypassing the first part of intestine. This decreases the amount of food that you can eat and the amount of fat your body can take in and store. Gastrectomy. A big portion of the stomach is removed to decrease the amount of food that you can eat. Gastric banding. A hollow band is placed around the upper part of the stomach creating a smaller stomach. This decreases the amount of food you can eat. Talk to your doctor to learn more about the benefits and risks of each type of surgery. Possible complications include bleeding, infection, internal rupture of sutures, or even death. Read gastric bypass surgery for more information. Read more Interested in learning why these surgeries lead to weight loss in some patients? First, these surgeries reduce the amount of food stored in the stomach and the amount of calories your body can take in. This can help your body restore energy balance. Second, these surgeries change the levels of certain hormones and the way the brain responds to these hormones to control hunger urges. After surgery, some people are less interested in eating or they prefer to eat healthier foods. In some cases, genetic differences may affect how much weight loss patients experience after bariatric surgery. Look for Living With\u00a0will explain recommendations that your doctor may give, including lifelong healthy lifestyle changes and medical care to prevent your condition from recurring, getting worse, or causing complications. Research for Your Health\u00a0will explain how we are using current research and advancing research to treat people with overweight and obesity. Participate in NHLBI Clinical Trials\u00a0will discuss our ongoing clinical studies that are investigating treatments for overweight and obesity.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/obe"
+  ],
+  [
+    "What are the treatments for Obesity?: CHANGING YOUR LIFESTYLE An active lifestyle and plenty of exercise, along with healthy eating, is the safest way to lose weight. Even modest weight loss can improve your health. You may need a lot of support from family and friends. Your main goal should be to learn new, healthy ways of eating and make them part of your daily routine. Many people find it hard to change their eating habits and behaviors. You may have practiced some habits for so long that you may not even know they are unhealthy, or you do them without thinking. You need to be motivated to make lifestyle changes. Make the behavior change part of your life over the long term. Know that it takes time to make and keep a change in your lifestyle. Work with your health care provider and dietitian to set realistic, safe daily calorie counts that help you lose weight while staying healthy. Remember that if you drop pounds slowly and steadily, you are more likely to keep them off. Your dietitian can teach you about: - Healthy food choices - Healthy snacks - Reading nutrition labels - New ways to prepare food - Portion sizes - Sweetened drinks Extreme diets (fewer than 1,100 calories per day) are not thought to be safe or to work very well. These types of diets often do not contain enough vitamins and minerals. Most people who lose weight this way return to overeating and become obese again. Learn ways to manage stress other than snacking. Examples may be meditation, yoga, or exercise. If you are depressed or stressed a lot, talk to your provider. MEDICINES AND HERBAL REMEDIES You may see ads for supplements and herbal remedies that claim they will help you lose weight. Some of these claims may not be true. And some of these supplements can have serious side effects. Talk to your provider before using them. You can discuss weight loss medicines with your doctor. Many people lose at least 5 pounds by taking these drugs, but they may regain the weight when they stop taking the medicine unless they have made lifestyle changes. SURGERY Bariatric (weight-loss) surgery can reduce the risk of certain diseases in people with severe obesity. These risks include: - Arthritis - Diabetes - Heart disease - High blood pressure - Sleep apnea - Some cancers - Stroke Surgery may help people who have been very obese for 5 years or more and have not lost weight from other treatments, such as diet, exercise, or medicine. Surgery alone is not the answer for weight loss. It can train you to eat less, but you still have to do much of the work. You must be committed to diet and exercise after surgery. Talk to your doctor to learn if surgery is a good option for you. Weight-loss surgeries include: - Laparoscopic gastric banding - Gastric bypass surgery - Sleeve gastrectomy (less common) - Duodenal switch",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/007297.htm"
+  ],
+  [
+    "Insulin, Medicines, and Other Diabetes Treatments (Do I have other treatment options for my diabetes?): When medicines and lifestyle changes are not enough to manage your diabetes, a less common treatment may be an option. Other treatments include bariatric surgery for certain people with type 1 or type 2 diabetes, and an \"artificial pancreas\" and\u00a0pancreatic islet transplantation for some people with type 1 diabetes.Bariatric surgeryAlso called weight-loss surgery or metabolic surgery, bariatric surgery may help some people with obesity and type 2 diabetes lose a large amount of weight and regain normal blood glucose levels. Some people with diabetes may no longer need their diabetes medicine after bariatric surgery. Whether and for how long blood glucose levels improve seems to vary by the patient, type of weight-loss surgery, and amount of weight the person loses. Other factors include how long someone has had diabetes and whether or not the person uses insulin.1Recent research suggests that weight-loss surgery also may help improve blood glucose control in people with type 1 diabetes who are obese.2Researchers are studying the long-term results of bariatric surgery in people with type 1 and type 2 diabetes.Artificial PancreasThe NIDDK has played an important role in developing \u201cartificial pancreas\u201d technology. An artificial pancreas replaces manual blood glucose testing and the use of insulin shots or a pump. A single system monitors blood glucose levels around the clock and provides insulin or a combination of insulin and a second hormone, glucagon, automatically. The system can also be monitored remotely, for example by parents or medical staff.In 2016, the FDA approved a type of artificial pancreas system called a hybrid closed-loop system. This system tests your glucose level every 5 minutes throughout the day and night, and automatically gives you the right amount of insulin.You still need to manually adjust the amount of insulin the pump delivers at mealtimes. But, the artificial pancreas may free you from some of the daily tasks needed to keep your blood glucose stable\u2014or help you sleep through the night without the need to wake and test your glucose or take medicine.The hybrid closed-loop system is expected to be available in the U.S. in 2017. Talk with your health care provider about whether this system might be right for you.The NIDDK has funded several important studies on different types of artificial pancreas devices to better help people with type 1 diabetes manage their disease. The devices may also help people with type 2 diabetes and gestational diabetes.Pancreatic islet transplantationPancreatic islet transplantation is an experimental treatment for poorly controlled type 1 diabetes. Pancreatic islets are clusters of cells in the pancreas that make the hormone insulin. In type 1 diabetes, the body\u2019s immune system attacks these cells. A pancreatic islet transplant replaces destroyed islets with new ones that make and release insulin. This procedure takes islets from the pancreas of an organ donor and transfers them to a person with type 1 diabetes. Because researchers are still studying pancreatic islet transplantation, the procedure is only available to people enrolled in research studies. Learn more about islet transplantation studies.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/insulin-medicines-treatments"
+  ],
+  [
+    "Obesity (Treatment): The goal of obesity treatment is to reach and stay at a healthy weight. You may need to work with a team of health professionals - including a dietitian, behavior counselor or an obesity specialist - to help you understand and make changes in your eating and activity habits. The initial treatment goal is usually a modest weight loss - 3 to 5 percent of your total weight. That means that if you weigh 200 pounds (91 kg) and are obese by BMI standards, you would need to lose only about 6 to 10 pounds (2.7 to 4.5 kg) for your health to begin to improve. However, the more weight you lose, the greater the benefits. All weight-loss programs require changes in your eating habits and increased physical activity. The treatment methods that are right for you depend on your level of obesity, your overall health and your willingness to participate in your weight-loss plan. Other treatment tools include: - Dietary changes - Exercise and activity - Behavior change - Prescription weight-loss medications - Weight-loss surgery Dietary changes Reducing calories and practicing healthier eating habits are vital to overcoming obesity. Although you may lose weight quickly at first, slow and steady weight loss over the long term is considered the safest way to lose weight and the best way to keep it off permanently. Avoid drastic and unrealistic diet changes, such as crash diets, because they're unlikely to help you keep excess weight off for the long term. Plan to participate in a comprehensive weight-loss program for at least six months and in the maintenance phase of a program for at least a year to boost your odds of weight-loss success. There is no best weight-loss diet. Choose one that includes healthy foods that you feel will work for you. Dietary changes to treat obesity include: - Cutting calories. The key to weight loss is reducing how many calories you take in. You and your health care providers can review your typical eating and drinking habits to see how many calories you normally consume and where you can cut back. You and your doctor can decide how many calories you need to take in each day to lose weight, but a typical amount is 1,200 to 1,500 calories for women and 1,500 to 1,800 for men. - Feeling full on less. The concept of energy density can help you satisfy your hunger with fewer calories. All foods have a certain number of calories within a given amount (volume). Some foods - such as desserts, candies, fats and processed foods - are high in energy density. This means that a small volume of that food has a large number of calories. In contrast, other foods, such as fruits and vegetables, have lower energy density. These foods provide a larger portion size with a fewer number of calories. By eating larger portions of foods that have fewer calories, you reduce hunger pangs, take in fewer calories and feel better about your meal, which contributes to how satisfied you feel overall. - Making healthier choices. To make your overall diet healthier, eat more plant-based foods, such as fruits, vegetables and whole-grain carbohydrates. Also emphasize lean sources of protein - such as beans, lentils and soy - and lean meats. If you like fish, try to include fish twice a week. Limit salt and added sugar. Stick with low-fat dairy products. Eat small amounts of fats, and make sure they come from heart-healthy sources, such as olive, canola and nut oils. - Restricting certain foods. Certain diets limit the amount of a particular food group, such as high-carbohydrate or full-fat foods. Ask your doctor which diet plans have been found effective and which might be helpful for you. Drinking sugar-sweetened beverages is a sure way to consume more calories than you intended, and limiting these drinks or eliminating them altogether is a good place to start cutting calories. - Meal replacements. These plans suggest that you replace one or two meals with their products - such as low-calorie shakes or meal bars - and eat healthy snacks and a healthy, balanced third meal that's low in fat and calories. In the short term, this type of diet can help you lose weight. Keep in mind that these diets likely won't teach you how to change your overall lifestyle, though, so you may have to keep this up if you want to keep your weight off. Be wary of quick fixes. You may be tempted by fad diets that promise fast and easy weight loss. The reality, however, is that there are no magic foods or quick fixes. Fad diets may help in the short term, but the long-term results don't appear to be any better than other diets. Similarly, you may lose weight on a crash diet, but you're likely to regain it when you stop the diet. To lose weight - and keep it off - you have to adopt healthy-eating habits that you can maintain over time. Exercise and activity Increased physical activity or exercise is an essential part of obesity treatment. Most people who are able to maintain their weight loss for more than a year get regular exercise, even simply walking. To boost your activity level: - Exercise. People who are overweight or obese need to get at least 150 minutes a week of moderate-intensity physical activity to prevent further weight gain or to maintain the loss of a modest amount of weight. To achieve more-significant weight loss, you may need to exercise 300 minutes or more a week. You probably will need to gradually increase the amount you exercise as your endurance and fitness improve. - Keep moving. Even though regular aerobic exercise is the most efficient way to burn calories and shed excess weight, any extra movement helps burn calories. Making simple changes throughout your day can add up to big benefits. Park farther from store entrances, rev up your household chores, garden, get up and move around periodically, and wear a pedometer to track how many steps you actually take over the course of a day. Behavior changes A behavior modification program can help you make lifestyle changes and lose weight and keep it off. Steps to take include examining your current habits to find out what factors, stresses or situations may have contributed to your obesity. Everyone is different and has different obstacles to managing weight, such as a lack of time to exercise or late-night eating. Tailor your behavior changes to address your individual concerns. Behavior modification, sometimes called behavior therapy, can include: - Counseling. Therapy or interventions with trained mental health or other professionals can help you address emotional and behavioral issues related to eating. Therapy can help you understand why you overeat and learn healthy ways to cope with anxiety. You can also learn how to monitor your diet and activity, understand eating triggers, and cope with food cravings. Therapy can take place on both an individual and group basis. More-intensive programs - those that include 12 to 26 sessions a year - may be more helpful in achieving your weight-loss goals. - Support groups. You can find camaraderie and understanding in support groups where others share similar challenges with obesity. Check with your doctor, local hospitals or commercial weight-loss programs for support groups in your area, such as Weight Watchers. Prescription weight-loss medication Losing weight requires a healthy diet and regular exercise. But in certain situations, prescription weight-loss medication may help. Keep in mind, though, that weight-loss medication is meant to be used along with diet, exercise and behavior changes, not instead of them. If you don't make these other changes in your life, medication is unlikely to work. Your doctor may recommend weight-loss medication if other methods of weight loss haven't worked for you and you meet one of the following criteria: - Your body mass index (BMI) is 30 or greater - Your BMI is greater than 27, and you also have medical complications of obesity, such as diabetes, high blood pressure or sleep apnea Before selecting a medication for you, your doctor will consider your health history, as well as possible side effects. Some weight-loss medications can't be used by women who are pregnant, or people who take certain medications or have chronic health conditions. Commonly prescribed weight-loss medications include orlistat (Xenical), lorcaserin (Belviq), phentermine and topiramate (Qsymia), buproprion and naltrexone (Contrave), and liraglutide (Saxenda). You will need close medical monitoring while taking a prescription weight-loss medication. Also, keep in mind that a weight-loss medication may not work for everyone, and the effects may wane over time. When you stop taking a weight-loss medication, you may regain much or all of the weight you lost. Weight-loss surgery In some cases, weight-loss surgery, also called bariatric surgery, is an option. Weight-loss surgery limits the amount of food you're able to comfortably eat or decreases the absorption of food and calories or both. While weight-loss surgery offers the best chance of losing the most weight, it can pose serious risks. Weight-loss surgery for obesity may be considered if you have tried other methods to lose weight that haven't worked and: - You have extreme obesity (BMI of 40 or higher) - Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as diabetes or high blood pressure - You're committed to making the lifestyle changes that are necessary for surgery to work It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term. Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits. Common weight-loss surgeries include: - Gastric bypass surgery. In gastric bypass (Roux-en-Y gastric bypass), the surgeon creates a small pouch at the top of your stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of your stomach. - Laparoscopic adjustable gastric banding (LAGB). In this procedure, your stomach is separated into two pouches with an inflatable band. Pulling the band tight, like a belt, the surgeon creates a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently. - Biliopancreatic diversion with duodenal switch. This procedure begins with the surgeon removing a large part of the stomach. The surgeon leaves the valve that releases food to the small intestine and the first part of the small intestine (duodenum). Then the surgeon closes off the middle section of the intestine and attaches the last part directly to the duodenum. The separated section of the intestine is reattached to the end of the intestine to allow bile and digestive juices to flow into this part of the intestine. - Gastric sleeve. In this procedure, part of the stomach is removed, creating a smaller reservoir for food. It's a less complicated surgery than gastric bypass or biliopancreatic diversion with duodenal switch. Other treatments Vagal nerve blockade is another treatment for obesity. It involves implanting a device under the skin of the abdomen that sends intermittent electrical pulses to the abdominal vagus nerve, which tells the brain when the stomach feels empty or full. This new technology received FDA approval in 2014 for use by adults who have not been able to lose weight with a weight-loss program and who have a BMI of 35 to 45 with at least one obesity-related condition, such as type 2 diabetes. Preventing weight regain after obesity treatment Unfortunately, it's common to regain weight no matter what obesity treatment methods you try. If you take weight-loss medications, you'll probably regain weight when you stop taking them. You might even regain weight after weight-loss surgery if you continue to overeat or overindulge in high-calorie foods. But that doesn't mean your weight-loss efforts are futile. One of the best ways to prevent regaining the weight you've lost is to get regular physical activity. Aim for 60 minutes a day. Keep track of your physical activity if it helps you stay motivated and on course. As you lose weight and gain better health, talk to your doctor about what additional activities you might be able to do and, if appropriate, how to give your activity and exercise a boost. You may always have to remain vigilant about your weight. Combining a healthier diet and more activity in a practical and sustainable manner are the best ways to keep the weight you lost off for the long term. Take your weight loss and weight maintenance one day at a time and surround yourself with supportive resources to help ensure your success. Find a healthier way of living that you can stick with for the long term.",
+    "https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742"
+  ],
+  [
+    "Obesity Hypoventilation Syndrome (Treatment): Treatments for obesity hypoventilation syndrome (OHS) include breathing support, weight loss, and medicines. The goals of treating OHS may include: Supporting and aiding your breathing Achieving major weight loss Treating underlying and related conditions Breathing Support Positive Airway Pressure Treatment for OHS often involves a machine that provides positive airway pressure (PAP) while you sleep. PAP therapy uses mild air pressure to keep your airways open. This treatment can help your body better maintain the carbon dioxide and oxygen levels in your blood. PAP therapy also can help relieve daytime sleepiness. Your doctor might recommend CPAP (continuous positive airway pressure) or BiPAP (bilevel positive airway pressure). CPAP provides continuous mild air pressure to keep your airways open. BiPAP works almost the same, but it changes the air pressure while you breathe in and out. The machines have three main parts: A mask or other device that fits over your nose or your nose and mouth. Straps keep the mask in place while you're wearing it. A tube that connects the mask to the machine's motor. A motor that blows air into the tube. Some machines have other features, such as heated humidifiers. The machines are small, lightweight, and fairly quiet. The noise they make is soft and rhythmic. Some people who have OHS receive extra oxygen as part of their PAP treatment. However, oxygen therapy alone isn't recommended as a treatment for OHS. PAP therapy also is used to treat obstructive sleep apnea. Many people who have OHS also have this common condition. If your doctor prescribes PAP therapy, you'll work with someone from a home equipment provider to select a CPAP or BiPAP machine. The home equipment provider will help you pick a machine based on your prescription and the features that meet your needs. Ventilator Support If you have severe OHS that requires treatment in a hospital, you might be put on a ventilator. A ventilator is a machine that supports breathing. This machine: Gets oxygen into your lungs Removes carbon dioxide from your body Helps you breathe easier A ventilator blows air, or air with extra oxygen, into the airways through a breathing tube. One end of the tube is inserted into your windpipe, and the other end is hooked to the ventilator. Usually, the breathing tube is put into your nose or mouth and then moved down into your throat. A tube placed like this is called an endotracheal (en-do-TRA-ke-al) tube. Endotracheal tubes are used only in a hospital setting. Sometimes the breathing tube is placed through a surgically made hole called a tracheostomy (TRA-ke-OS-toe-me). The hole goes through the front of your neck and into your windpipe. The procedure to make a tracheostomy usually is done in an operating room. You'll be given medicine so you won't feel any pain. The tracheostomy allows you to be on a ventilator in the hospital, in a long-term care facility, or at home. Talk with your doctor about how long you'll need ventilator support and whether you can receive treatment at home. For more information about ventilator support, go to the Health Topics \u00a0Ventilator/Ventilator Support article. Weight Loss Your doctor will likely recommend weight loss as part of your treatment plan. Successful weight loss often involves setting goals and making lifestyle changes. For example, eating fewer calories and being physically active can help you lose weight. Medicines and weight-loss surgery might be an option if lifestyle changes aren't enough. Your doctor will advise you on the best weight-loss treatment for you. For more information about weight loss, go to the treatment section of the Health Topics Overweight and Obesity article. Medicines Your doctor may prescribe medicines to treat OHS (although this treatment is less common than others). Your doctor also may advise you to avoid certain substances and medicines that can worsen OHS. Examples include alcohol, sedatives, and narcotics. They can interfere with how well your body is able to maintain normal carbon dioxide and oxygen levels. If you're having surgery, make sure you tell your surgeon and health care team that you have OHS. Some medicines routinely used for surgery can worsen your condition.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/ohs"
+  ],
+  [
+    "Childhood obesity (Treatment): Treatment for childhood obesity is based on your child's age and if he or she has other medical conditions. Treatment usually includes changes in your child's eating habits and physical activity level. In certain circumstances, treatment might include medications or weight-loss surgery. Treatment for children who are overweight The American Academy of Pediatrics recommends that children older than 2 and adolescents whose weight falls in the overweight category be put on a weight-maintenance program to slow the progress of weight gain. This strategy allows the child to add inches in height but not pounds, causing BMI to drop over time into a healthier range. Treatment for children who are obese Children ages 6 to 11 who are obese might be encouraged to modify their eating habits for gradual weight loss of no more than 1 pound (or about 0.5 kilogram) a month. Older children and adolescents who are obese or severely obese might be encouraged to modify their eating habits to aim for weight loss of up to 2 pounds (or about 1 kilogram) a week. The methods for maintaining your child's current weight or losing weight are the same: Your child needs to eat a healthy diet - both in terms of type and amount of food - and increase physical activity. Success depends largely on your commitment to helping your child make these changes. Healthy eating Parents are the ones who buy groceries, cook meals and decide where the food is eaten. Even small changes can make a big difference in your child's health. - When food shopping, choose fruits and vegetables. Cut back on convenience foods - such as cookies, crackers and prepared meals - which are often high in sugar, fat and calories. Always have healthy snacks available. - Limit sweetened beverages. This includes those that contain fruit juice. These drinks provide little nutritional value in exchange for their high calories. They also can make your child feel too full to eat healthier foods. - Limit fast food. Many of the menu options are high in fat and calories. - Sit down together for family meals. Make it an event - a time to share news and tell stories. Discourage eating in front of a TV, computer or video game screen, which can lead to fast eating and lowered awareness of amount eaten. - Serve appropriate portion sizes. Children don't need as much food as adults do. Allow your child to eat until he or she is full, even if that means leaving food on the plate. And remember, when you eat out, restaurant portion sizes are often significantly oversized. Physical activity A critical part of achieving and maintaining a healthy weight, especially for children, is physical activity. It burns calories, strengthens bones and muscles, and helps children sleep well at night and stay alert during the day. Good habits established in childhood help adolescents maintain healthy weights despite the hormonal changes, rapid growth and social influences that often lead to overeating. And active children are more likely to become fit adults. To increase your child's activity level: - Limit TV and recreational computer time. Time spent watching television or using computers, smartphones or tablets is known as screen time. Children younger than 18 months should avoid all screen time, except for video-chatting with family and friends. For older preschooolers, limit screen use to 1 hour per day of high-quality programming. - Emphasize activity, not exercise. Children should be moderately to vigorously active for at least an hour a day. Your child's activity doesn't have to be a structured exercise program - the object is to get him or her moving. Free-play activities - such as playing hide-and-seek, tag or jump-rope - can be great for burning calories and improving fitness. - Find activities your child likes. For instance, if your child is artistically inclined, go on a nature hike to collect leaves and rocks that your child can use to make a collage. If your child likes to climb, head for the nearest neighborhood jungle gym or climbing wall. If your child likes to read, then walk or bike to the neighborhood library for a book. Medications Medication might be prescribed for some adolescents as part of an overall weight-loss plan. The risks of taking a prescription medication over the long term are unknown, and the medication's effect on weight loss and weight maintenance for adolescents is still in question. Weight-loss surgery Weight-loss surgery may be an option for severely obese adolescents who have been unable to lose weight through lifestyle changes. However, as with any type of surgery, there are potential risks and long-term complications. Also, the long-term effects of weight-loss surgery on future growth and development are largely unknown. Weight-loss surgery in adolescents is uncommon. But your doctor might recommend this surgery if your child's weight poses a greater health threat than do the potential risks of surgery. It's important that a child being considered for weight-loss surgery meet with a team of pediatric specialists, including a pediatric endocrinologist, psychologist and dietitian. Weight-loss surgery isn't a miracle cure. It doesn't guarantee that an adolescent will lose all of his or her excess weight or be able to keep it off long term. And surgery doesn't replace the need for a healthy diet and regular physical activity.",
+    "https://www.mayoclinic.org/diseases-conditions/childhood-obesity/symptoms-causes/syc-20354827"
+  ],
+  [
+    "Insulin, Medicines, and Other Diabetes Treatments (What oral medicines treat type 2 diabetes?): You may need medicines along with healthy eating and physical activity habits to manage your type 2 diabetes. You can take many diabetes medicines by mouth. These medicines are called oral medicines.Most people with type 2 diabetes start medical treatment with metformin pills. Metformin also comes as a liquid. Metformin lowers the amount of glucose that your liver makes and helps your body use insulin better. This drug may help you lose a small amount of weight.Other oral medicines act in different ways to lower blood glucose levels. You may need to add another diabetes medicine after a while or use a combination treatment. Combining two or three kinds of diabetes medicines can lower blood glucose levels more than taking just one.Read about different kinds of diabetes medicines from the Food and Drug Administration (FDA).",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/insulin-medicines-treatments"
+  ],
+  [
+    "Deciding about treatments that prolong life (Making the Decision for Yourself): If you are near the end of your life or you have an illness that will not improve, you can choose what kind of treatment you want to receive. You should know that the illness or the injury is the main cause of the end of life, not the removal of life support equipment. To help with your decision: - Talk to your providers to learn about life support care you are receiving or may need in the future. - Learn about the treatments and how they would benefit you. - Learn about side effects or problems the treatments might cause. - Think about the quality of life you value. - Ask your provider what happens if life support care is stopped or you choose not to start a treatment. - Find out if you will have more pain or discomfort if you stop life support care. These can be hard choices for you and those close to you. There is no hard and fast rule about what to choose. People's opinions and choices often change over time.",
+    "https://medlineplus.gov/ency/patientinstructions/000468.htm"
+  ],
+  [
+    "Overweight, obesity, and weight loss (Is liposuction a treatment for obesity?): Liposuction (LY-poh-suhk-shuhn) is not a treatment for obesity. In this procedure, a surgeon removes fat from under the skin. Liposuction can be used to reshape parts of your body. But this surgery does not promise lasting weight loss.",
+    "https://www.womenshealth.gov/a-z-topics/overweight-obesity-and-weight-loss"
+  ],
+  [
+    "Deciding about treatments that prolong life: Sometimes after injury or a long illness, the main organs of the body no longer work properly without support. Your health care provider may tell you that these organs will not repair themselves. Medical care to prolong life can keep you alive when these organs stop working well. The treatments extend your life, but DO NOT cure your illness. These are called life-sustaining treatments. Treatments to extend life can include the use of machines. This equipment does the work of the body organ, such as: - A machine to help with breathing (ventilator) - A machine to help your kidneys (dialysis) - A tube into your stomach to provide food (nasogastric or gastrostomy tube) - A tube into your vein to provide fluids and medicines (intravenous, IV tube) - A tube or mask to supply oxygen If you are near the end of your life or you have an illness that will not improve, you can choose what kind of treatment you want to receive. You should know that the illness or the injury is the main cause of the end of life, not the removal of life support equipment. To help with your decision: - Talk to your providers to learn about life support care you are receiving or may need in the future. - Learn about the treatments and how they would benefit you. - Learn about side effects or problems the treatments might cause. - Think about the quality of life you value. - Ask your provider what happens if life support care is stopped or you choose not to start a treatment. - Find out if you will have more pain or discomfort if you stop life support care. These can be hard choices for you and those close to you. There is no hard and fast rule about what to choose. People's opinions and choices often change over time. To make sure your wishes are followed: - Talk to your providers about your choices. - Write your decisions in an advance health care directive. - Find out about a do-not-resuscitate (DNR) order. - Ask someone to be your health care agent or proxy. Be sure this person knows your wishes and if you make any changes in your health care choices. As your life or health changes, you may also change your health care decisions. You can change or cancel an advanced care directive at any time. You may serve as a health care agent or proxy for someone else. In this role you may have to make the decision to start or remove life support machines. It is a very hard decision to make. If you need to make a decision about stopping treatment for a loved one: - Talk to your loved one's providers. - Review the goals of your loved one's medical care. - Weigh the benefits and burdens of treatments on your loved one's health. - Think about your loved one's wishes and values. - Seek advice from other health care professionals, such as a social worker. - Seek advice from other family members. Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000468.htm"
+  ],
+  [
+    "Overweight and Obesity (Diagnosis): Your doctor may diagnose overweight and obesity based on your medical history, physical exams that confirm you have a high body mass index (BMI) and possibly a high waist circumference, and tests to rule out other medical conditions. Confirming a high body mass index (BMI) To diagnose overweight and obesity, doctors measure BMI using calculations that depend on whether you are a child or an adult. Children: A healthy weight is usually when your child\u2019s BMI is at the 5th percentile up to less than the 85th percentile based on growth charts for children who are the same age and sex. To figure out your child\u2019s BMI, use the Center for Disease Control and Prevention (CDC) BMI Percentile Calculator for Child and Teen and compare the BMI with the table below. Adults: A healthy weight for adults is usually when your BMI is 18.5 to less than 25. To figure out your BMI, use the National Heart, Lung, and Blood Institute\u2019s online BMI calculator and compare it with the table below.\u00a0You can also download the BMI calculator app for iPhone and Android. Even if your BMI is in the healthy range, it is possible to be diagnosed as obese if you have a large waist circumference\u00a0that suggests increased amounts of fat in your abdomen that can lead to complications. Medical history Your doctor will ask about your eating and physical activity habits, family history, and will see if you have other\u00a0risk factors\u00a0Your doctor may ask if you have any other signs or symptoms. This information can help determine if you have other conditions that may be causing you to be overweight or obese or if you have\u00a0complications\u00a0from being overweight or obese. Physical exam During your physical exam, your doctor will measure your weight and height to calculate your BMI. Your doctor may also measure\u00a0your\u00a0waist circumference\u00a0to estimate the amount of\u00a0unhealthy fat\u00a0in your\u00a0abdomen.\u00a0In adults, a waist\u00a0circumference\u00a0over 35 inches for women who are not pregnant or 40 inches for men can help diagnose obesity and assess risk of future complications. If you are of South Asian or Central and South American descent, your doctor may use smaller waist circumference values to diagnose your obesity. People from these backgrounds often don\u2019t show signs of a large waist circumference even though they may have unhealthy amounts of fat deep in their abdomens and may be diagnosed with obesity. Visit\u00a0Assessing Your Weight\u00a0for more information. Read Living With\u00a0for more information about why it is important to monitor your waist circumference to assess your risk for complications. Tests to identify other medical conditions Your\u00a0doctor\u00a0may\u00a0order some\u00a0of the following tests to\u00a0identify\u00a0medical conditions that may be causing your\u00a0overweight and obesity. Blood tests. Blood tests that check your thyroid hormone levels can help rule out hypothyroidism as a cause of your overweight or obesity. Cortisol and adrenocorticotropic hormone (ACTH) tests can rule out Cushing\u2019s syndrome. Total testosterone and dehydroepiandrosterone sulphate (DHEAS) tests can help rule out polycystic ovary syndrome (PCOS). Pelvic ultrasound to examine the ovaries and detect cysts. This can rule out PCOS. Reminders Return to Risk Factors\u00a0to review family history, lifestyle, or other environmental factors that increase your risk of developing overweight and obesity. Return to Signs, Symptoms, and Complications\u00a0to review common signs and symptoms of overweight and obesity. Return to Screening and Prevention\u00a0to review how to screen for overweight and obesity.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/obe"
+  ],
+  [
+    "How to diagnose Obesity?: The health care provider will perform a physical exam and ask about your medical history, eating habits, and exercise routine. The two most common ways to assess your weight and measure health risks related to your weight are: - Body mass index (BMI) - Waist circumference (your waist measurement in inches) BMI is calculated using height and weight. You and your provider can use your BMI to estimate how much body fat you have. Your waist measurement is another way to estimate how much body fat you have. Extra weight around your middle or stomach area increases your risk for type 2 diabetes, heart disease, and stroke. People with \"apple-shaped\" bodies (meaning they tend to store fat around their waist and have a slim lower body) also have an increased risk for these diseases. Skin fold measurements may be taken to check your body fat percentage. Blood tests may be done to look for thyroid or hormone problems that could lead to weight gain.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/007297.htm"
+  ],
+  [
+    "Childhood obesity (Diagnosis): As part of regular well-child care, the doctor calculates your child's BMI and determines where it falls on the BMI-for-age growth chart. The BMI helps indicate if your child is overweight for his or her age and height. Using the growth chart, your doctor determines your child's percentile, meaning how your child compares with other children of the same sex and age. For example, if your child is in the 80th percentile, it means that compared with other children of the same sex and age, 80 percent have a lower weight or BMI. Cutoff points on these growth charts, established by the Centers for Disease Control and Prevention, help identify children who are overweight and obese: - BMI between 85th and 94th percentiles - overweight - BMI 95th percentile or above - obesity Because BMI doesn't consider things such as being muscular or having a larger than average body frame and because growth patterns vary greatly among children, your doctor also factors in your child's growth and development. This helps determine whether your child's weight is a health concern. In addition to BMI and charting weight on the growth charts, the doctor evaluates: - Your family's history of obesity and weight-related health problems, such as diabetes - Your child's eating habits - Your child's activity level - Other health conditions your child may have - Psychosocial history, including incidences of depression and sleep disturbances and sadness and whether your child has friends or is the target of bullying Blood tests Your child's doctor might order blood tests if he or she finds that your child is obese. These tests might include: - A cholesterol test - A blood sugar test - Other blood tests to check for hormone imbalances, vitamin D deficiency or other conditions associated with obesity Some of these tests require that your child not eat or drink anything before the test. Ask if your child needs to fast before a blood test and for how long.",
+    "https://www.mayoclinic.org/diseases-conditions/childhood-obesity/symptoms-causes/syc-20354827"
+  ],
+  [
+    "Obesity (Diagnosis): If your BMI is in the obese range, your health care provider will typically review your health history in detail, perform a physical exam and recommend some tests. These exams and tests generally include: - Taking your health history. Your doctor may review your weight history, weight-loss efforts, exercise habits, eating patterns, what other conditions you've had, medications, stress levels and other issues about your health. Your doctor may also review your family's health history to see if you may be predisposed to certain conditions. - A general physical exam. This includes also measuring your height; checking vital signs, such as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining your abdomen. - Calculating your BMI. Your doctor will check your body mass index (BMI) to determine your level of obesity. This should be done at least once a year. Your BMI also helps determine your overall health risk and what treatment may be appropriate. - Measuring your waist circumference. Fat stored around your waist, sometimes called visceral fat or abdominal fat, may further increase your risk of diseases, such as diabetes and heart disease. Women with a waist measurement (circumference) of more than 35 inches (80 centimeters, or cm) and men with a waist measurement of more than 40 inches (102 cm) may have more health risks than do people with smaller waist measurements. Like the BMI measurement, your waist circumference should be checked at least once a year. - Checking for other health problems. If you have known health problems, your doctor will evaluate them. Your doctor will also check for other possible health problems, such as high blood pressure and diabetes. - Blood tests. What tests you have depend on your health, risk factors and any current symptoms you may be having. Tests may include a cholesterol test, liver function tests, a fasting glucose, a thyroid test and others. Your doctor may also recommend certain heart tests, such as an electrocardiogram. Gathering all this information helps you and your doctor determine how much weight you need to lose and what health conditions or risks you already have. And this will guide treatment decisions.",
+    "https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742"
+  ],
+  [
+    "Obesity Hypoventilation Syndrome (Diagnosis): Obesity hypoventilation syndrome (OHS) is diagnosed based on your medical history, signs and symptoms, and test results. Specialists Involved A critical care specialist, pulmonologist (lung specialist), and/or sleep specialist may diagnose and treat your condition. A sleep specialist is a doctor who diagnoses and treats sleep problems. Examples of such doctors include lung and nerve specialists and ear, nose, and throat specialists. Other types of doctors also can be sleep specialists. Your health care team also may include: A registered dietitian or nutritionist to help you plan and follow a healthy diet. (Your primary care doctor also might oversee weight-loss treatment and progress.) An exercise physiologist or trainer to assess your fitness level and help create a physical activity plan that's safe for you. A bariatric surgeon if weight-loss surgery is an option for you. Medical History and Physical Exam Your doctor will ask about your signs and symptoms, such as loud snoring or daytime sleepiness. He or she also may ask about your use of alcohol and certain medicines, such as sedatives and narcotics. These substances can worsen OHS. During the physical exam, your doctor will listen to your heart with a stethoscope. He or she also will check to see whether another disease or condition could be the cause of your poor breathing. Diagnostic Tests In OHS, poor breathing leads to too much carbon dioxide and too little oxygen in the blood. An arterial blood gas test can measure the levels of these gases in your blood. For this test, a blood sample is taken from an artery, usually in your wrist. The sample is then sent to a laboratory, where the oxygen and carbon dioxide levels are measured. Other tests also can measure the carbon dioxide level or oxygen level in your blood. These tests include a serum bicarbonate test and pulse oximetry. A serum bicarbonate test measures the amount of carbon dioxide in the liquid part of your blood, called the serum. For this test, a blood sample is taken from a vein, usually in your wrist or hand. Pulse oximetry measures the level of oxygen in your blood. For this test, a small sensor is attached to your finger or ear. The sensor uses light to estimate how much oxygen is in your blood. Other Tests Your doctor may recommend other tests to help check for conditions and problems related to OHS. Polysomnogram A polysomnogram (PSG) is a type of sleep study. You usually have to stay overnight at a sleep center for a PSG. The test records brain activity, eye movements, heart rate, and blood pressure. A PSG also records the amount of oxygen in your blood, how much air is moving through your nose while you breathe, snoring, and chest movements. The chest movements show whether you're making an effort to breathe. Your doctor might use the PSG results to help diagnose sleep-related breathing disorders, such as sleep apnea. Lung Function Tests Lung function tests, also called pulmonary function tests, measure how well your lungs work. For example, these tests show: How much air you can take into your lungs. This amount is compared with that of other people your age, height, and sex. This allows your doctor to see whether you're in the normal range. How much air you can blow out of your lungs and how fast you can do it. How well your lungs deliver oxygen to your blood. The strength of your breathing muscles. Chest X Ray A chest x ray is a test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. This test can help rule out other conditions that might be causing your signs and symptoms. EKG (Electrocardiogram) An EKG is a test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart. The results from an EKG might show whether OHS has affected your heart function. Other Tests A complete blood count (CBC) can show whether your body is making too many red blood cells as a result of OHS. A CBC measures many parts of your blood, including red blood cells. A toxicology screen is a group of tests that shows which medicines and drugs you've taken and how much of them you've taken. A blood or urine sample usually is collected for a toxicology screen.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/ohs"
+  ],
+  [
+    "ROHHAD (Diagnosis): A diagnosis of ROHHAD is typically made based on the presence of the following: [2] Rapid-onset obesity and alveolar hypoventilation during sleep starting after the age of\u00a0one and a half years Signs and symptoms of hypothalamic dysfunction Exclusion of other condition that cause similar features, such as congenital central hypoventilation syndrome It can take several months to years for other associated health problems to develop after the onset of rapid weight gain. This means that a child may need to be monitored over an extended period of time before a diagnosis of ROHHAD can be made. [2] [6]",
+    "https://rarediseases.info.nih.gov/diseases/10407/rohhad"
+  ],
+  [
+    "MOMO syndrome (Diagnosis): No. Genetic testing is not available for MOMO syndrome as the underlying cause of MOMO syndrome has yet to be elucidated. Diagnosis is based upon the clinical findings (i.e., symptoms).",
+    "https://rarediseases.info.nih.gov/diseases/178/momo-syndrome"
+  ],
+  [
+    "Obesity (Overview): Obesity is a complex disorder involving an excessive amount of body fat. Obesity isn't just a cosmetic concern. It increases your risk of diseases and health problems, such as heart disease, diabetes and high blood pressure. Being extremely obese means you are especially likely to have health problems related to your weight. The good news is that even modest weight loss can improve or prevent the health problems associated with obesity. Dietary changes, increased physical activity and behavior changes can help you lose weight. Prescription medications and weight-loss surgery are additional options for treating obesity.",
+    "https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742"
+  ],
+  [
+    "Obesity (Summary): Summary Obesity means having too much body fat. It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat, and/or body water. Both terms mean that a person's weight is greater than what's considered healthy for his or her height. Obesity happens over time when you eat more calories than you use. The balance between calories-in and calories-out differs for each person. Factors that might affect your weight include your genetic makeup, overeating, eating high-fat foods, and not being physically active. Obesity increases your risk of diabetes, heart disease, stroke, arthritis, and some cancers. If you have obesity, losing even 5 to 10 percent of your weight can delay or prevent some of these diseases. For example, that means losing 10 to 20 pounds if you weigh 200 pounds. NIH: National Institute of Diabetes and Digestive and Kidney Diseases",
+    "#"
+  ],
+  [
+    "Obesity (Possible Complications): Obesity is a major health threat. The extra weight creates many risks to your health.",
+    "https://medlineplus.gov/ency/article/007297.htm"
+  ],
+  [
+    "Alcohol use disorder: Alcohol use disorder (which includes a level that's sometimes called alcoholism) is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect, or having withdrawal symptoms when you rapidly decrease or stop drinking. Unhealthy alcohol use includes any alcohol use that puts your health or safety at risk or causes other alcohol-related problems. It also includes binge drinking - a pattern of drinking where a male consumes five or more drinks within two hours or a female downs at least four drinks within two hours. Binge drinking causes significant health and safety risks. If your pattern of drinking results in repeated significant distress and problems functioning in your daily life, you likely have alcohol use disorder. It can range from mild to severe. However, even a mild disorder can escalate and lead to serious problems, so early treatment is important. Alcohol use disorder can be mild, moderate or severe, based on the number of symptoms you experience. Signs and symptoms may include: - Being unable to limit the amount of alcohol you drink - Wanting to cut down on how much you drink or making unsuccessful attempts to do so - Spending a lot of time drinking, getting alcohol or recovering from alcohol use - Feeling a strong craving or urge to drink alcohol - Failing to fulfill major obligations at work, school or home due to repeated alcohol use - Continuing to drink alcohol even though you know it's causing physical, social or interpersonal problems - Giving up or reducing social and work activities and hobbies - Using alcohol in situations where it's not safe, such as when driving or swimming - Developing a tolerance to alcohol so you need more to feel its effect or you have a reduced effect from the same amount - Experiencing withdrawal symptoms - such as nausea, sweating and shaking - when you don't drink, or drinking to avoid these symptoms Alcohol use disorder can include periods of alcohol intoxication and symptoms of withdrawal. - Alcohol intoxication results as the amount of alcohol in your blood stream increases. The higher the blood alcohol concentration is, the more impaired you become. Alcohol intoxication causes behavior problems and mental changes. These may include inappropriate behavior, unstable moods, impaired judgment, slurred speech, impaired attention or memory, and poor coordination. You can also have periods called \"blackouts,\" where you don't remember events. Very high blood alcohol levels can lead to coma or even death. - Alcohol withdrawal can occur when alcohol use has been heavy and prolonged and is then stopped or greatly reduced. It can occur within several hours to four or five days later. Symptoms include sweating, rapid heartbeat, hand tremors, problems sleeping, nausea and vomiting, hallucinations, restlessness and agitation, anxiety, and occasionally seizures. Symptoms can be severe enough to impair your ability to function at work or in social situations. What is considered one drink? The National Institute on Alcohol Abuse and Alcoholism defines one standard drink as any one of these: - 12 ounces (355 milliliters) of regular beer (about 5 percent alcohol) - 8 to 9 ounces (237 to 266 milliliters) of malt liquor (about 7 percent alcohol) - 5 ounces (148 milliliters) of unfortified wine (about 12 percent alcohol) - 1.5 ounces (44 milliliters) of 80-proof hard liquor (about 40 percent alcohol) When to see a doctor If you feel that you sometimes drink too much alcohol, or it's causing problems, or your family is concerned about your drinking, talk with your doctor. Other ways to get help include talking with a mental health provider or seeking help from a support group such as Alcoholics Anonymous or a similar type of self-help group. Because denial is common, you may not feel like you have a problem with drinking. You might not recognize how much you drink or how many problems in your life are related to alcohol use. Listen to relatives, friends or co-workers when they ask you to examine your drinking habits or to seek help. Consider talking with someone who has had a problem drinking, but has stopped. If your loved one needs help Many people with alcohol use disorder hesitate to get treatment because they don't recognize they have a problem. An intervention from loved ones can help some people recognize and accept that they need professional help. If you're concerned about someone who drinks too much, ask a professional experienced in alcohol treatment for advice on how to approach that person. Genetic, psychological, social and environmental factors can impact how drinking alcohol affects your body and behavior. Theories suggest that for certain people drinking has a different and stronger impact that can lead to alcohol use disorder. Over time, drinking too much alcohol may change the normal function of the areas of your brain associated with the experience of pleasure, judgment and the ability to exercise control over your behavior. This may result in craving alcohol to try to restore good feelings or reduce negative ones. Risk factors for alcohol use disorder include: - Steady drinking over time. Drinking too much on a regular basis for an extended period or binge drinking on a regular basis can lead to alcohol-related problems or alcohol use disorder. - Age. People who begin drinking at an early age, and especially in a binge fashion, are at a higher risk of alcohol use disorder. Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s and 30s. However, it can begin at any age. - Family history. The risk of alcohol use disorder is higher for people who have a parent or other close relative who has problems with alcohol. This may be influenced by genetic factors. - Depression and other mental health problems. It's common for people with a mental health disorder such as anxiety, depression, schizophrenia or bipolar disorder to have problems with alcohol or other substances. - Social and cultural factors. Having friends or a close partner who drinks regularly could increase your risk of alcohol use disorder. The glamorous way that drinking is sometimes portrayed in the media also may send the message that it's OK to drink too much. For young people, the influence of parents, peers and other role models can impact risk. Alcohol depresses your central nervous system. In some people, the initial reaction may be stimulation. But as you continue to drink, you become sedated. Too much alcohol affects your speech, muscle coordination and vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma or death. This is of particular concern when you're taking certain medications that also depress the brain's function. Impact on your safety Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, including: - Motor vehicle accidents and other types of accidental injury, such as drowning - Relationship problems - Poor performance at work or school - Increased likelihood of committing violent crimes or being the victim of a crime - Legal problems or problems with employment or finances - Problems with other substance use - Engaging in risky, unprotected sex, or becoming the victim of sexual abuse or date rape - Increased risk of attempted or completed suicide Impact on your health Drinking too much alcohol on a single occasion or over time can cause health problems, including: - Liver disease. Heavy drinking can cause increased fat in the liver (hepatic steatosis), inflammation of the liver (alcoholic hepatitis), and over time, irreversible destruction and scarring of liver tissue (cirrhosis). - Digestive problems. Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It also can interfere with absorption of B vitamins and other nutrients. Heavy drinking can damage your pancreas or lead to inflammation of the pancreas (pancreatitis). - Heart problems. Excessive drinking can lead to high blood pressure and increases your risk of an enlarged heart, heart failure or stroke. Even a single binge can cause a serious heart arrhythmia called atrial fibrillation. - Diabetes complications. Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin to lower your blood sugar level. - Sexual function and menstruation issues. Excessive drinking can cause erectile dysfunction in men. In women, it can interrupt menstruation. - Eye problems. Over time, heavy drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamine). A thiamine deficiency also can be associated with other brain changes, such as irreversible dementia, if not promptly treated. - Birth defects. Alcohol use during pregnancy may cause miscarriage. It also may cause fetal alcohol syndrome, resulting in giving birth to a child who has physical and developmental problems that last a lifetime. - Bone damage. Alcohol may interfere with the production of new bone. This bone loss can lead to thinning bones (osteoporosis) and an increased risk of fractures. Alcohol can also damage bone marrow, which makes blood cells. This can cause a low platelet count, which may result in bruising and bleeding. - Neurological complications. Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss. - Weakened immune system. Excessive alcohol use can make it harder for your body to resist disease, increasing your risk of various illnesses, especially pneumonia. - Increased risk of cancer. Long-term excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, colon and breast cancer. Even moderate drinking can increase the risk of breast cancer. - Medication and alcohol interactions. Some medications interact with alcohol, increasing its toxic effects. Drinking while taking these medications can either increase or decrease their effectiveness, or make them dangerous. You're likely to start by seeing your primary care doctor. If your doctor suspects you have a problem with alcohol, he or she may refer you to a mental health provider. To assess your problem with alcohol, your health care provider will likely: - Ask you several questions related to your drinking habits. The health care provider may ask for permission to speak with family members or friends. However, confidentiality laws prevent your health care provider from giving out any information about you without your consent. - Perform a physical exam. Your health care provider may do a physical exam and ask questions about your health. There are many physical signs that indicate complications of alcohol use. - Lab tests and imaging tests. While there are no specific tests to diagnose alcohol use disorder, certain patterns of lab test abnormalities may strongly suggest it. And you may need tests to identify health problems that may be linked to your alcohol use. Damage to your organs may be seen on tests. - Complete a psychological evaluation. This evaluation includes questions about your symptoms, thoughts, feelings and behavior patterns. You may need to fill out a questionnaire to help answer these questions. - Use the DSM-5 criteria. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, is often used by mental health providers to diagnose mental health conditions and by insurance companies to reimburse for treatment. Treatment for alcohol use disorder can vary, depending on your needs. Treatment may involve a brief intervention, individual or group counseling, an outpatient program, or a residential inpatient stay. Working to stop the use of alcohol to improve quality of life is the main treatment goal. Treatment for alcohol use disorder may include: - Detox and withdrawal. Treatment may begin with a program of detoxification or detox - withdrawal that's medically managed - which generally takes two to seven days. You may need to take sedating medications to prevent withdrawal symptoms. Detox is usually done at an inpatient treatment center or a hospital. - Learning skills and establishing a treatment plan. This usually involves alcohol treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center. - Psychological counseling. Counseling and therapy for groups and individuals help you better understand your problem with alcohol and support recovery from the psychological aspects of alcohol use. You may benefit from couples or family therapy - family support can be an important part of the recovery process. - Oral medications. Naltrexone (Revia), a drug that blocks the good feelings alcohol causes, may prevent heavy drinking and reduce the urge to drink. Acamprosate (Campral) may help combat alcohol cravings once you stop drinking. Disulfiram (Antabuse) may help to prevent you from drinking, though it won't cure alcohol use disorder or remove the compulsion to drink. If you drink alcohol, the drug produces a physical reaction that may include flushing, nausea, vomiting and headaches. Unlike disulfiram, naltrexone and acamprosate don't make you feel sick after taking a drink. - Injected medication. Vivitrol, a version of the drug naltrexone, is injected once a month by a health care professional. Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol use disorder to use consistently. - Continuing support. Aftercare programs and support groups help people recovering from alcohol use disorder to stop drinking, manage relapses and cope with necessary lifestyle changes. This may include medical or psychological care or attending a support group. - Treatment for psychological problems. Alcohol use disorder commonly occurs along with other mental health disorders. If you have depression, anxiety or another mental health condition, you may need talk therapy (psychotherapy), medications or other treatment. - Medical treatment for health conditions. Many alcohol-related health problems improve significantly once you stop drinking. But some health conditions may warrant continued treatment and follow-up. - Spiritual practice. People who are involved with some type of regular spiritual practice may find it easier to maintain recovery from alcohol use disorder or other addictions. For many people, gaining greater insight into their spiritual side is a key element in recovery. Residential treatment programs For a serious alcohol problem, you may need a stay at a residential treatment facility. Most residential treatment programs include individual and group therapy, support groups, educational lectures, family involvement and activity therapy. Residential treatment programs typically include licensed alcohol and drug counselors, social workers, nurses, doctors and others with expertise and experience in treating alcohol use disorder. You'll need to focus on changing your habits and making different lifestyle choices. - Consider your social situation. Make it clear to your friends and family that you're not drinking alcohol. Develop a support system of friends and family who can support your recovery. You may need to distance yourself from friends and social situations that impair your recovery. - Develop healthy habits. For example, good sleep, regular physical activity, managing stress more effectively and eating well all can make it easier for you to recover from alcohol use disorder. - Do things that don't involve alcohol. You may find that many of your activities involve drinking. Replace them with hobbies or activities that are not centered around alcohol. Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. But if used in addition to your treatment plan when recovering from alcohol use disorder, these techniques may be helpful: - Yoga. Yoga's series of postures and controlled breathing exercises may help you relax and manage stress. - Meditation. During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress. - Acupuncture. With acupuncture, hair-thin needles are inserted under the skin. Acupuncture may help reduce anxiety and depression.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "How to diagnose Alcohol use disorder?: Your health care provider will: - Examine you - Ask about your medical and family history - Ask about your alcohol use, and if you have any of the symptoms listed above Your provider may order tests to check for health problems that are common in people who use alcohol. These tests may include: - Blood alcohol level (This shows if you have recently been drinking alcohol. It does not diagnose alcohol use disorder.) - Complete blood count - Liver function tests - Magnesium blood test",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000944.htm"
+  ],
+  [
+    "Alcohol use disorder: Alcohol use disorder is when your drinking causes serious problems in your life, yet you keep drinking. You may also need more and more alcohol to feel drunk. Stopping suddenly may cause withdrawal symptoms. No one knows what causes problems with alcohol. Health experts think that it may be a combination of a person's: - Genes - Environment - Psychology, such as being impulsive or having low self-esteem Drinking an excessive amount of alcohol can put you at risk for alcohol-related problems if: - You are a man who has 15 or more drinks a week, or often have 5 or more drinks at a time - You are a woman who has 8 or more drinks a week, or often have 4 or more drinks at a time One drink is defined as 12 ounces or 360 milliliters (mL) of beer (5% alcohol content), 5 ounces or 150 mL of wine (12% alcohol content), or a 1.5-ounce or 45-mL shot of liquor (80-proof, or 40% alcohol content). If you have a parent with alcohol use disorder, you are more at risk for alcohol problems. You also may be more likely to have problems with alcohol if you: - Are a young adult under peer pressure - Have depression, bipolar disorder, anxiety disorders, or schizophrenia - Can easily obtain alcohol - Have low self-esteem - Have problems with relationships - Live a stressful lifestyle If you are concerned about your drinking, it may help to take a careful look at your alcohol use. Doctors have developed a list of symptoms that a person has to have in the past year to be diagnosed with alcohol use disorder. Symptoms may include: - Times when you drink more or longer than you planned to - Wanted to, or tried to, cut down or stop drinking, but could not - Spend a lot of time and effort to get alcohol, use it, or recover from its effects - Crave alcohol or have a strong urge to use it - Alcohol use is causing you to miss work or school, or you do not perform as well because of drinking - Continue to drink, even when relationships with family and friends are being harmed - Stop taking part in activities that you used to enjoy - While or after drinking, you get into situations that can cause you to get hurt, such as driving, using machinery, or having unsafe sex - Keep drinking, even though you know it is making a health problem caused by alcohol worse - Need more and more alcohol to feel its effects or to get drunk - You get withdrawal symptoms when the effects of alcohol wear off Your health care provider will: - Examine you - Ask about your medical and family history - Ask about your alcohol use, and if you have any of the symptoms listed above Your provider may order tests to check for health problems that are common in people who use alcohol. These tests may include: - Blood alcohol level (this shows if you have recently been drinking alcohol. It does not diagnose alcohol use disorder.) - Complete blood count - Liver function tests - Magnesium blood test Many people with an alcohol problem need to completely stop using alcohol. This is called abstinence. Having strong social and family support can help make it easier to quit drinking. Some people are able to just cut back on their drinking. So even if you do not give up alcohol altogether, you may be able to drink less. This can improve your health and relationships with others. It can also help you perform better at work or school. However, many people who drink too much find they can't just cut back. Abstinence may be the only way to manage a drinking problem. DECIDING TO QUIT Like many people with an alcohol problem, you may not recognize that your drinking has gotten out of\u00a0 hand. An important first step is to be aware of how much you drink. It also helps to understand the health risks of alcohol. If you decide to quit drinking, talk with your provider. Treatment involves helping you realize how much your alcohol use is harming your life and the lives those around you. Depending on how much and how long you have been drinking, you may be at risk for alcohol withdrawal. Withdrawal can be very uncomfortable and even life threatening. If you have been drinking a lot, you should cut back or stop drinking only under the care of a doctor. Talk with your provider about how to stop using alcohol. LONG-TERM SUPPORT Alcohol recovery or support programs can help you stop drinking completely. These programs usually offer: - Education about alcohol use and its effects - Counseling and therapy to discuss how to control your thoughts and behaviors - Physical health care For the best chance of success, you should live with people who support your efforts to avoid alcohol. Some programs offer housing options for people with alcohol problems. Depending on your needs and the programs that are available: - You may be treated in a special recovery center (inpatient) - You may attend a program while you live at home (outpatient) You may be prescribed medicines to help you quit. They are often used with long-term counseling or support groups. These medicines make it less likely that you will drink again or help limit the amount you drink. Drinking may mask depression or other mood or anxiety disorders. If you have a mood disorder, it may become more noticeable when you stop drinking. Your provider will treat any mental disorders in addition to your alcohol treatment. Support groups help many people who are dealing with alcohol use. How well a person does depends on whether they can successfully cut back or stop drinking. It may take several tries to stop drinking for good. If you are struggling to quit, do not give up hope. Getting treatment, if needed, along with support and encouragement from support groups and those around you can help you remain sober. Alcohol use disorder can increase your risk of many health problems, including: - Bleeding in the digestive tract - Brain cell damage - A brain disorder called Wernicke-Korsakoff syndrome - Cancer of the esophagus, liver, colon, breast and other areas - Changes in the menstrual cycle - Delirium tremens (DTs) - Dementia and memory loss - Depression and suicide - Erectile dysfunction - Heart damage - High blood pressure - Inflammation of the pancreas (pancreatitis) - Liver disease, including cirrhosis - Nerve damage - Poor nutrition - Sleeping problems (insomnia) - Sexually transmitted infections (STIs) Alcohol use also increases your risk for violence. Drinking alcohol while you are pregnant can lead to severe birth defects in the baby. This is called fetal alcohol syndrome. Talk with your provider if you or someone you know may have an alcohol problem. Seek immediate medical care or call your local emergency number (such as 911) if you or someone you know has an alcohol problem and develops severe confusion, seizures, or bleeding. The National Institute on Alcohol Abuse and Alcoholism recommends: - Women should not drink more than 1 drink per day - Men should not drink more than 2 drinks per day Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Editorial update 8/15/2016.",
+    "https://medlineplus.gov/ency/article/000944.htm"
+  ],
+  [
+    "Alcohol use disorder (Treatment): Treatment for alcohol use disorder can vary, depending on your needs. Treatment may involve a brief intervention, individual or group counseling, an outpatient program, or a residential inpatient stay. Working to stop the use of alcohol to improve quality of life is the main treatment goal. Treatment for alcohol use disorder may include: - Detox and withdrawal. Treatment may begin with a program of detoxification or detox - withdrawal that's medically managed - which generally takes two to seven days. You may need to take sedating medications to prevent withdrawal symptoms. Detox is usually done at an inpatient treatment center or a hospital. - Learning skills and establishing a treatment plan. This usually involves alcohol treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center. - Psychological counseling. Counseling and therapy for groups and individuals help you better understand your problem with alcohol and support recovery from the psychological aspects of alcohol use. You may benefit from couples or family therapy - family support can be an important part of the recovery process. - Oral medications. Naltrexone (Revia), a drug that blocks the good feelings alcohol causes, may prevent heavy drinking and reduce the urge to drink. Acamprosate (Campral) may help combat alcohol cravings once you stop drinking. Disulfiram (Antabuse) may help to prevent you from drinking, though it won't cure alcohol use disorder or remove the compulsion to drink. If you drink alcohol, the drug produces a physical reaction that may include flushing, nausea, vomiting and headaches. Unlike disulfiram, naltrexone and acamprosate don't make you feel sick after taking a drink. - Injected medication. Vivitrol, a version of the drug naltrexone, is injected once a month by a health care professional. Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol use disorder to use consistently. - Continuing support. Aftercare programs and support groups help people recovering from alcohol use disorder to stop drinking, manage relapses and cope with necessary lifestyle changes. This may include medical or psychological care or attending a support group. - Treatment for psychological problems. Alcohol use disorder commonly occurs along with other mental health disorders. If you have depression, anxiety or another mental health condition, you may need talk therapy (psychotherapy), medications or other treatment. - Medical treatment for health conditions. Many alcohol-related health problems improve significantly once you stop drinking. But some health conditions may warrant continued treatment and follow-up. - Spiritual practice. People who are involved with some type of regular spiritual practice may find it easier to maintain recovery from alcohol use disorder or other addictions. For many people, gaining greater insight into their spiritual side is a key element in recovery. Residential treatment programs For a serious alcohol problem, you may need a stay at a residential treatment facility. Most residential treatment programs include individual and group therapy, support groups, educational lectures, family involvement and activity therapy. Residential treatment programs typically include licensed alcohol and drug counselors, social workers, nurses, doctors and others with expertise and experience in treating alcohol use disorder.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Causes): Genetic, psychological, social and environmental factors can impact how drinking alcohol affects your body and behavior. Theories suggest that for certain people drinking has a different and stronger impact that can lead to alcohol use disorder. Over time, drinking too much alcohol may change the normal function of the areas of your brain associated with the experience of pleasure, judgment and the ability to exercise control over your behavior. This may result in craving alcohol to try to restore good feelings or reduce negative ones.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Lifestyle and home remedies): You'll need to focus on changing your habits and making different lifestyle choices. - Consider your social situation. Make it clear to your friends and family that you're not drinking alcohol. Develop a support system of friends and family who can support your recovery. You may need to distance yourself from friends and social situations that impair your recovery. - Develop healthy habits. For example, good sleep, regular physical activity, managing stress more effectively and eating well all can make it easier for you to recover from alcohol use disorder. - Do things that don't involve alcohol. You may find that many of your activities involve drinking. Replace them with hobbies or activities that are not centered around alcohol.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Alternative medicine): Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. But if used in addition to your treatment plan when recovering from alcohol use disorder, these techniques may be helpful: - Yoga. Yoga's series of postures and controlled breathing exercises may help you relax and manage stress. - Meditation. During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress. - Acupuncture. With acupuncture, hair-thin needles are inserted under the skin. Acupuncture may help reduce anxiety and depression.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Diagnosis): You're likely to start by seeing your primary care doctor. If your doctor suspects you have a problem with alcohol, he or she may refer you to a mental health provider. To assess your problem with alcohol, your health care provider will likely: - Ask you several questions related to your drinking habits. The health care provider may ask for permission to speak with family members or friends. However, confidentiality laws prevent your health care provider from giving out any information about you without your consent. - Perform a physical exam. Your health care provider may do a physical exam and ask questions about your health. There are many physical signs that indicate complications of alcohol use. - Lab tests and imaging tests. While there are no specific tests to diagnose alcohol use disorder, certain patterns of lab test abnormalities may strongly suggest it. And you may need tests to identify health problems that may be linked to your alcohol use. Damage to your organs may be seen on tests. - Complete a psychological evaluation. This evaluation includes questions about your symptoms, thoughts, feelings and behavior patterns. You may need to fill out a questionnaire to help answer these questions. - Use the DSM-5 criteria. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, is often used by mental health providers to diagnose mental health conditions and by insurance companies to reimburse for treatment.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Risk factors): Risk factors for alcohol use disorder include: - Steady drinking over time. Drinking too much on a regular basis for an extended period or binge drinking on a regular basis can lead to alcohol-related problems or alcohol use disorder. - Age. People who begin drinking at an early age, and especially in a binge fashion, are at a higher risk of alcohol use disorder. Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s and 30s. However, it can begin at any age. - Family history. The risk of alcohol use disorder is higher for people who have a parent or other close relative who has problems with alcohol. This may be influenced by genetic factors. - Depression and other mental health problems. It's common for people with a mental health disorder such as anxiety, depression, schizophrenia or bipolar disorder to have problems with alcohol or other substances. - Social and cultural factors. Having friends or a close partner who drinks regularly could increase your risk of alcohol use disorder. The glamorous way that drinking is sometimes portrayed in the media also may send the message that it's OK to drink too much. For young people, the influence of parents, peers and other role models can impact risk.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "How to diagnose Alcohol use disorder?: Your health care provider will: - Examine you - Ask about your medical and family history - Ask about your alcohol use, and if you have any of the symptoms listed above Your provider may order tests to check for health problems that are common in people who use alcohol. These tests may include: - Blood alcohol level (This shows if you have recently been drinking alcohol. It does not diagnose alcohol use disorder.) - Complete blood count - Liver function tests - Magnesium blood test",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000944.htm"
+  ],
+  [
+    "Alcohol use disorder (Treatment): Treatment for alcohol use disorder can vary, depending on your needs. Treatment may involve a brief intervention, individual or group counseling, an outpatient program, or a residential inpatient stay. Working to stop the use of alcohol to improve quality of life is the main treatment goal. Treatment for alcohol use disorder may include: - Detox and withdrawal. Treatment may begin with a program of detoxification or detox - withdrawal that's medically managed - which generally takes two to seven days. You may need to take sedating medications to prevent withdrawal symptoms. Detox is usually done at an inpatient treatment center or a hospital. - Learning skills and establishing a treatment plan. This usually involves alcohol treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center. - Psychological counseling. Counseling and therapy for groups and individuals help you better understand your problem with alcohol and support recovery from the psychological aspects of alcohol use. You may benefit from couples or family therapy - family support can be an important part of the recovery process. - Oral medications. Naltrexone (Revia), a drug that blocks the good feelings alcohol causes, may prevent heavy drinking and reduce the urge to drink. Acamprosate (Campral) may help combat alcohol cravings once you stop drinking. Disulfiram (Antabuse) may help to prevent you from drinking, though it won't cure alcohol use disorder or remove the compulsion to drink. If you drink alcohol, the drug produces a physical reaction that may include flushing, nausea, vomiting and headaches. Unlike disulfiram, naltrexone and acamprosate don't make you feel sick after taking a drink. - Injected medication. Vivitrol, a version of the drug naltrexone, is injected once a month by a health care professional. Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol use disorder to use consistently. - Continuing support. Aftercare programs and support groups help people recovering from alcohol use disorder to stop drinking, manage relapses and cope with necessary lifestyle changes. This may include medical or psychological care or attending a support group. - Treatment for psychological problems. Alcohol use disorder commonly occurs along with other mental health disorders. If you have depression, anxiety or another mental health condition, you may need talk therapy (psychotherapy), medications or other treatment. - Medical treatment for health conditions. Many alcohol-related health problems improve significantly once you stop drinking. But some health conditions may warrant continued treatment and follow-up. - Spiritual practice. People who are involved with some type of regular spiritual practice may find it easier to maintain recovery from alcohol use disorder or other addictions. For many people, gaining greater insight into their spiritual side is a key element in recovery. Residential treatment programs For a serious alcohol problem, you may need a stay at a residential treatment facility. Most residential treatment programs include individual and group therapy, support groups, educational lectures, family involvement and activity therapy. Residential treatment programs typically include licensed alcohol and drug counselors, social workers, nurses, doctors and others with expertise and experience in treating alcohol use disorder.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Causes): Genetic, psychological, social and environmental factors can impact how drinking alcohol affects your body and behavior. Theories suggest that for certain people drinking has a different and stronger impact that can lead to alcohol use disorder. Over time, drinking too much alcohol may change the normal function of the areas of your brain associated with the experience of pleasure, judgment and the ability to exercise control over your behavior. This may result in craving alcohol to try to restore good feelings or reduce negative ones.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Lifestyle and home remedies): You'll need to focus on changing your habits and making different lifestyle choices. - Consider your social situation. Make it clear to your friends and family that you're not drinking alcohol. Develop a support system of friends and family who can support your recovery. You may need to distance yourself from friends and social situations that impair your recovery. - Develop healthy habits. For example, good sleep, regular physical activity, managing stress more effectively and eating well all can make it easier for you to recover from alcohol use disorder. - Do things that don't involve alcohol. You may find that many of your activities involve drinking. Replace them with hobbies or activities that are not centered around alcohol.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Diagnosis): You're likely to start by seeing your primary care doctor. If your doctor suspects you have a problem with alcohol, he or she may refer you to a mental health provider. To assess your problem with alcohol, your health care provider will likely: - Ask you several questions related to your drinking habits. The health care provider may ask for permission to speak with family members or friends. However, confidentiality laws prevent your health care provider from giving out any information about you without your consent. - Perform a physical exam. Your health care provider may do a physical exam and ask questions about your health. There are many physical signs that indicate complications of alcohol use. - Lab tests and imaging tests. While there are no specific tests to diagnose alcohol use disorder, certain patterns of lab test abnormalities may strongly suggest it. And you may need tests to identify health problems that may be linked to your alcohol use. Damage to your organs may be seen on tests. - Complete a psychological evaluation. This evaluation includes questions about your symptoms, thoughts, feelings and behavior patterns. You may need to fill out a questionnaire to help answer these questions. - Use the DSM-5 criteria. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, is often used by mental health providers to diagnose mental health conditions and by insurance companies to reimburse for treatment.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Alternative medicine): Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. But if used in addition to your treatment plan when recovering from alcohol use disorder, these techniques may be helpful: - Yoga. Yoga's series of postures and controlled breathing exercises may help you relax and manage stress. - Meditation. During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress. - Acupuncture. With acupuncture, hair-thin needles are inserted under the skin. Acupuncture may help reduce anxiety and depression.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Complications): Alcohol depresses your central nervous system. In some people, the initial reaction may be stimulation. But as you continue to drink, you become sedated. Too much alcohol affects your speech, muscle coordination and vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma or death. This is of particular concern when you're taking certain medications that also depress the brain's function. Impact on your safety Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, including: - Motor vehicle accidents and other types of accidental injury, such as drowning - Relationship problems - Poor performance at work or school - Increased likelihood of committing violent crimes or being the victim of a crime - Legal problems or problems with employment or finances - Problems with other substance use - Engaging in risky, unprotected sex, or becoming the victim of sexual abuse or date rape - Increased risk of attempted or completed suicide Impact on your health Drinking too much alcohol on a single occasion or over time can cause health problems, including: - Liver disease. Heavy drinking can cause increased fat in the liver (hepatic steatosis), inflammation of the liver (alcoholic hepatitis), and over time, irreversible destruction and scarring of liver tissue (cirrhosis). - Digestive problems. Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It also can interfere with absorption of B vitamins and other nutrients. Heavy drinking can damage your pancreas or lead to inflammation of the pancreas (pancreatitis). - Heart problems. Excessive drinking can lead to high blood pressure and increases your risk of an enlarged heart, heart failure or stroke. Even a single binge can cause a serious heart arrhythmia called atrial fibrillation. - Diabetes complications. Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin to lower your blood sugar level. - Sexual function and menstruation issues. Excessive drinking can cause erectile dysfunction in men. In women, it can interrupt menstruation. - Eye problems. Over time, heavy drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamine). A thiamine deficiency also can be associated with other brain changes, such as irreversible dementia, if not promptly treated. - Birth defects. Alcohol use during pregnancy may cause miscarriage. It also may cause fetal alcohol syndrome, resulting in giving birth to a child who has physical and developmental problems that last a lifetime. - Bone damage. Alcohol may interfere with the production of new bone. This bone loss can lead to thinning bones (osteoporosis) and an increased risk of fractures. Alcohol can also damage bone marrow, which makes blood cells. This can cause a low platelet count, which may result in bruising and bleeding. - Neurological complications. Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss. - Weakened immune system. Excessive alcohol use can make it harder for your body to resist disease, increasing your risk of various illnesses, especially pneumonia. - Increased risk of cancer. Long-term excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, colon and breast cancer. Even moderate drinking can increase the risk of breast cancer. - Medication and alcohol interactions. Some medications interact with alcohol, increasing its toxic effects. Drinking while taking these medications can either increase or decrease their effectiveness, or make them dangerous.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Symptoms): Alcohol use disorder can be mild, moderate or severe, based on the number of symptoms you experience. Signs and symptoms may include: - Being unable to limit the amount of alcohol you drink - Wanting to cut down on how much you drink or making unsuccessful attempts to do so - Spending a lot of time drinking, getting alcohol or recovering from alcohol use - Feeling a strong craving or urge to drink alcohol - Failing to fulfill major obligations at work, school or home due to repeated alcohol use - Continuing to drink alcohol even though you know it's causing physical, social or interpersonal problems - Giving up or reducing social and work activities and hobbies - Using alcohol in situations where it's not safe, such as when driving or swimming - Developing a tolerance to alcohol so you need more to feel its effect or you have a reduced effect from the same amount - Experiencing withdrawal symptoms - such as nausea, sweating and shaking - when you don't drink, or drinking to avoid these symptoms Alcohol use disorder can include periods of alcohol intoxication and symptoms of withdrawal. - Alcohol intoxication results as the amount of alcohol in your blood stream increases. The higher the blood alcohol concentration is, the more impaired you become. Alcohol intoxication causes behavior problems and mental changes. These may include inappropriate behavior, unstable moods, impaired judgment, slurred speech, impaired attention or memory, and poor coordination. You can also have periods called \"blackouts,\" where you don't remember events. Very high blood alcohol levels can lead to coma or even death. - Alcohol withdrawal can occur when alcohol use has been heavy and prolonged and is then stopped or greatly reduced. It can occur within several hours to four or five days later. Symptoms include sweating, rapid heartbeat, hand tremors, problems sleeping, nausea and vomiting, hallucinations, restlessness and agitation, anxiety, and occasionally seizures. Symptoms can be severe enough to impair your ability to function at work or in social situations. What is considered one drink? The National Institute on Alcohol Abuse and Alcoholism defines one standard drink as any one of these: - 12 ounces (355 milliliters) of regular beer (about 5 percent alcohol) - 8 to 9 ounces (237 to 266 milliliters) of malt liquor (about 7 percent alcohol) - 5 ounces (148 milliliters) of unfortified wine (about 12 percent alcohol) - 1.5 ounces (44 milliliters) of 80-proof hard liquor (about 40 percent alcohol) When to see a doctor If you feel that you sometimes drink too much alcohol, or it's causing problems, or your family is concerned about your drinking, talk with your doctor. Other ways to get help include talking with a mental health provider or seeking help from a support group such as Alcoholics Anonymous or a similar type of self-help group. Because denial is common, you may not feel like you have a problem with drinking. You might not recognize how much you drink or how many problems in your life are related to alcohol use. Listen to relatives, friends or co-workers when they ask you to examine your drinking habits or to seek help. Consider talking with someone who has had a problem drinking, but has stopped. If your loved one needs help Many people with alcohol use disorder hesitate to get treatment because they don't recognize they have a problem. An intervention from loved ones can help some people recognize and accept that they need professional help. If you're concerned about someone who drinks too much, ask a professional experienced in alcohol treatment for advice on how to approach that person.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Diagnosis): You're likely to start by seeing your primary care doctor. If your doctor suspects you have a problem with alcohol, he or she may refer you to a mental health provider. To assess your problem with alcohol, your health care provider will likely: - Ask you several questions related to your drinking habits. The health care provider may ask for permission to speak with family members or friends. However, confidentiality laws prevent your health care provider from giving out any information about you without your consent. - Perform a physical exam. Your health care provider may do a physical exam and ask questions about your health. There are many physical signs that indicate complications of alcohol use. - Lab tests and imaging tests. While there are no specific tests to diagnose alcohol use disorder, certain patterns of lab test abnormalities may strongly suggest it. And you may need tests to identify health problems that may be linked to your alcohol use. Damage to your organs may be seen on tests. - Complete a psychological evaluation. This evaluation includes questions about your symptoms, thoughts, feelings and behavior patterns. You may need to fill out a questionnaire to help answer these questions. - Use the DSM-5 criteria. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, is often used by mental health providers to diagnose mental health conditions and by insurance companies to reimburse for treatment.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Causes): Genetic, psychological, social and environmental factors can impact how drinking alcohol affects your body and behavior. Theories suggest that for certain people drinking has a different and stronger impact that can lead to alcohol use disorder. Over time, drinking too much alcohol may change the normal function of the areas of your brain associated with the experience of pleasure, judgment and the ability to exercise control over your behavior. This may result in craving alcohol to try to restore good feelings or reduce negative ones.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Lifestyle and home remedies): You'll need to focus on changing your habits and making different lifestyle choices. - Consider your social situation. Make it clear to your friends and family that you're not drinking alcohol. Develop a support system of friends and family who can support your recovery. You may need to distance yourself from friends and social situations that impair your recovery. - Develop healthy habits. For example, good sleep, regular physical activity, managing stress more effectively and eating well all can make it easier for you to recover from alcohol use disorder. - Do things that don't involve alcohol. You may find that many of your activities involve drinking. Replace them with hobbies or activities that are not centered around alcohol.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Alternative medicine): Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. But if used in addition to your treatment plan when recovering from alcohol use disorder, these techniques may be helpful: - Yoga. Yoga's series of postures and controlled breathing exercises may help you relax and manage stress. - Meditation. During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress. - Acupuncture. With acupuncture, hair-thin needles are inserted under the skin. Acupuncture may help reduce anxiety and depression.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Treatment): Treatment for alcohol use disorder can vary, depending on your needs. Treatment may involve a brief intervention, individual or group counseling, an outpatient program, or a residential inpatient stay. Working to stop the use of alcohol to improve quality of life is the main treatment goal. Treatment for alcohol use disorder may include: - Detox and withdrawal. Treatment may begin with a program of detoxification or detox - withdrawal that's medically managed - which generally takes two to seven days. You may need to take sedating medications to prevent withdrawal symptoms. Detox is usually done at an inpatient treatment center or a hospital. - Learning skills and establishing a treatment plan. This usually involves alcohol treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center. - Psychological counseling. Counseling and therapy for groups and individuals help you better understand your problem with alcohol and support recovery from the psychological aspects of alcohol use. You may benefit from couples or family therapy - family support can be an important part of the recovery process. - Oral medications. Naltrexone (Revia), a drug that blocks the good feelings alcohol causes, may prevent heavy drinking and reduce the urge to drink. Acamprosate (Campral) may help combat alcohol cravings once you stop drinking. Disulfiram (Antabuse) may help to prevent you from drinking, though it won't cure alcohol use disorder or remove the compulsion to drink. If you drink alcohol, the drug produces a physical reaction that may include flushing, nausea, vomiting and headaches. Unlike disulfiram, naltrexone and acamprosate don't make you feel sick after taking a drink. - Injected medication. Vivitrol, a version of the drug naltrexone, is injected once a month by a health care professional. Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol use disorder to use consistently. - Continuing support. Aftercare programs and support groups help people recovering from alcohol use disorder to stop drinking, manage relapses and cope with necessary lifestyle changes. This may include medical or psychological care or attending a support group. - Treatment for psychological problems. Alcohol use disorder commonly occurs along with other mental health disorders. If you have depression, anxiety or another mental health condition, you may need talk therapy (psychotherapy), medications or other treatment. - Medical treatment for health conditions. Many alcohol-related health problems improve significantly once you stop drinking. But some health conditions may warrant continued treatment and follow-up. - Spiritual practice. People who are involved with some type of regular spiritual practice may find it easier to maintain recovery from alcohol use disorder or other addictions. For many people, gaining greater insight into their spiritual side is a key element in recovery. Residential treatment programs For a serious alcohol problem, you may need a stay at a residential treatment facility. Most residential treatment programs include individual and group therapy, support groups, educational lectures, family involvement and activity therapy. Residential treatment programs typically include licensed alcohol and drug counselors, social workers, nurses, doctors and others with expertise and experience in treating alcohol use disorder.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "What are the treatments for Alcohol use disorder?: Many people with an alcohol problem need to completely stop using alcohol. This is called abstinence. Having strong social and family support can help make it easier to quit drinking. Some people are able to just cut back on their drinking. So even if you do not give up alcohol altogether, you may be able to drink less. This can improve your health and relationships with others. It can also help you perform better at work or school. However, many people who drink too much find they cannot just cut back. Abstinence may be the only way to manage a drinking problem. DECIDING TO QUIT Like many people with an alcohol problem, you may not recognize that your drinking has gotten out of hand. An important first step is to be aware of how much you drink. It also helps to understand the health risks of alcohol. If you decide to quit drinking, talk with your health care provider. Treatment involves helping you realize how much your alcohol use is harming your life and the lives those around you. Depending on how much and how long you have been drinking, you may be at risk for alcohol withdrawal. Withdrawal can be very uncomfortable and even life-threatening. If you have been drinking a lot, you should cut back or stop drinking only under the care of a doctor. Talk with your provider about how to stop using alcohol. LONG-TERM SUPPORT Alcohol recovery or support programs can help you stop drinking completely. These programs usually offer: - Education about alcohol use and its effects - Counseling and therapy to discuss how to control your thoughts and behaviors - Physical health care For the best chance of success, you should live with people who support your efforts to avoid alcohol. Some programs offer housing options for people with alcohol problems. Depending on your needs and the programs that are available: - You may be treated in a special recovery center (inpatient) - You may attend a program while you live at home (outpatient) You may be prescribed medicines to help you quit. They are often used with long-term counseling or support groups. These medicines make it less likely that you will drink again or help limit the amount you drink. Drinking may mask depression or other mood or anxiety disorders. If you have a mood disorder, it may become more noticeable when you stop drinking. Your provider will treat any mental disorders in addition to your alcohol treatment.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000944.htm"
+  ],
+  [
+    "Alcohol use disorder (Alternative medicine): Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. But if used in addition to your treatment plan when recovering from alcohol use disorder, these techniques may be helpful: - Yoga. Yoga's series of postures and controlled breathing exercises may help you relax and manage stress. - Meditation. During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress. - Acupuncture. With acupuncture, hair-thin needles are inserted under the skin. Acupuncture may help reduce anxiety and depression.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Causes): Genetic, psychological, social and environmental factors can impact how drinking alcohol affects your body and behavior. Theories suggest that for certain people drinking has a different and stronger impact that can lead to alcohol use disorder. Over time, drinking too much alcohol may change the normal function of the areas of your brain associated with the experience of pleasure, judgment and the ability to exercise control over your behavior. This may result in craving alcohol to try to restore good feelings or reduce negative ones.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Diagnosis): You're likely to start by seeing your primary care doctor. If your doctor suspects you have a problem with alcohol, he or she may refer you to a mental health provider. To assess your problem with alcohol, your health care provider will likely: - Ask you several questions related to your drinking habits. The health care provider may ask for permission to speak with family members or friends. However, confidentiality laws prevent your health care provider from giving out any information about you without your consent. - Perform a physical exam. Your health care provider may do a physical exam and ask questions about your health. There are many physical signs that indicate complications of alcohol use. - Lab tests and imaging tests. While there are no specific tests to diagnose alcohol use disorder, certain patterns of lab test abnormalities may strongly suggest it. And you may need tests to identify health problems that may be linked to your alcohol use. Damage to your organs may be seen on tests. - Complete a psychological evaluation. This evaluation includes questions about your symptoms, thoughts, feelings and behavior patterns. You may need to fill out a questionnaire to help answer these questions. - Use the DSM-5 criteria. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, is often used by mental health providers to diagnose mental health conditions and by insurance companies to reimburse for treatment.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Lifestyle and home remedies): You'll need to focus on changing your habits and making different lifestyle choices. - Consider your social situation. Make it clear to your friends and family that you're not drinking alcohol. Develop a support system of friends and family who can support your recovery. You may need to distance yourself from friends and social situations that impair your recovery. - Develop healthy habits. For example, good sleep, regular physical activity, managing stress more effectively and eating well all can make it easier for you to recover from alcohol use disorder. - Do things that don't involve alcohol. You may find that many of your activities involve drinking. Replace them with hobbies or activities that are not centered around alcohol.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Complications): Alcohol depresses your central nervous system. In some people, the initial reaction may be stimulation. But as you continue to drink, you become sedated. Too much alcohol affects your speech, muscle coordination and vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma or death. This is of particular concern when you're taking certain medications that also depress the brain's function. Impact on your safety Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, including: - Motor vehicle accidents and other types of accidental injury, such as drowning - Relationship problems - Poor performance at work or school - Increased likelihood of committing violent crimes or being the victim of a crime - Legal problems or problems with employment or finances - Problems with other substance use - Engaging in risky, unprotected sex, or becoming the victim of sexual abuse or date rape - Increased risk of attempted or completed suicide Impact on your health Drinking too much alcohol on a single occasion or over time can cause health problems, including: - Liver disease. Heavy drinking can cause increased fat in the liver (hepatic steatosis), inflammation of the liver (alcoholic hepatitis), and over time, irreversible destruction and scarring of liver tissue (cirrhosis). - Digestive problems. Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It also can interfere with absorption of B vitamins and other nutrients. Heavy drinking can damage your pancreas or lead to inflammation of the pancreas (pancreatitis). - Heart problems. Excessive drinking can lead to high blood pressure and increases your risk of an enlarged heart, heart failure or stroke. Even a single binge can cause a serious heart arrhythmia called atrial fibrillation. - Diabetes complications. Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin to lower your blood sugar level. - Sexual function and menstruation issues. Excessive drinking can cause erectile dysfunction in men. In women, it can interrupt menstruation. - Eye problems. Over time, heavy drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamine). A thiamine deficiency also can be associated with other brain changes, such as irreversible dementia, if not promptly treated. - Birth defects. Alcohol use during pregnancy may cause miscarriage. It also may cause fetal alcohol syndrome, resulting in giving birth to a child who has physical and developmental problems that last a lifetime. - Bone damage. Alcohol may interfere with the production of new bone. This bone loss can lead to thinning bones (osteoporosis) and an increased risk of fractures. Alcohol can also damage bone marrow, which makes blood cells. This can cause a low platelet count, which may result in bruising and bleeding. - Neurological complications. Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss. - Weakened immune system. Excessive alcohol use can make it harder for your body to resist disease, increasing your risk of various illnesses, especially pneumonia. - Increased risk of cancer. Long-term excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, colon and breast cancer. Even moderate drinking can increase the risk of breast cancer. - Medication and alcohol interactions. Some medications interact with alcohol, increasing its toxic effects. Drinking while taking these medications can either increase or decrease their effectiveness, or make them dangerous.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Diagnosis): You're likely to start by seeing your primary care doctor. If your doctor suspects you have a problem with alcohol, he or she may refer you to a mental health provider. To assess your problem with alcohol, your health care provider will likely: - Ask you several questions related to your drinking habits. The health care provider may ask for permission to speak with family members or friends. However, confidentiality laws prevent your health care provider from giving out any information about you without your consent. - Perform a physical exam. Your health care provider may do a physical exam and ask questions about your health. There are many physical signs that indicate complications of alcohol use. - Lab tests and imaging tests. While there are no specific tests to diagnose alcohol use disorder, certain patterns of lab test abnormalities may strongly suggest it. And you may need tests to identify health problems that may be linked to your alcohol use. Damage to your organs may be seen on tests. - Complete a psychological evaluation. This evaluation includes questions about your symptoms, thoughts, feelings and behavior patterns. You may need to fill out a questionnaire to help answer these questions. - Use the DSM-5 criteria. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, is often used by mental health providers to diagnose mental health conditions and by insurance companies to reimburse for treatment.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "How to diagnose Alcohol use disorder?: Your health care provider will: - Examine you - Ask about your medical and family history - Ask about your alcohol use, and if you have any of the symptoms listed above Your provider may order tests to check for health problems that are common in people who use alcohol. These tests may include: - Blood alcohol level (This shows if you have recently been drinking alcohol. It does not diagnose alcohol use disorder.) - Complete blood count - Liver function tests - Magnesium blood test",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000944.htm"
+  ],
+  [
+    "Alcohol use disorder (Risk factors): Risk factors for alcohol use disorder include: - Steady drinking over time. Drinking too much on a regular basis for an extended period or binge drinking on a regular basis can lead to alcohol-related problems or alcohol use disorder. - Age. People who begin drinking at an early age, and especially in a binge fashion, are at a higher risk of alcohol use disorder. Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s and 30s. However, it can begin at any age. - Family history. The risk of alcohol use disorder is higher for people who have a parent or other close relative who has problems with alcohol. This may be influenced by genetic factors. - Depression and other mental health problems. It's common for people with a mental health disorder such as anxiety, depression, schizophrenia or bipolar disorder to have problems with alcohol or other substances. - Social and cultural factors. Having friends or a close partner who drinks regularly could increase your risk of alcohol use disorder. The glamorous way that drinking is sometimes portrayed in the media also may send the message that it's OK to drink too much. For young people, the influence of parents, peers and other role models can impact risk.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Treatment): Treatment for alcohol use disorder can vary, depending on your needs. Treatment may involve a brief intervention, individual or group counseling, an outpatient program, or a residential inpatient stay. Working to stop the use of alcohol to improve quality of life is the main treatment goal. Treatment for alcohol use disorder may include: - Detox and withdrawal. Treatment may begin with a program of detoxification or detox - withdrawal that's medically managed - which generally takes two to seven days. You may need to take sedating medications to prevent withdrawal symptoms. Detox is usually done at an inpatient treatment center or a hospital. - Learning skills and establishing a treatment plan. This usually involves alcohol treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center. - Psychological counseling. Counseling and therapy for groups and individuals help you better understand your problem with alcohol and support recovery from the psychological aspects of alcohol use. You may benefit from couples or family therapy - family support can be an important part of the recovery process. - Oral medications. Naltrexone (Revia), a drug that blocks the good feelings alcohol causes, may prevent heavy drinking and reduce the urge to drink. Acamprosate (Campral) may help combat alcohol cravings once you stop drinking. Disulfiram (Antabuse) may help to prevent you from drinking, though it won't cure alcohol use disorder or remove the compulsion to drink. If you drink alcohol, the drug produces a physical reaction that may include flushing, nausea, vomiting and headaches. Unlike disulfiram, naltrexone and acamprosate don't make you feel sick after taking a drink. - Injected medication. Vivitrol, a version of the drug naltrexone, is injected once a month by a health care professional. Although similar medication can be taken in pill form, the injectable version of the drug may be easier for people recovering from alcohol use disorder to use consistently. - Continuing support. Aftercare programs and support groups help people recovering from alcohol use disorder to stop drinking, manage relapses and cope with necessary lifestyle changes. This may include medical or psychological care or attending a support group. - Treatment for psychological problems. Alcohol use disorder commonly occurs along with other mental health disorders. If you have depression, anxiety or another mental health condition, you may need talk therapy (psychotherapy), medications or other treatment. - Medical treatment for health conditions. Many alcohol-related health problems improve significantly once you stop drinking. But some health conditions may warrant continued treatment and follow-up. - Spiritual practice. People who are involved with some type of regular spiritual practice may find it easier to maintain recovery from alcohol use disorder or other addictions. For many people, gaining greater insight into their spiritual side is a key element in recovery. Residential treatment programs For a serious alcohol problem, you may need a stay at a residential treatment facility. Most residential treatment programs include individual and group therapy, support groups, educational lectures, family involvement and activity therapy. Residential treatment programs typically include licensed alcohol and drug counselors, social workers, nurses, doctors and others with expertise and experience in treating alcohol use disorder.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Causes): Genetic, psychological, social and environmental factors can impact how drinking alcohol affects your body and behavior. Theories suggest that for certain people drinking has a different and stronger impact that can lead to alcohol use disorder. Over time, drinking too much alcohol may change the normal function of the areas of your brain associated with the experience of pleasure, judgment and the ability to exercise control over your behavior. This may result in craving alcohol to try to restore good feelings or reduce negative ones.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Lifestyle and home remedies): You'll need to focus on changing your habits and making different lifestyle choices. - Consider your social situation. Make it clear to your friends and family that you're not drinking alcohol. Develop a support system of friends and family who can support your recovery. You may need to distance yourself from friends and social situations that impair your recovery. - Develop healthy habits. For example, good sleep, regular physical activity, managing stress more effectively and eating well all can make it easier for you to recover from alcohol use disorder. - Do things that don't involve alcohol. You may find that many of your activities involve drinking. Replace them with hobbies or activities that are not centered around alcohol.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Alternative medicine): Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. But if used in addition to your treatment plan when recovering from alcohol use disorder, these techniques may be helpful: - Yoga. Yoga's series of postures and controlled breathing exercises may help you relax and manage stress. - Meditation. During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress. - Acupuncture. With acupuncture, hair-thin needles are inserted under the skin. Acupuncture may help reduce anxiety and depression.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Alcohol use disorder (Complications): Alcohol depresses your central nervous system. In some people, the initial reaction may be stimulation. But as you continue to drink, you become sedated. Too much alcohol affects your speech, muscle coordination and vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma or death. This is of particular concern when you're taking certain medications that also depress the brain's function. Impact on your safety Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, including: - Motor vehicle accidents and other types of accidental injury, such as drowning - Relationship problems - Poor performance at work or school - Increased likelihood of committing violent crimes or being the victim of a crime - Legal problems or problems with employment or finances - Problems with other substance use - Engaging in risky, unprotected sex, or becoming the victim of sexual abuse or date rape - Increased risk of attempted or completed suicide Impact on your health Drinking too much alcohol on a single occasion or over time can cause health problems, including: - Liver disease. Heavy drinking can cause increased fat in the liver (hepatic steatosis), inflammation of the liver (alcoholic hepatitis), and over time, irreversible destruction and scarring of liver tissue (cirrhosis). - Digestive problems. Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It also can interfere with absorption of B vitamins and other nutrients. Heavy drinking can damage your pancreas or lead to inflammation of the pancreas (pancreatitis). - Heart problems. Excessive drinking can lead to high blood pressure and increases your risk of an enlarged heart, heart failure or stroke. Even a single binge can cause a serious heart arrhythmia called atrial fibrillation. - Diabetes complications. Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin to lower your blood sugar level. - Sexual function and menstruation issues. Excessive drinking can cause erectile dysfunction in men. In women, it can interrupt menstruation. - Eye problems. Over time, heavy drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamine). A thiamine deficiency also can be associated with other brain changes, such as irreversible dementia, if not promptly treated. - Birth defects. Alcohol use during pregnancy may cause miscarriage. It also may cause fetal alcohol syndrome, resulting in giving birth to a child who has physical and developmental problems that last a lifetime. - Bone damage. Alcohol may interfere with the production of new bone. This bone loss can lead to thinning bones (osteoporosis) and an increased risk of fractures. Alcohol can also damage bone marrow, which makes blood cells. This can cause a low platelet count, which may result in bruising and bleeding. - Neurological complications. Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss. - Weakened immune system. Excessive alcohol use can make it harder for your body to resist disease, increasing your risk of various illnesses, especially pneumonia. - Increased risk of cancer. Long-term excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, colon and breast cancer. Even moderate drinking can increase the risk of breast cancer. - Medication and alcohol interactions. Some medications interact with alcohol, increasing its toxic effects. Drinking while taking these medications can either increase or decrease their effectiveness, or make them dangerous.",
+    "https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243"
+  ],
+  [
+    "Parkinson disease - resources: The following organizations are good resources for information on Parkinson disease: - The Michael J. Fox Foundation -- www.michaeljfox.org - National Institute of Neurological Disorders and Stroke -- www.ninds.nih.gov/Disorders/All-Disorders/Parkinsons-Disease-Information-Page - National Parkinson Foundation -- www.parkinson.org - Parkinson's Disease Foundation -- www.pdf.org - US National Library of Medicine, Genetics Home Reference -- ghr.nlm.nih.gov/condition/parkinson-disease Updated by: Jennifer K. Mannheim, ARNP, Medical Staff, Department of Psychiatry and Behavioral Health, Seattle Children's Hospital, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002196.htm"
+  ],
+  [
+    "How to diagnose Parkinson disease?: Your health care provider may be able to diagnose Parkinson disease based on your symptoms and a physical exam. But the symptoms can be hard to pin down, particularly in older adults. Symptoms are easier to recognize as the illness gets worse. The examination may show: - Difficulty starting or finishing a movement - Jerky, stiff movements - Muscle loss - Shaking (tremors) - Changes in your heart rate - Normal muscle reflexes Your doctor may do some tests to rule out other conditions that can cause similar symptoms.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000755.htm"
+  ],
+  [
+    "Parkinson disease - discharge: Your doctor has told you that you have Parkinson disease. This disease affects the brain and leads to tremors, problems with walking, movement, and coordination. Other symptoms or problems that may appear later on include difficulty swallowing, constipation, and drooling. Over time, symptoms get worse and it becomes more difficult to take care of yourself. Your doctor may have you take different medicines to treat your Parkinson disease and many of the problems that may come with the disease. - These medicines can cause severe side effects, including hallucinations, nausea, vomiting, diarrhea, and confusion. - Some medicines can lead to risky behaviors such as gambling. - Make sure you follow instructions. DO NOT stop taking medicines without first talking to your doctor. - Know what to do if you miss a dose. - Keep these and all other medicines stored in a cool, dry place, away from children. Exercise can help your muscles stay strong and help you keep your balance. It is good for your heart. Exercise may also help you sleep better and have regular bowel movements. Pace yourself when you do activities that may be tiring or need a lot of concentration. To stay safe in your home, have someone help you: - Remove things that can cause you to trip. These include throw rugs, loose wires, or cords. - Fix uneven flooring. - Make sure your home has good lighting, especially in hallways. - Install handrails in the bathtub or shower and next to the toilet. - Place a slip-proof mat in the bathtub or shower. - Re-organize your home so things are easier to reach. - Buy a cordless or cell phone so you have it with you when you need to make or receive calls. Your health care provider can refer you to a physical therapist to help with: - Exercises for strength and moving around - How to use your walker, cane, or scooter - How to set up your home to safely move around in and prevent falls - Replace shoe laces and buttons with Velcro - Get a phone with large buttons Constipation is a common problem if you have Parkinson disease. So have a routine. Once you find a bowel routine that works, stick with it. - Pick a regular time, such as after a meal or a warm bath, to try to have a bowel movement. - Be patient. It may take 15 to 30 minutes to have bowel movements. - Try gently rubbing your belly to help stool move through your colon. Also try drinking more fluids, staying active, and eating lots of fiber, including fruits, vegetables, prunes, and cereals. Ask your doctor about medicines you are taking that may cause constipation. These include medicines for depression, pain, bladder control, and muscle spasms. Ask whether you should take a stool softener. These general tips may help with swallowing problems. - Keep mealtime relaxed. Eat small meals, and eat more often. - Sit up straight when you eat. Sit upright for 30 to 45 minutes after eating. - Take small bites. Chew well and swallow your food before taking another bite. - Drink milkshakes and other thick drinks. Eat soft foods that are easy to chew. Or use a blender to prepare your food so that it is easy to swallow. - Ask caregivers and family members not to talk to you when you are eating or drinking. Eat healthy foods, and keep from becoming overweight. Having Parkinson disease may make you feel sad or depressed at times. Talk to friends or family about this. Ask your doctor about seeing a professional to help you with these feelings. Keep up to date with your vaccinations. Get a flu shot every year. Ask your doctor if you need a pneumonia shot. Ask your doctor if it is safe for you to drive. Call your doctor if you have: - Changes in your symptoms or problems with your medicines - Problems moving around or getting out of your bed or chair - Problems with thinking of becoming confused - Pain that is becoming worse - Recent falls - Choking or coughing when eating - Signs of a bladder infection (fever, burning when you urinate, or frequent urination) The American Parkinson Disease Association -- www.apdaparkinson.org The National Parkinson Foundation -- www.parkinson.org Updated by: Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000394.htm"
+  ],
+  [
+    "PARK7 gene (Parkinson disease): Researchers have identified more than 25 PARK7 gene mutations that can cause Parkinson disease, a condition characterized by progressive problems with movement and balance. These mutations are associated with the early-onset form of the disorder, which begins before age 50. Some PARK7 gene mutations lead to an abnormally small DJ-1 protein or change the building blocks (amino acids) used to make the protein. The altered protein is unstable and does not function properly, if at all. Other mutations delete a large portion of the PARK7 gene, preventing the production of any functional DJ-1 protein. It is unclear how loss of functional DJ-1 protein leads to Parkinson disease. Some studies suggest that PARK7 gene mutations disrupt the protein's chaperone function, which leads to a toxic buildup of misfolded or damaged proteins and eventually to cell death. Another possibility is that PARK7 gene mutations impair the protein's ability to protect cells from destructive oxidative stress. Nerve cells that make the chemical messenger dopamine are particularly vulnerable to oxidative stress. With diminished protection, free radicals may cause enough damage to kill these nerve cells. Progressive loss of dopamine-producing nerve cells is a characteristic feature of Parkinson disease. The death of these cells weakens communication between the brain and muscles, and ultimately the brain becomes unable to control muscle movement.",
+    "https://ghr.nlm.nih.gov/gene/PARK7"
+  ],
+  [
+    "Parkinson disease: Parkinson disease is a progressive disorder of the nervous system. The disorder affects several regions of the brain, especially an area called the substantia nigra that controls balance and movement. Often the first symptom of Parkinson disease is trembling or shaking (tremor) of a limb, especially when the body is at rest. Typically, the tremor begins on one side of the body, usually in one hand. Tremors can also affect the arms, legs, feet, and face. Other characteristic symptoms of Parkinson disease include rigidity or stiffness of the limbs and torso, slow movement (bradykinesia) or an inability to move (akinesia), and impaired balance and coordination (postural instability). These symptoms worsen slowly over time. Parkinson disease can also affect emotions and thinking ability (cognition). Some affected individuals develop psychiatric conditions such as depression and visual hallucinations. People with Parkinson disease also have an increased risk of developing dementia, which is a decline in intellectual functions including judgment and memory. Generally, Parkinson disease that begins after age 50 is called late-onset disease. The condition is described as early-onset disease if signs and symptoms begin before age 50. Early-onset cases that begin before age 20 are sometimes referred to as juvenile-onset Parkinson disease. Parkinson disease affects more than 1 million people in North America and more than 4 million people worldwide. In the United States, Parkinson disease occurs in approximately 13 per 100,000 people, and about 60,000 new cases are identified each year. The late-onset form is the most common type of Parkinson disease, and the risk of developing this condition increases with age. Because more people are living longer, the number of people with this disease is expected to increase in coming decades. Most cases of Parkinson disease probably result from a complex interaction of environmental and genetic factors. These cases are classified as sporadic and occur in people with no apparent history of the disorder in their family. The cause of these sporadic cases remains unclear. Approximately 15 percent of people with Parkinson disease have a family history of this disorder. Familial cases of Parkinson disease can be caused by mutations in the LRRK2, PARK7, PINK1, PRKN, or SNCA gene, or by alterations in genes that have not been identified. Mutations in some of these genes may also play a role in cases that appear to be sporadic (not inherited). Alterations in certain genes, including GBA and UCHL1, do not cause Parkinson disease but appear to modify the risk of developing the condition in some families. Variations in other genes that have not been identified probably also contribute to Parkinson disease risk. It is not fully understood how genetic changes cause Parkinson disease or influence the risk of developing the disorder. Many Parkinson disease symptoms occur when nerve cells (neurons) in the substantia nigra die or become impaired. Normally, these cells produce a chemical messenger called dopamine, which transmits signals within the brain to produce smooth physical movements. When these dopamine-producing neurons are damaged or die, communication between the brain and muscles weakens. Eventually, the brain becomes unable to control muscle movement. Some gene mutations appear to disturb the cell machinery that breaks down (degrades) unwanted proteins in dopamine-producing neurons. As a result, undegraded proteins accumulate, leading to the impairment or death of these cells. Other mutations may affect the function of mitochondria, the energy-producing structures within cells. As a byproduct of energy production, mitochondria make unstable molecules called free radicals that can damage cells. Cells normally counteract the effects of free radicals before they cause damage, but mutations can disrupt this process. As a result, free radicals may accumulate and impair or kill dopamine-producing neurons. In most cases of Parkinson disease, protein deposits called Lewy bodies appear in dead or dying dopamine-producing neurons. (When Lewy bodies are not present, the condition is sometimes referred to as parkinsonism.) It is unclear whether Lewy bodies play a role in killing nerve cells or if they are part of the cells' response to the disease. Most cases of Parkinson disease occur in people with no apparent family history of the disorder. These sporadic cases may not be inherited, or they may have an inheritance pattern that is unknown. Among familial cases of Parkinson disease, the inheritance pattern differs depending on the gene that is altered. If the LRRK2 or SNCA gene is involved, the disorder is inherited in an autosomal dominant pattern, which means one copy of an altered gene in each cell is sufficient to cause the disorder. In most cases, an affected person has one parent with the condition. If the PARK7, PINK1, or PRKN gene is involved, Parkinson disease is inherited in an autosomal recessive pattern. This type of inheritance means that two copies of the gene in each cell are altered. Most often, the parents of an individual with autosomal recessive Parkinson disease each carry one copy of the altered gene but do not show signs and symptoms of the disorder. When genetic alterations modify the risk of developing Parkinson disease, the inheritance pattern is usually unknown. Abou-Sleiman PM, Muqit MM, Wood NW. Expanding insights of mitochondrial dysfunction in Parkinson's disease. Nat Rev Neurosci. 2006 Mar;7(3):207-19. Review.",
+    "https://ghr.nlm.nih.gov/condition/parkinson-disease"
+  ],
+  [
+    "Autosomal recessive juvenile Parkinson disease: This condition doesn't have a summary yet. Please see our page(s) on Parkinson disease and Primary orthostatic hypotension. The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Adult onset - Autosomal recessive inheritance - Bradykinesia - Dystonia - Gait disturbance - Hyperreflexia - Parkinsonism - Postural instability - Rigidity - Substantia nigra gliosis - Tremor - View complete list of signs and symptoms... The resources below provide information about treatment options for this condition. If you have questions about which treatment is right for you, talk to your healthcare professional. Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information The following diseases are related to Autosomal recessive juvenile Parkinson disease. If you have a question about any of these diseases, you can contact GARD. Parkinson disease Primary orthostatic hypotension",
+    "https://rarediseases.info.nih.gov/diseases/9642/autosomal-recessive-juvenile-parkinson-disease"
+  ],
+  [
+    "PRKN gene (Parkinson disease): Researchers have identified more than 200 PRKN gene mutations that cause Parkinson disease, a condition characterized by progressive problems with movement and balance. Mutations in this gene are associated with the juvenile form of Parkinson disease, which appears before age 20, and some cases of the more common, late-onset form that begins after age 50. Some PRKN gene mutations lead to an abnormally small parkin protein that is nonfunctional and is rapidly broken down (degraded) within cells. Other mutations insert, delete, or change DNA building blocks (nucleotides) in the PRKN gene, leading to a defective version of the parkin protein or preventing the production of this protein. The PRKN gene mutations associated with Parkinson disease usually lead to a loss of parkin activity. It is unclear how PRKN gene mutations cause Parkinson disease. The loss of parkin activity probably disturbs the ubiquitin-proteasome system, which allows unneeded proteins to accumulate. A buildup of these proteins could disrupt normal cell activities such as the supply and release of synaptic vesicles, particularly those that contain a chemical messenger called dopamine. As parkin is normally abundant in the brain, its loss could lead to the impairment or death of nerve cells, including those that produce dopamine. Loss of dopamine-producing nerve cells is a characteristic feature of Parkinson disease. Mutations in the PRKN gene may also disrupt the regulation of mitochondria. Researchers speculate that mitochondrial dysfunction in dopamine-producing nerve cells may play an important role in causing the signs and symptoms of Parkinson disease.",
+    "https://ghr.nlm.nih.gov/gene/PRKN"
+  ],
+  [
+    "Parkinson disease: Parkinson disease causes certain brain cells to die. These are the cells that help control movement and coordination. The disease leads to shaking (tremors) and trouble walking and moving. Nerve cells use a brain chemical called dopamine to help control muscle movement. With Parkinson disease, the brain cells that make dopamine slowly die. Without dopamine, the cells that control movement cannot send messages to the muscles. This makes it hard to control the muscles. Slowly, over time, this damage gets worse. No one knows what causes these brain cells to waste away. Parkinson disease most often develops after age 50. It is one of the most common nervous system problems in older adults. - The disease tends to affect men more than women, although women also develop the disease. Parkinson disease sometimes runs in families. - The disease can occur in younger adults. In such cases, it is often due to the person's genes. - Parkinson disease is rare in children. Watch this video about: Parkinson disease Symptoms may be mild at first. For instance, you may have a mild tremor or a slight feeling that one leg is stiff and dragging. Symptoms may affect one or both sides of the body. General symptoms may include: - Problems with balance and walking - Rigid or stiff muscles - Muscle aches and pains - Low blood pressure when you stand up - Stooped posture - Constipation - Sweating and not being able to control your body temperature - Slow blinking - Difficulty swallowing - Drooling - Slowed, quieter speech and monotone voice - No expression in your face (like you are wearing a mask) Movement problems may include: - Difficulty starting movement, such as starting to walk or getting out of a chair - Difficulty continuing to move - Slowed movements - Loss of small hand movements (writing may become small and difficult to read) - Difficulty eating Symptoms of shaking (tremors): - Usually occur when your limbs are not moving; this is called resting tremor - Occur when your arm or leg is held out - Go away when you move - May be worse when you are tired, excited, or stressed - Can cause you to rub your finger and thumb together without meaning to (called pill-rolling tremor) - Eventually may occur in your head, lips, tongue, and feet Other symptoms may include: - Anxiety, stress, and tension - Confusion - Dementia - Depression - Fainting - Memory loss Your health care provider may be able to diagnose Parkinson disease based on your symptoms and a physical exam. But the symptoms can be hard to pin down, particularly in older adults. Symptoms are easier to recognize as the illness gets worse. The examination may show: - Difficulty starting or finishing a movement - Jerky, stiff movements - Muscle loss - Shaking (tremors) - Changes in your heart rate - Normal muscle reflexes Your doctor may do some tests to rule out other conditions that can cause similar symptoms. There is no cure for Parkinson disease, but treatment can help control your symptoms. MEDICINE Your provider will prescribe medicines to help control your shaking and movement symptoms. At certain times during the day, the medicine may wear off and symptoms can return. If this happens, your provider may need to change any of the following: - Type of medicine - Dose - Amount of time between doses - The way you take the medicine You may also need to take medicines to help with: - Mood and thinking problems - Pain relief - Sleep problems - Drooling (botulinum toxin is often used) Parkinson medicines can cause severe side effects, including: - Confusion - Seeing or hearing things that are not there (hallucinations) - Nausea, vomiting, or diarrhea - Feeling lightheaded or fainting - Behaviors that are hard to control, such as gambling - Delirium Tell your provider right away if you have these side effects. Never change or stop taking any medicines without talking with your provider. Stopping some medicines for Parkinson disease may lead to a severe reaction. Work with your provider to find a treatment plan that works for you. As the disease gets worse, symptoms such as stooped posture, frozen movements, and speech problems may not respond to the medicines. SURGERY Surgery may be an option for some people. Surgery does not cure Parkinson disease, but it may help ease symptoms. Types of surgery include: - Deep brain stimulation. This involves placing electric stimulators in areas of the brain that control movement. - Surgery to destroy brain tissue that causes Parkinson symptoms. - Stem cell transplant and other procedures are being studied. LIFESTYLE Certain lifestyle changes may help you cope with Parkinson disease: - Stay healthy by eating nutritious foods and not smoking. - Make changes in what you eat or drink if you have swallowing problems. - Use speech therapy to help you adjust to changes in your swallowing and speech. - Stay active as much as possible when you feel good. DO NOT overdo it when your energy is low. - Rest as needed during the day and avoid stress. - Use physical therapy and occupational therapy to help you stay independent and reduce the risk of falls. - Place handrails throughout your house to help prevent falls. Place them in bathrooms and along stairways. - Use assistive devices, when needed, to make movement easier. These devices may include special eating utensils, wheelchairs, bed lifts, shower chairs, and walkers. - Talk to a social worker or other counseling service to help you and your family cope with the disorder. These services can also help you get outside help, such as Meals on Wheels. Parkinson disease support groups can help you cope with the changes caused by the disease. Medicines can help most people with Parkinson disease. How well medicines relieve symptoms and for how long, can be different in each person. If not treated, the disorder gets worse until a person is totally disabled. Parkinson disease may lead to a decline in brain function and early death. Parkinson disease may cause problems such as: - Difficulty performing daily activities - Difficulty swallowing or eating - Disability (differs from person to person) - Injuries from falls - Pneumonia from breathing in saliva or from choking on food - Side effects of medicines Call your provider if: - You have symptoms of Parkinson disease - Symptoms get worse - New symptoms occur If you take medicines for Parkinson disease, tell your provider about any side effects, which may include: - Changes in alertness, behavior, or mood - Delusional behavior - Dizziness - Hallucinations - Involuntary movements - Loss of mental functions - Nausea and vomiting - Severe confusion or disorientation Also call your provider if the condition gets worse and home care is no longer possible. Updated by: Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000755.htm"
+  ],
+  [
+    "Secondary parkinsonism: Secondary parkinsonism is similar to Parkinson disease, but the symptoms are caused by certain medicines, a different nervous system disorder, or another illness. Parkinsonism refers to any condition that involves the types of movement problems seen in Parkinson disease. These problems include tremors, slow movement, and stiffness of the arms and legs. Secondary parkinsonism may be caused by health problems, including: - Brain injury - Diffuse Lewy body disease (a type of dementia) - Encephalitis - HIV/AIDS - Meningitis - Multiple system atrophy - Progressive supranuclear palsy - Stroke - Wilson disease Other causes of secondary parkinsonism include: - Brain damage caused by anesthesia drugs (such as during surgery) - Carbon monoxide poisoning - Certain medicines used to treat mental disorders or nausea - Mercury poisoning and other chemical poisonings - Overdoses of narcotics - MPTP (a contaminant in some street drugs) There have been rare cases of secondary parkinsonism among IV drug users who injected a substance called MPTP, which can be produced when making a form of heroin. Common symptoms include: - Decrease in facial expressions - Difficulty starting and controlling movement - Loss or weakness of movement (paralysis) - Soft voice - Stiffness of the trunk, arms, or legs - Tremor Confusion and memory loss may be likely in secondary parkinsonism. This is because many diseases that cause secondary parkinsonism also lead to dementia. The health care provider will perform a physical exam and ask questions about the person's medical history and symptoms. Be aware that the symptoms may be hard to assess, particularly in older adults. Examination may show: - Difficulty starting or stopping voluntary movements - Tense muscles - Problems with posture - Slow, shuffling walk - Tremors (shaking) Reflexes are usually normal. Tests may be ordered to confirm or rule out other problems that can cause similar symptoms. If the condition is caused by a medicine, the provider may recommend changing or stopping the medicine. Treating underlying conditions, such as stroke or infections, can reduce symptoms or prevent the condition from getting worse. If symptoms make it hard to do everyday activities, the provider may recommend medicine. Medicines used to treat this condition can cause severe side effects. It is important to see the provider for check-ups. Secondary parkinsonism tends to be less responsive to medical therapy than Parkinson disease. Unlike Parkinson disease, some types of secondary parkinsonism may stabilize or even improve if the underlying cause is treated. Brain problems, such as Lewy body disease, are not reversible. This condition may lead to these problems: - Difficulty doing daily activities - Difficulty swallowing (eating) - Disability (varying degrees) - Injuries from falls - Side effects of medicines used to treat the condition Side effects from loss of strength (debilitation): - Breathing in food, fluid, or mucus (aspiration) - Blood clot in a deep vein (deep vein thrombosis) - Malnutrition Call the provider if: - Symptoms of secondary parkinsonism develop, come back, or get worse - New symptoms appear, including confusion and movements that cannot be controlled - You are unable to care for the person at home after treatment starts Treating conditions that cause secondary parkinsonism may decrease the risk. People taking medicines that can cause secondary parkinsonism should be carefully monitored by the provider to prevent the condition from developing. Updated by: Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000759.htm"
+  ],
+  [
+    "Parkinson disease: Parkinson disease belongs to a group of conditions called movement disorders. The four main symptoms are tremor, or trembling in hands, arms, legs, jaw, or head; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance. These symptoms usually begin gradually and worsen with time.\u00a0 As they become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks.\u00a0 Not everyone with one or more of these symptoms has Parkinson disease, as the symptoms sometimes appear in other diseases as well. [1]\u00a0Parkinson disease\u00a0affects about 1 to 2 percent of people over the age of 60 years and the chance of developing Parkinson disease\u00a0increases as we age. [2] Although some Parkinson disease\u00a0cases appear to be hereditary most cases are sporadic\u00a0and occur in people with no apparent history of the disorder in their family. When three or more people are affected in a family, especially if they are diagnosed at an early age (under 50 years) \u00a0there may be a gene making this family more likely to develop the condition. Currently, seven genes that cause some form of Parkinson's disease have been identified. Mutations (changes) in three known genes called SNCA (PARK1),UCHL1 ( PARK 5), and LRRK2 ( PARK8) and another mapped gene ( PARK3) have been reported in families with dominant inheritance. Mutations in three known genes, PARK2 ( PARK2), PARK7 ( PARK7), and PINK1 ( PARK6) have been found in affected individuals who had siblings with the condition but whose parents did not have Parkinson's disease (recessive inheritance). There is some research to suggest that these genes are also involved in early-onset Parkinson's disease (diagnosed before the age of 30) or in dominantly inherited Parkinson's disease but it is too early yet to be certain. However, in most cases inheriting a mutation will not cause someone to develop Parkinson's disease because there may be additional genes and environmental factors determining who will get the condition, when they get it and how it affects them. [1]\u00a0 A number of disorders can cause symptoms similar to those of Parkinson disease.\u00a0People with symptoms that resemble Parkinson disease but that result from other causes are sometimes said to have parkinsonism. Some of these disorders are listed below. [1] Postencephalitic parkinsonism Drug-induced parkinsonism Toxin -induced parkinsonism Arteriosclerotic parkinsonism Parkinsonism- dementia complex of Guam Post-traumatic parkinsonism\u00a0 Essential tremor Normal pressure hydrocephalus \u00a0 Progressive supranuclear palsy Corticobasal degeneration\u00a0 Multiple system atrophy\u00a0 Dementia with Lewy bodies\u00a0 More information on each of these conditions is available in the National Institute of Neurological Disorders and Stroke (NINDS)\u00a0publication,\u00a0\u00a0 Parkinsonian symptoms may also appear in patients with other, clearly distinct neurological disorders such as Wilson disease, Huntington disease, Alzheimer disease, spinocerebellar ataxias, and Creutzfeldt-Jakob disease. Each of these disorders has specific features that help to distinguish them from Parkinson disease.[1] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Dysautonomia Occasional Hallucinations Occasional Bradykinesia - Constipation - Dementia - Depressivity - Dysarthria - Dysphagia - Dystonia - Insidious onset - Lewy bodies - Mask-like facies - Neuronal loss in central nervous system - Parkinsonism - Personality changes - Postural instability - Progressive - Resting tremor - Rigidity - Short stepped shuffling gait - Sleep disturbance - Sporadic - Substantia nigra gliosis - Urinary urgency - Weak voice - View complete list of signs and symptoms... Parkinson disease occurs when the nerve cells in the brain that make dopamine, a chemical messenger\u00a0which transmits signals within the brain to produce smooth physical movements,\u00a0are slowly destroyed. Without dopamine, the nerve cells in the part of the brain known as the\u00a0 substantia nigra cannot properly send messages. This leads to\u00a0progressive loss of muscle function. Exactly why these brain cells waste away is unknown. [1] [3] Recent studies have shown that people with Parkinson disease\u00a0also\u00a0experience damage to\u00a0the nerve endings that produce the neurotransmitter norepinephrine. Norepinephrine, which is closely related to dopamine, is the main chemical messenger of the sympathetic nervous system, the part of the nervous system that controls\u00a0the automatic functions of the body,\u00a0including pulse and blood pressure. The loss of norepinephrine may explain some of the\u00a0non-motor features seen in Parkinson disease,\u00a0including fatigue and\u00a0problems with\u00a0blood pressure regulation. [1]\u00a0 More detailed information about the cause of Parkinson disease\u00a0is available through an information page developed by the National Institute of Neurological Disorders and Stroke (NINDS). Click here to view this information. Most cases of Parkinson disease are classified as sporadic and occur in people with no apparent history of the disorder in their family. Although the cause of these cases remains unclear, sporadic cases probably result from a complex interaction of environmental and genetic factors. Additionally, certain drugs may cause Parkinson-like symptoms. [4] Approximately 15 percent of people with Parkinson disease have a family history of the disorder. These familial cases are caused by mutations in the , , , , or gene , or by alterations in genes that have not yet been identified. Mutations in some of these genes may also play a role in cases that appear to be sporadic.[4] It is not fully understood how mutations in the , , , , or gene cause Parkinson disease. Some mutations appear to disturb the cell machinery that breaks down (degrades) unwanted proteins . As a result, un-degraded proteins accumulate, leading to the impairment or death of dopamine-producing neurons. Other mutations may involve mitochondria , the energy-producing structures within cells. As a byproduct of energy production, mitochondria make unstable molecules , called free radicals, that can damage the cell. Normally, the cell neutralizes free radicals, but some gene mutations may disrupt this neutralization process. As a result, free radicals may accumulate and impair or kill dopamine-producing neurons.[4] In some families, alterations in the , , or gene appear to modify the risk of developing Parkinson disease. Researchers have identified some genetic changes that may reduce the risk of developing the disease, while other gene alterations seem to increase the risk.[4] There are currently no blood or laboratory tests that have been proven to help diagnose sporadic cases of Parkinson disease. The diagnosis is generally made after careful evaluation of medical history, current symptoms, and exclusion of other conditions. [1] The clinical findings of tremor, rigidity, and bradykinesia are highly suggestive of Parkinson disease. The genetic cause of some forms of Parkinson disease has been identified. In those cases, genetic testing may be utilized to identify affected family members. [5] The resources below provide information about treatment options for this condition. If you have questions about which treatment is right for you, talk to your healthcare professional. Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. The National Guideline Clearinghouse (NGC) is a public resource for evidence-based clinical practice guidelines. The NGC was originally created by the Agency for Healthcare Research and Quality (AHRQ) in partnership with the American Medical Association and the American Association of Health Plans. FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information National Library of Medicine Drug Information Portal Medline Plus Health Information National Library of Medicine Drug Information Portal The following diseases are related to Parkinson disease. If you have a question about any of these diseases, you can contact GARD. Autosomal recessive juvenile Parkinson disease",
+    "https://rarediseases.info.nih.gov/diseases/10251/parkinson-disease"
+  ],
+  [
+    "Etiology: Etiology describes the cause or causes of a disease. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002356.htm"
+  ],
+  [
+    "How to diagnose Parkinson disease?: Your health care provider may be able to diagnose Parkinson disease based on your symptoms and a physical exam. But the symptoms can be hard to pin down, particularly in older adults. Symptoms are easier to recognize as the illness gets worse. The examination may show: - Difficulty starting or finishing a movement - Jerky, stiff movements - Muscle loss - Shaking (tremors) - Changes in your heart rate - Normal muscle reflexes Your doctor may do some tests to rule out other conditions that can cause similar symptoms.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000755.htm"
+  ],
+  [
+    "Parkinson disease - resources (Summary): The following organizations are good resources for information on Parkinson disease: - The Michael J. Fox Foundation -- www.michaeljfox.org - National Institute of Neurological Disorders and Stroke -- www.ninds.nih.gov/Disorders/All-Disorders/Parkinsons-Disease-Information-Page - National Parkinson Foundation -- www.parkinson.org - Parkinson's Disease Foundation -- www.pdf.org - US National Library of Medicine, Genetics Home Reference -- ghr.nlm.nih.gov/condition/parkinson-disease",
+    "https://medlineplus.gov/ency/article/002196.htm"
+  ],
+  [
+    "Parkinson disease - discharge (Resources): The American Parkinson Disease Association -- www.apdaparkinson.org The National Parkinson Foundation -- www.parkinson.org",
+    "https://medlineplus.gov/ency/patientinstructions/000394.htm"
+  ],
+  [
+    "Parkinson disease - discharge (Summary): Your doctor has told you that you have Parkinson disease. This disease affects the brain and leads to tremors, problems with walking, movement, and coordination. Other symptoms or problems that may appear later on include difficulty swallowing, constipation, and drooling. Over time, symptoms get worse and it becomes more difficult to take care of yourself. Your doctor may have you take different medicines to treat your Parkinson disease and many of the problems that may come with the disease. - These medicines can cause severe side effects, including hallucinations, nausea, vomiting, diarrhea, and confusion. - Some medicines can lead to risky behaviors such as gambling. - Make sure you follow instructions. DO NOT stop taking medicines without first talking to your doctor. - Know what to do if you miss a dose. - Keep these and all other medicines stored in a cool, dry place, away from children.",
+    "https://medlineplus.gov/ency/patientinstructions/000394.htm"
+  ],
+  [
+    "Autosomal recessive juvenile Parkinson disease (Related Diseases): The following diseases are related to Autosomal recessive juvenile Parkinson disease. If you have a question about any of these diseases, you can contact GARD. Parkinson disease Primary orthostatic hypotension",
+    "https://rarediseases.info.nih.gov/diseases/9642/autosomal-recessive-juvenile-parkinson-disease"
+  ],
+  [
+    "Parkinson disease - discharge (Other Care): Having Parkinson disease may make you feel sad or depressed at times. Talk to friends or family about this. Ask your doctor about seeing a professional to help you with these feelings. Keep up to date with your vaccinations. Get a flu shot every year. Ask your doctor if you need a pneumonia shot. Ask your doctor if it is safe for you to drive.",
+    "https://medlineplus.gov/ency/patientinstructions/000394.htm"
+  ],
+  [
+    "Autosomal recessive juvenile Parkinson disease (Summary): This condition doesn't have a summary yet. Please see our page(s) on Parkinson disease and Primary orthostatic hypotension.",
+    "https://rarediseases.info.nih.gov/diseases/9642/autosomal-recessive-juvenile-parkinson-disease"
+  ],
+  [
+    "Autosomal recessive juvenile Parkinson disease: This condition doesn't have a summary yet. Please see our page(s) on Parkinson disease and Primary orthostatic hypotension. The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Adult onset - Autosomal recessive inheritance - Bradykinesia - Dystonia - Gait disturbance - Hyperreflexia - Parkinsonism - Postural instability - Rigidity - Substantia nigra gliosis - Tremor - View complete list of signs and symptoms... The resources below provide information about treatment options for this condition. If you have questions about which treatment is right for you, talk to your healthcare professional. Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information The following diseases are related to Autosomal recessive juvenile Parkinson disease. If you have a question about any of these diseases, you can contact GARD. Parkinson disease Primary orthostatic hypotension",
+    "https://rarediseases.info.nih.gov/diseases/9642/autosomal-recessive-juvenile-parkinson-disease"
+  ],
+  [
+    "Warning signs and symptoms of heart disease: Heart disease often develops over time. You may have early signs or symptoms long before you have serious heart problems. Or you may not realize you are developing heart disease. The warning signs of heart disease may not be obvious. Also, not every person has the same symptoms. Certain symptoms, such as chest pain, ankle swelling, and shortness of breath may be signals that something is wrong. Learning the warning signs can help you get treatment and help prevent a heart attack or stroke. Chest pain is discomfort or pain that you feel along the front of your body, between your neck and upper abdomen. There are many causes of chest pain that have nothing to do with your heart. But chest pain is still the most common symptom of poor blood flow to the heart or a heart attack. This type of chest pain is called angina. Chest pain can occur when the heart is not getting enough blood or oxygen. The amount and type of pain can vary from person to person. The intensity of the pain does not always relate to how severe the problem is. - Some people may feel a crushing pain, while others feel only mild discomfort. - Your chest may feel heavy or like someone is squeezing your heart. You may also feel a sharp, burning pain in your chest. - You may feel the pain under your breastbone (sternum), or in your neck, arms, stomach, jaw, or upper back. - Chest pain from angina often occurs with activity or emotion, and goes away with rest or a medicine called nitroglycerin. - Bad indigestion can also cause chest pain. Women, older adults, and people with diabetes may have little or no chest pain. They are more likely to have symptoms other than chest pain, such as: - Fatigue - Shortness of breath - General weakness - Change in skin color or greyish pallor (episodes of change in skin color associated with weakness) Other symptoms of a heart attack can include: - Extreme anxiety - Fainting or loss of consciousness - Lightheadedness or dizziness - Nausea or vomiting - Palpitations (feeling like your heart is beating too fast or irregularly) - Shortness of breath - Sweating, which may be very heavy When the heart can't pump blood as well as it should, blood backs up in the veins that go from the lungs to the heart. Fluid leaks into the lungs and causes shortness of breath. This is a symptom of heart failure. You may notice shortness of breath: - During activity - While you're resting - When you're lying flat on your back -- it may even wake you from sleep Coughing or wheezing that doesn't go away can be another sign that fluid is building up in your lungs. You may also cough up mucus that is pink or bloody. Swelling (edema) in your lower legs is another sign of a heart problem. When your heart doesn't work as well, blood flow slows and backs up in the veins in your legs. This causes fluid to build up in your tissues. You may also have swelling in your stomach or notice some weight gain. Narrowing of the blood vessels that bring blood to other parts of the body may mean you have a much higher risk for heart attack. It can occur when cholesterol and other fatty material (plaque) build up on the walls of your arteries. Poor blood supply to the legs may lead to: - Pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs. - Symptoms that often appear during walking or exercise, and go away after several minutes of rest. - Numbness in your legs or feet when you are at rest. Your legs may also feel cool to the touch, and the skin may look pale. A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a \"brain attack.\" Symptoms of stroke can include difficulty moving the limbs on one side of your body, one side of the face drooping, difficulty with speaking or understanding language. Tiredness can have many causes. Often it simply means that you need more rest. But feeling run down can be a sign of a more serious problem. Fatigue may be a sign of heart trouble when: - You feel much more tired than normal. It's common for women to feel severely tired before or during a heart attack. - You feel so tired that you can't do your normal daily activities. - You have sudden, severe weakness. If your heart can't pump blood as well, it may beat faster to try to keep up. You may feel your heart racing or throbbing. A fast or uneven heartbeat can also be the sign of an arrhythmia. This is a problem with your heart rate or rhythm. If you have any signs of heart disease, call your health care provider right away. Don't wait to see if the symptoms go away or dismiss them as nothing. Call your local emergency number (such as 911) if: - You have chest pain or other symptoms of a heart attack - If you know you have angina and have chest pain that doesn't go away after 5 minutes of rest or after taking nitroglycerine - If you think you may be having a heart attack - If you become extremely short of breath - If you think you may have lost consciousness Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000775.htm"
+  ],
+  [
+    "What are the symptoms of Parkinson disease type 9?: What are the signs and symptoms of Parkinson disease type 9? The Human Phenotype Ontology provides the following list of signs and symptoms for Parkinson disease type 9. If the information is available, the table below includes how often the symptom is seen in people with this condition. You can use the MedlinePlus Medical Dictionary to look up the definitions for these medical terms. Signs and Symptoms Approximate number of patients (when available) Distal sensory impairment 5% Seizures 5% Aggressive behavior - Akinesia - Anarthria - Anosmia - Autosomal recessive inheritance - Babinski sign - Dementia - Hallucinations - Hyperreflexia - Hypokinesia - Hyposmia - Mask-like facies - Myoclonus - Paraparesis - Parkinsonism - Parkinsonism with favorable response to dopaminergic medication - Postural instability - Psychotic episodes - Rapidly progressive - Rigidity - Slow saccadic eye movements - Spasticity - Supranuclear gaze palsy - Torticollis - The Human Phenotype Ontology (HPO) has collected information on how often a sign or symptom occurs in a condition. Much of this information comes from Orphanet, a European rare disease database. The frequency of a sign or symptom is usually listed as a rough estimate of the percentage of patients who have that feature. The frequency may also be listed as a fraction. The first number of the fraction is how many people had the symptom, and the second number is the total number of people who were examined in one study. For example, a frequency of 25/25 means that in a study of 25 people all patients were found to have that symptom. Because these frequencies are based on a specific study, the fractions may be different if another group of patients are examined. Sometimes, no information on frequency is available. In these cases, the sign or symptom may be rare or common.",
+    "https://rarediseases.info.nih.gov/gard/9174/parkinson-disease-type-9"
+  ],
+  [
+    "Autosomal recessive juvenile Parkinson disease (Symptoms): The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Adult onset - Autosomal recessive inheritance - Bradykinesia - Dystonia - Gait disturbance - Hyperreflexia - Parkinsonism - Postural instability - Rigidity - Substantia nigra gliosis - Tremor - View complete list of signs and symptoms...",
+    "https://rarediseases.info.nih.gov/diseases/9642/autosomal-recessive-juvenile-parkinson-disease"
+  ],
+  [
+    "Parkinson disease (Symptoms): A number of disorders can cause symptoms similar to those of Parkinson disease.\u00a0People with symptoms that resemble Parkinson disease but that result from other causes are sometimes said to have parkinsonism. Some of these disorders are listed below. [1] Postencephalitic parkinsonism Drug-induced parkinsonism Toxin -induced parkinsonism Arteriosclerotic parkinsonism Parkinsonism- dementia complex of Guam Post-traumatic parkinsonism\u00a0 Essential tremor Normal pressure hydrocephalus \u00a0 Progressive supranuclear palsy Corticobasal degeneration\u00a0 Multiple system atrophy\u00a0 Dementia with Lewy bodies\u00a0 More information on each of these conditions is available in the National Institute of Neurological Disorders and Stroke (NINDS)\u00a0publication,\u00a0\u00a0 Parkinsonian symptoms may also appear in patients with other, clearly distinct neurological disorders such as Wilson disease, Huntington disease, Alzheimer disease, spinocerebellar ataxias, and Creutzfeldt-Jakob disease. Each of these disorders has specific features that help to distinguish them from Parkinson disease.[1] The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Dysautonomia Occasional Hallucinations Occasional Bradykinesia - Constipation - Dementia - Depressivity - Dysarthria - Dysphagia - Dystonia - Insidious onset - Lewy bodies - Mask-like facies - Neuronal loss in central nervous system - Parkinsonism - Personality changes - Postural instability - Progressive - Resting tremor - Rigidity - Short stepped shuffling gait - Sleep disturbance - Sporadic - Substantia nigra gliosis - Urinary urgency - Weak voice - View complete list of signs and symptoms...",
+    "https://rarediseases.info.nih.gov/diseases/10251/parkinson-disease"
+  ],
+  [
+    "Parkinson disease - resources (Summary): The following organizations are good resources for information on Parkinson disease: - The Michael J. Fox Foundation -- www.michaeljfox.org - National Institute of Neurological Disorders and Stroke -- www.ninds.nih.gov/Disorders/All-Disorders/Parkinsons-Disease-Information-Page - National Parkinson Foundation -- www.parkinson.org - Parkinson's Disease Foundation -- www.pdf.org - US National Library of Medicine, Genetics Home Reference -- ghr.nlm.nih.gov/condition/parkinson-disease",
+    "https://medlineplus.gov/ency/article/002196.htm"
+  ],
+  [
+    "Parkinson disease - discharge (Resources): The American Parkinson Disease Association -- www.apdaparkinson.org The National Parkinson Foundation -- www.parkinson.org",
+    "https://medlineplus.gov/ency/patientinstructions/000394.htm"
+  ],
+  [
+    "Parkinson disease (Treatment): There is no cure for Parkinson disease, but treatment can help control your symptoms. MEDICINE Your provider will prescribe medicines to help control your shaking and movement symptoms. At certain times during the day, the medicine may wear off and symptoms can return. If this happens, your provider may need to change any of the following: - Type of medicine - Dose - Amount of time between doses - The way you take the medicine You may also need to take medicines to help with: - Mood and thinking problems - Pain relief - Sleep problems - Drooling (botulinum toxin is often used) Parkinson medicines can cause severe side effects, including: - Confusion - Seeing or hearing things that are not there (hallucinations) - Nausea, vomiting, or diarrhea - Feeling lightheaded or fainting - Behaviors that are hard to control, such as gambling - Delirium Tell your provider right away if you have these side effects. Never change or stop taking any medicines without talking with your provider. Stopping some medicines for Parkinson disease may lead to a severe reaction. Work with your provider to find a treatment plan that works for you. As the disease gets worse, symptoms such as stooped posture, frozen movements, and speech problems may not respond to the medicines. SURGERY Surgery may be an option for some people. Surgery does not cure Parkinson disease, but it may help ease symptoms. Types of surgery include: - Deep brain stimulation. This involves placing electric stimulators in areas of the brain that control movement. - Surgery to destroy brain tissue that causes Parkinson symptoms. - Stem cell transplant and other procedures are being studied. LIFESTYLE Certain lifestyle changes may help you cope with Parkinson disease: - Stay healthy by eating nutritious foods and not smoking. - Make changes in what you eat or drink if you have swallowing problems. - Use speech therapy to help you adjust to changes in your swallowing and speech. - Stay active as much as possible when you feel good. DO NOT overdo it when your energy is low. - Rest as needed during the day and avoid stress. - Use physical therapy and occupational therapy to help you stay independent and reduce the risk of falls. - Place handrails throughout your house to help prevent falls. Place them in bathrooms and along stairways. - Use assistive devices, when needed, to make movement easier. These devices may include special eating utensils, wheelchairs, bed lifts, shower chairs, and walkers. - Talk to a social worker or other counseling service to help you and your family cope with the disorder. These services can also help you get outside help, such as Meals on Wheels.",
+    "https://medlineplus.gov/ency/article/000755.htm"
+  ],
+  [
+    "What are the treatments for Parkinson disease?: These resources address the diagnosis or management of Parkinson disease: - Gene Review: Gene Review: Parkinson Disease Overview - Genetic Testing Registry: Parkinson disease 1 - Genetic Testing Registry: Parkinson disease 10 - Genetic Testing Registry: Parkinson disease 11 - Genetic Testing Registry: Parkinson disease 12 - Genetic Testing Registry: Parkinson disease 13 - Genetic Testing Registry: Parkinson disease 14 - Genetic Testing Registry: Parkinson disease 15 - Genetic Testing Registry: Parkinson disease 16 - Genetic Testing Registry: Parkinson disease 17 - Genetic Testing Registry: Parkinson disease 18 - Genetic Testing Registry: Parkinson disease 2 - Genetic Testing Registry: Parkinson disease 3 - Genetic Testing Registry: Parkinson disease 4 - Genetic Testing Registry: Parkinson disease 5 - Genetic Testing Registry: Parkinson disease 6, autosomal recessive early-onset - Genetic Testing Registry: Parkinson disease 7 - Genetic Testing Registry: Parkinson disease 8, autosomal dominant - Genetic Testing Registry: Parkinson disease, late-onset - Genetic Testing Registry: Parkinson disease, mitochondrial - MedlinePlus Encyclopedia: Parkinson's Disease - Michael J. Fox Foundation for Parkinson's Research: What Drugs Are Used to Treat Parkinson's Disease and How Do They Work? - National Institute of Neurological Disorders and Stroke: Deep Brain Stimulation for Parkinson's Disease - Parkinson's Disease Foundation: Diagnosis - Parkinson's Disease Foundation: Medications and Treatments These resources from MedlinePlus offer information about the diagnosis and management of various health conditions: - Diagnostic Tests - Drug Therapy - Surgery and Rehabilitation - Genetic Counseling - Palliative Care",
+    "https://ghr.nlm.nih.gov/condition/parkinson-disease"
+  ],
+  [
+    "Parkinson disease type 3 (Treatment): FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information",
+    "https://rarediseases.info.nih.gov/diseases/8578/parkinson-disease-type-3"
+  ],
+  [
+    "Secondary parkinsonism (Treatment): If the condition is caused by a medicine, the provider may recommend changing or stopping the medicine. Treating underlying conditions, such as stroke or infections, can reduce symptoms or prevent the condition from getting worse. If symptoms make it hard to do everyday activities, the provider may recommend medicine. Medicines used to treat this condition can cause severe side effects. It is important to see the provider for check-ups. Secondary parkinsonism tends to be less responsive to medical therapy than Parkinson disease.",
+    "https://medlineplus.gov/ency/article/000759.htm"
+  ],
+  [
+    "Autosomal recessive juvenile Parkinson disease (Treatment): The resources below provide information about treatment options for this condition. If you have questions about which treatment is right for you, talk to your healthcare professional. Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information",
+    "https://rarediseases.info.nih.gov/diseases/9642/autosomal-recessive-juvenile-parkinson-disease"
+  ],
+  [
+    "Parkinson disease - discharge (Summary): Your doctor has told you that you have Parkinson disease. This disease affects the brain and leads to tremors, problems with walking, movement, and coordination. Other symptoms or problems that may appear later on include difficulty swallowing, constipation, and drooling. Over time, symptoms get worse and it becomes more difficult to take care of yourself. Your doctor may have you take different medicines to treat your Parkinson disease and many of the problems that may come with the disease. - These medicines can cause severe side effects, including hallucinations, nausea, vomiting, diarrhea, and confusion. - Some medicines can lead to risky behaviors such as gambling. - Make sure you follow instructions. DO NOT stop taking medicines without first talking to your doctor. - Know what to do if you miss a dose. - Keep these and all other medicines stored in a cool, dry place, away from children.",
+    "https://medlineplus.gov/ency/patientinstructions/000394.htm"
+  ],
+  [
+    "Autosomal recessive juvenile Parkinson disease: This condition doesn't have a summary yet. Please see our page(s) on Parkinson disease and Primary orthostatic hypotension. The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Adult onset - Autosomal recessive inheritance - Bradykinesia - Dystonia - Gait disturbance - Hyperreflexia - Parkinsonism - Postural instability - Rigidity - Substantia nigra gliosis - Tremor - View complete list of signs and symptoms... The resources below provide information about treatment options for this condition. If you have questions about which treatment is right for you, talk to your healthcare professional. Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information The following diseases are related to Autosomal recessive juvenile Parkinson disease. If you have a question about any of these diseases, you can contact GARD. Parkinson disease Primary orthostatic hypotension",
+    "https://rarediseases.info.nih.gov/diseases/9642/autosomal-recessive-juvenile-parkinson-disease"
+  ],
+  [
+    "Parkinson disease - discharge (Resources): The American Parkinson Disease Association -- www.apdaparkinson.org The National Parkinson Foundation -- www.parkinson.org",
+    "https://medlineplus.gov/ency/patientinstructions/000394.htm"
+  ],
+  [
+    "Parkinson disease (Diagnosis): There are currently no blood or laboratory tests that have been proven to help diagnose sporadic cases of Parkinson disease. The diagnosis is generally made after careful evaluation of medical history, current symptoms, and exclusion of other conditions. [1] The clinical findings of tremor, rigidity, and bradykinesia are highly suggestive of Parkinson disease. The genetic cause of some forms of Parkinson disease has been identified. In those cases, genetic testing may be utilized to identify affected family members. [5]",
+    "https://rarediseases.info.nih.gov/diseases/10251/parkinson-disease"
+  ],
+  [
+    "How to diagnose Parkinson disease?: Your health care provider may be able to diagnose Parkinson disease based on your symptoms and a physical exam. But the symptoms can be hard to pin down, particularly in older adults. Symptoms are easier to recognize as the illness gets worse. The examination may show: - Difficulty starting or finishing a movement - Jerky, stiff movements - Muscle loss - Shaking (tremors) - Changes in your heart rate - Normal muscle reflexes Your doctor may do some tests to rule out other conditions that can cause similar symptoms.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000755.htm"
+  ],
+  [
+    "Parkinson disease - resources (Summary): The following organizations are good resources for information on Parkinson disease: - The Michael J. Fox Foundation -- www.michaeljfox.org - National Institute of Neurological Disorders and Stroke -- www.ninds.nih.gov/Disorders/All-Disorders/Parkinsons-Disease-Information-Page - National Parkinson Foundation -- www.parkinson.org - Parkinson's Disease Foundation -- www.pdf.org - US National Library of Medicine, Genetics Home Reference -- ghr.nlm.nih.gov/condition/parkinson-disease",
+    "https://medlineplus.gov/ency/article/002196.htm"
+  ],
+  [
+    "Parkinson disease - discharge (Resources): The American Parkinson Disease Association -- www.apdaparkinson.org The National Parkinson Foundation -- www.parkinson.org",
+    "https://medlineplus.gov/ency/patientinstructions/000394.htm"
+  ],
+  [
+    "Parkinson disease type 9 (Diagnosis): Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional.",
+    "https://rarediseases.info.nih.gov/diseases/9174/parkinson-disease-type-9"
+  ],
+  [
+    "Parkinson disease - discharge (Summary): Your doctor has told you that you have Parkinson disease. This disease affects the brain and leads to tremors, problems with walking, movement, and coordination. Other symptoms or problems that may appear later on include difficulty swallowing, constipation, and drooling. Over time, symptoms get worse and it becomes more difficult to take care of yourself. Your doctor may have you take different medicines to treat your Parkinson disease and many of the problems that may come with the disease. - These medicines can cause severe side effects, including hallucinations, nausea, vomiting, diarrhea, and confusion. - Some medicines can lead to risky behaviors such as gambling. - Make sure you follow instructions. DO NOT stop taking medicines without first talking to your doctor. - Know what to do if you miss a dose. - Keep these and all other medicines stored in a cool, dry place, away from children.",
+    "https://medlineplus.gov/ency/patientinstructions/000394.htm"
+  ],
+  [
+    "Autosomal recessive juvenile Parkinson disease: This condition doesn't have a summary yet. Please see our page(s) on Parkinson disease and Primary orthostatic hypotension. The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Adult onset - Autosomal recessive inheritance - Bradykinesia - Dystonia - Gait disturbance - Hyperreflexia - Parkinsonism - Postural instability - Rigidity - Substantia nigra gliosis - Tremor - View complete list of signs and symptoms... The resources below provide information about treatment options for this condition. If you have questions about which treatment is right for you, talk to your healthcare professional. Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information The following diseases are related to Autosomal recessive juvenile Parkinson disease. If you have a question about any of these diseases, you can contact GARD. Parkinson disease Primary orthostatic hypotension",
+    "https://rarediseases.info.nih.gov/diseases/9642/autosomal-recessive-juvenile-parkinson-disease"
+  ],
+  [
+    "Autosomal recessive juvenile Parkinson disease (Related Diseases): The following diseases are related to Autosomal recessive juvenile Parkinson disease. If you have a question about any of these diseases, you can contact GARD. Parkinson disease Primary orthostatic hypotension",
+    "https://rarediseases.info.nih.gov/diseases/9642/autosomal-recessive-juvenile-parkinson-disease"
+  ],
+  [
+    "Parkinson disease - discharge (Other Care): Having Parkinson disease may make you feel sad or depressed at times. Talk to friends or family about this. Ask your doctor about seeing a professional to help you with these feelings. Keep up to date with your vaccinations. Get a flu shot every year. Ask your doctor if you need a pneumonia shot. Ask your doctor if it is safe for you to drive.",
+    "https://medlineplus.gov/ency/patientinstructions/000394.htm"
+  ],
+  [
+    "Epilepsy: The epilepsies are a spectrum of brain disorders ranging from severe, life-threatening and disabling, to ones that are much more benign. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms, and loss of consciousness. The epilepsies have many possible causes and there are several types of seizures. Anything that disturbs the normal pattern of neuron activity\u2014from illness to brain damage to abnormal brain development\u2014can lead to seizures. Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters, changes in important features of brain cells called channels, or some combination of these and other factors. Having a single seizure as the result of a high fever (called febrile seizure) or head injury does not necessarily mean that a person has epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy. A measurement of electrical activity in the brain and brain scans such as magnetic resonance imaging or computed tomography are common diagnostic tests for epilepsy. Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. For about 70 percent of those diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical techniques. Some drugs are more effective for specific types of seizures. An individual with seizures, particularly those that are not easily controlled, may want to see a neurologist specifically trained to treat epilepsy. In some children, special diets may help to control seizures when medications are either not effective or cause serious side effects. While epilepsy cannot be cured, for some people the seizures can be controlled with medication, diet, devices, and/or surgery. Most seizures do not cause brain damage, but ongoing uncontrolled seizures may cause brain damage. It is not uncommon for people with epilepsy, especially children, to develop behavioral and emotional problems in conjunction with seizures. Issues may also arise as a result of the stigma attached to having epilepsy, which can led to embarrassment and frustration or bullying, teasing, or avoidance in school and other social settings. For many people with epilepsy, the risk of seizures restricts their independence (some states refuse drivers licenses to people with epilepsy) and recreational activities. Epilepsy can be a life-threatening condition. Some people with epilepsy are at special risk for abnormally prolonged seizures or sudden unexplained death in epilepsy.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Epilepsy-Information-Page"
+  ],
+  [
+    "What is Epilepsy?: Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters of nerve cells, or neurons, in the brain send out the wrong signals. People may have strange sensations and emotions or behave strangely. They may have violent muscle spasms or lose consciousness. Epilepsy has many possible causes, including illness, brain injury, and abnormal brain development. In many cases, the cause is unknown. Doctors use brain scans and other tests to diagnose epilepsy. It is important to start treatment right away. There is no cure for epilepsy, but medicines can control seizures for most people. When medicines are not working well, surgery or implanted devices such as vagus nerve stimulators may help. Special diets can help some children with epilepsy. NIH: National Institute of Neurological Disorders and Stroke",
+    "https://www.nlm.nih.gov/medlineplus/epilepsy.html"
+  ],
+  [
+    "Epilepsy - resources: The following organizations are good resources for information on epilepsy: - Epilepsy Foundation -- www.epilepsy.com - National Institute of Neurological Disorders and Stroke -- www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm - US Centers for Disease Control and Prevention -- www.cdc.gov/epilepsy Updated by: Jennifer K. Mannheim, ARNP, Medical Staff, Department of Psychiatry and Behavioral Health, Seattle Children's Hospital, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002175.htm"
+  ],
+  [
+    "Epilepsy: Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness. Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds and ages. Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs. Having a single seizure doesn't mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis. Treatment with medications or sometimes surgery can control seizures for the majority of people with epilepsy. Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy may outgrow the condition with age. Epilepsy care at Mayo Clinic Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process your brain coordinates. Seizure signs and symptoms may include: - Temporary confusion - A staring spell - Uncontrollable jerking movements of the arms and legs - Loss of consciousness or awareness - Psychic symptoms such as fear, anxiety or deja vu Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode. Doctors generally classify seizures as either focal or generalized, based on how the abnormal brain activity begins. Focal seizures When seizures appear to result from abnormal activity in just one area of your brain, they're called focal (partial) seizures. These seizures fall into two categories: - Focal seizures without loss of consciousness. Once called simple partial seizures, these seizures don't cause a loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. They may also result in involuntary jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness and flashing lights. - Focal seizures with impaired awareness. Once called complex partial seizures, these seizures involve a change or loss of consciousness or awareness. During a complex partial seizure, you may stare into space and not respond normally to your environment or perform repetitive movements, such as hand rubbing, chewing, swallowing or walking in circles. Symptoms of focal seizures may be confused with other neurological disorders, such as migraine, narcolepsy or mental illness. A thorough examination and testing are needed to distinguish epilepsy from other disorders. Generalized seizures Seizures that appear to involve all areas of the brain are called generalized seizures. Six types of generalized seizures exist. - Absence seizures. Absence seizures, previously known as petit mal seizures, often occur in children and are characterized by staring into space or subtle body movements such as eye blinking or lip smacking. These seizures may occur in clusters and cause a brief loss of awareness. - Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures usually affect muscles in your back, arms and legs and may cause you to fall to the ground. - Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of muscle control, which may cause you to suddenly collapse or fall down. - Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face and arms. - Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or twitches of your arms and legs. - Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal seizures, are the most dramatic type of epileptic seizure and can cause an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue. When to see a doctor Seek immediate medical help if any of the following occurs: - The seizure lasts more than five minutes. - Breathing or consciousness doesn't return after the seizure stops. - A second seizure follows immediately. - You have a high fever. - You're experiencing heat exhaustion. - You're pregnant. - You have diabetes. - You've injured yourself during the seizure. If you experience a seizure for the first time, seek medical advice. Epilepsy has no identifiable cause in about half the people with the condition. In the other half, the condition may be traced to various factors, including: - Genetic influence. Some types of epilepsy, which are categorized by the type of seizure you experience or the part of the brain that is affected, run in families. In these cases, it's likely that there's a genetic influence. Researchers have linked some types of epilepsy to specific genes, but for most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures. - Head trauma. Head trauma as a result of a car accident or other traumatic injury can cause epilepsy. - Brain conditions. Brain conditions that cause damage to the brain, such as brain tumors or strokes, can cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age 35. - Infectious diseases. Infectious diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy. - Prenatal injury. Before birth, babies are sensitive to brain damage that could be caused by several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy. - Developmental disorders. Epilepsy can sometimes be associated with developmental disorders, such as autism and neurofibromatosis. Certain factors may increase your risk of epilepsy: - Age. The onset of epilepsy is most common in children and older adults, but the condition can occur at any age. - Family history. If you have a family history of epilepsy, you may be at an increased risk of developing a seizure disorder. - Head injuries. Head injuries are responsible for some cases of epilepsy. You can reduce your risk by wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing, riding a motorcycle or engaging in other activities with a high risk of head injury. - Stroke and other vascular diseases. Stroke and other blood vessel (vascular) diseases can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of these diseases, including limiting your intake of alcohol and avoiding cigarettes, eating a healthy diet, and exercising regularly. - Dementia. Dementia can increase the risk of epilepsy in older adults. - Brain infections. Infections such as meningitis, which causes inflammation in your brain or spinal cord, can increase your risk. - Seizures in childhood. High fevers in childhood can sometimes be associated with seizures. Children who have seizures due to high fevers generally won't develop epilepsy. The risk of epilepsy increases if a child has a long seizure, another nervous system condition or a family history of epilepsy. To diagnose your condition, your doctor will review your symptoms and medical history. Your doctor may order several tests to diagnose epilepsy and determine the cause of seizures. Your evaluation may include: - A neurological exam. Your doctor may test your behavior, motor abilities, mental function and other areas to diagnose your condition and determine the type of epilepsy you may have. - Blood tests. Your doctor may take a blood sample to check for signs of infections, genetic conditions or other conditions that may be associated with seizures. Your doctor may also suggest tests to detect brain abnormalities, such as: - Electroencephalogram (EEG). This is the most common test used to diagnose epilepsy. In this test, doctors attach electrodes to your scalp with a paste-like substance. The electrodes record the electrical activity of your brain. If you have epilepsy, it's common to have changes in your normal pattern of brain waves, even when you're not having a seizure. Your doctor may monitor you on video while conducting an EEG while you're awake or asleep, to record any seizures you experience. Recording the seizures may help the doctor determine what kind of seizures you're having or rule out other conditions. Your doctor may give you instructions to do something that will cause seizures, such as getting little sleep prior to the test. - High-density EEG. In a variation of an EEG test, your doctor may recommend high-density EEG, which spaces electrodes more closely than conventional EEG - about a half a centimeter apart. High-density EEG may help your doctor more precisely determine which areas of your brain are affected by seizures. - Computerized tomography (CT) scan. A CT scan uses X-rays to obtain cross-sectional images of your brain. CT scans can reveal abnormalities in your brain that might be causing your seizures, such as tumors, bleeding and cysts. - Magnetic resonance imaging (MRI). An MRI uses powerful magnets and radio waves to create a detailed view of your brain. Your doctor may be able to detect lesions or abnormalities in your brain that could be causing your seizures. - Functional MRI (fMRI). A functional MRI measures the changes in blood flow that occur when specific parts of your brain are working. Doctors may use an fMRI before surgery to identify the exact locations of critical functions, such as speech and movement, so that surgeons can avoid injuring those places while operating. - Positron emission tomography (PET). PET scans use a small amount of low-dose radioactive material that's injected into a vein to help visualize active areas of the brain and detect abnormalities. - Single-photon emission computerized tomography (SPECT). This type of test is used primarily if you've had an MRI and EEG that didn't pinpoint the location in your brain where the seizures are originating. A SPECT test uses a small amount of low-dose radioactive material that's injected into a vein to create a detailed, 3-D map of the blood flow activity in your brain during seizures. Doctors also may conduct a form of a SPECT test called subtraction ictal SPECT coregistered to MRI (SISCOM), which may provide even more-detailed results. - Neuropsychological tests. In these tests, doctors assess your thinking, memory and speech skills. The test results help doctors determine which areas of your brain are affected. Along with your test results, your doctor may use a combination of analysis techniques to help pinpoint where in the brain seizures start: - Statistical parametric mapping (SPM). SPM is a method of comparing areas of the brain that have increased metabolism during seizures to normal brains, which can give doctors an idea of where seizures begin. - Curry analysis. Curry analysis is a technique that takes EEG data and projects it onto an MRI of the brain to show doctors where seizures are occurring. - Magnetoencephalography (MEG). MEG measures the magnetic fields produced by brain activity to identify potential areas of seizure onset. Accurate diagnosis of your seizure type and where seizures begin gives you the best chance for finding an effective treatment. Doctors generally begin by treating epilepsy with medication. If medications don't treat the condition, doctors may propose surgery or another type of treatment. Medication Most people with epilepsy can become seizure-free by taking one anti-seizure medication, which is also called anti-epileptic medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications. Many children with epilepsy who aren't experiencing epilepsy symptoms can eventually discontinue medications and live a seizure-free life. Many adults can discontinue medications after two or more years without seizures. Your doctor will advise you about the appropriate time to stop taking medications. Finding the right medication and dosage can be complex. Your doctor will consider your condition, frequency of seizures, your age and other factors when choosing which medication to prescribe. Your doctor will also review any other medications you may be taking, to ensure the anti-epileptic medications won't interact with them. Your doctor likely will first prescribe a single medication at a relatively low dosage and may increase the dosage gradually until your seizures are well-controlled. Anti-seizure medications may have some side effects. Mild side effects include: - Fatigue - Dizziness - Weight gain - Loss of bone density - Skin rashes - Loss of coordination - Speech problems - Memory and thinking problems More-severe but rare side effects include: - Depression - Suicidal thoughts and behaviors - Severe rash - Inflammation of certain organs, such as your liver To achieve the best seizure control possible with medication, follow these steps: - Take medications exactly as prescribed. - Always call your doctor before switching to a generic version of your medication or taking other prescription medications, over-the-counter drugs or herbal remedies. - Never stop taking your medication without talking to your doctor. - Notify your doctor immediately if you notice new or increased feelings of depression, suicidal thoughts, or unusual changes in your mood or behaviors. - Tell your doctor if you have migraines. Doctors may prescribe one of the anti-epileptic medications that can prevent your migraines and treat epilepsy. At least half the people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don't provide satisfactory results, your doctor may suggest surgery or other therapies. You'll have regular follow-up appointments with your doctor to evaluate your condition and medications. Surgery When medications fail to provide adequate control over seizures, surgery may be an option. With epilepsy surgery, a surgeon removes the area of your brain that's causing seizures. Doctors usually perform surgery when tests show that: - Your seizures originate in a small, well-defined area of your brain - The area in your brain to be operated on doesn't interfere with vital functions such as speech, language, motor function, vision or hearing Although many people continue to need some medication to help prevent seizures after successful surgery, you may be able to take fewer drugs and reduce your dosages. In a small number of cases, surgery for epilepsy can cause complications such as permanently altering your thinking (cognitive) abilities. Talk to your surgeon about his or her experience, success rates, and complication rates with the procedure you're considering. Therapies Apart from medications and surgery, these potential therapies offer an alternative for treating epilepsy: - Vagus nerve stimulation. In vagus nerve stimulation, doctors implant a device called a vagus nerve stimulator underneath the skin of your chest, similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in your neck. The battery-powered device sends bursts of electrical energy through the vagus nerve and to your brain. It's not clear how this inhibits seizures, but the device can usually reduce seizures by 20 to 40 percent. Most people still need to take anti-epileptic medication, although some people may be able to lower their medication dose. You may experience side effects from vagus nerve stimulation, such as throat pain, hoarse voice, shortness of breath or coughing. - Ketogenic diet. Some children with epilepsy have been able to reduce their seizures by following a strict diet that's high in fats and low in carbohydrates. In this diet, called a ketogenic diet, the body breaks down fats instead of carbohydrates for energy. After a few years, some children may be able to stop the ketogenic diet - under close supervision of their doctors - and remain seizure-free. Consult a doctor if you or your child is considering a ketogenic diet. It's important to make sure that your child doesn't become malnourished when following the diet. Side effects of a ketogenic diet may include dehydration, constipation, slowed growth because of nutritional deficiencies and a buildup of uric acid in the blood, which can cause kidney stones. These side effects are uncommon if the diet is properly and medically supervised. Following a ketogenic diet can be a challenge. Low-glycemic index and modified Atkins diets offer less restrictive alternatives that may still provide some benefit for seizure control. Potential future treatments Researchers are studying many potential new treatments for epilepsy, including: - Deep brain stimulation. In deep brain stimulation, surgeons implant electrodes into a specific part of your brain, typically your thalamus. The electrodes are connected to a generator implanted in your chest or the skull that sends electrical pulses to your brain and may reduce your seizures. - Responsive neurostimulation. Implantable, pacemaker-like devices that help prevent seizures are also under investigation. These responsive stimulation or closed loop devices analyze brain activity patterns to detect seizures before they happen and deliver an electrical charge or drug to stop the seizure. - Continuous stimulation of the seizure onset zone (subthreshold stimulation). Subthreshold stimulation - continuous stimulation to an area of your brain below a level that's physically noticeable - appears to improve seizure outcomes and quality of life for some people with seizures. This treatment approach may work in people who have seizures that start in an area of the brain that can't be removed because it would affect speech and motor functions (eloquent area). Or it might benefit people whose seizure characteristics mean their chances of successful treatment with responsive neurostimulation are low. - Minimally invasive surgery. New minimally invasive surgical techniques, such as MRI-guided laser ablation, show promise at reducing seizures with fewer risks than traditional open brain surgery for epilepsy. - Stereotactic laser ablation or radiosurgery. For some types of epilepsy, stereotactic laser ablation or stereotactic radiosurgery may provide effective treatment for people in which an open procedure may be too risky. In these procedures, doctors direct radiation at the specific area in the brain causing seizures, to destroy that tissue in an effort to better control the seizures. - External nerve stimulation device. Similar to vagus nerve stimulation, this device would stimulate specific nerves to reduce frequency of seizures. But unlike vagus nerve stimulation, this device would be worn externally so that no surgery to implant the device is needed. Understanding your condition can help you take better control of it: - Take your medication correctly. Don't adjust your dosage before talking to your doctor. If you feel your medication should be changed, discuss it with your doctor. - Get enough sleep. Lack of sleep can trigger seizures. Be sure to get adequate rest every night. - Wear a medical alert bracelet. This will help emergency personnel know how to treat you correctly. - Exercise. Exercising may help keep you physically healthy and reduce depression. Make sure to drink enough water, and rest if you get tired during exercise. In addition, make healthy life choices, such as managing stress, limiting alcoholic beverages and avoiding cigarettes.",
+    "https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093"
+  ],
+  [
+    "Epilepsy - overview: Epilepsy is a brain disorder in which a person has repeated seizures over time. Seizures are episodes of uncontrolled and abnormal firing of brain cells that may cause changes in attention or behavior. Epilepsy occurs when permanent changes in the brain cause it to be too excitable or irritable. As a result, the brain sends out abnormal signals. This leads to repeated, unpredictable seizures. (A single seizure that does not happen again is not epilepsy.) Epilepsy may be due to a medical condition or injury that affects the brain. Or the cause may be unknown (idiopathic). Common causes of epilepsy include: - Stroke or transient ischemic attack (TIA) - Dementia, such as Alzheimer disease - Traumatic brain injury - Infections, including brain abscess, meningitis, encephalitis, and HIV/AIDS - Brain problems that are present at birth (congenital brain defect) - Brain injury that occurs during or near birth - Metabolism disorders present at birth (such as phenylketonuria) - Brain tumor - Abnormal blood vessels in the brain - Other illness that damages or destroys brain tissue Epileptic seizures usually begin between ages 5 and 20. There is also a higher chance of seizures in adults older than 60. But epileptic seizures can happen at any age. There may be a family history of seizures or epilepsy. Symptoms vary from person to person. Some people may have simple staring spells. Others have violent shaking and loss of alertness. The type of seizure depends on the part of the brain that is affected. Most of the time, the seizure is similar to the one before it. Some people with epilepsy have a strange sensation before each seizure. Sensations may be tingling, smelling an odor that is not actually there, or emotional changes. This is called an aura. Your doctor can tell you more about the specific type of seizure you may have: - Absence (petit mal) seizure (staring spells) - Generalized tonic-clonic (grand mal) seizure (involves the entire body, including aura, rigid muscles, and loss of alertness) - Partial (focal) seizure (can involve any of the symptoms described above, depending on where in the brain the seizure starts) The doctor will perform a physical exam. This will include a detailed look at the brain and nervous system. An EEG (electroencephalogram) will be done to check the electrical activity in the brain. People with epilepsy often have abnormal electrical activity seen on this test. In some cases, the test shows the area in the brain where the seizures start. The brain may appear normal after a seizure or between seizures. To diagnose epilepsy or plan for epilepsy surgery, you may need to: - Wear an EEG recorder for days or weeks as you go about your everyday life. - Stay in a special hospital where brain activity can be recorded while video cameras capture what happens to you during the seizure. This is called video EEG. Tests that may be done include: - Blood chemistry - Blood sugar - Complete blood count (CBC) - Kidney function tests - Liver function tests - Lumbar puncture (spinal tap) - Tests for infectious diseases Head CT or MRI scan is often done to find the cause and location of the problem in the brain. Treatment for epilepsy includes taking medicines, lifestyle changes, and sometimes surgery. If epilepsy is due to a tumor, abnormal blood vessels, or bleeding in the brain, surgery to treat these disorders may make the seizures stop. Medicines to prevent seizures, called anticonvulsants (or antiepileptic drugs), may reduce the number of future seizures: - These drugs are taken by mouth. Which type you are prescribed depends on the type of seizures you have. - Your dosage may need to be changed from time to time. You may need regular blood tests to check for side effects. - Always take your medicine on time and as directed. Missing a dose can cause you to have a seizure. DO NOT stop taking or change medicines on your own. Talk to your doctor first. - Many epilepsy medicines cause birth defects. Women who plan to become pregnant should tell their doctor in advance in order to adjust medicines. Many epilepsy drugs may affect the health of your bones. Talk to your doctor about whether you need vitamins and other supplements. Epilepsy that does not get better after 2 or 3 anti-seizure drugs have been tried is called \"medically refractory epilepsy.\" In this case, the doctor may recommend surgery to: - Remove the abnormal brain cells causing the seizures. - Place a vagal nerve stimulator (VNS). This device is similar to a heart pacemaker. It can help reduce the number of seizures. Some children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, may also be helpful in some adults. Be sure to discuss these options with your doctor before trying them. Lifestyle or medical changes can increase the risk for a seizure in adults and children with epilepsy. Talk with your doctor about: - New prescribed drugs, vitamins, or supplements - Emotional stress - Illness, especially infection - Lack of sleep - Pregnancy - Skipping doses of epilepsy medicines - Use of alcohol or other recreational drugs Other considerations: - People with epilepsy should wear medical alert jewelry so that prompt treatment can be obtained if a seizure occurs. - People with poorly controlled epilepsy should not drive. Check your state's law about which people with a history of seizures are allowed to drive. - DO NOT use machinery or do activities that can cause loss of awareness, such as climbing to high places, biking, and swimming alone. The stress of having epilepsy or being a caretaker of someone with epilepsy can often be helped by joining a support group. In these groups, members share common experiences and problems. Some people with epilepsy may be able to reduce or even stop their anti-seizure medicines after having no seizures for several years. Certain types of childhood epilepsy go away or improve with age, usually in the late teens or 20s. For many people, epilepsy is a lifelong condition. In these cases, anti-seizure drugs need to be continued. There is a very low risk for sudden death with epilepsy. Complications may include: - Difficulty learning - Breathing in food or saliva into the lungs during a seizure, which can cause aspiration pneumonia - Injury from falls, bumps, self-inflicted bites, driving or operating machinery during a seizure - Permanent brain damage (stroke or other damage) - Side effects of medicines Call your local emergency number (such as 911) if: - This is the first time a person has a seizure - A seizure occurs in someone who is not wearing a medical ID bracelet (which has instructions explaining what to do) In the case of someone who has had seizures before, call 911 for any of these emergency situations: - This is a longer seizure than the person normally has, or an unusual number of seizures for the person - Repeated seizures over a few minutes - Repeated seizures in which consciousness or normal behavior is not regained between them (status epilepticus) Call your doctor if any new symptoms occur: - Loss of hair - Nausea or vomiting - Rash - Side effects of medicines, such as drowsiness, restlessness, confusion, sedation - Tremors or abnormal movements, or problems with coordination There is no known way to prevent epilepsy. Proper diet and sleep, and staying away from alcohol and illegal drugs may decrease the likelihood of triggering seizures in people with epilepsy. Reduce the risk for head injury by wearing a helmet during risky activities. This can lessen the likelihood of a brain injury that leads to seizures and epilepsy. Updated by: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000694.htm"
+  ],
+  [
+    "Epilepsy - children: Epilepsy is a brain disorder in which a person has repeated seizures over time. A seizure is a sudden change in the electrical and chemical activity in the brain. A single seizure that does not happen again is NOT epilepsy. Epilepsy may be due to a medical condition or injury that affects the brain. Or the cause may be unknown. Common causes of epilepsy include: - Traumatic brain injury - Damage or scarring after infections of the brain - Birth defects that involve the brain - Brain injury that occurs during or near birth - Metabolic disorders present at birth (such as phenylketonuria) - Benign brain tumor, often very small - Abnormal blood vessels in the brain - Stroke - Other illnesses that damage or destroy brain tissue Epileptic seizures usually start between ages 5 and 20. But they can happen at any age. There may be a family history of seizures or epilepsy. A febrile seizure is a convulsion in a child triggered by a fever. Most of the time, a febrile seizure is not a sign that the child has epilepsy. Symptoms vary from child to child. Some children may simply stare. Others may shake violently and lose alertness. The movements or symptoms of a seizure may depend on the part of the brain that is affected. Your child's health care provider can tell you more about the specific type of seizure your child may\u00a0have: - Absence (petit mal) seizure: Staring spells - Generalized tonic-clonic (grand mal) seizure: Involves the entire body, including aura, rigid muscles, and loss of alertness - Partial (focal) seizure: Can involve any of the symptoms described above, depending on where in the brain the seizure starts Most of the time, the seizure is similar to the one before it. Some children have a strange sensation before a seizure. Sensations may be tingling, smelling an odor that is not actually there, feeling fear or anxiety for no reason or having a sense of d\u00e9j\u00e0 vu (feeling that something has happened before). This is called an aura. The provider will: - Ask about your child's medical and family history in detail - Ask about the seizure episode - Do a physical exam of your child, including a detailed look at the brain and nervous system The provider will order an EEG (electroencephalogram) to check the electrical activity in the brain. This test often shows any abnormal electrical activity in the brain. In some cases, the test shows the area in the brain where the seizures start. The brain may appear normal after a seizure or between seizures. To diagnose epilepsy or plan for epilepsy surgery, your child may need to: - Wear an EEG recorder for few days during day-to-day activities - Stay in the hospital where brain activity can be watched on video cameras (video EEG) The provider also may order other tests, including: - Blood chemistry - Blood sugar - Complete blood count (CBC) - Kidney function tests - Liver function tests - Lumbar puncture (spinal tap) - Tests for infectious diseases Head CT or MRI scan are often done to find the cause and location of the problem in the brain. Much less often, PET scan of the brain is needed to help plan surgery. Treatment for epilepsy includes: - Medicines - Lifestyle changes - Surgery If your child's epilepsy is due to a tumor, abnormal blood vessels, or bleeding in the brain, surgery may be needed. Medicines to prevent seizures are called anticonvulsants or antiepileptic drugs. These may reduce the number of future seizures. - These medicines are taken by mouth. The type of medicine prescribed depends on the type of seizure your child has. - The dosage may need to be changed from time to time. The provider may order regular blood tests to check for side effects. - Always make sure your child takes the medicine on time and as directed. Missing a dose can cause your child to have a seizure. Do NOT stop or change medicines on your own. Talk to the provider first. Many epilepsy drugs may affect your child's bone health. Talk to your child's provider about whether your child needs vitamins and other supplements. Epilepsy that is not well controlled after trying a number of antiseizure drugs is called \"medically refractory epilepsy.\" In this case, the doctor may recommend surgery to: - Remove the abnormal brain cells causing the seizures. - Place a vagal nerve stimulator (VNS). This device is similar to a heart pacemaker. It can help reduce the number of seizures. Some children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, also may be helpful. Be sure to discuss these options with your child's provider before trying them. Epilepsy is often a lifelong or chronic illness. Important management issues include: - Taking medicines - Staying safe, such as never swimming alone, fall-proofing your home and so on\u00a0 - Managing stress and sleep - Avoiding alcohol and drug abuse - Keeping up in school - Managing other illnesses Managing these lifestyle or medical issues at home can be a challenge. The stress of being a caretaker of a child with epilepsy can often be helped by joining a support group. In these groups, members share common experiences and problems. Most children with epilepsy live a normal life. Certain types of childhood epilepsy go away or improve with age, usually in the late teens or 20s. If your child does not have seizures for a few years, the provider may stop medicines. For many children, epilepsy is a lifelong condition. In these cases, the medicines need to be continued. Children who have developmental disorders that also cause epilepsy may face challenges throughout their life. Knowing more about the condition will help you take better care of your child's epilepsy. Complications may include: - Difficulty learning - Breathing in food or saliva into the lungs during a seizure, which can cause aspiration pneumonia - Irregular heartbeat - Injury from falls, bumps, or self-caused bites during a seizure - Permanent brain damage (stroke or other damage) - Side effects of medicines Call your local emergency number (such as 911) if: - This is the first time your child has a seizure - A seizure occurs in a child who is not wearing a medical ID bracelet (which has instructions explaining what to do) If your child has had seizures before, call 911 for any of these emergency situations: - The seizure is longer than the child normally has or the child has an unusual number of seizures - The child has repeated seizures over a few minutes - The child has repeated seizures in which consciousness or normal behavior is not regained between them (status epilepticus) - The child gets injured during the seizure - The child has difficulty breathing Call the provider if your child has new symptoms: - Nausea or vomiting - Rash - Side effects of medicines, such as drowsiness, restlessness, or confusion - Tremors or abnormal movements, or problems with coordination Contact the provider even if your child is normal after the seizure has stopped. There is no known way to prevent epilepsy. Proper diet and sleep may decrease the chances of seizures in children with epilepsy. Reduce the risk of head injury during risky activities. This can decrease the likelihood of a brain injury that leads to seizures and epilepsy. Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007681.htm"
+  ],
+  [
+    "Progressive myoclonic epilepsy: Progressive myoclonus epilepsy (PME) refers to a group of inherited conditions involving the central nervous system and representing more than a dozen different diseases. These diseases share certain features, including a worsening of symptoms over time and the presence of both muscle contractions ( myoclonus) and seizures ( epilepsy).\u00a0PME\u00a0is different from myoclonic epilepsy. [1]\u00a0Other\u00a0features include\u00a0 dementia , dystonia , and trouble walking or speaking. These rare disorders often get worse over time and sometimes are fatal.\u00a0Many of these PME diseases begin in childhood or adolescence. [2] The following diseases are related to Progressive myoclonic epilepsy. If you have a question about any of these diseases, you can contact GARD. Familial encephalopathy with neuroserpin inclusion bodies Lafora disease Unverricht-Lundborg disease",
+    "https://rarediseases.info.nih.gov/diseases/7140/progressive-myoclonic-epilepsy"
+  ],
+  [
+    "Epilepsy juvenile absence: The following summary is from Orphanet, a European reference portal for information on rare diseases and orphan drugs. Orpha Number: 1941 Disease definition Juvenile absence epilepsy (JAE) is a genetic epilepsy with onset occurring around puberty. JAE is characterized by sporadic occurrence of absence seizures , frequently associated with a long-life prevalence of generalized tonic-clonic seizures (GTCS) and sporadic myoclonic jerks. Epidemiology The incidence of JAE is still unknown but it accounts for approximately 2-3% of patients with adult epilepsy in general, and about 8-10% of patients with genetic generalized epilepsy (GGE). No sex predominance has been observed. Clinical description JAE is characterized by sporadic occurrence of absence seizures (only one or a few absences daily; 100% of cases), frequently associated with a long-life prevalence of generalized tonic-clonic seizures (GTCS; 80%) and sporadic myoclonic jerks (20%). The seizures onset is typically between 9 and 13 years of age and it manifests as a ''staring spell'' that can be accompanied by atonic postures such as drooping of the head and/or automatisms such as lip smacking. GTCS and myoclonic seizures often occur 1-10 years after the absence seizure onset. Patients with JAE usually develop normally, although uncontrolled absence seizures may have an impact on their ability to learn at school. Etiology The exact etiology of JAE is still elusive. However, genetic mutations for voltage-gated sodium channels ( CACNB4 gene (2q22-q23)), potassium channels ( CLCN2 gene (3q27.1)), and EFHC1 (6p12.3) may be involved in a subset of patients. Moreover, different mutations have been found in genes for GABA receptors (ligand ion channels), specifically in the GABRA1 gene (5q34). Diagnostic methods Diagnosis relies on the clinical features and on electroencephalogram (EEG) recorded awake and during sleep, that displays a generalized 3-4 Hz spike-and-slow-wave complexes. Differential diagnosis Differential diagnosis includes childhood absence epilepsy, juvenile myoclonic epilepsy, Jeavons syndrome (see these terms). Genetic counseling The transmission is still unknown although an increased risk for first degree related parents to develop JME may exist. Management and treatment The antiepileptic drugs of choice are valproic acid (VPA) and lamotrigine (LTG). In cases where VPA deals with only partial seizure control, add-on of LTG (GTCS) or ethosuximide (absence seizures) can be beneficial. Prognosis Prognosis of JAE is usually favorable with good therapy responsiveness. Generally, seizure freedom can be achieved with antiepileptic medication in 62-84% of all patients with JAE. However, the occurrence of GTCS predicts a worse prognosis. Visit the Orphanet disease page for more resources. The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) EEG with polyspike wave complexes Very frequent Generalized tonic-clonic seizures Very frequent Abnormality of the mouth Frequent Absence seizures Occasional Febrile seizures Occasional Myoclonus Very rare Autosomal dominant inheritance - EEG with spike-wave complexes (>3.5 Hz) - Generalized myoclonic seizures - Generalized tonic-clonic seizures on awakening - Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional.",
+    "https://rarediseases.info.nih.gov/diseases/2162/epilepsy-juvenile-absence"
+  ],
+  [
+    "Epilepsy occipital calcifications: The following summary is from Orphanet, a European reference portal for information on rare diseases and orphan drugs. Orpha Number: 1459 Disease definition Celiac disease, epilepsy and cerebral calcification syndrome (CEC) is a rare disorder characterized by the combination of auto-immune intestinal disease, epileptic seizures and cerebral calcifications. Epidemiology CEC was first described in 1992 and fewer than 200 cases have been reported so far. Clinical description Celiac disease (CD, see this term) and epilepsy manifest at a variable age, and CD is frequently diagnosed in late childhood, when specific investigations are performed secondary to observation of epileptic seizures and cerebral calcifications (CC). CD can present in a typical form characterized by onset in the first 2 years of life, chronic diarrhea, weight loss, short stature , anorexia, and, in some cases, irritability and vomiting. CD may also present in silent or latent forms, which are characterized - in the absence of gastrointestinal symptoms - by dermatitis herpetiformis, dental enamel defects or autoimmune thyroiditis. In CEC patients, CD usually evolves into latent, silent or paucisymptomatic forms. Epilepsy onset is between infancy and adulthood; most cases occur in early childhood. Most patients present with occipital epileptic seizures, the course being highly variable, with benign, drug-resistant, or epileptic encephalopathy forms. In the latter, severe mental deterioration and/or learning disorders have been reported while a mild mental deterioration is observed in only one third of all CEC cases. CCs are seen in subcortical parieto-occipital regions. CC size does not change significantly over time, but in several cases, new CCs appeared in other regions. Patients with CCs and CD without epilepsy are considered as having an incomplete form of CEC. Some patients with epilepsy and CC without CD are considered to have a CEC with latent CD. Etiology Etiology of CEC is unclear. It is not known if epilepsy and/or CC are a consequence of CD. CD is an immune auto-inflammatory reaction occurring in predisposed gluten-intolerant individuals. It originates from the jejunal mucosa and spreads to the lamina propria, leading to the observed histopathological features (crypt hyperplasia, jejunal villous atrophy and inflammatory infiltrate in the lamina propria). CD may induce autoimmune responses outside the gastrointestinal tract. Circulating activated T cells may cross the blood-brain barrier and be toxic to myelin or myelin-producing cells. As for isolated CD, CEC is associated with the HLA-DQ2 and HLA-DQ8 genes . Diagnostic methods Diagnosis relies on anamnestic investigation and EEG to characterize epileptic seizures. Computed tomography (CT) imaging reveals CC. Laboratory findings (antiendomisium antibodies , antigliadin antibodies, anti- tissue -transglutaminase type 2 antibodies, HLA phenotype ), and histopathological analysis of small bowel biopsy (jejunal mucosa villous atrophy) enable identification of silent or latent CD in a patient with epileptic seizures and CC. Differential diagnosis Differential diagnosis of CEC includes Sturge-Weber syndrome (see this term) without nevus flammeus and other conditions such as congenital folate malabsorption or adverse effects of methotrexate, antifolate agents and radiotherapy of leukemic children. Management and treatment CD requires life-long observance of a gluten-free diet (GFD), leading to clinical and histopathological resolution of symptoms. A study has revealed that early CD diagnosis and treatment by GFD could prevent or reverse the epileptic disorder. Prognosis Early diagnosis and good compliance of GFD greatly improve outcome. On the contrary, if treatment is delayed, epilepsy may be more severe and epileptic encephalopathy may develop. Visit the Orphanet disease page for more resources. The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Celiac disease -",
+    "https://rarediseases.info.nih.gov/diseases/2166/epilepsy-occipital-calcifications"
+  ],
+  [
+    "DEPDC5-Related Epilepsy: The resources below provide information about treatment options for this condition. If you have questions about which treatment is right for you, talk to your healthcare professional. Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions. The following diseases are related to DEPDC5-Related Epilepsy. If you have a question about any of these diseases, you can contact GARD. Familial focal epilepsy with variable foci",
+    "https://rarediseases.info.nih.gov/diseases/13299/depdc5-related-epilepsy"
+  ],
+  [
+    "Etiology: Etiology describes the cause or causes of a disease. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002356.htm"
+  ],
+  [
+    "What is Epilepsy?: The epilepsies are a spectrum of brain disorders ranging from severe, life-threatening and disabling, to ones that are much more benign. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms, and loss of consciousness. The epilepsies have many possible causes and there are several types of seizures. Anything that disturbs the normal pattern of neuron activityfrom illness to brain damage to abnormal brain developmentcan lead to seizures. Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters, changes in important features of brain cells called channels, or some combination of these and other factors. Having a single seizure as the result of a high fever (called febrile seizure) or head injury does not necessarily mean that a person has epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy. A measurement of electrical activity in the brain and brain scans such as magnetic resonance imaging or computed tomography are common diagnostic tests for epilepsy.",
+    "http://www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm"
+  ],
+  [
+    "Epilepsy juvenile absence (Summary): The following summary is from Orphanet, a European reference portal for information on rare diseases and orphan drugs. Orpha Number: 1941 Disease definition Juvenile absence epilepsy (JAE) is a genetic epilepsy with onset occurring around puberty. JAE is characterized by sporadic occurrence of absence seizures , frequently associated with a long-life prevalence of generalized tonic-clonic seizures (GTCS) and sporadic myoclonic jerks. Epidemiology The incidence of JAE is still unknown but it accounts for approximately 2-3% of patients with adult epilepsy in general, and about 8-10% of patients with genetic generalized epilepsy (GGE). No sex predominance has been observed. Clinical description JAE is characterized by sporadic occurrence of absence seizures (only one or a few absences daily; 100% of cases), frequently associated with a long-life prevalence of generalized tonic-clonic seizures (GTCS; 80%) and sporadic myoclonic jerks (20%). The seizures onset is typically between 9 and 13 years of age and it manifests as a ''staring spell'' that can be accompanied by atonic postures such as drooping of the head and/or automatisms such as lip smacking. GTCS and myoclonic seizures often occur 1-10 years after the absence seizure onset. Patients with JAE usually develop normally, although uncontrolled absence seizures may have an impact on their ability to learn at school. Etiology The exact etiology of JAE is still elusive. However, genetic mutations for voltage-gated sodium channels ( CACNB4 gene (2q22-q23)), potassium channels ( CLCN2 gene (3q27.1)), and EFHC1 (6p12.3) may be involved in a subset of patients. Moreover, different mutations have been found in genes for GABA receptors (ligand ion channels), specifically in the GABRA1 gene (5q34). Diagnostic methods Diagnosis relies on the clinical features and on electroencephalogram (EEG) recorded awake and during sleep, that displays a generalized 3-4 Hz spike-and-slow-wave complexes. Differential diagnosis Differential diagnosis includes childhood absence epilepsy, juvenile myoclonic epilepsy, Jeavons syndrome (see these terms). Genetic counseling The transmission is still unknown although an increased risk for first degree related parents to develop JME may exist. Management and treatment The antiepileptic drugs of choice are valproic acid (VPA) and lamotrigine (LTG). In cases where VPA deals with only partial seizure control, add-on of LTG (GTCS) or ethosuximide (absence seizures) can be beneficial. Prognosis Prognosis of JAE is usually favorable with good therapy responsiveness. Generally, seizure freedom can be achieved with antiepileptic medication in 62-84% of all patients with JAE. However, the occurrence of GTCS predicts a worse prognosis. Visit the Orphanet disease page for more resources.",
+    "https://rarediseases.info.nih.gov/diseases/2162/epilepsy-juvenile-absence"
+  ],
+  [
+    "Epilepsy - resources (Summary): The following organizations are good resources for information on epilepsy: - Epilepsy Foundation -- www.epilepsy.com - National Institute of Neurological Disorders and Stroke -- www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm - US Centers for Disease Control and Prevention -- www.cdc.gov/epilepsy",
+    "https://medlineplus.gov/ency/article/002175.htm"
+  ],
+  [
+    "Epilepsy - children (Outlook (Prognosis)): Most children with epilepsy live a normal life. Certain types of childhood epilepsy go away or improve with age, usually in the late teens or 20s. If your child does not have seizures for a few years, the provider may stop medicines. For many children, epilepsy is a lifelong condition. In these cases, the medicines need to be continued. Children who have developmental disorders that also cause epilepsy may face challenges throughout their life. Knowing more about the condition will help you take better care of your child's epilepsy.",
+    "https://medlineplus.gov/ency/article/007681.htm"
+  ],
+  [
+    "Epilepsy - children (Prevention): There is no known way to prevent epilepsy. Proper diet and sleep may decrease the chances of seizures in children with epilepsy. Reduce the risk of head injury during risky activities. This can decrease the likelihood of a brain injury that leads to seizures and epilepsy.",
+    "https://medlineplus.gov/ency/article/007681.htm"
+  ],
+  [
+    "Epilepsy occipital calcifications (Summary): The following summary is from Orphanet, a European reference portal for information on rare diseases and orphan drugs. Orpha Number: 1459 Disease definition Celiac disease, epilepsy and cerebral calcification syndrome (CEC) is a rare disorder characterized by the combination of auto-immune intestinal disease, epileptic seizures and cerebral calcifications. Epidemiology CEC was first described in 1992 and fewer than 200 cases have been reported so far. Clinical description Celiac disease (CD, see this term) and epilepsy manifest at a variable age, and CD is frequently diagnosed in late childhood, when specific investigations are performed secondary to observation of epileptic seizures and cerebral calcifications (CC). CD can present in a typical form characterized by onset in the first 2 years of life, chronic diarrhea, weight loss, short stature , anorexia, and, in some cases, irritability and vomiting. CD may also present in silent or latent forms, which are characterized - in the absence of gastrointestinal symptoms - by dermatitis herpetiformis, dental enamel defects or autoimmune thyroiditis. In CEC patients, CD usually evolves into latent, silent or paucisymptomatic forms. Epilepsy onset is between infancy and adulthood; most cases occur in early childhood. Most patients present with occipital epileptic seizures, the course being highly variable, with benign, drug-resistant, or epileptic encephalopathy forms. In the latter, severe mental deterioration and/or learning disorders have been reported while a mild mental deterioration is observed in only one third of all CEC cases. CCs are seen in subcortical parieto-occipital regions. CC size does not change significantly over time, but in several cases, new CCs appeared in other regions. Patients with CCs and CD without epilepsy are considered as having an incomplete form of CEC. Some patients with epilepsy and CC without CD are considered to have a CEC with latent CD. Etiology Etiology of CEC is unclear. It is not known if epilepsy and/or CC are a consequence of CD. CD is an immune auto-inflammatory reaction occurring in predisposed gluten-intolerant individuals. It originates from the jejunal mucosa and spreads to the lamina propria, leading to the observed histopathological features (crypt hyperplasia, jejunal villous atrophy and inflammatory infiltrate in the lamina propria). CD may induce autoimmune responses outside the gastrointestinal tract. Circulating activated T cells may cross the blood-brain barrier and be toxic to myelin or myelin-producing cells. As for isolated CD, CEC is associated with the HLA-DQ2 and HLA-DQ8 genes . Diagnostic methods Diagnosis relies on anamnestic investigation and EEG to characterize epileptic seizures. Computed tomography (CT) imaging reveals CC. Laboratory findings (antiendomisium antibodies , antigliadin antibodies, anti- tissue -transglutaminase type 2 antibodies, HLA phenotype ), and histopathological analysis of small bowel biopsy (jejunal mucosa villous atrophy) enable identification of silent or latent CD in a patient with epileptic seizures and CC. Differential diagnosis Differential diagnosis of CEC includes Sturge-Weber syndrome (see this term) without nevus flammeus and other conditions such as congenital folate malabsorption or adverse effects of methotrexate, antifolate agents and radiotherapy of leukemic children. Management and treatment CD requires life-long observance of a gluten-free diet (GFD), leading to clinical and histopathological resolution of symptoms. A study has revealed that early CD diagnosis and treatment by GFD could prevent or reverse the epileptic disorder. Prognosis Early diagnosis and good compliance of GFD greatly improve outcome. On the contrary, if treatment is delayed, epilepsy may be more severe and epileptic encephalopathy may develop. Visit the Orphanet disease page for more resources.",
+    "https://rarediseases.info.nih.gov/diseases/2166/epilepsy-occipital-calcifications"
+  ],
+  [
+    "Epilepsy (Overview): Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness. Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds and ages. Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs. Having a single seizure doesn't mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis. Treatment with medications or sometimes surgery can control seizures for the majority of people with epilepsy. Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy may outgrow the condition with age. Epilepsy care at Mayo Clinic",
+    "https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093"
+  ],
+  [
+    "Epilepsy (Prognosis): While epilepsy cannot be cured, for some people the seizures can be controlled with medication, diet, devices, and/or surgery. Most seizures do not cause brain damage, but ongoing uncontrolled seizures may cause brain damage. It is not uncommon for people with epilepsy, especially children, to develop behavioral and emotional problems in conjunction with seizures. Issues may also arise as a result of the stigma attached to having epilepsy, which can led to embarrassment and frustration or bullying, teasing, or avoidance in school and other social settings. For many people with epilepsy, the risk of seizures restricts their independence (some states refuse drivers licenses to people with epilepsy) and recreational activities. Epilepsy can be a life-threatening condition. Some people with epilepsy are at special risk for abnormally prolonged seizures or sudden unexplained death in epilepsy.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Epilepsy-Information-Page"
+  ],
+  [
+    "Epilepsy (Symptoms): Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process your brain coordinates. Seizure signs and symptoms may include: - Temporary confusion - A staring spell - Uncontrollable jerking movements of the arms and legs - Loss of consciousness or awareness - Psychic symptoms such as fear, anxiety or deja vu Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode. Doctors generally classify seizures as either focal or generalized, based on how the abnormal brain activity begins. Focal seizures When seizures appear to result from abnormal activity in just one area of your brain, they're called focal (partial) seizures. These seizures fall into two categories: - Focal seizures without loss of consciousness. Once called simple partial seizures, these seizures don't cause a loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. They may also result in involuntary jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness and flashing lights. - Focal seizures with impaired awareness. Once called complex partial seizures, these seizures involve a change or loss of consciousness or awareness. During a complex partial seizure, you may stare into space and not respond normally to your environment or perform repetitive movements, such as hand rubbing, chewing, swallowing or walking in circles. Symptoms of focal seizures may be confused with other neurological disorders, such as migraine, narcolepsy or mental illness. A thorough examination and testing are needed to distinguish epilepsy from other disorders. Generalized seizures Seizures that appear to involve all areas of the brain are called generalized seizures. Six types of generalized seizures exist. - Absence seizures. Absence seizures, previously known as petit mal seizures, often occur in children and are characterized by staring into space or subtle body movements such as eye blinking or lip smacking. These seizures may occur in clusters and cause a brief loss of awareness. - Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures usually affect muscles in your back, arms and legs and may cause you to fall to the ground. - Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of muscle control, which may cause you to suddenly collapse or fall down. - Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face and arms. - Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or twitches of your arms and legs. - Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal seizures, are the most dramatic type of epileptic seizure and can cause an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue. When to see a doctor Seek immediate medical help if any of the following occurs: - The seizure lasts more than five minutes. - Breathing or consciousness doesn't return after the seizure stops. - A second seizure follows immediately. - You have a high fever. - You're experiencing heat exhaustion. - You're pregnant. - You have diabetes. - You've injured yourself during the seizure. If you experience a seizure for the first time, seek medical advice.",
+    "https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093"
+  ],
+  [
+    "What are the symptoms of Epilepsy - overview?: Symptoms vary from person to person. Some people may have simple staring spells. Others have violent shaking and loss of alertness. The type of seizure depends on the part of the brain that is affected. Most of the time, the seizure is similar to the one before it. Some people with epilepsy have a strange sensation before each seizure. Sensations may be tingling, smelling an odor that is not actually there, or emotional changes. This is called an aura. Your doctor can tell you more about the specific type of seizure you may have: - Absence (petit mal) seizure (staring spells) - Generalized tonic-clonic (grand mal) seizure (involves the entire body, including aura, rigid muscles, and loss of alertness) - Partial (focal) seizure (can involve any of the symptoms described above, depending on where in the brain the seizure starts)",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000694.htm"
+  ],
+  [
+    "Epilepsy - children (Symptoms): Symptoms vary from child to child. Some children may simply stare. Others may shake violently and lose alertness. The movements or symptoms of a seizure may depend on the part of the brain that is affected. Your child's health care provider can tell you more about the specific type of seizure your child may\u00a0have: - Absence (petit mal) seizure: Staring spells - Generalized tonic-clonic (grand mal) seizure: Involves the entire body, including aura, rigid muscles, and loss of alertness - Partial (focal) seizure: Can involve any of the symptoms described above, depending on where in the brain the seizure starts Most of the time, the seizure is similar to the one before it. Some children have a strange sensation before a seizure. Sensations may be tingling, smelling an odor that is not actually there, feeling fear or anxiety for no reason or having a sense of d\u00e9j\u00e0 vu (feeling that something has happened before). This is called an aura.",
+    "https://medlineplus.gov/ency/article/007681.htm"
+  ],
+  [
+    "Epilepsy juvenile absence (Symptoms): The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) EEG with polyspike wave complexes Very frequent Generalized tonic-clonic seizures Very frequent Abnormality of the mouth Frequent Absence seizures Occasional Febrile seizures Occasional Myoclonus Very rare Autosomal dominant inheritance - EEG with spike-wave complexes (>3.5 Hz) - Generalized myoclonic seizures - Generalized tonic-clonic seizures on awakening -",
+    "https://rarediseases.info.nih.gov/diseases/2162/epilepsy-juvenile-absence"
+  ],
+  [
+    "Epilepsy - resources (Summary): The following organizations are good resources for information on epilepsy: - Epilepsy Foundation -- www.epilepsy.com - National Institute of Neurological Disorders and Stroke -- www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm - US Centers for Disease Control and Prevention -- www.cdc.gov/epilepsy",
+    "https://medlineplus.gov/ency/article/002175.htm"
+  ],
+  [
+    "Epilepsy (Overview): Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness. Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds and ages. Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs. Having a single seizure doesn't mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis. Treatment with medications or sometimes surgery can control seizures for the majority of people with epilepsy. Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy may outgrow the condition with age. Epilepsy care at Mayo Clinic",
+    "https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093"
+  ],
+  [
+    "Epilepsy (Treatment): Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. For about 70 percent of those diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical techniques. Some drugs are more effective for specific types of seizures. An individual with seizures, particularly those that are not easily controlled, may want to see a neurologist specifically trained to treat epilepsy. In some children, special diets may help to control seizures when medications are either not effective or cause serious side effects.",
+    "https://www.ninds.nih.gov/Disorders/All-Disorders/Epilepsy-Information-Page"
+  ],
+  [
+    "Epilepsy - children (Treatment): Treatment for epilepsy includes: - Medicines - Lifestyle changes - Surgery If your child's epilepsy is due to a tumor, abnormal blood vessels, or bleeding in the brain, surgery may be needed. Medicines to prevent seizures are called anticonvulsants or antiepileptic drugs. These may reduce the number of future seizures. - These medicines are taken by mouth. The type of medicine prescribed depends on the type of seizure your child has. - The dosage may need to be changed from time to time. The provider may order regular blood tests to check for side effects. - Always make sure your child takes the medicine on time and as directed. Missing a dose can cause your child to have a seizure. Do NOT stop or change medicines on your own. Talk to the provider first. Many epilepsy drugs may affect your child's bone health. Talk to your child's provider about whether your child needs vitamins and other supplements. Epilepsy that is not well controlled after trying a number of antiseizure drugs is called \"medically refractory epilepsy.\" In this case, the doctor may recommend surgery to: - Remove the abnormal brain cells causing the seizures. - Place a vagal nerve stimulator (VNS). This device is similar to a heart pacemaker. It can help reduce the number of seizures. Some children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, also may be helpful. Be sure to discuss these options with your child's provider before trying them. Epilepsy is often a lifelong or chronic illness. Important management issues include: - Taking medicines - Staying safe, such as never swimming alone, fall-proofing your home and so on\u00a0 - Managing stress and sleep - Avoiding alcohol and drug abuse - Keeping up in school - Managing other illnesses Managing these lifestyle or medical issues at home can be a challenge.",
+    "https://medlineplus.gov/ency/article/007681.htm"
+  ],
+  [
+    "Epilepsy (Treatment): Doctors generally begin by treating epilepsy with medication. If medications don't treat the condition, doctors may propose surgery or another type of treatment. Medication Most people with epilepsy can become seizure-free by taking one anti-seizure medication, which is also called anti-epileptic medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications. Many children with epilepsy who aren't experiencing epilepsy symptoms can eventually discontinue medications and live a seizure-free life. Many adults can discontinue medications after two or more years without seizures. Your doctor will advise you about the appropriate time to stop taking medications. Finding the right medication and dosage can be complex. Your doctor will consider your condition, frequency of seizures, your age and other factors when choosing which medication to prescribe. Your doctor will also review any other medications you may be taking, to ensure the anti-epileptic medications won't interact with them. Your doctor likely will first prescribe a single medication at a relatively low dosage and may increase the dosage gradually until your seizures are well-controlled. Anti-seizure medications may have some side effects. Mild side effects include: - Fatigue - Dizziness - Weight gain - Loss of bone density - Skin rashes - Loss of coordination - Speech problems - Memory and thinking problems More-severe but rare side effects include: - Depression - Suicidal thoughts and behaviors - Severe rash - Inflammation of certain organs, such as your liver To achieve the best seizure control possible with medication, follow these steps: - Take medications exactly as prescribed. - Always call your doctor before switching to a generic version of your medication or taking other prescription medications, over-the-counter drugs or herbal remedies. - Never stop taking your medication without talking to your doctor. - Notify your doctor immediately if you notice new or increased feelings of depression, suicidal thoughts, or unusual changes in your mood or behaviors. - Tell your doctor if you have migraines. Doctors may prescribe one of the anti-epileptic medications that can prevent your migraines and treat epilepsy. At least half the people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don't provide satisfactory results, your doctor may suggest surgery or other therapies. You'll have regular follow-up appointments with your doctor to evaluate your condition and medications. Surgery When medications fail to provide adequate control over seizures, surgery may be an option. With epilepsy surgery, a surgeon removes the area of your brain that's causing seizures. Doctors usually perform surgery when tests show that: - Your seizures originate in a small, well-defined area of your brain - The area in your brain to be operated on doesn't interfere with vital functions such as speech, language, motor function, vision or hearing Although many people continue to need some medication to help prevent seizures after successful surgery, you may be able to take fewer drugs and reduce your dosages. In a small number of cases, surgery for epilepsy can cause complications such as permanently altering your thinking (cognitive) abilities. Talk to your surgeon about his or her experience, success rates, and complication rates with the procedure you're considering. Therapies Apart from medications and surgery, these potential therapies offer an alternative for treating epilepsy: - Vagus nerve stimulation. In vagus nerve stimulation, doctors implant a device called a vagus nerve stimulator underneath the skin of your chest, similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in your neck. The battery-powered device sends bursts of electrical energy through the vagus nerve and to your brain. It's not clear how this inhibits seizures, but the device can usually reduce seizures by 20 to 40 percent. Most people still need to take anti-epileptic medication, although some people may be able to lower their medication dose. You may experience side effects from vagus nerve stimulation, such as throat pain, hoarse voice, shortness of breath or coughing. - Ketogenic diet. Some children with epilepsy have been able to reduce their seizures by following a strict diet that's high in fats and low in carbohydrates. In this diet, called a ketogenic diet, the body breaks down fats instead of carbohydrates for energy. After a few years, some children may be able to stop the ketogenic diet - under close supervision of their doctors - and remain seizure-free. Consult a doctor if you or your child is considering a ketogenic diet. It's important to make sure that your child doesn't become malnourished when following the diet. Side effects of a ketogenic diet may include dehydration, constipation, slowed growth because of nutritional deficiencies and a buildup of uric acid in the blood, which can cause kidney stones. These side effects are uncommon if the diet is properly and medically supervised. Following a ketogenic diet can be a challenge. Low-glycemic index and modified Atkins diets offer less restrictive alternatives that may still provide some benefit for seizure control. Potential future treatments Researchers are studying many potential new treatments for epilepsy, including: - Deep brain stimulation. In deep brain stimulation, surgeons implant electrodes into a specific part of your brain, typically your thalamus. The electrodes are connected to a generator implanted in your chest or the skull that sends electrical pulses to your brain and may reduce your seizures. - Responsive neurostimulation. Implantable, pacemaker-like devices that help prevent seizures are also under investigation. These responsive stimulation or closed loop devices analyze brain activity patterns to detect seizures before they happen and deliver an electrical charge or drug to stop the seizure. - Continuous stimulation of the seizure onset zone (subthreshold stimulation). Subthreshold stimulation - continuous stimulation to an area of your brain below a level that's physically noticeable - appears to improve seizure outcomes and quality of life for some people with seizures. This treatment approach may work in people who have seizures that start in an area of the brain that can't be removed because it would affect speech and motor functions (eloquent area). Or it might benefit people whose seizure characteristics mean their chances of successful treatment with responsive neurostimulation are low. - Minimally invasive surgery. New minimally invasive surgical techniques, such as MRI-guided laser ablation, show promise at reducing seizures with fewer risks than traditional open brain surgery for epilepsy. - Stereotactic laser ablation or radiosurgery. For some types of epilepsy, stereotactic laser ablation or stereotactic radiosurgery may provide effective treatment for people in which an open procedure may be too risky. In these procedures, doctors direct radiation at the specific area in the brain causing seizures, to destroy that tissue in an effort to better control the seizures. - External nerve stimulation device. Similar to vagus nerve stimulation, this device would stimulate specific nerves to reduce frequency of seizures. But unlike vagus nerve stimulation, this device would be worn externally so that no surgery to implant the device is needed.",
+    "https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093"
+  ],
+  [
+    "Unverricht-Lundborg disease (Treatment): The resources below provide information about treatment options for this condition. If you have questions about which treatment is right for you, talk to your healthcare professional. Management Guidelines GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions.",
+    "https://rarediseases.info.nih.gov/diseases/3876/unverricht-lundborg-disease"
+  ],
+  [
+    "Epilepsy (Overview): Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness. Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds and ages. Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs. Having a single seizure doesn't mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis. Treatment with medications or sometimes surgery can control seizures for the majority of people with epilepsy. Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy may outgrow the condition with age. Epilepsy care at Mayo Clinic",
+    "https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093"
+  ],
+  [
+    "Epilepsy - resources (Summary): The following organizations are good resources for information on epilepsy: - Epilepsy Foundation -- www.epilepsy.com - National Institute of Neurological Disorders and Stroke -- www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm - US Centers for Disease Control and Prevention -- www.cdc.gov/epilepsy",
+    "https://medlineplus.gov/ency/article/002175.htm"
+  ],
+  [
+    "Epilepsy (Summary): Summary Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters of nerve cells, or neurons, in the brain send out the wrong signals. People may have strange sensations and emotions or behave strangely. They may have violent muscle spasms or lose consciousness. Epilepsy has many possible causes, including illness, brain injury, and abnormal brain development. In many cases, the cause is unknown. Doctors use brain scans and other tests to diagnose epilepsy. It is important to start treatment right away. There is no cure for epilepsy, but medicines can control seizures for most people. When medicines are not working well, surgery or implanted devices such as vagus nerve stimulators may help. Special diets can help some children with epilepsy. NIH: National Institute of Neurological Disorders and Stroke",
+    "#"
+  ],
+  [
+    "Epilepsy (Diagnosis): To diagnose your condition, your doctor will review your symptoms and medical history. Your doctor may order several tests to diagnose epilepsy and determine the cause of seizures. Your evaluation may include: - A neurological exam. Your doctor may test your behavior, motor abilities, mental function and other areas to diagnose your condition and determine the type of epilepsy you may have. - Blood tests. Your doctor may take a blood sample to check for signs of infections, genetic conditions or other conditions that may be associated with seizures. Your doctor may also suggest tests to detect brain abnormalities, such as: - Electroencephalogram (EEG). This is the most common test used to diagnose epilepsy. In this test, doctors attach electrodes to your scalp with a paste-like substance. The electrodes record the electrical activity of your brain. If you have epilepsy, it's common to have changes in your normal pattern of brain waves, even when you're not having a seizure. Your doctor may monitor you on video while conducting an EEG while you're awake or asleep, to record any seizures you experience. Recording the seizures may help the doctor determine what kind of seizures you're having or rule out other conditions. Your doctor may give you instructions to do something that will cause seizures, such as getting little sleep prior to the test. - High-density EEG. In a variation of an EEG test, your doctor may recommend high-density EEG, which spaces electrodes more closely than conventional EEG - about a half a centimeter apart. High-density EEG may help your doctor more precisely determine which areas of your brain are affected by seizures. - Computerized tomography (CT) scan. A CT scan uses X-rays to obtain cross-sectional images of your brain. CT scans can reveal abnormalities in your brain that might be causing your seizures, such as tumors, bleeding and cysts. - Magnetic resonance imaging (MRI). An MRI uses powerful magnets and radio waves to create a detailed view of your brain. Your doctor may be able to detect lesions or abnormalities in your brain that could be causing your seizures. - Functional MRI (fMRI). A functional MRI measures the changes in blood flow that occur when specific parts of your brain are working. Doctors may use an fMRI before surgery to identify the exact locations of critical functions, such as speech and movement, so that surgeons can avoid injuring those places while operating. - Positron emission tomography (PET). PET scans use a small amount of low-dose radioactive material that's injected into a vein to help visualize active areas of the brain and detect abnormalities. - Single-photon emission computerized tomography (SPECT). This type of test is used primarily if you've had an MRI and EEG that didn't pinpoint the location in your brain where the seizures are originating. A SPECT test uses a small amount of low-dose radioactive material that's injected into a vein to create a detailed, 3-D map of the blood flow activity in your brain during seizures. Doctors also may conduct a form of a SPECT test called subtraction ictal SPECT coregistered to MRI (SISCOM), which may provide even more-detailed results. - Neuropsychological tests. In these tests, doctors assess your thinking, memory and speech skills. The test results help doctors determine which areas of your brain are affected. Along with your test results, your doctor may use a combination of analysis techniques to help pinpoint where in the brain seizures start: - Statistical parametric mapping (SPM). SPM is a method of comparing areas of the brain that have increased metabolism during seizures to normal brains, which can give doctors an idea of where seizures begin. - Curry analysis. Curry analysis is a technique that takes EEG data and projects it onto an MRI of the brain to show doctors where seizures are occurring. - Magnetoencephalography (MEG). MEG measures the magnetic fields produced by brain activity to identify potential areas of seizure onset. Accurate diagnosis of your seizure type and where seizures begin gives you the best chance for finding an effective treatment.",
+    "https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093"
+  ],
+  [
+    "What is Epilepsy?: The epilepsies are a spectrum of brain disorders ranging from severe, life-threatening and disabling, to ones that are much more benign. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms, and loss of consciousness. The epilepsies have many possible causes and there are several types of seizures. Anything that disturbs the normal pattern of neuron activityfrom illness to brain damage to abnormal brain developmentcan lead to seizures. Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters, changes in important features of brain cells called channels, or some combination of these and other factors. Having a single seizure as the result of a high fever (called febrile seizure) or head injury does not necessarily mean that a person has epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy. A measurement of electrical activity in the brain and brain scans such as magnetic resonance imaging or computed tomography are common diagnostic tests for epilepsy.",
+    "http://www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm"
+  ],
+  [
+    "Epilepsy (Summary): Summary Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters of nerve cells, or neurons, in the brain send out the wrong signals. People may have strange sensations and emotions or behave strangely. They may have violent muscle spasms or lose consciousness. Epilepsy has many possible causes, including illness, brain injury, and abnormal brain development. In many cases, the cause is unknown. Doctors use brain scans and other tests to diagnose epilepsy. It is important to start treatment right away. There is no cure for epilepsy, but medicines can control seizures for most people. When medicines are not working well, surgery or implanted devices such as vagus nerve stimulators may help. Special diets can help some children with epilepsy. NIH: National Institute of Neurological Disorders and Stroke",
+    "#"
+  ],
+  [
+    "Epilepsy juvenile absence (Diagnosis): Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional.",
+    "https://rarediseases.info.nih.gov/diseases/2162/epilepsy-juvenile-absence"
+  ],
+  [
+    "Autosomal dominant nocturnal frontal lobe epilepsy (Diagnosis): The diagnosis of autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is made on clinical grounds. The key to diagnosis is a detailed history from the affected person, as well as witnesses. Sometimes video- EEG monitoring is necessary. The features that are suggestive of a diagnosis of ADNFLE are: clusters of seizures with a frontal semiology seizures that occur predominantly during sleep normal clinical neurologic exam normal intellect (although reduced intellect, cognitive deficits, or psychiatric disorders may occur) normal findings on neuroimaging ictal EEG (recorded during a seizure) that may be normal or obscured by movement of the cables or electrodes interictal EEG (recorded in between seizures) that shows infrequent epileptiform discharges (distinctive patterns resembling those that occur in people with epilepsy) the presence of the same disorder in other family members, with evidence of autosomal dominant inheritance The diagnosis can be established in a person with the above features, combined with a positive family history and/or genetic testing that detects a mutation in one of the genes known to cause ADNFLE. People who are concerned they may be having seizures or other neurological signs or symptoms should be evaluated by a neurologist .",
+    "https://rarediseases.info.nih.gov/diseases/11918/autosomal-dominant-nocturnal-frontal-lobe-epilepsy"
+  ],
+  [
+    "Epilepsy - children (Exams and Tests): The provider will: - Ask about your child's medical and family history in detail - Ask about the seizure episode - Do a physical exam of your child, including a detailed look at the brain and nervous system The provider will order an EEG (electroencephalogram) to check the electrical activity in the brain. This test often shows any abnormal electrical activity in the brain. In some cases, the test shows the area in the brain where the seizures start. The brain may appear normal after a seizure or between seizures. To diagnose epilepsy or plan for epilepsy surgery, your child may need to: - Wear an EEG recorder for few days during day-to-day activities - Stay in the hospital where brain activity can be watched on video cameras (video EEG) The provider also may order other tests, including: - Blood chemistry - Blood sugar - Complete blood count (CBC) - Kidney function tests - Liver function tests - Lumbar puncture (spinal tap) - Tests for infectious diseases Head CT or MRI scan are often done to find the cause and location of the problem in the brain. Much less often, PET scan of the brain is needed to help plan surgery.",
+    "https://medlineplus.gov/ency/article/007681.htm"
+  ],
+  [
+    "Epilepsy - overview (Exams and Tests): The doctor will perform a physical exam. This will include a detailed look at the brain and nervous system. An EEG (electroencephalogram) will be done to check the electrical activity in the brain. People with epilepsy often have abnormal electrical activity seen on this test. In some cases, the test shows the area in the brain where the seizures start. The brain may appear normal after a seizure or between seizures. To diagnose epilepsy or plan for epilepsy surgery, you may need to: - Wear an EEG recorder for days or weeks as you go about your everyday life. - Stay in a special hospital where brain activity can be recorded while video cameras capture what happens to you during the seizure. This is called video EEG. Tests that may be done include: - Blood chemistry - Blood sugar - Complete blood count (CBC) - Kidney function tests - Liver function tests - Lumbar puncture (spinal tap) - Tests for infectious diseases Head CT or MRI scan is often done to find the cause and location of the problem in the brain.",
+    "https://medlineplus.gov/ency/article/000694.htm"
+  ],
+  [
+    "Epilepsy - resources (Summary): The following organizations are good resources for information on epilepsy: - Epilepsy Foundation -- www.epilepsy.com - National Institute of Neurological Disorders and Stroke -- www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm - US Centers for Disease Control and Prevention -- www.cdc.gov/epilepsy",
+    "https://medlineplus.gov/ency/article/002175.htm"
+  ],
+  [
+    "Epilepsy (Overview): Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness. Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds and ages. Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs. Having a single seizure doesn't mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis. Treatment with medications or sometimes surgery can control seizures for the majority of people with epilepsy. Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy may outgrow the condition with age. Epilepsy care at Mayo Clinic",
+    "https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093"
+  ],
+  [
+    "Epilepsy - children: Epilepsy is a brain disorder in which a person has repeated seizures over time. A seizure is a sudden change in the electrical and chemical activity in the brain. A single seizure that does not happen again is NOT epilepsy. Epilepsy may be due to a medical condition or injury that affects the brain. Or the cause may be unknown. Common causes of epilepsy include: - Traumatic brain injury - Damage or scarring after infections of the brain - Birth defects that involve the brain - Brain injury that occurs during or near birth - Metabolic disorders present at birth (such as phenylketonuria) - Benign brain tumor, often very small - Abnormal blood vessels in the brain - Stroke - Other illnesses that damage or destroy brain tissue Epileptic seizures usually start between ages 5 and 20. But they can happen at any age. There may be a family history of seizures or epilepsy. A febrile seizure is a convulsion in a child triggered by a fever. Most of the time, a febrile seizure is not a sign that the child has epilepsy. Symptoms vary from child to child. Some children may simply stare. Others may shake violently and lose alertness. The movements or symptoms of a seizure may depend on the part of the brain that is affected. Your child's health care provider can tell you more about the specific type of seizure your child may\u00a0have: - Absence (petit mal) seizure: Staring spells - Generalized tonic-clonic (grand mal) seizure: Involves the entire body, including aura, rigid muscles, and loss of alertness - Partial (focal) seizure: Can involve any of the symptoms described above, depending on where in the brain the seizure starts Most of the time, the seizure is similar to the one before it. Some children have a strange sensation before a seizure. Sensations may be tingling, smelling an odor that is not actually there, feeling fear or anxiety for no reason or having a sense of d\u00e9j\u00e0 vu (feeling that something has happened before). This is called an aura. The provider will: - Ask about your child's medical and family history in detail - Ask about the seizure episode - Do a physical exam of your child, including a detailed look at the brain and nervous system The provider will order an EEG (electroencephalogram) to check the electrical activity in the brain. This test often shows any abnormal electrical activity in the brain. In some cases, the test shows the area in the brain where the seizures start. The brain may appear normal after a seizure or between seizures. To diagnose epilepsy or plan for epilepsy surgery, your child may need to: - Wear an EEG recorder for few days during day-to-day activities - Stay in the hospital where brain activity can be watched on video cameras (video EEG) The provider also may order other tests, including: - Blood chemistry - Blood sugar - Complete blood count (CBC) - Kidney function tests - Liver function tests - Lumbar puncture (spinal tap) - Tests for infectious diseases Head CT or MRI scan are often done to find the cause and location of the problem in the brain. Much less often, PET scan of the brain is needed to help plan surgery. Treatment for epilepsy includes: - Medicines - Lifestyle changes - Surgery If your child's epilepsy is due to a tumor, abnormal blood vessels, or bleeding in the brain, surgery may be needed. Medicines to prevent seizures are called anticonvulsants or antiepileptic drugs. These may reduce the number of future seizures. - These medicines are taken by mouth. The type of medicine prescribed depends on the type of seizure your child has. - The dosage may need to be changed from time to time. The provider may order regular blood tests to check for side effects. - Always make sure your child takes the medicine on time and as directed. Missing a dose can cause your child to have a seizure. Do NOT stop or change medicines on your own. Talk to the provider first. Many epilepsy drugs may affect your child's bone health. Talk to your child's provider about whether your child needs vitamins and other supplements. Epilepsy that is not well controlled after trying a number of antiseizure drugs is called \"medically refractory epilepsy.\" In this case, the doctor may recommend surgery to: - Remove the abnormal brain cells causing the seizures. - Place a vagal nerve stimulator (VNS). This device is similar to a heart pacemaker. It can help reduce the number of seizures. Some children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, also may be helpful. Be sure to discuss these options with your child's provider before trying them. Epilepsy is often a lifelong or chronic illness. Important management issues include: - Taking medicines - Staying safe, such as never swimming alone, fall-proofing your home and so on\u00a0 - Managing stress and sleep - Avoiding alcohol and drug abuse - Keeping up in school - Managing other illnesses Managing these lifestyle or medical issues at home can be a challenge. The stress of being a caretaker of a child with epilepsy can often be helped by joining a support group. In these groups, members share common experiences and problems. Most children with epilepsy live a normal life. Certain types of childhood epilepsy go away or improve with age, usually in the late teens or 20s. If your child does not have seizures for a few years, the provider may stop medicines. For many children, epilepsy is a lifelong condition. In these cases, the medicines need to be continued. Children who have developmental disorders that also cause epilepsy may face challenges throughout their life. Knowing more about the condition will help you take better care of your child's epilepsy. Complications may include: - Difficulty learning - Breathing in food or saliva into the lungs during a seizure, which can cause aspiration pneumonia - Irregular heartbeat - Injury from falls, bumps, or self-caused bites during a seizure - Permanent brain damage (stroke or other damage) - Side effects of medicines Call your local emergency number (such as 911) if: - This is the first time your child has a seizure - A seizure occurs in a child who is not wearing a medical ID bracelet (which has instructions explaining what to do) If your child has had seizures before, call 911 for any of these emergency situations: - The seizure is longer than the child normally has or the child has an unusual number of seizures - The child has repeated seizures over a few minutes - The child has repeated seizures in which consciousness or normal behavior is not regained between them (status epilepticus) - The child gets injured during the seizure - The child has difficulty breathing Call the provider if your child has new symptoms: - Nausea or vomiting - Rash - Side effects of medicines, such as drowsiness, restlessness, or confusion - Tremors or abnormal movements, or problems with coordination Contact the provider even if your child is normal after the seizure has stopped. There is no known way to prevent epilepsy. Proper diet and sleep may decrease the chances of seizures in children with epilepsy. Reduce the risk of head injury during risky activities. This can decrease the likelihood of a brain injury that leads to seizures and epilepsy. Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/007681.htm"
+  ],
+  [
+    "Fanconi anemia: Fanconi anemia is a disease passed down through families (inherited) that mainly affects the bone marrow. It results in decreased production of all types of blood cells. Fanconi anemia is different from Fanconi syndrome, a rare kidney disorder. Fanconi anemia is due to an abnormal gene that damages cells, which keeps them from repairing damaged DNA. To inherit Fanconi anemia, a person must get 1 copy of the abnormal gene from each parent. The condition is most often diagnosed in children between 2 and 15 years old. People with Fanconi anemia have lower-than-normal numbers of white blood cells, red blood cells, and platelets (cells that help the blood clot). Not enough white blood cells can lead to infections. A lack of red blood cells may result in fatigue (anemia). A lower-than-normal amount of platelets may lead to excess bleeding. Most people with Fanconi anemia have some of these symptoms: - Abnormal heart, lungs, and digestive tract - Bone problems (especially the hips, spine or ribs, can cause a curved spine (scoliosis) - Changes in the color of the skin, such as darkened areas of the skin, called caf\u00e9 au lait spots, and vitiligo - Deafness due to abnormal ears - Eye or eyelid problems - Kidney(s) that did not form correctly - Problems with the arms and hands, such as missing, extra or misshapen thumbs, problems of the hands and the bone in the lower arm, and small or missing bone in the forearm - Short height - Small head - Small testicles and genital changes Other possible symptoms: - Failure to thrive - Learning disability - Low birth weight - Intellectual disability Common tests for Fanconi anemia include: - Bone marrow biopsy - Complete blood count (CBC) - Developmental tests - Drugs added to a blood sample to check for damage to chromosomes - Hand x-ray and other imaging studies (CT scan, MRI) - Hearing test - HLA tissue typing (to find matching bone-marrow donors) - Ultrasound of the kidneys Pregnant women may have amniocentesis or chorionic villous sampling to diagnose the condition in their unborn child. People with mild to moderate blood cell changes who do not need a transfusion may only need regular check-ups and blood count checks. The health care provider will closely monitor the person for other cancers. These may include leukemia or cancers of the head, neck, or urinary system. Medicines called growth factors (such as erythropoietin, G-CSF, and GM-CSF) can improve blood counts for a short while. A bone marrow transplant can cure the blood count problems of Fanconi anemia. (The best bone marrow donor is a brother or sister whose tissue type matches the person affected by Fanconi anemia.) People who have had a successful bone marrow transplant still need regular check-ups because of the risk for additional cancers. Hormone therapy combined with low doses of steroids (such as hydrocortisone or prednisone) is prescribed to those who do not have a bone marrow donor. Most people respond to hormone therapy. But everyone with the disorder will quickly get worse when the drugs are stopped. In most cases, these drugs eventually stop working. Additional treatments may include: - Antibiotics (possibly given through a vein) to treat infections - Blood transfusions to treat symptoms due to low blood counts Most people with this condition visit a a doctor who is blood disorder specialist (hematologist), a doctor who treats diseases related to glands (endocrinologist), and an eye doctor (ophthalmologist) regularly. They also may see a bone doctor (orthopedist), gynecologist, or kidney disease specialist (nephrologist). The survival rates vary from person to person. The outlook is poor in those with low blood counts. New and improved treatments, such as bone marrow transplants, have likely improved survival. People with Fanconi anemia are more likely to develop several types of blood disorders and cancers. These may include leukemia, myelodysplastic syndrome, and cancer of the head, neck, or urinary system. Women with Fanconi anemia who become pregnant should be watched carefully by a doctor. Such women often need transfusions throughout pregnancy. Men with Fanconi anemia have decreased fertility. Families with a history of this condition can have genetic counseling to better understand their risk. Vaccination can reduce certain complications, including pneumococcal pneumonia, hepatitis, and varicella infections. People with Fanconi anemia should avoid cancer-causing substances (carcinogens) and have regular check-ups to screen for cancer. Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists and Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000334.htm"
+  ],
+  [
+    "What is Anemia?: Espaol Anemia (uh-NEE-me-uh) is a condition in which your blood has a lower than normal number of red blood cells. Anemia also can occur if your red blood cells don't contain enough hemoglobin (HEE-muh-glow-bin). Hemoglobin is an iron-rich protein that gives blood its red color. This protein helps red blood cells carry oxygen from the lungs to the rest of the body. If you have anemia, your body doesn't get enough oxygen-rich blood. As a result, you may feel tired or weak. You also may have other symptoms, such as shortness of breath, dizziness, or headaches. Severe or long-lasting anemia can damage your heart, brain, and other organs in your body. Very severe anemia may even cause death. Overview Blood is made up of many parts, including red blood cells, white blood cells, platelets (PLATE-lets), and plasma (the fluid portion of blood). Red blood cells are disc-shaped and look like doughnuts without holes in the center. They carry oxygen and remove carbon dioxide (a waste product) from your body. These cells are made in the bone marrowa sponge-like tissue inside the bones. White blood cells and platelets (PLATE-lets) also are made in the bone marrow. White blood cells help fight infection. Platelets stick together to seal small cuts or breaks on the blood vessel walls and stop bleeding. With some types of anemia, you may have low numbers of all three types of blood cells. Anemia has three main causes: blood loss, lack of red blood cell production, or high rates of red blood cell destruction. These causes might be the result of diseases, conditions, or other factors. Outlook Many types of anemia can be mild, short term, and easily treated. You can even prevent some types with a healthy diet. Other types can be treated with dietary supplements. However, certain types of anemia can be severe, long lasting, and even life threatening if not diagnosed and treated. If you have signs or symptoms of anemia, see your doctor to find out whether you have the condition. Treatment will depend on the cause of the anemia and how severe it is.",
+    "http://www.nhlbi.nih.gov/health/health-topics/topics/anemia"
+  ],
+  [
+    "Anemia: Anemia is a condition in which you don't have enough healthy red blood cells to carry adequate oxygen to the body's tissues. Having anemia may make you feel tired and weak. There are many forms of anemia, each with its own cause. Anemia can be temporary or long term, and it can range from mild to severe. See your doctor if you suspect you have anemia because it can be a warning sign of serious illness. Treatments for anemia range from taking supplements to undergoing medical procedures. You may be able to prevent some types of anemia by eating a healthy, varied diet. Anemia care at Mayo Clinic Anemia signs and symptoms vary depending on the cause of your anemia. They may include: - Fatigue - Weakness - Pale or yellowish skin - Irregular heartbeats - Shortness of breath - Dizziness or lightheadedness - Chest pain - Cold hands and feet - Headache At first anemia can be so mild that it goes unnoticed. But symptoms worsen as anemia worsens. Make an appointment with your doctor if you're feeling fatigued for unexplained reasons. Some anemias, such as iron deficiency anemia or vitamin B-12 deficiency, are common. Fatigue has many causes besides anemia, so don't assume that if you're tired you must be anemic. Some people learn that their hemoglobin is low, which indicates anemia, when they go to donate blood. If you're told that you can't donate blood because of low hemoglobin, make an appointment with your doctor. Anemia occurs when your blood doesn't have enough red blood cells. This can happen if: - Your body doesn't make enough red blood cells - Bleeding causes you to lose red blood cells more quickly than they can be replaced - Your body destroys red blood cells Your body makes three types of blood cells - white blood cells to fight infection, platelets to help your blood clot and red blood cells to carry oxygen throughout your body. Red blood cells contain hemoglobin - an iron-rich protein that gives blood its red color. Hemoglobin enables red blood cells to carry oxygen from your lungs to all parts of your body and to carry carbon dioxide from other parts of the body to your lungs so that it can be exhaled. Most blood cells, including red blood cells, are produced regularly in your bone marrow - a spongy material found within the cavities of many of your large bones. To produce hemoglobin and red blood cells, your body needs iron, vitamin B-12, folate and other nutrients from the foods you eat. Different types of anemia and their causes include: - Iron deficiency anemia. This is the most common type of anemia worldwide. Iron deficiency anemia is caused by a shortage of iron in your body. Your bone marrow needs iron to make hemoglobin. Without adequate iron, your body can't produce enough hemoglobin for red blood cells. Without iron supplementation, this type of anemia occurs in many pregnant women. It is also caused by blood loss, such as from heavy menstrual bleeding, an ulcer, cancer and regular use of some over-the-counter pain relievers, especially aspirin. - Vitamin deficiency anemia. In addition to iron, your body needs folate and vitamin B-12 to produce enough healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production. Additionally, some people may consume enough B-12, but their bodies aren't able to process the vitamin. This can lead to vitamin deficiency anemia, also known as pernicious anemia. - Anemia of chronic disease. Certain diseases - such as cancer, HIV/AIDS, rheumatoid arthritis, kidney disease, Crohn's disease and other chronic inflammatory diseases - can interfere with the production of red blood cells. - Aplastic anemia. This rare, life-threatening anemia occurs when your body doesn't produce enough red blood cells. Causes of aplastic anemia include infections, certain medicines, autoimmune diseases and exposure to toxic chemicals. - Anemias associated with bone marrow disease. A variety of diseases, such as leukemia and myelofibrosis, can cause anemia by affecting blood production in your bone marrow. The effects of these types of cancer and cancer-like disorders vary from mild to life-threatening. - Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases increase red blood cell destruction. You can inherit a hemolytic anemia, or you can develop it later in life. - Sickle cell anemia. This inherited and sometimes serious condition is an inherited hemolytic anemia. It's caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal crescent (sickle) shape. These irregular blood cells die prematurely, resulting in a chronic shortage of red blood cells. - Other anemias. There are several other forms of anemia, such as thalassemia and malarial anemia. These factors place you at increased risk of anemia: - A diet lacking in certain vitamins. Having a diet that is consistently low in iron, vitamin B-12 and folate increases your risk of anemia. - Intestinal disorders. Having an intestinal disorder that affects the absorption of nutrients in your small intestine - such as Crohn's disease and celiac disease - puts you at risk of anemia. - Menstruation. In general, women who haven't experienced menopause have a greater risk of iron deficiency anemia than do men and postmenopausal women. That's because menstruation causes the loss of red blood cells. - Pregnancy. If you're pregnant and aren't taking a multivitamin with folic acid, you're at an increased risk of anemia. - Chronic conditions. If you have cancer, kidney failure or another chronic condition, you may be at risk of anemia of chronic disease. These conditions can lead to a shortage of red blood cells. Slow, chronic blood loss from an ulcer or other source within your body can deplete your body's store of iron, leading to iron deficiency anemia. - Family history. If your family has a history of an inherited anemia, such as sickle cell anemia, you also may be at increased risk of the condition. - Other factors. A history of certain infections, blood diseases and autoimmune disorders, alcoholism, exposure to toxic chemicals, and the use of some medications can affect red blood cell production and lead to anemia. - Age. People over age 65 are at increased risk of anemia. Left untreated, anemia can cause many health problems, such as: - Severe fatigue. When anemia is severe enough, you may be so tired that you can't complete everyday tasks. - Pregnancy complications. Pregnant women with folate deficiency anemia may be more likely to experience complications, such as premature birth. - Heart problems. Anemia can lead to a rapid or irregular heartbeat (arrhythmia). When you're anemic your heart must pump more blood to compensate for the lack of oxygen in the blood. This can lead to an enlarged heart or heart failure. - Death. Some inherited anemias, such as sickle cell anemia, can be serious and lead to life-threatening complications. Losing a lot of blood quickly results in acute, severe anemia and can be fatal. To diagnose anemia, your doctor may ask you about your medical and family history, perform a physical exam, and run the following tests: - Complete blood count (CBC). A CBC is used to count the number of blood cells in a sample of your blood. For anemia your doctor will be interested in the levels of the red blood cells contained in the blood (hematocrit) and the hemoglobin in your blood. Normal adult hematocrit values vary from one medical practice to another but are generally between 40 and 52 percent for men and 35 and 47 percent for women. Normal adult hemoglobin values are generally 14 to 18 grams per deciliter for men and 12 to 16 grams per deciliter for women. - A test to determine the size and shape of your red blood cells. Some of your red blood cells may also be examined for unusual size, shape and color. Additional diagnostic tests If you receive a diagnosis of anemia, your doctor may order additional tests to determine the underlying cause. For example, iron deficiency anemia can result from chronic bleeding of ulcers, benign polyps in the colon, colon cancer, tumors or kidney problems. Occasionally, it may be necessary to study a sample of your bone marrow to diagnose anemia. Anemia treatment depends on the cause. - Iron deficiency anemia. Treatment for this form of anemia usually involves taking iron supplements and making changes to your diet. If the underlying cause of iron deficiency is loss of blood - other than from menstruation - the source of the bleeding must be located and stopped. This may involve surgery. - Vitamin deficiency anemias. Treatment for folic acid and B-12 deficiency involves dietary supplements and increasing these nutrients in your diet. If your digestive system has trouble absorbing vitamin B-12 from the food you eat, you may need vitamin B-12 shots. At first, you may receive the shots every other day. Eventually, you'll need shots just once a month, which may continue for life, depending on your situation. - Anemia of chronic disease. There's no specific treatment for this type of anemia. Doctors focus on treating the underlying disease. If symptoms become severe, a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by your kidneys, may help stimulate red blood cell production and ease fatigue. - Aplastic anemia. Treatment for this anemia may include blood transfusions to boost levels of red blood cells. You may need a bone marrow transplant if your bone marrow is diseased and can't make healthy blood cells. - Anemias associated with bone marrow disease. Treatment of these various diseases can include medication, chemotherapy or bone marrow transplantation. - Hemolytic anemias. Managing hemolytic anemias includes avoiding suspect medications, treating related infections and taking drugs that suppress your immune system, which may be attacking your red blood cells. Depending on the severity of your anemia, a blood transfusion or plasmapheresis may be necessary. Plasmapheresis is a type of blood-filtering procedure. In certain cases, removal of the spleen can be helpful. - Sickle cell anemia. Treatment for this anemia may include the administration of oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and prevent complications. Doctors also may recommend blood transfusions, folic acid supplements and antibiotics. A bone marrow transplant may be an effective treatment in some circumstances. A cancer drug called hydroxyurea (Droxia, Hydrea) also is used to treat sickle cell anemia. - Thalassemia. This anemia may be treated with blood transfusions, folic acid supplements, medication, removal of the spleen (splenectomy), or a blood and bone marrow stem cell transplant.",
+    "https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360"
+  ],
+  [
+    "What is Anemia?: Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Different types of anemia include: - Anemia due to B12 deficiency - Anemia due to folate deficiency - Anemia due to iron deficiency - Anemia of chronic disease - Hemolytic anemia - Idiopathic aplastic anemia - Megaloblastic anemia - Pernicious anemia - Sickle cell anemia - Thalassemia",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000560.htm"
+  ],
+  [
+    "What is Anemia?: If you have anemia, your blood does not carry enough oxygen to the rest of your body. The most common cause of anemia is not having enough iron. Your body needs iron to make hemoglobin. Hemoglobin is an iron-rich protein that gives the red color to blood. It carries oxygen from the lungs to the rest of the body. Anemia has three main causes: blood loss, lack of red blood cell production, and high rates of red blood cell destruction. Conditions that may lead to anemia include - Heavy periods - Pregnancy - Ulcers - Colon polyps or colon cancer - Inherited disorders - A diet that does not have enough iron, folic acid or vitamin B12 - Blood disorders such as sickle cell anemia and thalassemia, or cancer - Aplastic anemia, a condition that can be inherited or acquired - G6PD deficiency, a metabolic disorder Anemia can make you feel tired, cold, dizzy, and irritable. You may be short of breath or have a headache. Your doctor will diagnose anemia with a physical exam and blood tests. Treatment depends on the kind of anemia you have. NIH: National Heart, Lung, and Blood Institute",
+    "https://www.nlm.nih.gov/medlineplus/anemia.html"
+  ],
+  [
+    "Hemolytic anemia: Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Normally, red blood cells last for about 120 days in the body. In hemolytic anemia, red blood cells in the blood are destroyed earlier than normal. The bone marrow is mostly responsible for making new red cells. Bone marrow is the soft tissue in the center of bones that helps form all blood cells. Hemolytic anemia occurs when the bone marrow isn't making enough red cells to replace the ones that are being destroyed. There are several possible causes of hemolytic anemia. Red blood cells may be destroyed due to: - An autoimmune problem in which the immune system mistakenly sees your own red blood cells as foreign substances and destroys them - Genetic defects within the red cells (such as sickle cell anemia, thalassemia, and G6PD deficiency) - Exposure to certain chemicals, drugs, and toxins - Infections - Blood clots in small blood vessels - Transfusion of blood from a donor with a blood type that does not match yours You may not have symptoms if the anemia is mild. If the problem develops slowly, the first symptoms may be: - Feeling weak or tired more often than usual, or with exercise - Headaches - Problems concentrating or thinking If the anemia gets worse, symptoms may include: - Lightheadedness when you stand up - Pale skin - Shortness of breath - Sore tongue - Enlarged spleen A test called a complete blood count (CBC) can help diagnose anemia and offer some hints to the type and cause of the problem. Important parts of the CBC include red blood cell count (RBC), hemoglobin, and hematocrit (HCT). These tests can identify the type of hemolytic anemia: - Absolute reticulocyte count - Coombs test, direct and indirect - Donath-Landsteiner test - Cold agglutinins - Free hemoglobin in the serum or urine - Hemosiderin in the urine - Platelet count - Protein electrophoresis - serum - Pyruvate kinase - Serum haptoglobin levels - Serum LDH Treatment depends on the type and cause of the hemolytic anemia: - In emergencies, a blood transfusion may be needed. - For an overactive immune system, drugs that suppress the immune system may be used. - When blood cells are being destroyed at a fast pace, the body may need extra folic acid and iron supplements to replace what is being lost. In rare cases, surgery is needed to take out the spleen. This is because the spleen acts as a filter that removes abnormal cells from the blood. Outcome depends on the type and cause of hemolytic anemia. Severe anemia can make heart disease, lung disease, or cerebrovascular disease worse. Call your health care provider if you develop symptoms of hemolytic anemia. Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists and Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000571.htm"
+  ],
+  [
+    "Aplastic anemia: Aplastic anemia \u00a0is a blood disorder caused by failure of the bone marrow to make enough new blood cells . Bone marrow is a sponge-like tissue inside the bones that makes stem cells that develop into red blood cells , white blood cells , and platelets . [1] Symptoms may include fatigue, weakness, dizziness, shortness of breath, frequent infections, and bleeding. Aplastic anemia can lead to other health concerns such as an irregular heartbeat, an enlarged heart, and heart failure. It can be caused by injury to blood stem cells due to exposure to certain drugs, chemotherapy , congenital disorders, drug therapy to suppress the immune system , pregnancy, radiation therapy , or toxins such as benzene or arsenic. When the cause is unknown, it is referred to as idiopathic aplastic anemia. In about half of all cases, no cause can be found. The blood disorder can be acute or chronic. [2] Treatment may consist of\u00a0supportive care only, blood transfusions, medicines to suppress the immune system, or hematopoietic cell transplantation. [3]\u00a0 The British Committee for Standards in Haematology recommends treating infection or uncontrolled bleeding before administering immunosuppressive therapy, including in patients scheduled for HCT. [5] In the presence of severe infection, however, it may be necessary to proceed directly to HCT to provide the patient with the best chance for early neutrophil recovery. [5] \u00a0The Pediatric Haemato-Oncology Italian Association recommends HCT from a matched sibling donor\u00a0for severe aplastic anemia, and if a matched donor is not available, options include immunosuppressive therapy or unrelated donor HCT. [6] Approximately one third of patients with aplastic anemia do not respond to immunosuppression. The thrombopoietin-receptor agonist eltrombopag is approved for use in patients with severe aplastic anemia who fail to respond adequately to immunosuppressive therapy. Independent of response or degree of response, risks include\u00a0 relapse and late-onset clonal disease, such as paroxysmal nocturnal hemoglobinuria (PNH), myelodysplastic syndrome (MDS), or leukemia. [14, 38, 39, 40, 41] Pregnant women with aplastic anemia have a 33% risk of relapse. [5] Provide supportive care in these patients, maintain the platelet count above 20 \u00d7 10 9/L, if possible, and consider administering cyclosporine. [5] Note that monotherapy with hematopoietic growth factors (eg, recombinant human erythropoietin [rHuEPO], granulocyte colony-stimulating factor [G-CSF]) is not recommended for newly diagnosed patients. [5] Frequent outpatient follow-up for patients with aplastic anemia is needed to monitor blood counts and any adverse effects of various drugs. Transfusions of packed red blood cells (RBCs) and platelets are administered on an outpatient basis. The symptoms of aplastic anemia vary depending on how severe it is and how low blood counts are. Signs and symptoms may include: [2] [3] [4] Low numbers of red blood cells (anemia): May cause paleness (pallor), headache, palpitations,\u00a0rapid heart rate Low numbers of platelets ( thrombocytopenia ): May result in gum bleeding, nosebleeds or bleeding in the internal organs and skin bruises. Low white blood cells (neutropenia): May present infections, recurrent infections, mouth sores.\u00a0 The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Aplastic anemia - Bone marrow hypocellularity - Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. Treatment for aplastic anemia varies depending on the severity. While some individuals with mild to moderate aplastic anemia may not require treatment, for others, treatment may include: [3] [5] Blood transfusions to keep blood cell counts at acceptable levels Blood and marrow stem cell transplants to replace damaged stem cells with health ones from a donor (another person) Medications to stimulate the bone marrow, suppress the immune system , and prevent and treat infections Blood and marrow stem cell transplants may cure aplastic anemia in some instances. This treatment option works best in children and young adults with severe aplastic anemia who are otherwise in good health. [5] For patients with severe aplastic anemia who are under the age of 20 years, and those ages 20 to 50 years who are otherwise in good health the first option is the transplant when a sibling donor is available. For those who do not have an available sibling donor, the medication eltrombopag or eltrombopag plus immunesuppression therapy can be used. For patients over 50 years of age, the decision is based on the patient\u2019s overall health, and preferences, and treatment may include eltrombopag or eltrombopag plus immunesuppression therapy (horse anti-thymocyte globulin (ATG), cyclosporin A (CSA), and glucocorticoids). People older than 50 years old have more risks of having rejection with the transplant and have greater risks of treatment toxicity and early mortality. FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information A small number of people with aplastic anemia may spontaneously recover with supportive care; however, for most individuals, the condition worsens without identification and treatment of the underlying cause and/or treatment of the disease. Bone marrow transplant may cure the disease in children and young patients and has a 10 year survival rate of approximately 73%. For many, bone marrow transplant is not an option due to the risks and potential long-term side effects. [3] [4] [5]",
+    "https://rarediseases.info.nih.gov/diseases/5836/aplastic-anemia"
+  ],
+  [
+    "Sideroblastic anemia: Sideroblastic anemia \u00a0is a group of blood disorders characterized by an impaired ability of the bone marrow to produce normal red blood cells . In this condition, the iron inside red blood cells is inadequately used to make hemoglobin, despite normal amounts of iron. As a result, iron accumulates in the red blood cells, giving a ringed appearance to the nucleus (ringed sideroblast). The signs and symptoms of this condition may include fatigue, breathing difficulties, weakness, and enlargement of the liver or spleen. There are many potential causes of sideroblastic anemia. [1] Depending on the cause, it can be classified as hereditary (sometimes called congenital ), acquired, and idiopathic (cause unknown). The treatment for this condition differs depending on the underlying cause. If acquired, avoidance and or removal of the toxin or drug can lead to recovery. Vitamin B6 (pyridoxine) may be useful in some circumstances. [1] [2] The signs and symptoms of sideroblastic anemia may include: fatigue, weakness, the sensation of a pounding or racing heart ( palpitations), shortness of breath, headaches, irritability, and chest pain. Physical findings may include pale skin and/or a lemon-yellow colored tinge to the skin and rarely, a brownish discoloration caused by bleeding under the skin. Enlargement of the spleen ( splenomegaly) and/or liver ( hepatomegaly) may also occur. Rarely, in severe cases, acute leukemia\u00a0can develop. [1] Sideroblastic anemia can be caused by hereditary factors, acquired as part of an underlying condition or exposure to drugs or toxins , or the cause may be unknown (idiopathic). [1] Hereditary causes of sideroblastic anemia include: [2] [3] Mutations in the\u00a0ALAS2,\u00a0ABCB7, SCL19A2,\u00a0GLRX5,\u00a0 PSU1\u00a0 Pearson syndrome Wolfram or DIDMOAD syndrome Mitochondrial SLC25A38 Erythropoietic protoporphyria Acquired causes of sideroblastic anemia include: [2] [3] Myelodysplastic syndrome SF3B1 - Splicing factor 3B subunit 1 mutations Nutritional deficiencies (copper, vitamin B6) Lead poisoning Zinc overdose Alcohol Drugs (anti-tuberculous agents, antibiotics , progesterone , chelators, busulfan) Hypothermia The diagnostic workup for sideroblastic anemia may include blood work ( complete blood count, peripheral smear, iron studies) and a bone marrow aspiration and/or\u00a0 biopsy . Additional studies that may be useful include imaging of the brain, such as MRI and genetic testing for known or suspected hereditary conditions associated with sideroblastic anemia. [3] The treatment of sideroblastic anemia may differ depending on whether the underlying cause is inherited or acquired. For acquired cases, avoidance or removal of the toxin or causative medication may lead to recovery. Vitamin B6 (pyridoxine) therapy may be beneficial in both inherited and acquired forms. If vitamin B6 therapy is not effective, a blood transfusion can be useful, but since it has been known to worsen iron overload, the benefits and limitations of this option should be carefully considered. Rarely, when all other treatment methods have been exhausted, bone marrow transplantation may be utilized. While this therapy may offer the possibility of a cure, the complications associated with transplantation surgery must be considered. [2] [3] It is recommended that all individuals with sideroblastic anemia avoid zinc-containing supplements and the use of alcohol. Regular follow-up and care with a hematologist is important. [3] The prognosis of sideroblastic anemia varies depending on the underlying cause. For acquired cases, such as those associated with alcohol and drugs, there may not be long-term symptoms. Patients\u00a0requiring transfusions, those with conditions unresponsive to pyridoxine and other therapies, and those with a myelodysplastic syndrome that develops into acute leukemia have a\u00a0poorer prognosis. Major causes of death in cases of sideroblastic anemia are secondary hemochromatosis from transfusions and leukemia. Thrombocytosis appears to be a relatively good prognostic sign. Patients with no need for blood transfusions are very likely to be long-term survivors, whereas those who become transfusion dependent are at risk of death from the complications of secondary hemochromatosis. [3]",
+    "https://rarediseases.info.nih.gov/diseases/667/sideroblastic-anemia"
+  ],
+  [
+    "Pernicious anemia: Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. There are many types of anemia. Pernicious anemia is a decrease in red blood cells that occurs when the intestines cannot properly absorb vitamin B12. Pernicious anemia is a type of vitamin B12 anemia. The body needs vitamin B12 to make red blood cells. You get this vitamin from eating foods such as meat, poultry, shellfish, eggs, and dairy products. A special protein, called intrinsic factor (IF), helps your intestines absorb vitamin B12. This protein is released by cells in the stomach. When the stomach does not make enough intrinsic factor, the intestine cannot properly absorb vitamin B12. Common causes of pernicious anemia include: - Weakened stomach lining (atrophic gastritis) - An autoimmune condition in which the body's immune system attacks the actual intrinsic factor protein or the cells in the lining of your stomach that make it. Very rarely, pernicious anemia is passed down through families. This is called congenital pernicious anemia. Babies with this type of anemia do not make enough intrinsic factor. Or they cannot properly absorb vitamin B12 in the small intestine. In adults, symptoms of pernicious anemia are usually not seen until after age 30. The average age of diagnosis is age 60. You are more likely to develop this disease if you: - Are Scandinavian or Northern European - Have a family history of the condition Certain diseases can also raise your risk. They include: - Addison disease - Chronic thyroiditis - Graves disease - Hypoparathyroidism - Hypopituitarism - Myasthenia gravis - Secondary amenorrhea - Type 1 diabetes - Testicular dysfunction - Vitiligo Some people do not have symptoms. Symptoms may be mild. They can include: - Desire to eat ice or other non-food things (pica) - Diarrhea or constipation - Fatigue, lack of energy, or lightheadedness when standing up or with exertion - Loss of appetite - Pale skin - Problems concentrating - Shortness of breath, mostly during exercise - Swollen, red tongue or bleeding gums If you have a low vitamin B12 level for a long time, you can have nervous system damage. Symptoms can include: - Confusion - Depression - Loss of balance - Numbness and tingling in the hands and feet The health care provider will perform a physical exam. Tests that may be done include: - Bone marrow examination (only needed if diagnosis is unclear) - Complete blood count (CBC) - Reticulocyte count - Schilling test - LDH level - Methylmalonic acid (MMA) level - Vitamin B12 level - Levels of antibodies against IF or the cells which make IF The goal of treatment is to increase your vitamin B12 level: - Treatment involves a shot of vitamin B12 once a month. People with severely low levels of B12 may need more shots in the beginning. - Some people may also need to take vitamin B12 supplements by mouth. - A certain type of vitamin B12 may be given through the nose. Your provider will also recommend eating a variety of foods. Most people often do well with treatment. It is important to start treatment early. Nerve damage can be permanent if treatment does not start within 6 months of symptoms. People with pernicious anemia may have gastric polyps. They are also more likely to develop gastric cancer and gastric carcinoid tumors. Brain and nervous system problems may continue or be permanent if treatment is delayed. A woman with a low B12 level may have a false positive Pap smear. This is because vitamin B12 deficiency affects the way certain cells (epithelial cells) in the cervix look. Call your provider if you have symptoms of vitamin B12 deficiency. There is no known way to prevent this type of vitamin B12 anemia. However, early detection and treatment can help reduce complications. Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists and Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000569.htm"
+  ],
+  [
+    "Aplastic anemia: Aplastic anemia is a condition that occurs when your body stops producing enough new blood cells. Aplastic anemia leaves you feeling fatigued and with a higher risk of infections and uncontrolled bleeding. A rare and serious condition, aplastic anemia can develop at any age. Aplastic anemia may occur suddenly, or it can occur slowly and get worse over a long period of time. Treatment for aplastic anemia may include medications, blood transfusions or a stem cell transplant, also known as a bone marrow transplant. Aplastic anemia symptoms may include: - Fatigue - Shortness of breath with exertion - Rapid or irregular heart rate - Pale skin - Frequent or prolonged infections - Unexplained or easy bruising - Nosebleeds and bleeding gums - Prolonged bleeding from cuts - Skin rash - Dizziness - Headache Aplastic anemia can progress slowly over weeks or months, or it may come on suddenly. The illness may be brief, or it may become chronic. Aplastic anemia can be very severe and even fatal. Aplastic anemia develops when damage occurs to your bone marrow, slowing or shutting down the production of new blood cells. Bone marrow is a red, spongy material inside your bones that produces stem cells, which give rise to other cells. Stem cells in the bone marrow produce blood cells - red cells, white cells and platelets. In aplastic anemia, the bone marrow is described in medical terms as aplastic or hypoplastic - meaning that it's empty (aplastic) or contains very few blood cells (hypoplastic). Factors that can temporarily or permanently injure bone marrow and affect blood cell production include: - Radiation and chemotherapy treatments. While these cancer-fighting therapies kill cancer cells, they can also damage healthy cells, including stem cells in bone marrow. Aplastic anemia can be a temporary side effect of these treatments. - Exposure to toxic chemicals. Exposure to toxic chemicals, such as some used in pesticides and insecticides, may cause aplastic anemia. Exposure to benzene - an ingredient in gasoline - also has been linked to aplastic anemia. This type of anemia may get better on its own if you avoid repeated exposure to the chemicals that caused your initial illness. - Use of certain drugs. Some medications, such as those used to treat rheumatoid arthritis and some antibiotics, can cause aplastic anemia. - Autoimmune disorders. An autoimmune disorder, in which your immune system begins attacking healthy cells, may involve stem cells in your bone marrow. - A viral infection. Viral infections that affect bone marrow may play a role in the development of aplastic anemia in some people. Viruses that have been linked to the development of aplastic anemia include hepatitis, Epstein-Barr, cytomegalovirus, parvovirus B19 and HIV. - Pregnancy. Aplastic anemia that occurs in pregnancy may be related to an autoimmune problem - your immune system may attack your bone marrow during pregnancy. - Unknown factors. In many cases, doctors aren't able to identify the cause of aplastic anemia. This is called idiopathic aplastic anemia. Aplastic anemia can be mistaken for a condition called myelodysplastic syndrome. In this group of disorders, the bone marrow produces new blood cells, but they're deformed and underdeveloped. The bone marrow in myelodysplastic syndrome is sometimes called hyperplastic - meaning that it's packed with blood cells. But some people with myelodysplastic syndrome have empty marrow that's difficult to distinguish from aplastic anemia. Some people with aplastic anemia also have a rare disorder known as paroxysmal nocturnal hemoglobinuria. This disorder causes red blood cells to break down too soon. Paroxysmal nocturnal hemoglobinuria can lead to aplastic anemia, or aplastic anemia can evolve into paroxysmal nocturnal hemoglobinuria. Fanconi's anemia is a rare, inherited disease that leads to aplastic anemia. Children born with it tend to be smaller than average and have birth defects, such as underdeveloped limbs. The disease is diagnosed with the help of blood tests. Aplastic anemia is rare. Factors that may increase your risk include: - Treatment with high-dose radiation or chemotherapy for cancer - Exposure to toxic chemicals - The use of some prescription drugs - such as chloramphenicol, which is used to treat bacterial infections, and gold compounds used to treat rheumatoid arthritis - Certain blood diseases, autoimmune disorders and serious infections - Pregnancy, rarely To diagnose aplastic anemia, your doctor may recommend: - Blood tests. Normally, red blood cell, white blood cell and platelet levels stay within a certain range. Your doctor may suspect aplastic anemia when all three of these blood cell levels are very low. - Bone marrow biopsy. To confirm a diagnosis, you'll need to undergo a bone marrow biopsy. In this procedure, a doctor uses a needle to remove a small sample of bone marrow from a large bone in your body, such as your hipbone. The bone marrow sample is examined under a microscope to rule out other blood-related diseases. In aplastic anemia, bone marrow contains fewer blood cells than normal. Once you've received a diagnosis of aplastic anemia, you may need additional tests to determine an underlying cause. Treatments for aplastic anemia may include observation for mild cases, blood transfusions and medications for more-serious cases, and in severe cases, bone marrow transplantation. Severe aplastic anemia, in which your blood cell counts are extremely low, is life-threatening and requires immediate hospitalization for treatment. Blood transfusions Treatment for aplastic anemia usually involves blood transfusions to control bleeding and relieve anemia symptoms. Blood transfusions aren't a cure for aplastic anemia. But they do relieve signs and symptoms by providing blood cells that your bone marrow isn't producing. A transfusion may include: - Red blood cells. Transfusions of red blood cells raise red blood cell counts. This helps relieve anemia and fatigue. - Platelets. Transfusions of platelets help prevent excessive bleeding. While there's generally no limit to the number of blood cell transfusions you can have, complications can sometimes arise with multiple transfusions. Transfused red blood cells contain iron that can accumulate in your body and can damage vital organs if an iron overload isn't treated. Medications can help your body get rid of excess iron. Over time, your body may develop antibodies to transfused blood cells, making them less effective at relieving symptoms. The use of immunosuppressant medication makes this complication less likely. Stem cell transplant A stem cell transplant to rebuild the bone marrow with stem cells from a donor may offer the only successful treatment option for people with severe aplastic anemia. A stem cell transplant, which is also called a bone marrow transplant, is generally the treatment of choice for people who are younger and have a matching donor - most often a sibling. If a donor is found, your diseased bone marrow is first depleted with radiation or chemotherapy. Healthy stem cells from the donor are filtered from the blood. The healthy stem cells are injected intravenously into your bloodstream, where they migrate to the bone marrow cavities and begin generating new blood cells. The procedure requires a lengthy hospital stay. After the transplant, you'll receive drugs to help prevent rejection of the donated stem cells. A stem cell transplant carries risks. There's a chance that your body may reject the transplant, leading to life-threatening complications. In addition, not everyone is a candidate for transplantation or can find a suitable donor. Immunosuppressants For people who can't undergo a bone marrow transplant or for those whose aplastic anemia may be due to an autoimmune disorder, treatment may involve drugs that alter or suppress the immune system (immunosuppressants). Drugs such as cyclosporine (Gengraf, Neoral, Sandimmune) and anti-thymocyte globulin are examples. These drugs suppress the activity of immune cells that are damaging your bone marrow. This helps your bone marrow recover and generate new blood cells. Cyclosporine and anti-thymocyte globulin are often used in combination. Corticosteroids, such as methylprednisolone (Medrol, Solu-Medrol), are often given at the same time as these drugs. Immune-suppressing drugs can be very effective at treating aplastic anemia. The downside is that these drugs further weaken your immune system. It's also possible that after you stop taking these drugs, aplastic anemia may return. Bone marrow stimulants Certain drugs - including colony-stimulating factors, such as sargramostim (Leukine), filgrastim (Neupogen) and pegfilgrastim (Neulasta), and epoetin alfa (Epogen, Procrit) - may help stimulate the bone marrow to produce new blood cells. Growth factors are often used in combination with immune-suppressing drugs. Antibiotics, antivirals Having aplastic anemia weakens your immune system. You have fewer white blood cells in circulation to fight off germs. This leaves you susceptible to infections. At the first sign of infection, such as a fever, see your doctor. You don't want the infection to get worse, because it could prove life-threatening. If you have severe aplastic anemia, your doctor may give you antibiotics or antiviral medications to help prevent infections. Other treatments Aplastic anemia caused by radiation and chemotherapy treatments for cancer usually improves once you complete those treatments. The same is true for most other drugs that induce aplastic anemia. Pregnant women with aplastic anemia are treated with blood transfusions. For many women, pregnancy-related aplastic anemia improves once the pregnancy ends. If that doesn't happen, treatment is still necessary. If you have aplastic anemia, take care of yourself by: - Resting when you need to. Anemia can cause fatigue and shortness of breath with even mild exertion. Take a break and rest when you need to. - Avoiding contact sports. Because of the risk of bleeding associated with a low platelet count, avoid activities that may result in a cut or fall. - Protecting yourself from germs. You can reduce your risk of infections with frequent hand-washing and by avoiding sick people. If you develop a fever or other indicators of an infection, see your doctor for treatment.",
+    "https://www.mayoclinic.org/diseases-conditions/aplastic-anemia/symptoms-causes/syc-20355015"
+  ],
+  [
+    "Etiology: Etiology describes the cause or causes of a disease. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002356.htm"
+  ],
+  [
+    "What causes Anemia?: The three main causes of anemia are: Blood loss Lack of red blood cell production High rates of red blood cell destruction For some people, the condition is caused by more than one of these factors. Blood Loss Blood loss is the most common cause of anemia, especially iron-deficiency anemia. Blood loss can be short term or persist over time. Heavy menstrual periods or bleeding in the digestive or urinary tract can cause blood loss. Surgery, trauma, or cancer also can cause blood loss. If a lot of blood is lost, the body may lose enough red blood cells to cause anemia. Lack of Red Blood Cell Production Both acquired and inherited conditions and factors can prevent your body from making enough red blood cells. \"Acquired\" means you aren't born with the condition, but you develop it. \"Inherited\" means your parents passed the gene for the condition on to you. Acquired conditions and factors that can lead to anemia include poor diet, abnormal hormone levels, some chronic (ongoing) diseases, and pregnancy. Aplastic anemia also can prevent your body from making enough red blood cells. This condition can be acquired or inherited. Diet A diet that lacks iron, folic acid (folate), or vitamin B12 can prevent your body from making enough red blood cells. Your body also needs small amounts of vitamin C, riboflavin, and copper to make red blood cells. Conditions that make it hard for your body to absorb nutrients also can prevent your body from making enough red blood cells. Hormones Your body needs the hormone erythropoietin (eh-rith-ro-POY-eh-tin) to make red blood cells. This hormone stimulates the bone marrow to make these cells. A low level of this hormone can lead to anemia. Diseases and Disease Treatments Chronic diseases, like kidney disease and cancer, can make it hard for your body to make enough red blood cells. Some cancer treatments may damage the bone marrow or damage the red blood cells' ability to carry oxygen. If the bone marrow is damaged, it can't make red blood cells fast enough to replace the ones that die or are destroyed. People who have HIV/AIDS may develop anemia due to infections or medicines used to treat their diseases. Pregnancy Anemia can occur during pregnancy due to low levels of iron and folic acid and changes in the blood. During the first 6 months of pregnancy, the fluid portion of a woman's blood (the plasma) increases faster than the number of red blood cells. This dilutes the blood and can lead to anemia. Aplastic Anemia Some infants are born without the ability to make enough red blood cells. This condition is called aplastic anemia. Infants and children who have aplastic anemia often need blood transfusions to increase the number of red blood cells in their blood. Acquired conditions or factors, such as certain medicines, toxins, and infectious diseases, also can cause aplastic anemia. High Rates of Red Blood Cell Destruction Both acquired and inherited conditions and factors can cause your body to destroy too many red blood cells. One example of an acquired condition is an enlarged or diseased spleen. The spleen is an organ that removes wornout red blood cells from the body. If the spleen is enlarged or diseased, it may remove more red blood cells than normal, causing anemia. Examples of inherited conditions that can cause your body to destroy too many red blood cells include sickle cell anemia, thalassemias, and lack of certain enzymes. These conditions create defects in the red blood cells that cause them to die faster than healthy red blood cells. Hemolytic anemia is another example of a condition in which your body destroys too many red blood cells. Inherited or acquired conditions or factors can cause hemolytic anemia. Examples include immune disorders, infections, certain medicines, or reactions to blood transfusions.",
+    "http://www.nhlbi.nih.gov/health/health-topics/topics/anemia"
+  ],
+  [
+    "Fanconi anemia (Outlook (Prognosis)): The survival rates vary from person to person. The outlook is poor in those with low blood counts. New and improved treatments, such as bone marrow transplants, have likely improved survival. People with Fanconi anemia are more likely to develop several types of blood disorders and cancers. These may include leukemia, myelodysplastic syndrome, and cancer of the head, neck, or urinary system. Women with Fanconi anemia who become pregnant should be watched carefully by a doctor. Such women often need transfusions throughout pregnancy. Men with Fanconi anemia have decreased fertility.",
+    "https://medlineplus.gov/ency/article/000334.htm"
+  ],
+  [
+    "What causes Anemia?: Although many parts of the body help make red blood cells, most of the work is done in the bone marrow. Bone marrow is the soft tissue in the center of bones that helps form all blood cells. Healthy red blood cells last between 90 and 120 days. Parts of your body then remove old blood cells. A hormone called erythropoietin (epo) made in your kidneys signals your bone marrow to make more red blood cells. Hemoglobin is the oxygen-carrying protein inside red blood cells. It gives red blood cells their color. People with anemia do not have enough hemoglobin. The body needs certain vitamins, minerals, and nutrients to make enough red blood cells. Iron, vitamin B12, and folic acid are three of the most important ones. The body may not have enough of these nutrients due to: - Changes in the lining of the stomach or intestines affect how well nutrients are absorbed (for example, celiac disease) - Poor diet - Slow blood loss (for example, from heavy menstrual periods or stomach ulcers) - Surgery that removes part of the stomach or intestines Possible causes of anemia include: - Certain medicines - Destruction of red blood cells earlier than normal (which may be caused by immune system problems) - Long-term (chronic) diseases such as chronic kidney disease, cancer, ulcerative colitis, or rheumatoid arthritis - Some forms of anemia, such as thalassemia or sickle cell anemia, which can be inherited - Pregnancy - Problems with bone marrow such as lymphoma, leukemia, myelodysplasia, multiple myeloma, or aplastic anemia",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000560.htm"
+  ],
+  [
+    "Aplastic anemia (Summary): Aplastic anemia \u00a0is a blood disorder caused by failure of the bone marrow to make enough new blood cells . Bone marrow is a sponge-like tissue inside the bones that makes stem cells that develop into red blood cells , white blood cells , and platelets . [1] Symptoms may include fatigue, weakness, dizziness, shortness of breath, frequent infections, and bleeding. Aplastic anemia can lead to other health concerns such as an irregular heartbeat, an enlarged heart, and heart failure. It can be caused by injury to blood stem cells due to exposure to certain drugs, chemotherapy , congenital disorders, drug therapy to suppress the immune system , pregnancy, radiation therapy , or toxins such as benzene or arsenic. When the cause is unknown, it is referred to as idiopathic aplastic anemia. In about half of all cases, no cause can be found. The blood disorder can be acute or chronic. [2] Treatment may consist of\u00a0supportive care only, blood transfusions, medicines to suppress the immune system, or hematopoietic cell transplantation. [3]\u00a0 The British Committee for Standards in Haematology recommends treating infection or uncontrolled bleeding before administering immunosuppressive therapy, including in patients scheduled for HCT. [5] In the presence of severe infection, however, it may be necessary to proceed directly to HCT to provide the patient with the best chance for early neutrophil recovery. [5] \u00a0The Pediatric Haemato-Oncology Italian Association recommends HCT from a matched sibling donor\u00a0for severe aplastic anemia, and if a matched donor is not available, options include immunosuppressive therapy or unrelated donor HCT. [6] Approximately one third of patients with aplastic anemia do not respond to immunosuppression. The thrombopoietin-receptor agonist eltrombopag is approved for use in patients with severe aplastic anemia who fail to respond adequately to immunosuppressive therapy. Independent of response or degree of response, risks include\u00a0 relapse and late-onset clonal disease, such as paroxysmal nocturnal hemoglobinuria (PNH), myelodysplastic syndrome (MDS), or leukemia. [14, 38, 39, 40, 41] Pregnant women with aplastic anemia have a 33% risk of relapse. [5] Provide supportive care in these patients, maintain the platelet count above 20 \u00d7 10 9/L, if possible, and consider administering cyclosporine. [5] Note that monotherapy with hematopoietic growth factors (eg, recombinant human erythropoietin [rHuEPO], granulocyte colony-stimulating factor [G-CSF]) is not recommended for newly diagnosed patients. [5] Frequent outpatient follow-up for patients with aplastic anemia is needed to monitor blood counts and any adverse effects of various drugs. Transfusions of packed red blood cells (RBCs) and platelets are administered on an outpatient basis.",
+    "https://rarediseases.info.nih.gov/diseases/5836/aplastic-anemia"
+  ],
+  [
+    "Fanconi anemia (Summary): Fanconi anemia is a disease passed down through families (inherited) that mainly affects the bone marrow. It results in decreased production of all types of blood cells. Fanconi anemia is different from Fanconi syndrome, a rare kidney disorder.",
+    "https://medlineplus.gov/ency/article/000334.htm"
+  ],
+  [
+    "Aplastic anemia (Treatment): Treatment for aplastic anemia varies depending on the severity. While some individuals with mild to moderate aplastic anemia may not require treatment, for others, treatment may include: [3] [5] Blood transfusions to keep blood cell counts at acceptable levels Blood and marrow stem cell transplants to replace damaged stem cells with health ones from a donor (another person) Medications to stimulate the bone marrow, suppress the immune system , and prevent and treat infections Blood and marrow stem cell transplants may cure aplastic anemia in some instances. This treatment option works best in children and young adults with severe aplastic anemia who are otherwise in good health. [5] For patients with severe aplastic anemia who are under the age of 20 years, and those ages 20 to 50 years who are otherwise in good health the first option is the transplant when a sibling donor is available. For those who do not have an available sibling donor, the medication eltrombopag or eltrombopag plus immunesuppression therapy can be used. For patients over 50 years of age, the decision is based on the patient\u2019s overall health, and preferences, and treatment may include eltrombopag or eltrombopag plus immunesuppression therapy (horse anti-thymocyte globulin (ATG), cyclosporin A (CSA), and glucocorticoids). People older than 50 years old have more risks of having rejection with the transplant and have greater risks of treatment toxicity and early mortality. FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information",
+    "https://rarediseases.info.nih.gov/diseases/5836/aplastic-anemia"
+  ],
+  [
+    "Fanconi anemia (Causes): Fanconi anemia is due to an abnormal gene that damages cells, which keeps them from repairing damaged DNA. To inherit Fanconi anemia, a person must get 1 copy of the abnormal gene from each parent. The condition is most often diagnosed in children between 2 and 15 years old.",
+    "https://medlineplus.gov/ency/article/000334.htm"
+  ],
+  [
+    "Aplastic anemia (Symptoms): The symptoms of aplastic anemia vary depending on how severe it is and how low blood counts are. Signs and symptoms may include: [2] [3] [4] Low numbers of red blood cells (anemia): May cause paleness (pallor), headache, palpitations,\u00a0rapid heart rate Low numbers of platelets ( thrombocytopenia ): May result in gum bleeding, nosebleeds or bleeding in the internal organs and skin bruises. Low white blood cells (neutropenia): May present infections, recurrent infections, mouth sores.\u00a0 The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Aplastic anemia - Bone marrow hypocellularity -",
+    "https://rarediseases.info.nih.gov/diseases/5836/aplastic-anemia"
+  ],
+  [
+    "Pernicious anemia (Summary): Biermer's disease, also called acquired pernicious anemia , is a condition in which the body is unable to properly utilize vitamin B12. Because vitamin B12 is essential for the formation of red blood cells , this condition is primarily characterized by anemia (too few red blood cells ). Affected people may also experience gastrointestinal issues and neurological abnormalities (such as paresthesia, weakness, and clumsiness). Biermer's disease and other forms of pernicious anemia are thought to be autoimmune conditions which occur when the body's immune system mistakenly attacks healthy tissue . Treatment generally consists of large doses of vitamin B12, usually as an injection. [1] [2]",
+    "https://rarediseases.info.nih.gov/diseases/12671/pernicious-anemia"
+  ],
+  [
+    "Anemia (Signs and Symptoms): The most common symptom of anemia is fatigue (feeling tired or weak). If you have anemia, you may find it hard to find the energy to do normal activities. Other signs and symptoms of anemia include: Shortness of breath Dizziness Headache Coldness in the hands and feet Pale skin Chest pain These signs and symptoms can occur because your heart has to work harder to pump oxygen-rich blood through your body. Mild to moderate anemia may cause very mild symptoms or none at all. Complications of Anemia Some people who have anemia may have arrhythmias (ah-RITH-me-ahs). Arrhythmias are problems with the rate or rhythm of the heartbeat. Over time, arrhythmias can damage your heart and possibly lead to heart failure. Anemia also can damage other organs in your body because your blood can't get enough oxygen to them. Anemia can weaken people who have cancer or HIV/AIDS. This can make their treatments not work as well. Anemia also can cause many other health problems. People who have kidney disease and anemia are more likely to have heart problems. With some types of anemia, too little fluid intake or too much loss of fluid in the blood and body can occur. Severe loss of fluid can be life threatening.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/anemia"
+  ],
+  [
+    "Myopathy with extrapyramidal signs (Symptoms): The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Ataxia Occasional Microcephaly Occasional Ophthalmoplegia Occasional Optic atrophy Occasional Peripheral axonal neuropathy Occasional Ptosis Occasional Abnormality of extrapyramidal motor function Very rare Chorea Very rare Dystonia Very rare Orofacial dyskinesia Very rare Proximal muscle weakness Very rare Specific learning disability Very rare Tremor Very rare Autosomal recessive inheritance - Difficulty running - Difficulty walking - Elevated serum creatine phosphokinase - Motor delay - View complete list of signs and symptoms...",
+    "https://rarediseases.info.nih.gov/diseases/12978/myopathy-with-extrapyramidal-signs"
+  ],
+  [
+    "What are the symptoms of Anemia?: You may have no symptoms if the anemia is mild or if the problem develops slowly. Symptoms that may occur first include: - Feeling grumpy - Feeling weak or tired more often than usual, or with exercise - Headaches - Problems concentrating or thinking If the anemia gets worse, symptoms may include: - Blue color to the whites of the eyes - Brittle nails - Desire to eat ice or other non-food things (pica syndrome) - Light-headedness when you stand up - Pale skin color - Shortness of breath with mild activity or even at rest - Sore tongue",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000560.htm"
+  ],
+  [
+    "Aplastic anemia (Symptoms): The symptoms of aplastic anemia vary depending on how severe it is and how low blood counts are. Signs and symptoms may include: [2] [3] [4] Low numbers of red blood cells (anemia): May cause paleness (pallor), headache, palpitations,\u00a0rapid heart rate Low numbers of platelets ( thrombocytopenia ): May result in gum bleeding, nosebleeds or bleeding in the internal organs and skin bruises. Low white blood cells (neutropenia): May present infections, recurrent infections, mouth sores.\u00a0 The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Aplastic anemia - Bone marrow hypocellularity -",
+    "https://rarediseases.info.nih.gov/diseases/5836/aplastic-anemia"
+  ],
+  [
+    "Aplastic Anemia (SIGNS and SYMPTOMS): Lower than normal numbers of red blood cells, white blood cells, and platelets cause most of the signs and symptoms of aplastic anemia. Signs and Symptoms of Low Blood Cell Counts \u00a0 Red Blood Cells The most common symptom of a low red blood cell count is fatigue (tiredness). A lack of hemoglobin in the blood causes fatigue. Hemoglobin is an iron-rich protein in red blood cells. It helps carry oxygen to the body. A low red blood cell count also can cause shortness of breath; dizziness, especially when standing up; headaches; coldness in your hands or feet; pale skin; and chest pain. If you don't have enough hemoglobin-carrying red blood cells, your heart has to work harder to move the reduced amount of oxygen in your blood. This can lead to arrhythmias (irregular heartbeats), a heart murmur, an enlarged heart, or even heart failure. White Blood Cells White blood cells help fight infections. Signs and symptoms of a low white blood cell count include fevers, frequent infections that can be severe, and flu-like illnesses that linger. Platelets Platelets stick together to seal small cuts or breaks on blood vessel walls and stop bleeding. People who have low platelet counts tend to bruise and bleed easily, and the bleeding may be hard to stop. Common types of bleeding associated with a low platelet count include nosebleeds, bleeding gums, pinpoint red spots on the skin, and blood in the stool. Women also may have heavy menstrual bleeding. Other Signs and Symptoms Aplastic anemia can cause signs and symptoms that aren't directly related to low blood cell counts. Examples include nausea (feeling sick to your stomach) and skin rashes. Paroxysmal Nocturnal Hemoglobinuria Some people who have aplastic anemia have a condition called paroxysmal (par-ok-SIZ-mal) nocturnal hemoglobinuria (HE-mo-glo-bi-NOO-re-ah), or PNH. This is a red blood cell disorder. Most people who have PNH don't have any signs or symptoms. If symptoms do occur, they may include: Shortness of breath Swelling or pain in the abdomen or swelling in the legs caused by blood clots Blood in the urine Headaches Jaundice (a yellowish color of the skin or whites of the eyes) In people who have aplastic anemia and PNH, either condition can develop first.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/aplastic"
+  ],
+  [
+    "Symptoms and Causes of Diabetes (What are the symptoms of diabetes?): Symptoms of diabetes includeincreased thirst and urination increased hunger fatigue blurred vision numbness or tingling in the feet or hands sores that do not heal unexplained weight lossSymptoms of type 1 diabetes can start quickly, in a matter of weeks. Symptoms of type 2 diabetes often develop slowly\u2014over the course of several years\u2014and can be so mild that you might not even notice them. Many people with type 2 diabetes have no symptoms. Some people do not find out they have the disease until they have diabetes-related health problems, such as blurred vision or heart trouble.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes"
+  ],
+  [
+    "Vital signs: Vital signs reflect essential body functions, including your heartbeat, breathing rate, temperature, and blood pressure. Your health care provider may watch, measure, or monitor your vital signs to check your level of physical functioning. Normal vital signs change with age, sex, weight, exercise capability, and overall health. Normal vital sign ranges for the average healthy adult while resting are: - Blood pressure: 90/60 mm Hg to 120/80 mm Hg - Breathing: 12 to 18 breaths per minute - Pulse: 60 to 100 beats per minute - Temperature: 97.8\u00b0F to 99.1\u00b0F (36.5\u00b0C to 37.3\u00b0C)/average 98.6\u00b0F (37\u00b0C) Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002341.htm"
+  ],
+  [
+    "Aplastic anemia (Treatment): Treatment for aplastic anemia varies depending on the severity. While some individuals with mild to moderate aplastic anemia may not require treatment, for others, treatment may include: [3] [5] Blood transfusions to keep blood cell counts at acceptable levels Blood and marrow stem cell transplants to replace damaged stem cells with health ones from a donor (another person) Medications to stimulate the bone marrow, suppress the immune system , and prevent and treat infections Blood and marrow stem cell transplants may cure aplastic anemia in some instances. This treatment option works best in children and young adults with severe aplastic anemia who are otherwise in good health. [5] For patients with severe aplastic anemia who are under the age of 20 years, and those ages 20 to 50 years who are otherwise in good health the first option is the transplant when a sibling donor is available. For those who do not have an available sibling donor, the medication eltrombopag or eltrombopag plus immunesuppression therapy can be used. For patients over 50 years of age, the decision is based on the patient\u2019s overall health, and preferences, and treatment may include eltrombopag or eltrombopag plus immunesuppression therapy (horse anti-thymocyte globulin (ATG), cyclosporin A (CSA), and glucocorticoids). People older than 50 years old have more risks of having rejection with the transplant and have greater risks of treatment toxicity and early mortality. FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information",
+    "https://rarediseases.info.nih.gov/diseases/5836/aplastic-anemia"
+  ],
+  [
+    "What are the treatments for Anemia?: Treatment for anemia depends on the type, cause, and severity of the condition. Treatments may include dietary changes or supplements, medicines, procedures, or surgery to treat blood loss. Goals of Treatment The goal of treatment is to increase the amount of oxygen that your blood can carry. This is done by raising the red blood cell count and/or hemoglobin level. (Hemoglobin is the iron-rich protein in red blood cells that carries oxygen to the body.) Another goal is to treat the underlying cause of the anemia. Dietary Changes and Supplements Low levels of vitamins or iron in the body can cause some types of anemia. These low levels might be the result of a poor diet or certain diseases or conditions. To raise your vitamin or iron level, your doctor may ask you to change your diet or take vitamin or iron supplements. Common vitamin supplements are vitamin B12 and folic acid (folate). Vitamin C sometimes is given to help the body absorb iron. Iron Your body needs iron to make hemoglobin. Your body can more easily absorb iron from meats than from vegetables or other foods. To treat your anemia, your doctor may suggest eating more meatespecially red meat (such as beef or liver), as well as chicken, turkey, pork, fish, and shellfish. Nonmeat foods that are good sources of iron include: Spinach and other dark green leafy vegetables Tofu Peas; lentils; white, red, and baked beans; soybeans; and chickpeas Dried fruits, such as prunes, raisins, and apricots Prune juice Iron-fortified cereals and breads You can look at the Nutrition Facts label on packaged foods to find out how much iron the items contain. The amount is given as a percentage of the total amount of iron you need every day. Iron also is available as a supplement. It's usually combined with multivitamins and other minerals that help your body absorb iron. Doctors may recommend iron supplements for premature infants, infants and young children who drink a lot of cow's milk, and infants who are fed breast milk only or formula that isn't fortified with iron. Large amounts of iron can be harmful, so take iron supplements only as your doctor prescribes. Vitamin B12 Low levels of vitamin B12 can lead to pernicious anemia. This type of anemia often is treated with vitamin B12 supplements. Good food sources of vitamin B12 include: Breakfast cereals with added vitamin B12 Meats such as beef, liver, poultry, and fish Eggs and dairy products (such as milk, yogurt, and cheese) Foods fortified with vitamin B12, such as soy-based beverages and vegetarian burgers Folic Acid Folic acid (folate) is a form of vitamin B that's found in foods. Your body needs folic acid to make and maintain new cells. Folic acid also is very important for pregnant women. It helps them avoid anemia and promotes healthy growth of the fetus. Good sources of folic acid include: Bread, pasta, and rice with added folic acid Spinach and other dark green leafy vegetables Black-eyed peas and dried beans Beef liver Eggs Bananas, oranges, orange juice, and some other fruits and juices Vitamin C Vitamin C helps the body absorb iron. Good sources of vitamin C are vegetables and fruits, especially citrus fruits. Citrus fruits include oranges, grapefruits, tangerines, and similar fruits. Fresh and frozen fruits, vegetables, and juices usually have more vitaminC than canned ones. If you're taking medicines, ask your doctor or pharmacist whether you can eat grapefruit or drink grapefruit juice. This fruit can affect the strength of a few medicines and how well they work. Other fruits rich in vitamin C include kiwi fruit, strawberries, and cantaloupes. Vegetables rich in vitamin C include broccoli, peppers, Brussels sprouts, tomatoes, cabbage, potatoes, and leafy green vegetables like turnip greens and spinach. Medicines Your doctor may prescribe medicines to help your body make more red blood cells or to treat an underlying cause of anemia. Some of these medicines include: Antibiotics to treat infections. Hormones to treat heavy menstrual bleeding in teenaged and adult women. A man-made version of erythropoietin to stimulate your body to make more red blood cells. This hormone has some risks. You and your doctor will decide whether the benefits of this treatment outweigh the risks. Medicines to prevent the body's immune system from destroying its own red blood cells. Chelation (ke-LAY-shun) therapy for lead poisoning. Chelation therapy is used mainly in children. This is because children who have iron-deficiency anemia are at increased risk of lead poisoning. Procedures If your anemia is severe, your doctor may recommend a medical procedure. Procedures include blood transfusions and blood and marrow stem cell transplants. Blood Transfusion A blood transfusion is a safe, common procedure in which blood is given to you through an intravenous (IV) line in one of your blood vessels. Transfusions require careful matching of donated blood with the recipient's blood. For more information, go to the Health Topics Blood Transfusion article. Blood and Marrow Stem Cell Transplant A blood and marrow stem cell transplant replaces your faulty stem cells with healthy ones from another person (a donor). Stem cells are made in the bone marrow. They develop into red and white blood cells and platelets. During the transplant, which is like a blood transfusion, you get donated stem cells through a tube placed in a vein in your chest. Once the stem cells are in your body, they travel to your bone marrow and begin making new blood cells. For more information, go to the Health Topics Blood and Marrow Stem Cell Transplant article. Surgery If you have serious or life-threatening bleeding that's causing anemia, you may need surgery. For example, you may need surgery to control ongoing bleeding due to a stomach ulcer or colon cancer. If your body is destroying red blood cells at a high rate, you may need to have your spleen removed. The spleen is an organ that removes wornout red blood cells from the body. An enlarged or diseased spleen may remove more red blood cells than normal, causing anemia.",
+    "http://www.nhlbi.nih.gov/health/health-topics/topics/anemia"
+  ],
+  [
+    "Aplastic anemia (Treatment): Treatments for aplastic anemia may include observation for mild cases, blood transfusions and medications for more-serious cases, and in severe cases, bone marrow transplantation. Severe aplastic anemia, in which your blood cell counts are extremely low, is life-threatening and requires immediate hospitalization for treatment. Blood transfusions Treatment for aplastic anemia usually involves blood transfusions to control bleeding and relieve anemia symptoms. Blood transfusions aren't a cure for aplastic anemia. But they do relieve signs and symptoms by providing blood cells that your bone marrow isn't producing. A transfusion may include: - Red blood cells. Transfusions of red blood cells raise red blood cell counts. This helps relieve anemia and fatigue. - Platelets. Transfusions of platelets help prevent excessive bleeding. While there's generally no limit to the number of blood cell transfusions you can have, complications can sometimes arise with multiple transfusions. Transfused red blood cells contain iron that can accumulate in your body and can damage vital organs if an iron overload isn't treated. Medications can help your body get rid of excess iron. Over time, your body may develop antibodies to transfused blood cells, making them less effective at relieving symptoms. The use of immunosuppressant medication makes this complication less likely. Stem cell transplant A stem cell transplant to rebuild the bone marrow with stem cells from a donor may offer the only successful treatment option for people with severe aplastic anemia. A stem cell transplant, which is also called a bone marrow transplant, is generally the treatment of choice for people who are younger and have a matching donor - most often a sibling. If a donor is found, your diseased bone marrow is first depleted with radiation or chemotherapy. Healthy stem cells from the donor are filtered from the blood. The healthy stem cells are injected intravenously into your bloodstream, where they migrate to the bone marrow cavities and begin generating new blood cells. The procedure requires a lengthy hospital stay. After the transplant, you'll receive drugs to help prevent rejection of the donated stem cells. A stem cell transplant carries risks. There's a chance that your body may reject the transplant, leading to life-threatening complications. In addition, not everyone is a candidate for transplantation or can find a suitable donor. Immunosuppressants For people who can't undergo a bone marrow transplant or for those whose aplastic anemia may be due to an autoimmune disorder, treatment may involve drugs that alter or suppress the immune system (immunosuppressants). Drugs such as cyclosporine (Gengraf, Neoral, Sandimmune) and anti-thymocyte globulin are examples. These drugs suppress the activity of immune cells that are damaging your bone marrow. This helps your bone marrow recover and generate new blood cells. Cyclosporine and anti-thymocyte globulin are often used in combination. Corticosteroids, such as methylprednisolone (Medrol, Solu-Medrol), are often given at the same time as these drugs. Immune-suppressing drugs can be very effective at treating aplastic anemia. The downside is that these drugs further weaken your immune system. It's also possible that after you stop taking these drugs, aplastic anemia may return. Bone marrow stimulants Certain drugs - including colony-stimulating factors, such as sargramostim (Leukine), filgrastim (Neupogen) and pegfilgrastim (Neulasta), and epoetin alfa (Epogen, Procrit) - may help stimulate the bone marrow to produce new blood cells. Growth factors are often used in combination with immune-suppressing drugs. Antibiotics, antivirals Having aplastic anemia weakens your immune system. You have fewer white blood cells in circulation to fight off germs. This leaves you susceptible to infections. At the first sign of infection, such as a fever, see your doctor. You don't want the infection to get worse, because it could prove life-threatening. If you have severe aplastic anemia, your doctor may give you antibiotics or antiviral medications to help prevent infections. Other treatments Aplastic anemia caused by radiation and chemotherapy treatments for cancer usually improves once you complete those treatments. The same is true for most other drugs that induce aplastic anemia. Pregnant women with aplastic anemia are treated with blood transfusions. For many women, pregnancy-related aplastic anemia improves once the pregnancy ends. If that doesn't happen, treatment is still necessary.",
+    "https://www.mayoclinic.org/diseases-conditions/aplastic-anemia/symptoms-causes/syc-20355015"
+  ],
+  [
+    "What are the treatments for Anemia?: Treatment should be directed at the cause of the anemia, and may include: - Blood transfusions - Corticosteroids or other medicines that suppress the immune system - Erythropoietin, a medicine that helps your bone marrow make more blood cells - Supplements of iron, vitamin B12, folic acid, or other vitamins and minerals",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000560.htm"
+  ],
+  [
+    "Fanconi anemia (Treatment): People with mild to moderate blood cell changes who do not need a transfusion may only need regular check-ups and blood count checks. The health care provider will closely monitor the person for other cancers. These may include leukemia or cancers of the head, neck, or urinary system. Medicines called growth factors (such as erythropoietin, G-CSF, and GM-CSF) can improve blood counts for a short while. A bone marrow transplant can cure the blood count problems of Fanconi anemia. (The best bone marrow donor is a brother or sister whose tissue type matches the person affected by Fanconi anemia.) People who have had a successful bone marrow transplant still need regular check-ups because of the risk for additional cancers. Hormone therapy combined with low doses of steroids (such as hydrocortisone or prednisone) is prescribed to those who do not have a bone marrow donor. Most people respond to hormone therapy. But everyone with the disorder will quickly get worse when the drugs are stopped. In most cases, these drugs eventually stop working. Additional treatments may include: - Antibiotics (possibly given through a vein) to treat infections - Blood transfusions to treat symptoms due to low blood counts Most people with this condition visit a a doctor who is blood disorder specialist (hematologist), a doctor who treats diseases related to glands (endocrinologist), and an eye doctor (ophthalmologist) regularly. They also may see a bone doctor (orthopedist), gynecologist, or kidney disease specialist (nephrologist).",
+    "https://medlineplus.gov/ency/article/000334.htm"
+  ],
+  [
+    "Sideroblastic anemia pyridoxine-refractory autosomal recessive (Treatment): Currently there is not a cure for\u00a0sideroblastic anemia pyridoxine-refractory autosomal recessive , however with proper treatment the life-expectancy of people with\u00a0this\u00a0anemia\u00a0can be close to normal. Treatments are aimed at preventing organ damage from iron overload, and controlling\u00a0symptoms of anemia.\u00a0People with severe anemia\u00a0may require periodic transfusions.\u00a0Transfusions of red cells are\u00a0kept to a minimum, to avoid\u00a0accelerating\u00a0iron overload. [5]\u00a0Treatment of iron overload involves an iron depletion program, such as therapeutic phlebotomy or iron chelation. [5] Total splenectomy is contraindicated in this disorder. [5] This form of sideroblastic anemia\u00a0is not associated with an increased risk for leukemia. [5] A few small studies have described the use of allogenic bone marrow or stem cell transplantation for hereditary and congenital forms of sideroblastic anemia. While these therapies may offer the possibility of a cure, the complications associated with transplantation surgery must be considered. [6] All patients with sideroblastic anemia should be followed by a hematologist and avoid alcohol. [1] [3]",
+    "https://rarediseases.info.nih.gov/diseases/8249/sideroblastic-anemia-pyridoxine-refractory-autosomal-recessive"
+  ],
+  [
+    "Anemia (Treatment): Anemia treatment depends on the cause. - Iron deficiency anemia. Treatment for this form of anemia usually involves taking iron supplements and making changes to your diet. If the underlying cause of iron deficiency is loss of blood - other than from menstruation - the source of the bleeding must be located and stopped. This may involve surgery. - Vitamin deficiency anemias. Treatment for folic acid and B-12 deficiency involves dietary supplements and increasing these nutrients in your diet. If your digestive system has trouble absorbing vitamin B-12 from the food you eat, you may need vitamin B-12 shots. At first, you may receive the shots every other day. Eventually, you'll need shots just once a month, which may continue for life, depending on your situation. - Anemia of chronic disease. There's no specific treatment for this type of anemia. Doctors focus on treating the underlying disease. If symptoms become severe, a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by your kidneys, may help stimulate red blood cell production and ease fatigue. - Aplastic anemia. Treatment for this anemia may include blood transfusions to boost levels of red blood cells. You may need a bone marrow transplant if your bone marrow is diseased and can't make healthy blood cells. - Anemias associated with bone marrow disease. Treatment of these various diseases can include medication, chemotherapy or bone marrow transplantation. - Hemolytic anemias. Managing hemolytic anemias includes avoiding suspect medications, treating related infections and taking drugs that suppress your immune system, which may be attacking your red blood cells. Depending on the severity of your anemia, a blood transfusion or plasmapheresis may be necessary. Plasmapheresis is a type of blood-filtering procedure. In certain cases, removal of the spleen can be helpful. - Sickle cell anemia. Treatment for this anemia may include the administration of oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and prevent complications. Doctors also may recommend blood transfusions, folic acid supplements and antibiotics. A bone marrow transplant may be an effective treatment in some circumstances. A cancer drug called hydroxyurea (Droxia, Hydrea) also is used to treat sickle cell anemia. - Thalassemia. This anemia may be treated with blood transfusions, folic acid supplements, medication, removal of the spleen (splenectomy), or a blood and bone marrow stem cell transplant.",
+    "https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360"
+  ],
+  [
+    "Sideroblastic anemia (Treatment): The treatment of sideroblastic anemia may differ depending on whether the underlying cause is inherited or acquired. For acquired cases, avoidance or removal of the toxin or causative medication may lead to recovery. Vitamin B6 (pyridoxine) therapy may be beneficial in both inherited and acquired forms. If vitamin B6 therapy is not effective, a blood transfusion can be useful, but since it has been known to worsen iron overload, the benefits and limitations of this option should be carefully considered. Rarely, when all other treatment methods have been exhausted, bone marrow transplantation may be utilized. While this therapy may offer the possibility of a cure, the complications associated with transplantation surgery must be considered. [2] [3] It is recommended that all individuals with sideroblastic anemia avoid zinc-containing supplements and the use of alcohol. Regular follow-up and care with a hematologist is important. [3]",
+    "https://rarediseases.info.nih.gov/diseases/667/sideroblastic-anemia"
+  ],
+  [
+    "Sickle cell anemia (Treatment): Bone marrow transplant, also known as stem cell transplant, offers the only potential cure for sickle cell anemia. It's usually reserved for people younger than age 16 because the risks increase for people older than 16. Finding a donor is difficult, and the procedure has serious risks associated with it, including death. As a result, treatment for sickle cell anemia is usually aimed at avoiding crises, relieving symptoms and preventing complications. Babies and children age 2 and younger with sickle cell anemia should make frequent visits to a doctor. Children older than 2 and adults with sickle cell anemia should see a doctor at least once a year, according to the Centers for Disease Control and Prevention. Treatments might include medications to reduce pain and prevent complications, and blood transfusions, as well as a bone marrow transplant. Medications Medications used to treat sickle cell anemia include: - Antibiotics. Children with sickle cell anemia may begin taking the antibiotic penicillin when they're about 2 months old and continue taking it until they're at least 5 years old. Doing so helps prevent infections, such as pneumonia, which can be life-threatening to an infant or child with sickle cell anemia. As an adult, if you've had your spleen removed or had pneumonia, you might need to take penicillin throughout your life. - Pain-relieving medications. To relieve pain during a sickle cell crisis, your doctor might prescribe pain medications. - Hydroxyurea (Droxia, Hydrea). When taken daily, hydroxyurea reduces the frequency of painful crises and might reduce the need for blood transfusions and hospitalizations. Hydroxyurea seems to work by stimulating production of fetal hemoglobin - a type of hemoglobin found in newborns that helps prevent the formation of sickle cells. Hydroxyurea increases your risk of infections, and there is some concern that long-term use of this drug might cause problems later in life for people who take it for many years. More study is needed. Your doctor can help you determine if this drug might be beneficial for you or your child. Don't take the drug if you're pregnant. Assessing stroke risk Using a special ultrasound machine (transcranial), doctors can learn which children have a higher risk of stroke. This painless test, which uses sound waves to measure blood flow, can be used on children as young as 2 years. Regular blood transfusions can decrease stroke risk. Vaccinations to prevent infections Childhood vaccinations are important for preventing disease in all children. They're even more important for children with sickle cell anemia because their infections can be severe. Your doctor will make sure your child receives all of the recommended childhood vaccinations. Vaccinations, such as the pneumococcal vaccine and the annual flu shot, are also important for adults with sickle cell anemia. Blood transfusions In a red blood cell transfusion, red blood cells are removed from a supply of donated blood, then given intravenously to a person with sickle cell anemia. Blood transfusions increase the number of normal red blood cells in circulation, helping to relieve anemia. In children with sickle cell anemia at high risk of stroke, regular blood transfusions can decrease the risk. Transfusions can also be used to treat other complications of sickle cell anemia, or they can be given to prevent complications. Blood transfusions carry some risk, including infection and excess iron buildup in your body. Because excess iron can damage your heart, liver and other organs, people who undergo regular transfusions might need treatment to reduce iron levels. Bone marrow transplant A bone marrow transplant, also called a stem cell transplant, involves replacing bone marrow affected by sickle cell anemia with healthy bone marrow from a donor. The procedure usually uses a matched donor, such as a sibling, who doesn't have sickle cell anemia. For many, donors aren't available. But stem cells from umbilical cord blood might be an option. Because of the risks associated with a bone marrow transplant, the procedure is recommended only for people, usually children, who have significant symptoms and problems from sickle cell anemia. If a donor is found, the person with sickle cell anemia receives radiation or chemotherapy to destroy or reduce his or her bone marrow stem cells. Healthy stem cells from the donor are injected intravenously into the bloodstream of the person with sickle cell anemia, where they migrate to the bone marrow and begin generating new blood cells. The procedure requires a lengthy hospital stay. After the transplant, you'll receive drugs to help prevent rejection of the donated stem cells. Even so, your body might reject the transplant, leading to life-threatening complications. Treating sickle cell complications Doctors treat most complications of sickle cell anemia as they occur. Treatment might include antibiotics, vitamins, blood transfusions, pain-relieving medicines, other medications and possibly surgery, such as to correct vision problems or to remove a damaged spleen. Experimental treatments Scientists are studying new treatments for sickle cell anemia, including: - Gene therapy. Researchers are exploring whether inserting a normal gene into the bone marrow of people with sickle cell anemia will result in normal hemoglobin. Scientists are also exploring the possibility of turning off the defective gene while reactivating another gene responsible for the production of fetal hemoglobin - a type of hemoglobin found in newborns that prevents sickle cells from forming. Potential treatments using gene therapy are a long way off, however. - Nitric oxide. People with sickle cell anemia have low levels of nitric oxide in their blood. Nitric oxide is a gas that helps keep blood vessels open and reduces the stickiness of red blood cells. Treatment with inhaled nitric oxide might prevent sickle cells from clumping together. Studies on nitric oxide have shown little benefit so far. - Drugs to boost fetal hemoglobin production. Researchers are studying various drugs to devise a way to boost the production of fetal hemoglobin. This is a type of hemoglobin that stops sickle cells from forming.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Insulin, Medicines, and Other Diabetes Treatments (Do I have other treatment options for my diabetes?): When medicines and lifestyle changes are not enough to manage your diabetes, a less common treatment may be an option. Other treatments include bariatric surgery for certain people with type 1 or type 2 diabetes, and an \"artificial pancreas\" and\u00a0pancreatic islet transplantation for some people with type 1 diabetes.Bariatric surgeryAlso called weight-loss surgery or metabolic surgery, bariatric surgery may help some people with obesity and type 2 diabetes lose a large amount of weight and regain normal blood glucose levels. Some people with diabetes may no longer need their diabetes medicine after bariatric surgery. Whether and for how long blood glucose levels improve seems to vary by the patient, type of weight-loss surgery, and amount of weight the person loses. Other factors include how long someone has had diabetes and whether or not the person uses insulin.1Recent research suggests that weight-loss surgery also may help improve blood glucose control in people with type 1 diabetes who are obese.2Researchers are studying the long-term results of bariatric surgery in people with type 1 and type 2 diabetes.Artificial PancreasThe NIDDK has played an important role in developing \u201cartificial pancreas\u201d technology. An artificial pancreas replaces manual blood glucose testing and the use of insulin shots or a pump. A single system monitors blood glucose levels around the clock and provides insulin or a combination of insulin and a second hormone, glucagon, automatically. The system can also be monitored remotely, for example by parents or medical staff.In 2016, the FDA approved a type of artificial pancreas system called a hybrid closed-loop system. This system tests your glucose level every 5 minutes throughout the day and night, and automatically gives you the right amount of insulin.You still need to manually adjust the amount of insulin the pump delivers at mealtimes. But, the artificial pancreas may free you from some of the daily tasks needed to keep your blood glucose stable\u2014or help you sleep through the night without the need to wake and test your glucose or take medicine.The hybrid closed-loop system is expected to be available in the U.S. in 2017. Talk with your health care provider about whether this system might be right for you.The NIDDK has funded several important studies on different types of artificial pancreas devices to better help people with type 1 diabetes manage their disease. The devices may also help people with type 2 diabetes and gestational diabetes.Pancreatic islet transplantationPancreatic islet transplantation is an experimental treatment for poorly controlled type 1 diabetes. Pancreatic islets are clusters of cells in the pancreas that make the hormone insulin. In type 1 diabetes, the body\u2019s immune system attacks these cells. A pancreatic islet transplant replaces destroyed islets with new ones that make and release insulin. This procedure takes islets from the pancreas of an organ donor and transfers them to a person with type 1 diabetes. Because researchers are still studying pancreatic islet transplantation, the procedure is only available to people enrolled in research studies. Learn more about islet transplantation studies.",
+    "https://www.niddk.nih.gov/health-information/diabetes/overview/insulin-medicines-treatments"
+  ],
+  [
+    "Anemia (Diagnosis): To diagnose anemia, your doctor may ask you about your medical and family history, perform a physical exam, and run the following tests: - Complete blood count (CBC). A CBC is used to count the number of blood cells in a sample of your blood. For anemia your doctor will be interested in the levels of the red blood cells contained in the blood (hematocrit) and the hemoglobin in your blood. Normal adult hematocrit values vary from one medical practice to another but are generally between 40 and 52 percent for men and 35 and 47 percent for women. Normal adult hemoglobin values are generally 14 to 18 grams per deciliter for men and 12 to 16 grams per deciliter for women. - A test to determine the size and shape of your red blood cells. Some of your red blood cells may also be examined for unusual size, shape and color. Additional diagnostic tests If you receive a diagnosis of anemia, your doctor may order additional tests to determine the underlying cause. For example, iron deficiency anemia can result from chronic bleeding of ulcers, benign polyps in the colon, colon cancer, tumors or kidney problems. Occasionally, it may be necessary to study a sample of your bone marrow to diagnose anemia.",
+    "https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes/syc-20351360"
+  ],
+  [
+    "How to diagnose Anemia?: Your doctor will diagnose anemia based on your medical and family histories, a physical exam, and results from tests and procedures. Because anemia doesn't always cause symptoms, your doctor may find out you have it while checking for another condition. Medical and Family Histories Your doctor may ask whether you have any of the common signs or symptoms of anemia. He or she also may ask whether you've had an illness or condition that could cause anemia. Let your doctor know about any medicines you take, what you typically eat (your diet), and whether you have family members who have anemia or a history of it. Physical Exam Your doctor will do a physical exam to find out how severe your anemia is and to check for possible causes. He or she may: Listen to your heart for a rapid or irregular heartbeat Listen to your lungs for rapid or uneven breathing Feel your abdomen to check the size of your liver and spleen Your doctor also may do a pelvic or rectal exam to check for common sources of blood loss. Diagnostic Tests and Procedures You may have various blood tests and other tests or procedures to find out what type of anemia you have and how severe it is. Complete Blood Count Often, the first test used to diagnose anemia is a complete blood count (CBC). The CBC measures many parts of your blood. The test checks your hemoglobin and hematocrit (hee-MAT-oh-crit) levels. Hemoglobin is the iron-rich protein in red blood cells that carries oxygen to the body. Hematocrit is a measure of how much space red blood cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia. The normal range of these levels might be lower in certain racial and ethnic populations. Your doctor can explain your test results to you. The CBC also checks the number of red blood cells, white blood cells, and platelets in your blood. Abnormal results might be a sign of anemia, another blood disorder, an infection, or another condition. Finally, the CBC looks at mean corpuscular (kor-PUS-kyu-lar) volume (MCV). MCV is a measure of the average size of your red blood cells and a clue as to the cause of your anemia. In iron-deficiency anemia, for example, red blood cells usually are smaller than normal. Other Tests and Procedures If the CBC results show that you have anemia, you may need other tests, such as: Hemoglobin electrophoresis (e-lek-tro-FOR-e-sis). This test looks at the different types of hemoglobin in your blood. The test can help diagnose the type of anemia you have. A reticulocyte (re-TIK-u-lo-site) count. This test measures the number of young red blood cells in your blood. The test shows whether your bone marrow is making red blood cells at the correct rate. Tests for the level of iron in your blood and body. These tests include serum iron and serum ferritin tests. Transferrin level and total iron-binding capacity tests also measure iron levels. Because anemia has many causes, you also might be tested for conditions such as kidney failure, lead poisoning (in children), and vitamin deficiencies (lack of vitamins, such as B12 and folic acid). If your doctor thinks that you have anemia due to internal bleeding, he or she may suggest several tests to look for the source of the bleeding. A test to check the stool for blood might be done in your doctor's office or at home. Your doctor can give you a kit to help you get a sample at home. He or she will tell you to bring the sample back to the office or send it to a laboratory. If blood is found in the stool, you may have other tests to find the source of the bleeding. One such test is endoscopy (en-DOS-ko-pe). For this test, a tube with a tiny camera is used to view the lining of the digestive tract. Your doctor also may want to do bone marrow tests. These tests show whether your bone marrow is healthy and making enough blood cells.",
+    "http://www.nhlbi.nih.gov/health/health-topics/topics/anemia"
+  ],
+  [
+    "How to diagnose Anemia?: The doctor will perform a physical examination, and may find: - A heart murmur - Low blood pressure, especially when you stand up - Pale skin - Rapid heart rate Some types of anemia may cause other findings on a physical exam. Blood tests used to diagnose some common types of anemia may include: - Blood levels of iron, vitamin B12, folic acid, and other vitamins and minerals - Red blood count and hemoglobin level - Reticulocyte count Other tests may be done to find medical problems that can cause anemia.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000560.htm"
+  ],
+  [
+    "Aplastic anemia (Diagnosis): To diagnose aplastic anemia, your doctor may recommend: - Blood tests. Normally, red blood cell, white blood cell and platelet levels stay within a certain range. Your doctor may suspect aplastic anemia when all three of these blood cell levels are very low. - Bone marrow biopsy. To confirm a diagnosis, you'll need to undergo a bone marrow biopsy. In this procedure, a doctor uses a needle to remove a small sample of bone marrow from a large bone in your body, such as your hipbone. The bone marrow sample is examined under a microscope to rule out other blood-related diseases. In aplastic anemia, bone marrow contains fewer blood cells than normal. Once you've received a diagnosis of aplastic anemia, you may need additional tests to determine an underlying cause.",
+    "https://www.mayoclinic.org/diseases-conditions/aplastic-anemia/symptoms-causes/syc-20355015"
+  ],
+  [
+    "Hemolytic Anemia (Diagnosis): Your doctor will diagnose hemolytic anemia based on your medical and family histories, a physical exam, and test results. Specialists Involved Primary care doctors, such as a family doctor or pediatrician, may help diagnose and treat hemolytic anemia. Your primary care doctor also may refer you to a hematologist. This is a doctor who specializes in diagnosing and treating blood diseases and disorders. Doctors and clinics that specialize in treating inherited blood disorders, such as sickle cell anemia and thalassemias, also may be involved. If your hemolytic anemia is inherited, you may want to consult a genetic counselor. A counselor can help you understand your risk of having a child who has the condition. He or she also can explain the choices that are available to you. Medical and Family Histories To find the cause and severity of hemolytic anemia, your doctor may ask detailed questions about your symptoms, personal medical history, and your family medical history. He or she may ask whether: You or anyone in your family has had problems with anemia You've recently had any illnesses or medical conditions You take any medicines, and which ones You've been exposed to certain chemicals or substances You have an artificial heart valve or other medical device that could damage your red blood cells Physical Exam Your doctor will do a physical exam to check for signs of hemolytic anemia. He or she will try to find out how severe the condition is and what's causing it. The exam may include: Checking for jaundice (a yellowish color of the skin or whites of the eyes) Listening to your heart for rapid or irregular heartbeats Listening for rapid or uneven breathing Feeling your abdomen to check the size of your spleen Doing a pelvic and rectal exam to check for internal bleeding Diagnostic Tests and Procedures Many tests are used to diagnose hemolytic anemia. These tests can help confirm a diagnosis, look for a cause, and find out how severe the condition is. Complete Blood Count Often, the first test used to diagnose anemia is a complete blood count (CBC). The CBC measures many parts of your blood. This test checks your hemoglobin and hematocrit (hee-MAT-oh-crit) levels. Hemoglobin is an iron-rich protein in red blood cells that carries oxygen to the body. Hematocrit is a measure of how much space red blood cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia. The normal range of these levels may vary in certain racial and ethnic populations. Your doctor can explain your test results to you. The CBC also checks the number of red blood cells, white blood cells, and platelets in your blood. Abnormal results may be a sign of hemolytic anemia, a different blood disorder, an infection, or another condition. Finally, the CBC looks at mean corpuscular (kor-PUS-kyu-lar) volume (MCV). MCV is a measure of the average size of your red blood cells. The results may be a clue as to the cause of your anemia. Other Blood Tests If the CBC results confirm that you have anemia, you may need other blood tests to find out what type of anemia you have and how severe it is. Reticulocyte count. A reticulocyte (re-TIK-u-lo-site) count measures the number of young red blood cells in your blood. The test shows whether your bone marrow is making red blood cells at the correct rate. People who have hemolytic anemia usually have high reticulocyte counts because their bone marrow is working hard to replace the destroyed red blood cells. Peripheral smear. For this test, your doctor will look at your red blood cells through a microscope. Some types of hemolytic anemia change the normal shape of red blood cells. Coombs' test. This test can show whether your body is making antibodies (proteins) to destroy red blood cells. Haptoglobin, bilirubin, and liver function tests. When red blood cells break down, they release hemoglobin into the bloodstream. The hemoglobin combines with a chemical called haptoglobin. A low level of haptoglobin in the bloodstream is a sign of hemolytic anemia. Hemoglobin is broken down into a compound called bilirubin. High levels of bilirubin in the bloodstream may be a sign of hemolytic anemia. High levels of this compound also occur with some liver and gallbladder diseases. Thus, you may need liver function tests to find out what's causing the high bilirubin levels. Hemoglobin electrophoresis. This test looks at the different types of hemoglobin in your blood. It can help diagnose the type of anemia you have. Testing for paroxysmal nocturnal hemoglobinuria (PNH). In PNH, the red blood cells are missing certain proteins. The test for PNH can detect red blood cells that are missing these proteins. Osmotic fragility test. This test looks for red blood cells that are more fragile than normal. These cells may be a sign of hereditary spherocytosis (an inherited type of hemolytic anemia). Testing for glucose-6-phosphate dehydrogenase (G6PD) deficiency. In G6PD deficiency, the red blood cells are missing an important enzyme called G6PD. The test for G6PD deficiency looks for this enzyme in a sample of blood. Urine Test A urine test will look for the presence of free hemoglobin (a protein that carries oxygen in the blood) and iron. Bone Marrow Tests Bone marrow tests show whether your bone marrow is healthy and making enough blood cells. The two bone marrow tests are aspiration (as-pi-RA-shun) and biopsy. For a bone marrow aspiration, your doctor removes a small amount of fluid bone marrow through a needle. The sample is examined under a microscope to check for faulty cells. A bone marrow biopsy may be done at the same time as an aspiration or afterward. For this test, your doctor removes a small amount of bone marrow tissue through a needle. The tissue is examined to check the number and type of cells in the bone marrow. You may not need bone marrow tests if blood tests show what's causing your hemolytic anemia. Tests for Other Causes of Anemia Because anemia has many causes, you may have tests for conditions such as: Kidney failure Lead poisoning Vitamin or iron deficiency Newborn Testing for Sickle Cell Anemia and G6PD Deficiency All States mandate screening for sickle cell anemia as part of their newborn screening programs. Some States also mandate screening for G6PD deficiency. These inherited types of hemolytic anemia can be detected with routine blood tests. Diagnosing these conditions as early as possible is important so that children can get proper treatment.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/ha"
+  ],
+  [
+    "Fanconi Anemia (Diagnosis): People who have Fanconi anemia (FA) are born with the disorder. They may or may not show signs or symptoms of it at birth. For this reason, FA isn't always diagnosed when a person is born. In fact, most people who have the disorder are diagnosed between the ages of 2 and 15 years. The tests used to diagnose FA depend on a person's age and symptoms. In all cases, medical and family histories are an important part of diagnosing FA. However, because FA has many of the same signs and symptoms as other diseases, only genetic testing can confirm its diagnosis. Specialists Involved A geneticist is a doctor or scientist who studies how genes work and how diseases and traits are passed from parents to children through genes. Geneticists do genetic testing for FA. They also can provide counseling about how FA is inherited and the types of prenatal (before birth) testing used to diagnose it. An obstetrician may detect birth defects linked to FA before your child is born. An obstetrician is a doctor who specializes in providing care for pregnant women. After your child is born, a pediatrician also can help find out whether your child has FA. A pediatrician is a doctor who specializes in treating children and teens. A hematologist (blood disease specialist) also may help diagnose FA. Family and Medical Histories FA is an inherited disease. Some parents are aware that their family has a medical history of FA, even if they don't have the disease. Other parents, especially if they're FA carriers, may not be aware of a family history of FA. Many parents may not know that FA can be passed from parents to children. Knowing your family medical history can help your doctor diagnose whether you or your child has FA or another condition with similar symptoms. If your doctor thinks that you, your siblings, or your children have FA, he or she may ask you detailed questions about: Any personal or family history of anemia Any surgeries you\u2019ve had related to the digestive system Any personal or family history of immune disorders Your appetite, eating habits, and any medicines you take If you know your family has a history of FA, or if your answers to your doctor's questions suggest a possible diagnosis of FA, your doctor will recommend further testing. Diagnostic Tests and Procedures The signs and symptoms of FA aren't unique to the disease. They're also linked to many other diseases and conditions, such as aplastic anemia. For this reason, genetic testing is needed to confirm a diagnosis of FA. Genetic tests for FA include the following. Chromosome Breakage Test This is the most common test for FA. It's available only in special laboratories (labs). It shows whether your chromosomes (long chains of genes) break more easily than normal. Skin cells sometimes are used for the test. Usually, though, a small amount of blood is taken from a vein in your arm using a needle. A technician combines some of the blood cells with certain chemicals. If you have FA, the chromosomes in your blood sample break and rearrange when mixed with the test chemicals. This doesn't happen in the cells of people who don't have FA. Cytometric Flow Analysis Cytometric flow analysis, or CFA, is done in a lab. This test examines how chemicals affect your chromosomes as your cells grow and divide. Skin cells are used for this test. A technician mixes the skin cells with chemicals that can cause the chromosomes in the cells to act abnormally. If you have FA, your cells are much more sensitive to these chemicals. The chromosomes in your skin cells will break at a high rate during the test. This doesn't happen in the cells of people who don't have FA. Mutation Screening A mutation is an abnormal change in a gene or genes. Geneticists and other specialists can examine your genes, usually using a sample of your skin cells. With special equipment and lab processes, they can look for gene mutations that are linked to FA. Diagnosing Different Age Groups Before Birth (Prenatal) If your family has a history of FA and you get pregnant, your doctor may want to test you or your fetus for FA. Two tests can be used to diagnose FA in a developing fetus: amniocentesis (AM-ne-o-sen-TE-sis) and chorionic villus (ko-re-ON-ik VIL-us) sampling (CVS). Both tests are done in a doctor's office or hospital. Amniocentesis is done 15 to 18 weeks after a pregnant woman's last period. A doctor uses a needle to remove a small amount of fluid from the sac around the fetus. A technician tests chromosomes (chains of genes) from the fluid sample to see whether they have faulty genes associated with FA. CVS is done 10 to 12 weeks after a pregnant woman's last period. A doctor inserts a thin tube through the vagina and cervix to the placenta (the temporary organ that connects the fetus to the mother). The doctor removes a tissue sample from the placenta using gentle suction. The tissue sample is sent to a lab to be tested for genetic defects associated with FA. At Birth Three out of four people who inherit FA are born with birth defects. If your baby is born with certain birth defects, your doctor may recommend genetic testing to confirm a diagnosis of FA. For more information about these defects, go to \u201cWhat Are the Signs and Symptoms of Fanconi Anemia?\u201d Childhood and Later Some people who have FA are not born with birth defects. Doctors may not diagnose them with the disorder until signs of bone marrow failure or cancer occur. This usually happens within the first 10 years of life. Signs of bone marrow failure most often begin between the ages of 3 and 12 years, with 7 to 8 years as the most common ages. However, 10 percent of children who have FA aren't diagnosed until after 16 years of age. If your bone marrow is failing, you may have signs of aplastic anemia. FA is one type of aplastic anemia. In aplastic anemia, your bone marrow stops making or doesn't make enough of all three types of blood cells: red blood cells, white blood cells, and platelets. Aplastic anemia can be inherited or acquired after birth through exposure to chemicals, radiation, or medicines. Doctors diagnose aplastic anemia using: Family and medical histories and a physical exam. A complete blood count (CBC) to check the number, size, and condition of your red blood cells. The CBC also checks numbers of white blood cells and platelets. A reticulocyte (re-TIK-u-lo-site) count. This test counts the number of new red blood cells in your blood to see whether your bone marrow is making red blood cells at the proper rate. Bone marrow tests. For a bone marrow aspiration, a small amount of liquid bone marrow is removed and tested to see whether it's making enough blood cells. For a bone marrow biopsy, a small amount of bone marrow tissue is removed and tested to see whether it's making enough blood cells. If you or your child is diagnosed with aplastic anemia, your doctor will want to find the cause. If your doctor suspects you have FA, he or she may recommend genetic testing. For more information, go to the Health Topics Aplastic Anemia article.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/fanconi"
+  ],
+  [
+    "Pernicious Anemia (Diagnosis): Your doctor will diagnose pernicious anemia based on your medical and family histories, a physical exam, and test results. Your doctor will want to find out whether the condition is due to a lack of intrinsic factor or another cause. He or she also will want to find out the severity of the condition, so it can be properly treated. Specialists Involved Primary care doctors\u2014such as family doctors, internists, and pediatricians (doctors who treat children)\u2014often diagnose and treat pernicious anemia. Other kinds of doctors also may be involved, including: A neurologist (nervous system specialist) A cardiologist (heart specialist) A hematologist (blood disease specialist) A gastroenterologist (digestive tract specialist) Medical and Family Histories Your doctor may ask about your signs and symptoms. He or she also may ask: Whether you've had any stomach or intestinal surgeries Whether you have any digestive disorders, such as celiac disease or Crohn's disease About your diet and any medicines you take Whether you have a family history of anemia or pernicious anemia Whether you have a family history of autoimmune disorders (such as Addison's disease, type 1 diabetes, Graves' disease, or vitiligo). Research suggests a link may exist between these autoimmune disorders and pernicious anemia that's caused by an autoimmune response. Physical Exam During the physical exam, your doctor may check for pale or yellowish skin and an enlarged liver. He or she may listen to your heart for rapid or irregular heartbeats or a heart murmur. Your doctor also may check for signs of nerve damage. He or she may want to see how well your muscles, eyes, senses, and reflexes work. Your doctor may ask questions or do tests to check your mental status, coordination, and ability to walk. Diagnostic Tests and Procedures Blood tests and procedures can help diagnose pernicious anemia and find out what's causing it. Complete Blood Count Often, the first test used to diagnose many types of anemia is a complete blood count (CBC). This test measures many parts of your blood. For this test, a small amount of blood is drawn from a vein (usually in your arm) using a needle. A CBC checks your hemoglobin (HEE-muh-glow-bin) and hematocrit (hee-MAT-oh-crit) levels. Hemoglobin is an iron-rich protein that helps red blood cells carry oxygen from the lungs to the rest of the body. Hematocrit is a measure of how much space red blood cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia. The normal range of these levels may be lower in certain racial and ethnic populations. Your doctor can explain your test results to you. The CBC also checks the number of red blood cells, white blood cells, and platelets (PLATE-lets) in your blood. Abnormal results may be a sign of anemia, another blood disorder, an infection, or another condition. Finally, the CBC looks at mean corpuscular (kor-PUS-kyu-lar) volume (MCV). MCV is a measure of the average size of your red blood cells. MCV can be a clue as to what's causing your anemia. In pernicious anemia, the red blood cells tend to be larger than normal. Other Blood Tests If the CBC results confirm that you have anemia, you may need other blood tests to find out what type of anemia you have. A reticulocyte (re-TIK-u-lo-site) count measures the number of young red blood cells in your blood. The test shows whether your bone marrow is making red blood cells at the correct rate. People who have pernicious anemia have low reticulocyte counts. Serum folate, iron, and iron-binding capacity tests also can help show whether you have pernicious anemia or another type of anemia. Another common test, called the Combined Binding Luminescence Test, sometimes gives false results. Scientists are working to develop a more reliable test. Your doctor may recommend other blood tests to check: Your vitamin B12 level. A low level of vitamin B12 in the blood indicates pernicious anemia. However, a falsely normal or high value of vitamin B12 in the blood may occur if antibodies interfere with the test. Your homocysteine and methylmalonic acid (MMA) levels. High levels of these substances in your body are a sign of pernicious anemia. For intrinsic factor antibodies and parietal cell antibodies. These antibodies also are a sign of pernicious anemia. Bone Marrow Tests Bone marrow tests can show whether your bone marrow is healthy and making enough red blood cells. The two bone marrow tests are aspiration (as-pi-RA-shun) and biopsy. For aspiration, your doctor removes a small amount of fluid bone marrow through a needle. For a biopsy, your doctor removes a small amount of bone marrow tissue through a larger needle. The samples are then examined under a microscope. In pernicious anemia, the bone marrow cells that turn into blood cells are larger than normal.",
+    "https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia"
+  ],
+  [
+    "Sideroblastic anemia (Diagnosis): The diagnostic workup for sideroblastic anemia may include blood work ( complete blood count, peripheral smear, iron studies) and a bone marrow aspiration and/or\u00a0 biopsy . Additional studies that may be useful include imaging of the brain, such as MRI and genetic testing for known or suspected hereditary conditions associated with sideroblastic anemia. [3]",
+    "https://rarediseases.info.nih.gov/diseases/667/sideroblastic-anemia"
+  ],
+  [
+    "Aplastic anemia (Diagnosis): Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional.",
+    "https://rarediseases.info.nih.gov/diseases/5836/aplastic-anemia"
+  ],
+  [
+    "Sickle cell anemia: Sickle cell anemia is an inherited form of anemia - a condition in which there aren't enough healthy red blood cells to carry adequate oxygen throughout your body. Normally, your red blood cells are flexible and round, moving easily through your blood vessels. In sickle cell anemia, the red blood cells become rigid and sticky and are shaped like sickles or crescent moons. These irregularly shaped cells can get stuck in small blood vessels, which can slow or block blood flow and oxygen to parts of the body. There's no cure for most people with sickle cell anemia. But treatments can relieve pain and help prevent problems associated with the disease. Signs and symptoms of sickle cell anemia, which vary from person to person and change over time, include: - Anemia. Sickle cells break apart easily and die, leaving you without enough red blood cells. Red blood cells usually live for about 120 days before they need to be replaced. But sickle cells usually die in 10 to 20 days, leaving a shortage of red blood cells (anemia). Without enough red blood cells, your body can't get the oxygen it needs to feel energized, causing fatigue. - Episodes of pain. Periodic episodes of pain, called crises, are a major symptom of sickle cell anemia. Pain develops when sickle-shaped red blood cells block blood flow through tiny blood vessels to your chest, abdomen and joints. Pain can also occur in your bones. The pain varies in intensity and can last for a few hours to a few weeks. Some people have only a few pain episodes. Others have a dozen or more crises a year. If a crisis is severe enough, you might need to be hospitalized. Some adolescents and adults with sickle cell anemia also have chronic pain, which can result from bone and joint damage, ulcers and other causes. - Painful swelling of hands and feet. The swelling is caused by sickle-shaped red blood cells blocking blood flow to the hands and feet. - Frequent infections. Sickle cells can damage an organ that fights infection (spleen), leaving you more vulnerable to infections. Doctors commonly give infants and children with sickle cell anemia vaccinations and antibiotics to prevent potentially life-threatening infections, such as pneumonia. - Delayed growth. Red blood cells provide your body with the oxygen and nutrients you need for growth. A shortage of healthy red blood cells can slow growth in infants and children and delay puberty in teenagers. - Vision problems. Tiny blood vessels that supply your eyes may become plugged with sickle cells. This can damage the retina - the portion of the eye that processes visual images, leading to vision problems. When to see a doctor Although sickle cell anemia is usually diagnosed in infancy, if you or your child develops any of the following problems, see your doctor right away or seek emergency medical care: - Unexplained episodes of severe pain, such as pain in the abdomen, chest, bones or joints. - Swelling in the hands or feet. - Abdominal swelling, especially if the area is tender to the touch. - Fever. People with sickle cell anemia have an increased risk of infection, and fever can be the first sign of an infection. - Pale skin or nail beds. - Yellow tint to the skin or whites of the eyes. - Signs or symptoms of stroke. If you notice one-sided paralysis or weakness in the face, arms or legs; confusion; trouble walking or talking; sudden vision problems or unexplained numbness; or a headache, call 911 or your local emergency number right away. Sickle cell anemia is caused by a mutation in the gene that tells your body to make the red, iron-rich compound that gives blood its red color (hemoglobin). Hemoglobin allows red blood cells to carry oxygen from your lungs to all parts of your body. In sickle cell anemia, the abnormal hemoglobin causes red blood cells to become rigid, sticky and misshapen. The sickle cell gene is passed from generation to generation in a pattern of inheritance called autosomal recessive inheritance. This means that both the mother and the father must pass on the defective form of the gene for a child to be affected. If only one parent passes the sickle cell gene to the child, that child will have the sickle cell trait. With one normal hemoglobin gene and one defective form of the gene, people with the sickle cell trait make both normal hemoglobin and sickle cell hemoglobin. Their blood might contain some sickle cells, but they generally don't have symptoms. But they are carriers of the disease, which means they can pass the gene to their children. For a baby to be born with sickle cell anemia, both parents must carry a sickle cell gene. In the United States, it most commonly affects black people. Sickle cell anemia can lead to a host of complications, including: - Stroke. A stroke can occur if sickle cells block blood flow to an area of your brain. Signs of stroke include seizures, weakness or numbness of your arms and legs, sudden speech difficulties, and loss of consciousness. If your baby or child has any of these signs and symptoms, seek medical treatment immediately. A stroke can be fatal. - Acute chest syndrome. This life-threatening complication causes chest pain, fever and difficulty breathing. Acute chest syndrome can be caused by a lung infection or by sickle cells blocking blood vessels in your lungs. It might require emergency medical treatment with antibiotics and other treatments. - Pulmonary hypertension. People with sickle cell anemia can develop high blood pressure in their lungs (pulmonary hypertension). This complication usually affects adults rather than children. Shortness of breath and fatigue are common symptoms of this condition, which can be fatal. - Organ damage. Sickle cells that block blood flow through blood vessels immediately deprive the affected organ of blood and oxygen. In sickle cell anemia, blood is also chronically low on oxygen. Chronic deprivation of oxygen-rich blood can damage nerves and organs in your body, including your kidneys, liver and spleen. Organ damage can be fatal. - Blindness. Sickle cells can block tiny blood vessels that supply your eyes. Over time, this can damage the portion of the eye that processes visual images (retina) and lead to blindness. - Leg ulcers. Sickle cell anemia can cause open sores, called ulcers, on your legs. - Gallstones. The breakdown of red blood cells produces a substance called bilirubin. A high level of bilirubin in your body can lead to gallstones. - Priapism. Men with sickle cell anemia can have painful, long-lasting erections, a condition called priapism. As occurs in other parts of the body, sickle cells can block the blood vessels in the penis. This can damage the penis and lead to impotence. A blood test can check for hemoglobin S - the defective form of hemoglobin that underlies sickle cell anemia. In the United States, this blood test is part of routine newborn screening done at the hospital. But older children and adults can be tested, too. In adults, a blood sample is drawn from a vein in the arm. In young children and babies, the blood sample is usually collected from a finger or heel. The sample is then sent to a laboratory, where it's screened for hemoglobin S. If the screening test is negative, there is no sickle cell gene present. If the screening test is positive, further tests will be done to determine whether one or two sickle cell genes are present. Additional tests If you or your child has sickle cell anemia, a blood test to check for a low red blood cell count (anemia) will be done. Your doctor might suggest additional tests to check for possible complications of the disease. If you or your child carries the sickle cell gene, you'll likely be referred to a genetic counselor. Tests to detect sickle cell genes before birth Sickle cell disease can be diagnosed in an unborn baby by sampling some of the fluid surrounding the baby in the mother's womb (amniotic fluid) to look for the sickle cell gene. If you or your partner has been diagnosed with sickle cell anemia or sickle cell trait, ask your doctor about whether you should consider this screening. Ask for a referral to a genetic counselor who can help you understand the risk to your baby. Bone marrow transplant, also known as stem cell transplant, offers the only potential cure for sickle cell anemia. It's usually reserved for people younger than age 16 because the risks increase for people older than 16. Finding a donor is difficult, and the procedure has serious risks associated with it, including death. As a result, treatment for sickle cell anemia is usually aimed at avoiding crises, relieving symptoms and preventing complications. Babies and children age 2 and younger with sickle cell anemia should make frequent visits to a doctor. Children older than 2 and adults with sickle cell anemia should see a doctor at least once a year, according to the Centers for Disease Control and Prevention. Treatments might include medications to reduce pain and prevent complications, and blood transfusions, as well as a bone marrow transplant. Medications Medications used to treat sickle cell anemia include: - Antibiotics. Children with sickle cell anemia may begin taking the antibiotic penicillin when they're about 2 months old and continue taking it until they're at least 5 years old. Doing so helps prevent infections, such as pneumonia, which can be life-threatening to an infant or child with sickle cell anemia. As an adult, if you've had your spleen removed or had pneumonia, you might need to take penicillin throughout your life. - Pain-relieving medications. To relieve pain during a sickle cell crisis, your doctor might prescribe pain medications. - Hydroxyurea (Droxia, Hydrea). When taken daily, hydroxyurea reduces the frequency of painful crises and might reduce the need for blood transfusions and hospitalizations. Hydroxyurea seems to work by stimulating production of fetal hemoglobin - a type of hemoglobin found in newborns that helps prevent the formation of sickle cells. Hydroxyurea increases your risk of infections, and there is some concern that long-term use of this drug might cause problems later in life for people who take it for many years. More study is needed. Your doctor can help you determine if this drug might be beneficial for you or your child. Don't take the drug if you're pregnant. Assessing stroke risk Using a special ultrasound machine (transcranial), doctors can learn which children have a higher risk of stroke. This painless test, which uses sound waves to measure blood flow, can be used on children as young as 2 years. Regular blood transfusions can decrease stroke risk. Vaccinations to prevent infections Childhood vaccinations are important for preventing disease in all children. They're even more important for children with sickle cell anemia because their infections can be severe. Your doctor will make sure your child receives all of the recommended childhood vaccinations. Vaccinations, such as the pneumococcal vaccine and the annual flu shot, are also important for adults with sickle cell anemia. Blood transfusions In a red blood cell transfusion, red blood cells are removed from a supply of donated blood, then given intravenously to a person with sickle cell anemia. Blood transfusions increase the number of normal red blood cells in circulation, helping to relieve anemia. In children with sickle cell anemia at high risk of stroke, regular blood transfusions can decrease the risk. Transfusions can also be used to treat other complications of sickle cell anemia, or they can be given to prevent complications. Blood transfusions carry some risk, including infection and excess iron buildup in your body. Because excess iron can damage your heart, liver and other organs, people who undergo regular transfusions might need treatment to reduce iron levels. Bone marrow transplant A bone marrow transplant, also called a stem cell transplant, involves replacing bone marrow affected by sickle cell anemia with healthy bone marrow from a donor. The procedure usually uses a matched donor, such as a sibling, who doesn't have sickle cell anemia. For many, donors aren't available. But stem cells from umbilical cord blood might be an option. Because of the risks associated with a bone marrow transplant, the procedure is recommended only for people, usually children, who have significant symptoms and problems from sickle cell anemia. If a donor is found, the person with sickle cell anemia receives radiation or chemotherapy to destroy or reduce his or her bone marrow stem cells. Healthy stem cells from the donor are injected intravenously into the bloodstream of the person with sickle cell anemia, where they migrate to the bone marrow and begin generating new blood cells. The procedure requires a lengthy hospital stay. After the transplant, you'll receive drugs to help prevent rejection of the donated stem cells. Even so, your body might reject the transplant, leading to life-threatening complications. Treating sickle cell complications Doctors treat most complications of sickle cell anemia as they occur. Treatment might include antibiotics, vitamins, blood transfusions, pain-relieving medicines, other medications and possibly surgery, such as to correct vision problems or to remove a damaged spleen. Experimental treatments Scientists are studying new treatments for sickle cell anemia, including: - Gene therapy. Researchers are exploring whether inserting a normal gene into the bone marrow of people with sickle cell anemia will result in normal hemoglobin. Scientists are also exploring the possibility of turning off the defective gene while reactivating another gene responsible for the production of fetal hemoglobin - a type of hemoglobin found in newborns that prevents sickle cells from forming. Potential treatments using gene therapy are a long way off, however. - Nitric oxide. People with sickle cell anemia have low levels of nitric oxide in their blood. Nitric oxide is a gas that helps keep blood vessels open and reduces the stickiness of red blood cells. Treatment with inhaled nitric oxide might prevent sickle cells from clumping together. Studies on nitric oxide have shown little benefit so far. - Drugs to boost fetal hemoglobin production. Researchers are studying various drugs to devise a way to boost the production of fetal hemoglobin. This is a type of hemoglobin that stops sickle cells from forming. Taking the following steps to stay healthy may help you avoid complications of sickle cell anemia: - Take folic acid supplements daily, and choose a healthy diet. Bone marrow needs folic acid and other vitamins to make new red blood cells. Your doctor might recommend a folic acid supplement. Choose a diet that focuses on a variety of colorful fruits and vegetables, as well as whole grains. - Drink plenty of water. Dehydration can increase your risk of a sickle cell crisis. Drink water throughout your day, aiming for about eight glasses a day. Increase the amount of water you drink if you exercise or spend time in a hot, dry climate. - Avoid temperature extremes. Exposure to extreme heat or cold can increase your risk of a sickle cell crisis. - Exercise regularly, but don't overdo it. Talk with your doctor about how much exercise is right for you. - Use over-the-counter (OTC) medications with caution. Use OTC pain medications, such as ibuprofen (Advil, Motrin IB, Children's Motrin, others) or naproxen sodium (Aleve) sparingly, if at all, because of the possible effect on your kidneys. Ask your doctor before taking OTC drugs.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "How to diagnose Sickle cell anemia?: Tests commonly done diagnose and monitor patients with sickle cell anemia include: - Bilirubin - Blood oxygen saturation - Complete blood count (CBC) - Hemoglobin electrophoresis - Serum creatinine - Serum potassium - Sickle cell test",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000527.htm"
+  ],
+  [
+    "Sickle cell anemia - resources: The following organizations are good resources for information on sickle cell anemia: - American Sickle Cell Anemia Association -- www.ascaa.org - US National Library of Medicine -- ghr.nlm.nih.gov/condition/sickle-cell-disease - National Heart, Lung, and Blood Institute -- www.nhlbi.nih.gov/health/health-topics/topics/sca/ - Sickle Cell Disease Association of America -- www.sicklecelldisease.org - Centers for Disease Control and Prevention -- www.cdc.gov/ncbddd/sicklecell Updated by: Jennifer K. Mannheim, ARNP, Medical Staff, Department of Psychiatry and Behavioral Health, Seattle Children's Hospital, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002200.htm"
+  ],
+  [
+    "Sickle cell anemia: Sickle cell anemia is a disease passed down through families. The red blood cells that are normally shaped like a disc take on a sickle or crescent shape. Red blood cells carry oxygen throughout the body. Sickle cell anemia is caused by an abnormal type of hemoglobin called hemoglobin S. Hemoglobin is a protein inside red blood cells that carries oxygen. - Hemoglobin S changes the red blood cells. The red blood cells become fragile and shaped like crescents or sickles. - The abnormal cells deliver less oxygen to the body's tissues. - They can also easily get stuck in small blood vessels and break into pieces. This can interrupt healthy blood flow and cut down even more on the amount of oxygen flowing to body tissues. Sickle cell anemia is inherited from both parents. If you get the sickle cell gene from only 1 parent, you will have sickle cell trait. People with sickle cell trait do not have the symptoms of sickle cell anemia. Sickle cell disease is much more common in people of African and Mediterranean descent. It is also seen in people from South and Central America, the Caribbean, and the Middle East. Symptoms usually do not occur until after the age of 4 months. Almost all people with sickle cell anemia have painful episodes called crises. These can last from hours to days. Crises can cause pain in the lower back, leg, joints, and chest. Some people have 1 episode every few years. Others have many episodes each year. The crises can be severe enough to require a hospital stay. When the anemia becomes more severe, symptoms may include: - Fatigue - Paleness - Rapid heart rate - Shortness of breath - Yellowing of the eyes and skin (jaundice) Younger children with sickle cell anemia have attacks of abdominal pain. The following symptoms may occur because small blood vessels become blocked by the abnormal cells: - Painful and prolonged erection (priapism) - Poor eyesight or blindness - Problems with thinking or confusion caused by small strokes - Ulcers on the lower legs (in adolescents and adults) Over time, the spleen stops working. As a result, people with sickle cell anemia may have symptoms of infections such as: - Bone infection (osteomyelitis) - Gallbladder infection (cholecystitis) - Lung infection (pneumonia) - Urinary tract infection Other signs and symptoms include: - Delayed growth and puberty - Painful joints caused by arthritis - Heart or liver failure due to too much iron (from blood transfusions) Tests commonly done to diagnose and monitor people with sickle cell anemia include: - Bilirubin - Blood oxygen saturation - Complete blood count (CBC) - Hemoglobin electrophoresis - Serum creatinine - Serum potassium - Sickle cell test The goal of treatment is to manage and control symptoms, and to limit the number of crises. People with sickle cell disease need ongoing treatment, even when not having a crisis. People with this condition should take folic acid supplements. Folic acid helps make new red blood cells. Treatment for a sickle cell crisis includes: - Blood transfusions (may also be given regularly to prevent stroke) - Pain medicines - Plenty of fluids Other treatments for sickle cell anemia may include: - Hydroxyurea (Hydrea), which helps reduce the number of pain episodes (including chest pain and breathing problems) in some people - Antibiotics, which help prevent bacterial infections that are common in children with sickle cell disease - Medicines that reduce the amount of iron in the body. Treatments that may be needed to manage complications of sickle cell anemia include: - Dialysis or kidney transplant for kidney disease - Counseling for psychological complications - Gallbladder removal in people with gallstone disease - Hip replacement for avascular necrosis of the hip - Surgery for eye problems - Treatment for overuse or abuse of narcotic pain medicines - Wound care for leg ulcers Bone marrow or stem cell transplants can cure sickle cell anemia, but this treatment is not an option for most people. Sickle cell anemia people often cannot find well-matched stem cell donors. People with sickle cell disease should have the following vaccinations to lower the risk of infection: - Haemophilus influenzae vaccine (Hib) - Pneumococcal conjugate vaccine (PCV) - Pneumococcal polysaccharide vaccine (PPV) Joining a support group where members share common issues can relieve the stress of a chronic disease. In the past, people with sickle cell disease often died between ages 20 and 40. Thanks to a modern care, people now can live to the age of 50 and beyond. Causes of death include organ failure and infection. Call your health care provider if you have: - Any symptoms of infection (fever, body aches, headache, fatigue) - Pain crises - Painful and long-term erection (in men) Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists and Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000527.htm"
+  ],
+  [
+    "Sickle cell anemia (Treatment): Bone marrow transplant, also known as stem cell transplant, offers the only potential cure for sickle cell anemia. It's usually reserved for people younger than age 16 because the risks increase for people older than 16. Finding a donor is difficult, and the procedure has serious risks associated with it, including death. As a result, treatment for sickle cell anemia is usually aimed at avoiding crises, relieving symptoms and preventing complications. Babies and children age 2 and younger with sickle cell anemia should make frequent visits to a doctor. Children older than 2 and adults with sickle cell anemia should see a doctor at least once a year, according to the Centers for Disease Control and Prevention. Treatments might include medications to reduce pain and prevent complications, and blood transfusions, as well as a bone marrow transplant. Medications Medications used to treat sickle cell anemia include: - Antibiotics. Children with sickle cell anemia may begin taking the antibiotic penicillin when they're about 2 months old and continue taking it until they're at least 5 years old. Doing so helps prevent infections, such as pneumonia, which can be life-threatening to an infant or child with sickle cell anemia. As an adult, if you've had your spleen removed or had pneumonia, you might need to take penicillin throughout your life. - Pain-relieving medications. To relieve pain during a sickle cell crisis, your doctor might prescribe pain medications. - Hydroxyurea (Droxia, Hydrea). When taken daily, hydroxyurea reduces the frequency of painful crises and might reduce the need for blood transfusions and hospitalizations. Hydroxyurea seems to work by stimulating production of fetal hemoglobin - a type of hemoglobin found in newborns that helps prevent the formation of sickle cells. Hydroxyurea increases your risk of infections, and there is some concern that long-term use of this drug might cause problems later in life for people who take it for many years. More study is needed. Your doctor can help you determine if this drug might be beneficial for you or your child. Don't take the drug if you're pregnant. Assessing stroke risk Using a special ultrasound machine (transcranial), doctors can learn which children have a higher risk of stroke. This painless test, which uses sound waves to measure blood flow, can be used on children as young as 2 years. Regular blood transfusions can decrease stroke risk. Vaccinations to prevent infections Childhood vaccinations are important for preventing disease in all children. They're even more important for children with sickle cell anemia because their infections can be severe. Your doctor will make sure your child receives all of the recommended childhood vaccinations. Vaccinations, such as the pneumococcal vaccine and the annual flu shot, are also important for adults with sickle cell anemia. Blood transfusions In a red blood cell transfusion, red blood cells are removed from a supply of donated blood, then given intravenously to a person with sickle cell anemia. Blood transfusions increase the number of normal red blood cells in circulation, helping to relieve anemia. In children with sickle cell anemia at high risk of stroke, regular blood transfusions can decrease the risk. Transfusions can also be used to treat other complications of sickle cell anemia, or they can be given to prevent complications. Blood transfusions carry some risk, including infection and excess iron buildup in your body. Because excess iron can damage your heart, liver and other organs, people who undergo regular transfusions might need treatment to reduce iron levels. Bone marrow transplant A bone marrow transplant, also called a stem cell transplant, involves replacing bone marrow affected by sickle cell anemia with healthy bone marrow from a donor. The procedure usually uses a matched donor, such as a sibling, who doesn't have sickle cell anemia. For many, donors aren't available. But stem cells from umbilical cord blood might be an option. Because of the risks associated with a bone marrow transplant, the procedure is recommended only for people, usually children, who have significant symptoms and problems from sickle cell anemia. If a donor is found, the person with sickle cell anemia receives radiation or chemotherapy to destroy or reduce his or her bone marrow stem cells. Healthy stem cells from the donor are injected intravenously into the bloodstream of the person with sickle cell anemia, where they migrate to the bone marrow and begin generating new blood cells. The procedure requires a lengthy hospital stay. After the transplant, you'll receive drugs to help prevent rejection of the donated stem cells. Even so, your body might reject the transplant, leading to life-threatening complications. Treating sickle cell complications Doctors treat most complications of sickle cell anemia as they occur. Treatment might include antibiotics, vitamins, blood transfusions, pain-relieving medicines, other medications and possibly surgery, such as to correct vision problems or to remove a damaged spleen. Experimental treatments Scientists are studying new treatments for sickle cell anemia, including: - Gene therapy. Researchers are exploring whether inserting a normal gene into the bone marrow of people with sickle cell anemia will result in normal hemoglobin. Scientists are also exploring the possibility of turning off the defective gene while reactivating another gene responsible for the production of fetal hemoglobin - a type of hemoglobin found in newborns that prevents sickle cells from forming. Potential treatments using gene therapy are a long way off, however. - Nitric oxide. People with sickle cell anemia have low levels of nitric oxide in their blood. Nitric oxide is a gas that helps keep blood vessels open and reduces the stickiness of red blood cells. Treatment with inhaled nitric oxide might prevent sickle cells from clumping together. Studies on nitric oxide have shown little benefit so far. - Drugs to boost fetal hemoglobin production. Researchers are studying various drugs to devise a way to boost the production of fetal hemoglobin. This is a type of hemoglobin that stops sickle cells from forming.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Diagnosis): A blood test can check for hemoglobin S - the defective form of hemoglobin that underlies sickle cell anemia. In the United States, this blood test is part of routine newborn screening done at the hospital. But older children and adults can be tested, too. In adults, a blood sample is drawn from a vein in the arm. In young children and babies, the blood sample is usually collected from a finger or heel. The sample is then sent to a laboratory, where it's screened for hemoglobin S. If the screening test is negative, there is no sickle cell gene present. If the screening test is positive, further tests will be done to determine whether one or two sickle cell genes are present. Additional tests If you or your child has sickle cell anemia, a blood test to check for a low red blood cell count (anemia) will be done. Your doctor might suggest additional tests to check for possible complications of the disease. If you or your child carries the sickle cell gene, you'll likely be referred to a genetic counselor. Tests to detect sickle cell genes before birth Sickle cell disease can be diagnosed in an unborn baby by sampling some of the fluid surrounding the baby in the mother's womb (amniotic fluid) to look for the sickle cell gene. If you or your partner has been diagnosed with sickle cell anemia or sickle cell trait, ask your doctor about whether you should consider this screening. Ask for a referral to a genetic counselor who can help you understand the risk to your baby.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Complications): Sickle cell anemia can lead to a host of complications, including: - Stroke. A stroke can occur if sickle cells block blood flow to an area of your brain. Signs of stroke include seizures, weakness or numbness of your arms and legs, sudden speech difficulties, and loss of consciousness. If your baby or child has any of these signs and symptoms, seek medical treatment immediately. A stroke can be fatal. - Acute chest syndrome. This life-threatening complication causes chest pain, fever and difficulty breathing. Acute chest syndrome can be caused by a lung infection or by sickle cells blocking blood vessels in your lungs. It might require emergency medical treatment with antibiotics and other treatments. - Pulmonary hypertension. People with sickle cell anemia can develop high blood pressure in their lungs (pulmonary hypertension). This complication usually affects adults rather than children. Shortness of breath and fatigue are common symptoms of this condition, which can be fatal. - Organ damage. Sickle cells that block blood flow through blood vessels immediately deprive the affected organ of blood and oxygen. In sickle cell anemia, blood is also chronically low on oxygen. Chronic deprivation of oxygen-rich blood can damage nerves and organs in your body, including your kidneys, liver and spleen. Organ damage can be fatal. - Blindness. Sickle cells can block tiny blood vessels that supply your eyes. Over time, this can damage the portion of the eye that processes visual images (retina) and lead to blindness. - Leg ulcers. Sickle cell anemia can cause open sores, called ulcers, on your legs. - Gallstones. The breakdown of red blood cells produces a substance called bilirubin. A high level of bilirubin in your body can lead to gallstones. - Priapism. Men with sickle cell anemia can have painful, long-lasting erections, a condition called priapism. As occurs in other parts of the body, sickle cells can block the blood vessels in the penis. This can damage the penis and lead to impotence.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Causes): Sickle cell anemia is caused by a mutation in the gene that tells your body to make the red, iron-rich compound that gives blood its red color (hemoglobin). Hemoglobin allows red blood cells to carry oxygen from your lungs to all parts of your body. In sickle cell anemia, the abnormal hemoglobin causes red blood cells to become rigid, sticky and misshapen. The sickle cell gene is passed from generation to generation in a pattern of inheritance called autosomal recessive inheritance. This means that both the mother and the father must pass on the defective form of the gene for a child to be affected. If only one parent passes the sickle cell gene to the child, that child will have the sickle cell trait. With one normal hemoglobin gene and one defective form of the gene, people with the sickle cell trait make both normal hemoglobin and sickle cell hemoglobin. Their blood might contain some sickle cells, but they generally don't have symptoms. But they are carriers of the disease, which means they can pass the gene to their children.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia - resources (Summary): The following organizations are good resources for information on sickle cell anemia: - American Sickle Cell Anemia Association -- www.ascaa.org - US National Library of Medicine -- ghr.nlm.nih.gov/condition/sickle-cell-disease - National Heart, Lung, and Blood Institute -- www.nhlbi.nih.gov/health/health-topics/topics/sca/ - Sickle Cell Disease Association of America -- www.sicklecelldisease.org - Centers for Disease Control and Prevention -- www.cdc.gov/ncbddd/sicklecell",
+    "https://medlineplus.gov/ency/article/002200.htm"
+  ],
+  [
+    "How to diagnose Sickle cell anemia?: Tests commonly done diagnose and monitor patients with sickle cell anemia include: - Bilirubin - Blood oxygen saturation - Complete blood count (CBC) - Hemoglobin electrophoresis - Serum creatinine - Serum potassium - Sickle cell test",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000527.htm"
+  ],
+  [
+    "Sickle cell anemia (Treatment): Bone marrow transplant, also known as stem cell transplant, offers the only potential cure for sickle cell anemia. It's usually reserved for people younger than age 16 because the risks increase for people older than 16. Finding a donor is difficult, and the procedure has serious risks associated with it, including death. As a result, treatment for sickle cell anemia is usually aimed at avoiding crises, relieving symptoms and preventing complications. Babies and children age 2 and younger with sickle cell anemia should make frequent visits to a doctor. Children older than 2 and adults with sickle cell anemia should see a doctor at least once a year, according to the Centers for Disease Control and Prevention. Treatments might include medications to reduce pain and prevent complications, and blood transfusions, as well as a bone marrow transplant. Medications Medications used to treat sickle cell anemia include: - Antibiotics. Children with sickle cell anemia may begin taking the antibiotic penicillin when they're about 2 months old and continue taking it until they're at least 5 years old. Doing so helps prevent infections, such as pneumonia, which can be life-threatening to an infant or child with sickle cell anemia. As an adult, if you've had your spleen removed or had pneumonia, you might need to take penicillin throughout your life. - Pain-relieving medications. To relieve pain during a sickle cell crisis, your doctor might prescribe pain medications. - Hydroxyurea (Droxia, Hydrea). When taken daily, hydroxyurea reduces the frequency of painful crises and might reduce the need for blood transfusions and hospitalizations. Hydroxyurea seems to work by stimulating production of fetal hemoglobin - a type of hemoglobin found in newborns that helps prevent the formation of sickle cells. Hydroxyurea increases your risk of infections, and there is some concern that long-term use of this drug might cause problems later in life for people who take it for many years. More study is needed. Your doctor can help you determine if this drug might be beneficial for you or your child. Don't take the drug if you're pregnant. Assessing stroke risk Using a special ultrasound machine (transcranial), doctors can learn which children have a higher risk of stroke. This painless test, which uses sound waves to measure blood flow, can be used on children as young as 2 years. Regular blood transfusions can decrease stroke risk. Vaccinations to prevent infections Childhood vaccinations are important for preventing disease in all children. They're even more important for children with sickle cell anemia because their infections can be severe. Your doctor will make sure your child receives all of the recommended childhood vaccinations. Vaccinations, such as the pneumococcal vaccine and the annual flu shot, are also important for adults with sickle cell anemia. Blood transfusions In a red blood cell transfusion, red blood cells are removed from a supply of donated blood, then given intravenously to a person with sickle cell anemia. Blood transfusions increase the number of normal red blood cells in circulation, helping to relieve anemia. In children with sickle cell anemia at high risk of stroke, regular blood transfusions can decrease the risk. Transfusions can also be used to treat other complications of sickle cell anemia, or they can be given to prevent complications. Blood transfusions carry some risk, including infection and excess iron buildup in your body. Because excess iron can damage your heart, liver and other organs, people who undergo regular transfusions might need treatment to reduce iron levels. Bone marrow transplant A bone marrow transplant, also called a stem cell transplant, involves replacing bone marrow affected by sickle cell anemia with healthy bone marrow from a donor. The procedure usually uses a matched donor, such as a sibling, who doesn't have sickle cell anemia. For many, donors aren't available. But stem cells from umbilical cord blood might be an option. Because of the risks associated with a bone marrow transplant, the procedure is recommended only for people, usually children, who have significant symptoms and problems from sickle cell anemia. If a donor is found, the person with sickle cell anemia receives radiation or chemotherapy to destroy or reduce his or her bone marrow stem cells. Healthy stem cells from the donor are injected intravenously into the bloodstream of the person with sickle cell anemia, where they migrate to the bone marrow and begin generating new blood cells. The procedure requires a lengthy hospital stay. After the transplant, you'll receive drugs to help prevent rejection of the donated stem cells. Even so, your body might reject the transplant, leading to life-threatening complications. Treating sickle cell complications Doctors treat most complications of sickle cell anemia as they occur. Treatment might include antibiotics, vitamins, blood transfusions, pain-relieving medicines, other medications and possibly surgery, such as to correct vision problems or to remove a damaged spleen. Experimental treatments Scientists are studying new treatments for sickle cell anemia, including: - Gene therapy. Researchers are exploring whether inserting a normal gene into the bone marrow of people with sickle cell anemia will result in normal hemoglobin. Scientists are also exploring the possibility of turning off the defective gene while reactivating another gene responsible for the production of fetal hemoglobin - a type of hemoglobin found in newborns that prevents sickle cells from forming. Potential treatments using gene therapy are a long way off, however. - Nitric oxide. People with sickle cell anemia have low levels of nitric oxide in their blood. Nitric oxide is a gas that helps keep blood vessels open and reduces the stickiness of red blood cells. Treatment with inhaled nitric oxide might prevent sickle cells from clumping together. Studies on nitric oxide have shown little benefit so far. - Drugs to boost fetal hemoglobin production. Researchers are studying various drugs to devise a way to boost the production of fetal hemoglobin. This is a type of hemoglobin that stops sickle cells from forming.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia: Sickle cell anemia is an inherited form of anemia - a condition in which there aren't enough healthy red blood cells to carry adequate oxygen throughout your body. Normally, your red blood cells are flexible and round, moving easily through your blood vessels. In sickle cell anemia, the red blood cells become rigid and sticky and are shaped like sickles or crescent moons. These irregularly shaped cells can get stuck in small blood vessels, which can slow or block blood flow and oxygen to parts of the body. There's no cure for most people with sickle cell anemia. But treatments can relieve pain and help prevent problems associated with the disease. Signs and symptoms of sickle cell anemia, which vary from person to person and change over time, include: - Anemia. Sickle cells break apart easily and die, leaving you without enough red blood cells. Red blood cells usually live for about 120 days before they need to be replaced. But sickle cells usually die in 10 to 20 days, leaving a shortage of red blood cells (anemia). Without enough red blood cells, your body can't get the oxygen it needs to feel energized, causing fatigue. - Episodes of pain. Periodic episodes of pain, called crises, are a major symptom of sickle cell anemia. Pain develops when sickle-shaped red blood cells block blood flow through tiny blood vessels to your chest, abdomen and joints. Pain can also occur in your bones. The pain varies in intensity and can last for a few hours to a few weeks. Some people have only a few pain episodes. Others have a dozen or more crises a year. If a crisis is severe enough, you might need to be hospitalized. Some adolescents and adults with sickle cell anemia also have chronic pain, which can result from bone and joint damage, ulcers and other causes. - Painful swelling of hands and feet. The swelling is caused by sickle-shaped red blood cells blocking blood flow to the hands and feet. - Frequent infections. Sickle cells can damage an organ that fights infection (spleen), leaving you more vulnerable to infections. Doctors commonly give infants and children with sickle cell anemia vaccinations and antibiotics to prevent potentially life-threatening infections, such as pneumonia. - Delayed growth. Red blood cells provide your body with the oxygen and nutrients you need for growth. A shortage of healthy red blood cells can slow growth in infants and children and delay puberty in teenagers. - Vision problems. Tiny blood vessels that supply your eyes may become plugged with sickle cells. This can damage the retina - the portion of the eye that processes visual images, leading to vision problems. When to see a doctor Although sickle cell anemia is usually diagnosed in infancy, if you or your child develops any of the following problems, see your doctor right away or seek emergency medical care: - Unexplained episodes of severe pain, such as pain in the abdomen, chest, bones or joints. - Swelling in the hands or feet. - Abdominal swelling, especially if the area is tender to the touch. - Fever. People with sickle cell anemia have an increased risk of infection, and fever can be the first sign of an infection. - Pale skin or nail beds. - Yellow tint to the skin or whites of the eyes. - Signs or symptoms of stroke. If you notice one-sided paralysis or weakness in the face, arms or legs; confusion; trouble walking or talking; sudden vision problems or unexplained numbness; or a headache, call 911 or your local emergency number right away. Sickle cell anemia is caused by a mutation in the gene that tells your body to make the red, iron-rich compound that gives blood its red color (hemoglobin). Hemoglobin allows red blood cells to carry oxygen from your lungs to all parts of your body. In sickle cell anemia, the abnormal hemoglobin causes red blood cells to become rigid, sticky and misshapen. The sickle cell gene is passed from generation to generation in a pattern of inheritance called autosomal recessive inheritance. This means that both the mother and the father must pass on the defective form of the gene for a child to be affected. If only one parent passes the sickle cell gene to the child, that child will have the sickle cell trait. With one normal hemoglobin gene and one defective form of the gene, people with the sickle cell trait make both normal hemoglobin and sickle cell hemoglobin. Their blood might contain some sickle cells, but they generally don't have symptoms. But they are carriers of the disease, which means they can pass the gene to their children. For a baby to be born with sickle cell anemia, both parents must carry a sickle cell gene. In the United States, it most commonly affects black people. Sickle cell anemia can lead to a host of complications, including: - Stroke. A stroke can occur if sickle cells block blood flow to an area of your brain. Signs of stroke include seizures, weakness or numbness of your arms and legs, sudden speech difficulties, and loss of consciousness. If your baby or child has any of these signs and symptoms, seek medical treatment immediately. A stroke can be fatal. - Acute chest syndrome. This life-threatening complication causes chest pain, fever and difficulty breathing. Acute chest syndrome can be caused by a lung infection or by sickle cells blocking blood vessels in your lungs. It might require emergency medical treatment with antibiotics and other treatments. - Pulmonary hypertension. People with sickle cell anemia can develop high blood pressure in their lungs (pulmonary hypertension). This complication usually affects adults rather than children. Shortness of breath and fatigue are common symptoms of this condition, which can be fatal. - Organ damage. Sickle cells that block blood flow through blood vessels immediately deprive the affected organ of blood and oxygen. In sickle cell anemia, blood is also chronically low on oxygen. Chronic deprivation of oxygen-rich blood can damage nerves and organs in your body, including your kidneys, liver and spleen. Organ damage can be fatal. - Blindness. Sickle cells can block tiny blood vessels that supply your eyes. Over time, this can damage the portion of the eye that processes visual images (retina) and lead to blindness. - Leg ulcers. Sickle cell anemia can cause open sores, called ulcers, on your legs. - Gallstones. The breakdown of red blood cells produces a substance called bilirubin. A high level of bilirubin in your body can lead to gallstones. - Priapism. Men with sickle cell anemia can have painful, long-lasting erections, a condition called priapism. As occurs in other parts of the body, sickle cells can block the blood vessels in the penis. This can damage the penis and lead to impotence. A blood test can check for hemoglobin S - the defective form of hemoglobin that underlies sickle cell anemia. In the United States, this blood test is part of routine newborn screening done at the hospital. But older children and adults can be tested, too. In adults, a blood sample is drawn from a vein in the arm. In young children and babies, the blood sample is usually collected from a finger or heel. The sample is then sent to a laboratory, where it's screened for hemoglobin S. If the screening test is negative, there is no sickle cell gene present. If the screening test is positive, further tests will be done to determine whether one or two sickle cell genes are present. Additional tests If you or your child has sickle cell anemia, a blood test to check for a low red blood cell count (anemia) will be done. Your doctor might suggest additional tests to check for possible complications of the disease. If you or your child carries the sickle cell gene, you'll likely be referred to a genetic counselor. Tests to detect sickle cell genes before birth Sickle cell disease can be diagnosed in an unborn baby by sampling some of the fluid surrounding the baby in the mother's womb (amniotic fluid) to look for the sickle cell gene. If you or your partner has been diagnosed with sickle cell anemia or sickle cell trait, ask your doctor about whether you should consider this screening. Ask for a referral to a genetic counselor who can help you understand the risk to your baby. Bone marrow transplant, also known as stem cell transplant, offers the only potential cure for sickle cell anemia. It's usually reserved for people younger than age 16 because the risks increase for people older than 16. Finding a donor is difficult, and the procedure has serious risks associated with it, including death. As a result, treatment for sickle cell anemia is usually aimed at avoiding crises, relieving symptoms and preventing complications. Babies and children age 2 and younger with sickle cell anemia should make frequent visits to a doctor. Children older than 2 and adults with sickle cell anemia should see a doctor at least once a year, according to the Centers for Disease Control and Prevention. Treatments might include medications to reduce pain and prevent complications, and blood transfusions, as well as a bone marrow transplant. Medications Medications used to treat sickle cell anemia include: - Antibiotics. Children with sickle cell anemia may begin taking the antibiotic penicillin when they're about 2 months old and continue taking it until they're at least 5 years old. Doing so helps prevent infections, such as pneumonia, which can be life-threatening to an infant or child with sickle cell anemia. As an adult, if you've had your spleen removed or had pneumonia, you might need to take penicillin throughout your life. - Pain-relieving medications. To relieve pain during a sickle cell crisis, your doctor might prescribe pain medications. - Hydroxyurea (Droxia, Hydrea). When taken daily, hydroxyurea reduces the frequency of painful crises and might reduce the need for blood transfusions and hospitalizations. Hydroxyurea seems to work by stimulating production of fetal hemoglobin - a type of hemoglobin found in newborns that helps prevent the formation of sickle cells. Hydroxyurea increases your risk of infections, and there is some concern that long-term use of this drug might cause problems later in life for people who take it for many years. More study is needed. Your doctor can help you determine if this drug might be beneficial for you or your child. Don't take the drug if you're pregnant. Assessing stroke risk Using a special ultrasound machine (transcranial), doctors can learn which children have a higher risk of stroke. This painless test, which uses sound waves to measure blood flow, can be used on children as young as 2 years. Regular blood transfusions can decrease stroke risk. Vaccinations to prevent infections Childhood vaccinations are important for preventing disease in all children. They're even more important for children with sickle cell anemia because their infections can be severe. Your doctor will make sure your child receives all of the recommended childhood vaccinations. Vaccinations, such as the pneumococcal vaccine and the annual flu shot, are also important for adults with sickle cell anemia. Blood transfusions In a red blood cell transfusion, red blood cells are removed from a supply of donated blood, then given intravenously to a person with sickle cell anemia. Blood transfusions increase the number of normal red blood cells in circulation, helping to relieve anemia. In children with sickle cell anemia at high risk of stroke, regular blood transfusions can decrease the risk. Transfusions can also be used to treat other complications of sickle cell anemia, or they can be given to prevent complications. Blood transfusions carry some risk, including infection and excess iron buildup in your body. Because excess iron can damage your heart, liver and other organs, people who undergo regular transfusions might need treatment to reduce iron levels. Bone marrow transplant A bone marrow transplant, also called a stem cell transplant, involves replacing bone marrow affected by sickle cell anemia with healthy bone marrow from a donor. The procedure usually uses a matched donor, such as a sibling, who doesn't have sickle cell anemia. For many, donors aren't available. But stem cells from umbilical cord blood might be an option. Because of the risks associated with a bone marrow transplant, the procedure is recommended only for people, usually children, who have significant symptoms and problems from sickle cell anemia. If a donor is found, the person with sickle cell anemia receives radiation or chemotherapy to destroy or reduce his or her bone marrow stem cells. Healthy stem cells from the donor are injected intravenously into the bloodstream of the person with sickle cell anemia, where they migrate to the bone marrow and begin generating new blood cells. The procedure requires a lengthy hospital stay. After the transplant, you'll receive drugs to help prevent rejection of the donated stem cells. Even so, your body might reject the transplant, leading to life-threatening complications. Treating sickle cell complications Doctors treat most complications of sickle cell anemia as they occur. Treatment might include antibiotics, vitamins, blood transfusions, pain-relieving medicines, other medications and possibly surgery, such as to correct vision problems or to remove a damaged spleen. Experimental treatments Scientists are studying new treatments for sickle cell anemia, including: - Gene therapy. Researchers are exploring whether inserting a normal gene into the bone marrow of people with sickle cell anemia will result in normal hemoglobin. Scientists are also exploring the possibility of turning off the defective gene while reactivating another gene responsible for the production of fetal hemoglobin - a type of hemoglobin found in newborns that prevents sickle cells from forming. Potential treatments using gene therapy are a long way off, however. - Nitric oxide. People with sickle cell anemia have low levels of nitric oxide in their blood. Nitric oxide is a gas that helps keep blood vessels open and reduces the stickiness of red blood cells. Treatment with inhaled nitric oxide might prevent sickle cells from clumping together. Studies on nitric oxide have shown little benefit so far. - Drugs to boost fetal hemoglobin production. Researchers are studying various drugs to devise a way to boost the production of fetal hemoglobin. This is a type of hemoglobin that stops sickle cells from forming. Taking the following steps to stay healthy may help you avoid complications of sickle cell anemia: - Take folic acid supplements daily, and choose a healthy diet. Bone marrow needs folic acid and other vitamins to make new red blood cells. Your doctor might recommend a folic acid supplement. Choose a diet that focuses on a variety of colorful fruits and vegetables, as well as whole grains. - Drink plenty of water. Dehydration can increase your risk of a sickle cell crisis. Drink water throughout your day, aiming for about eight glasses a day. Increase the amount of water you drink if you exercise or spend time in a hot, dry climate. - Avoid temperature extremes. Exposure to extreme heat or cold can increase your risk of a sickle cell crisis. - Exercise regularly, but don't overdo it. Talk with your doctor about how much exercise is right for you. - Use over-the-counter (OTC) medications with caution. Use OTC pain medications, such as ibuprofen (Advil, Motrin IB, Children's Motrin, others) or naproxen sodium (Aleve) sparingly, if at all, because of the possible effect on your kidneys. Ask your doctor before taking OTC drugs.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Diagnosis): A blood test can check for hemoglobin S - the defective form of hemoglobin that underlies sickle cell anemia. In the United States, this blood test is part of routine newborn screening done at the hospital. But older children and adults can be tested, too. In adults, a blood sample is drawn from a vein in the arm. In young children and babies, the blood sample is usually collected from a finger or heel. The sample is then sent to a laboratory, where it's screened for hemoglobin S. If the screening test is negative, there is no sickle cell gene present. If the screening test is positive, further tests will be done to determine whether one or two sickle cell genes are present. Additional tests If you or your child has sickle cell anemia, a blood test to check for a low red blood cell count (anemia) will be done. Your doctor might suggest additional tests to check for possible complications of the disease. If you or your child carries the sickle cell gene, you'll likely be referred to a genetic counselor. Tests to detect sickle cell genes before birth Sickle cell disease can be diagnosed in an unborn baby by sampling some of the fluid surrounding the baby in the mother's womb (amniotic fluid) to look for the sickle cell gene. If you or your partner has been diagnosed with sickle cell anemia or sickle cell trait, ask your doctor about whether you should consider this screening. Ask for a referral to a genetic counselor who can help you understand the risk to your baby.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Causes): Sickle cell anemia is caused by a mutation in the gene that tells your body to make the red, iron-rich compound that gives blood its red color (hemoglobin). Hemoglobin allows red blood cells to carry oxygen from your lungs to all parts of your body. In sickle cell anemia, the abnormal hemoglobin causes red blood cells to become rigid, sticky and misshapen. The sickle cell gene is passed from generation to generation in a pattern of inheritance called autosomal recessive inheritance. This means that both the mother and the father must pass on the defective form of the gene for a child to be affected. If only one parent passes the sickle cell gene to the child, that child will have the sickle cell trait. With one normal hemoglobin gene and one defective form of the gene, people with the sickle cell trait make both normal hemoglobin and sickle cell hemoglobin. Their blood might contain some sickle cells, but they generally don't have symptoms. But they are carriers of the disease, which means they can pass the gene to their children.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Complications): Sickle cell anemia can lead to a host of complications, including: - Stroke. A stroke can occur if sickle cells block blood flow to an area of your brain. Signs of stroke include seizures, weakness or numbness of your arms and legs, sudden speech difficulties, and loss of consciousness. If your baby or child has any of these signs and symptoms, seek medical treatment immediately. A stroke can be fatal. - Acute chest syndrome. This life-threatening complication causes chest pain, fever and difficulty breathing. Acute chest syndrome can be caused by a lung infection or by sickle cells blocking blood vessels in your lungs. It might require emergency medical treatment with antibiotics and other treatments. - Pulmonary hypertension. People with sickle cell anemia can develop high blood pressure in their lungs (pulmonary hypertension). This complication usually affects adults rather than children. Shortness of breath and fatigue are common symptoms of this condition, which can be fatal. - Organ damage. Sickle cells that block blood flow through blood vessels immediately deprive the affected organ of blood and oxygen. In sickle cell anemia, blood is also chronically low on oxygen. Chronic deprivation of oxygen-rich blood can damage nerves and organs in your body, including your kidneys, liver and spleen. Organ damage can be fatal. - Blindness. Sickle cells can block tiny blood vessels that supply your eyes. Over time, this can damage the portion of the eye that processes visual images (retina) and lead to blindness. - Leg ulcers. Sickle cell anemia can cause open sores, called ulcers, on your legs. - Gallstones. The breakdown of red blood cells produces a substance called bilirubin. A high level of bilirubin in your body can lead to gallstones. - Priapism. Men with sickle cell anemia can have painful, long-lasting erections, a condition called priapism. As occurs in other parts of the body, sickle cells can block the blood vessels in the penis. This can damage the penis and lead to impotence.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Symptoms): Signs and symptoms of sickle cell anemia, which vary from person to person and change over time, include: - Anemia. Sickle cells break apart easily and die, leaving you without enough red blood cells. Red blood cells usually live for about 120 days before they need to be replaced. But sickle cells usually die in 10 to 20 days, leaving a shortage of red blood cells (anemia). Without enough red blood cells, your body can't get the oxygen it needs to feel energized, causing fatigue. - Episodes of pain. Periodic episodes of pain, called crises, are a major symptom of sickle cell anemia. Pain develops when sickle-shaped red blood cells block blood flow through tiny blood vessels to your chest, abdomen and joints. Pain can also occur in your bones. The pain varies in intensity and can last for a few hours to a few weeks. Some people have only a few pain episodes. Others have a dozen or more crises a year. If a crisis is severe enough, you might need to be hospitalized. Some adolescents and adults with sickle cell anemia also have chronic pain, which can result from bone and joint damage, ulcers and other causes. - Painful swelling of hands and feet. The swelling is caused by sickle-shaped red blood cells blocking blood flow to the hands and feet. - Frequent infections. Sickle cells can damage an organ that fights infection (spleen), leaving you more vulnerable to infections. Doctors commonly give infants and children with sickle cell anemia vaccinations and antibiotics to prevent potentially life-threatening infections, such as pneumonia. - Delayed growth. Red blood cells provide your body with the oxygen and nutrients you need for growth. A shortage of healthy red blood cells can slow growth in infants and children and delay puberty in teenagers. - Vision problems. Tiny blood vessels that supply your eyes may become plugged with sickle cells. This can damage the retina - the portion of the eye that processes visual images, leading to vision problems. When to see a doctor Although sickle cell anemia is usually diagnosed in infancy, if you or your child develops any of the following problems, see your doctor right away or seek emergency medical care: - Unexplained episodes of severe pain, such as pain in the abdomen, chest, bones or joints. - Swelling in the hands or feet. - Abdominal swelling, especially if the area is tender to the touch. - Fever. People with sickle cell anemia have an increased risk of infection, and fever can be the first sign of an infection. - Pale skin or nail beds. - Yellow tint to the skin or whites of the eyes. - Signs or symptoms of stroke. If you notice one-sided paralysis or weakness in the face, arms or legs; confusion; trouble walking or talking; sudden vision problems or unexplained numbness; or a headache, call 911 or your local emergency number right away.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "What are the symptoms of Sickle cell anemia?: Symptoms usually do not occur until after the age of 4 months. Almost all people with sickle cell anemia have painful episodes called crises. These can last from hours to days. Crises can cause pain in the lower back, leg, joints, and chest. Some people have one episode every few years. Others have many episodes each year. The crises can be severe enough to require a hospital stay. When the anemia becomes more severe, symptoms may include: - Fatigue - Paleness - Rapid heart rate - Shortness of breath - Yellowing of the eyes and skin (jaundice) Younger children with sickle cell anemia have attacks of abdominal pain. The following symptoms may occur because small blood vessels become blocked by the abnormal cells: - Painful and prolonged erection (priapism) - Poor eyesight or blindness - Problems with thinking or confusion caused by small strokes - Ulcers on the lower legs (in adolescents and adults) Over time, the spleen stops working. As a result, people with sickle cell anemia may have symptoms of infections such as: - Bone infection (osteomyelitis) - Gallbladder infection (cholecystitis) - Lung infection (pneumonia) - Urinary tract infection Other signs and symptoms include: - Delayed growth and puberty - Painful joints caused by arthritis - Heart failure due to too much iron (from blood transfusions)",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000527.htm"
+  ],
+  [
+    "Sickle cell anemia - resources (Summary): The following organizations are good resources for information on sickle cell anemia: - American Sickle Cell Anemia Association -- www.ascaa.org - US National Library of Medicine -- ghr.nlm.nih.gov/condition/sickle-cell-disease - National Heart, Lung, and Blood Institute -- www.nhlbi.nih.gov/health/health-topics/topics/sca/ - Sickle Cell Disease Association of America -- www.sicklecelldisease.org - Centers for Disease Control and Prevention -- www.cdc.gov/ncbddd/sicklecell",
+    "https://medlineplus.gov/ency/article/002200.htm"
+  ],
+  [
+    "Sickle cell anemia (Treatment): Bone marrow transplant, also known as stem cell transplant, offers the only potential cure for sickle cell anemia. It's usually reserved for people younger than age 16 because the risks increase for people older than 16. Finding a donor is difficult, and the procedure has serious risks associated with it, including death. As a result, treatment for sickle cell anemia is usually aimed at avoiding crises, relieving symptoms and preventing complications. Babies and children age 2 and younger with sickle cell anemia should make frequent visits to a doctor. Children older than 2 and adults with sickle cell anemia should see a doctor at least once a year, according to the Centers for Disease Control and Prevention. Treatments might include medications to reduce pain and prevent complications, and blood transfusions, as well as a bone marrow transplant. Medications Medications used to treat sickle cell anemia include: - Antibiotics. Children with sickle cell anemia may begin taking the antibiotic penicillin when they're about 2 months old and continue taking it until they're at least 5 years old. Doing so helps prevent infections, such as pneumonia, which can be life-threatening to an infant or child with sickle cell anemia. As an adult, if you've had your spleen removed or had pneumonia, you might need to take penicillin throughout your life. - Pain-relieving medications. To relieve pain during a sickle cell crisis, your doctor might prescribe pain medications. - Hydroxyurea (Droxia, Hydrea). When taken daily, hydroxyurea reduces the frequency of painful crises and might reduce the need for blood transfusions and hospitalizations. Hydroxyurea seems to work by stimulating production of fetal hemoglobin - a type of hemoglobin found in newborns that helps prevent the formation of sickle cells. Hydroxyurea increases your risk of infections, and there is some concern that long-term use of this drug might cause problems later in life for people who take it for many years. More study is needed. Your doctor can help you determine if this drug might be beneficial for you or your child. Don't take the drug if you're pregnant. Assessing stroke risk Using a special ultrasound machine (transcranial), doctors can learn which children have a higher risk of stroke. This painless test, which uses sound waves to measure blood flow, can be used on children as young as 2 years. Regular blood transfusions can decrease stroke risk. Vaccinations to prevent infections Childhood vaccinations are important for preventing disease in all children. They're even more important for children with sickle cell anemia because their infections can be severe. Your doctor will make sure your child receives all of the recommended childhood vaccinations. Vaccinations, such as the pneumococcal vaccine and the annual flu shot, are also important for adults with sickle cell anemia. Blood transfusions In a red blood cell transfusion, red blood cells are removed from a supply of donated blood, then given intravenously to a person with sickle cell anemia. Blood transfusions increase the number of normal red blood cells in circulation, helping to relieve anemia. In children with sickle cell anemia at high risk of stroke, regular blood transfusions can decrease the risk. Transfusions can also be used to treat other complications of sickle cell anemia, or they can be given to prevent complications. Blood transfusions carry some risk, including infection and excess iron buildup in your body. Because excess iron can damage your heart, liver and other organs, people who undergo regular transfusions might need treatment to reduce iron levels. Bone marrow transplant A bone marrow transplant, also called a stem cell transplant, involves replacing bone marrow affected by sickle cell anemia with healthy bone marrow from a donor. The procedure usually uses a matched donor, such as a sibling, who doesn't have sickle cell anemia. For many, donors aren't available. But stem cells from umbilical cord blood might be an option. Because of the risks associated with a bone marrow transplant, the procedure is recommended only for people, usually children, who have significant symptoms and problems from sickle cell anemia. If a donor is found, the person with sickle cell anemia receives radiation or chemotherapy to destroy or reduce his or her bone marrow stem cells. Healthy stem cells from the donor are injected intravenously into the bloodstream of the person with sickle cell anemia, where they migrate to the bone marrow and begin generating new blood cells. The procedure requires a lengthy hospital stay. After the transplant, you'll receive drugs to help prevent rejection of the donated stem cells. Even so, your body might reject the transplant, leading to life-threatening complications. Treating sickle cell complications Doctors treat most complications of sickle cell anemia as they occur. Treatment might include antibiotics, vitamins, blood transfusions, pain-relieving medicines, other medications and possibly surgery, such as to correct vision problems or to remove a damaged spleen. Experimental treatments Scientists are studying new treatments for sickle cell anemia, including: - Gene therapy. Researchers are exploring whether inserting a normal gene into the bone marrow of people with sickle cell anemia will result in normal hemoglobin. Scientists are also exploring the possibility of turning off the defective gene while reactivating another gene responsible for the production of fetal hemoglobin - a type of hemoglobin found in newborns that prevents sickle cells from forming. Potential treatments using gene therapy are a long way off, however. - Nitric oxide. People with sickle cell anemia have low levels of nitric oxide in their blood. Nitric oxide is a gas that helps keep blood vessels open and reduces the stickiness of red blood cells. Treatment with inhaled nitric oxide might prevent sickle cells from clumping together. Studies on nitric oxide have shown little benefit so far. - Drugs to boost fetal hemoglobin production. Researchers are studying various drugs to devise a way to boost the production of fetal hemoglobin. This is a type of hemoglobin that stops sickle cells from forming.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Complications): Sickle cell anemia can lead to a host of complications, including: - Stroke. A stroke can occur if sickle cells block blood flow to an area of your brain. Signs of stroke include seizures, weakness or numbness of your arms and legs, sudden speech difficulties, and loss of consciousness. If your baby or child has any of these signs and symptoms, seek medical treatment immediately. A stroke can be fatal. - Acute chest syndrome. This life-threatening complication causes chest pain, fever and difficulty breathing. Acute chest syndrome can be caused by a lung infection or by sickle cells blocking blood vessels in your lungs. It might require emergency medical treatment with antibiotics and other treatments. - Pulmonary hypertension. People with sickle cell anemia can develop high blood pressure in their lungs (pulmonary hypertension). This complication usually affects adults rather than children. Shortness of breath and fatigue are common symptoms of this condition, which can be fatal. - Organ damage. Sickle cells that block blood flow through blood vessels immediately deprive the affected organ of blood and oxygen. In sickle cell anemia, blood is also chronically low on oxygen. Chronic deprivation of oxygen-rich blood can damage nerves and organs in your body, including your kidneys, liver and spleen. Organ damage can be fatal. - Blindness. Sickle cells can block tiny blood vessels that supply your eyes. Over time, this can damage the portion of the eye that processes visual images (retina) and lead to blindness. - Leg ulcers. Sickle cell anemia can cause open sores, called ulcers, on your legs. - Gallstones. The breakdown of red blood cells produces a substance called bilirubin. A high level of bilirubin in your body can lead to gallstones. - Priapism. Men with sickle cell anemia can have painful, long-lasting erections, a condition called priapism. As occurs in other parts of the body, sickle cells can block the blood vessels in the penis. This can damage the penis and lead to impotence.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Causes): Sickle cell anemia is caused by a mutation in the gene that tells your body to make the red, iron-rich compound that gives blood its red color (hemoglobin). Hemoglobin allows red blood cells to carry oxygen from your lungs to all parts of your body. In sickle cell anemia, the abnormal hemoglobin causes red blood cells to become rigid, sticky and misshapen. The sickle cell gene is passed from generation to generation in a pattern of inheritance called autosomal recessive inheritance. This means that both the mother and the father must pass on the defective form of the gene for a child to be affected. If only one parent passes the sickle cell gene to the child, that child will have the sickle cell trait. With one normal hemoglobin gene and one defective form of the gene, people with the sickle cell trait make both normal hemoglobin and sickle cell hemoglobin. Their blood might contain some sickle cells, but they generally don't have symptoms. But they are carriers of the disease, which means they can pass the gene to their children.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Diagnosis): A blood test can check for hemoglobin S - the defective form of hemoglobin that underlies sickle cell anemia. In the United States, this blood test is part of routine newborn screening done at the hospital. But older children and adults can be tested, too. In adults, a blood sample is drawn from a vein in the arm. In young children and babies, the blood sample is usually collected from a finger or heel. The sample is then sent to a laboratory, where it's screened for hemoglobin S. If the screening test is negative, there is no sickle cell gene present. If the screening test is positive, further tests will be done to determine whether one or two sickle cell genes are present. Additional tests If you or your child has sickle cell anemia, a blood test to check for a low red blood cell count (anemia) will be done. Your doctor might suggest additional tests to check for possible complications of the disease. If you or your child carries the sickle cell gene, you'll likely be referred to a genetic counselor. Tests to detect sickle cell genes before birth Sickle cell disease can be diagnosed in an unborn baby by sampling some of the fluid surrounding the baby in the mother's womb (amniotic fluid) to look for the sickle cell gene. If you or your partner has been diagnosed with sickle cell anemia or sickle cell trait, ask your doctor about whether you should consider this screening. Ask for a referral to a genetic counselor who can help you understand the risk to your baby.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Treatment): Bone marrow transplant, also known as stem cell transplant, offers the only potential cure for sickle cell anemia. It's usually reserved for people younger than age 16 because the risks increase for people older than 16. Finding a donor is difficult, and the procedure has serious risks associated with it, including death. As a result, treatment for sickle cell anemia is usually aimed at avoiding crises, relieving symptoms and preventing complications. Babies and children age 2 and younger with sickle cell anemia should make frequent visits to a doctor. Children older than 2 and adults with sickle cell anemia should see a doctor at least once a year, according to the Centers for Disease Control and Prevention. Treatments might include medications to reduce pain and prevent complications, and blood transfusions, as well as a bone marrow transplant. Medications Medications used to treat sickle cell anemia include: - Antibiotics. Children with sickle cell anemia may begin taking the antibiotic penicillin when they're about 2 months old and continue taking it until they're at least 5 years old. Doing so helps prevent infections, such as pneumonia, which can be life-threatening to an infant or child with sickle cell anemia. As an adult, if you've had your spleen removed or had pneumonia, you might need to take penicillin throughout your life. - Pain-relieving medications. To relieve pain during a sickle cell crisis, your doctor might prescribe pain medications. - Hydroxyurea (Droxia, Hydrea). When taken daily, hydroxyurea reduces the frequency of painful crises and might reduce the need for blood transfusions and hospitalizations. Hydroxyurea seems to work by stimulating production of fetal hemoglobin - a type of hemoglobin found in newborns that helps prevent the formation of sickle cells. Hydroxyurea increases your risk of infections, and there is some concern that long-term use of this drug might cause problems later in life for people who take it for many years. More study is needed. Your doctor can help you determine if this drug might be beneficial for you or your child. Don't take the drug if you're pregnant. Assessing stroke risk Using a special ultrasound machine (transcranial), doctors can learn which children have a higher risk of stroke. This painless test, which uses sound waves to measure blood flow, can be used on children as young as 2 years. Regular blood transfusions can decrease stroke risk. Vaccinations to prevent infections Childhood vaccinations are important for preventing disease in all children. They're even more important for children with sickle cell anemia because their infections can be severe. Your doctor will make sure your child receives all of the recommended childhood vaccinations. Vaccinations, such as the pneumococcal vaccine and the annual flu shot, are also important for adults with sickle cell anemia. Blood transfusions In a red blood cell transfusion, red blood cells are removed from a supply of donated blood, then given intravenously to a person with sickle cell anemia. Blood transfusions increase the number of normal red blood cells in circulation, helping to relieve anemia. In children with sickle cell anemia at high risk of stroke, regular blood transfusions can decrease the risk. Transfusions can also be used to treat other complications of sickle cell anemia, or they can be given to prevent complications. Blood transfusions carry some risk, including infection and excess iron buildup in your body. Because excess iron can damage your heart, liver and other organs, people who undergo regular transfusions might need treatment to reduce iron levels. Bone marrow transplant A bone marrow transplant, also called a stem cell transplant, involves replacing bone marrow affected by sickle cell anemia with healthy bone marrow from a donor. The procedure usually uses a matched donor, such as a sibling, who doesn't have sickle cell anemia. For many, donors aren't available. But stem cells from umbilical cord blood might be an option. Because of the risks associated with a bone marrow transplant, the procedure is recommended only for people, usually children, who have significant symptoms and problems from sickle cell anemia. If a donor is found, the person with sickle cell anemia receives radiation or chemotherapy to destroy or reduce his or her bone marrow stem cells. Healthy stem cells from the donor are injected intravenously into the bloodstream of the person with sickle cell anemia, where they migrate to the bone marrow and begin generating new blood cells. The procedure requires a lengthy hospital stay. After the transplant, you'll receive drugs to help prevent rejection of the donated stem cells. Even so, your body might reject the transplant, leading to life-threatening complications. Treating sickle cell complications Doctors treat most complications of sickle cell anemia as they occur. Treatment might include antibiotics, vitamins, blood transfusions, pain-relieving medicines, other medications and possibly surgery, such as to correct vision problems or to remove a damaged spleen. Experimental treatments Scientists are studying new treatments for sickle cell anemia, including: - Gene therapy. Researchers are exploring whether inserting a normal gene into the bone marrow of people with sickle cell anemia will result in normal hemoglobin. Scientists are also exploring the possibility of turning off the defective gene while reactivating another gene responsible for the production of fetal hemoglobin - a type of hemoglobin found in newborns that prevents sickle cells from forming. Potential treatments using gene therapy are a long way off, however. - Nitric oxide. People with sickle cell anemia have low levels of nitric oxide in their blood. Nitric oxide is a gas that helps keep blood vessels open and reduces the stickiness of red blood cells. Treatment with inhaled nitric oxide might prevent sickle cells from clumping together. Studies on nitric oxide have shown little benefit so far. - Drugs to boost fetal hemoglobin production. Researchers are studying various drugs to devise a way to boost the production of fetal hemoglobin. This is a type of hemoglobin that stops sickle cells from forming.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "What are the treatments for Sickle cell anemia?: The goal of treatment is to manage and control symptoms, and to limit the number of crises. People with sickle cell disease need ongoing treatment, even when not having a crisis. People with this condition should take folic acid supplements. Folic acid helps make newred blood cells. Treatment for a sickle cell crisis includes: - Blood transfusions (may also be given regularly to prevent stroke) - Pain medicines - Plenty of fluids Other treatments for sickle cell anemia may include: - Hydroxyurea (Hydrea), which helps reduce the number of pain episodes (including chest pain and breathing problems) in some people - Antibiotics, which help prevent bacterial infections that are common in children with sickle cell disease - Medicines that reduce the amount of iron in the body. Treatments that may be needed to manage complications of sickle cell anemia include: - Dialysis or kidney transplant for kidney disease - Counseling forpsychological complications - Gallbladder removal inpeople with gallstone disease - Hip replacement for avascular necrosis of the hip - Surgery for eye problems - Treatment for overuse or abuse of narcotic pain medicines - Wound care for leg ulcers Bone marrow or stem cell transplants can cure sickle cell anemia, but this treatment is not an option for most people. Sickle cell anemia patients often cannot find well-matched stem cell donors. People with sickle cell disease should have the following vaccinations to lower the risk of infection: - Haemophilus influenzae vaccine (Hib) - Pneumococcal conjugate vaccine (PCV) - Pneumococcal polysaccharide vaccine (PPV)",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000527.htm"
+  ],
+  [
+    "Sickle cell anemia: Sickle cell anemia is an inherited form of anemia - a condition in which there aren't enough healthy red blood cells to carry adequate oxygen throughout your body. Normally, your red blood cells are flexible and round, moving easily through your blood vessels. In sickle cell anemia, the red blood cells become rigid and sticky and are shaped like sickles or crescent moons. These irregularly shaped cells can get stuck in small blood vessels, which can slow or block blood flow and oxygen to parts of the body. There's no cure for most people with sickle cell anemia. But treatments can relieve pain and help prevent problems associated with the disease. Signs and symptoms of sickle cell anemia, which vary from person to person and change over time, include: - Anemia. Sickle cells break apart easily and die, leaving you without enough red blood cells. Red blood cells usually live for about 120 days before they need to be replaced. But sickle cells usually die in 10 to 20 days, leaving a shortage of red blood cells (anemia). Without enough red blood cells, your body can't get the oxygen it needs to feel energized, causing fatigue. - Episodes of pain. Periodic episodes of pain, called crises, are a major symptom of sickle cell anemia. Pain develops when sickle-shaped red blood cells block blood flow through tiny blood vessels to your chest, abdomen and joints. Pain can also occur in your bones. The pain varies in intensity and can last for a few hours to a few weeks. Some people have only a few pain episodes. Others have a dozen or more crises a year. If a crisis is severe enough, you might need to be hospitalized. Some adolescents and adults with sickle cell anemia also have chronic pain, which can result from bone and joint damage, ulcers and other causes. - Painful swelling of hands and feet. The swelling is caused by sickle-shaped red blood cells blocking blood flow to the hands and feet. - Frequent infections. Sickle cells can damage an organ that fights infection (spleen), leaving you more vulnerable to infections. Doctors commonly give infants and children with sickle cell anemia vaccinations and antibiotics to prevent potentially life-threatening infections, such as pneumonia. - Delayed growth. Red blood cells provide your body with the oxygen and nutrients you need for growth. A shortage of healthy red blood cells can slow growth in infants and children and delay puberty in teenagers. - Vision problems. Tiny blood vessels that supply your eyes may become plugged with sickle cells. This can damage the retina - the portion of the eye that processes visual images, leading to vision problems. When to see a doctor Although sickle cell anemia is usually diagnosed in infancy, if you or your child develops any of the following problems, see your doctor right away or seek emergency medical care: - Unexplained episodes of severe pain, such as pain in the abdomen, chest, bones or joints. - Swelling in the hands or feet. - Abdominal swelling, especially if the area is tender to the touch. - Fever. People with sickle cell anemia have an increased risk of infection, and fever can be the first sign of an infection. - Pale skin or nail beds. - Yellow tint to the skin or whites of the eyes. - Signs or symptoms of stroke. If you notice one-sided paralysis or weakness in the face, arms or legs; confusion; trouble walking or talking; sudden vision problems or unexplained numbness; or a headache, call 911 or your local emergency number right away. Sickle cell anemia is caused by a mutation in the gene that tells your body to make the red, iron-rich compound that gives blood its red color (hemoglobin). Hemoglobin allows red blood cells to carry oxygen from your lungs to all parts of your body. In sickle cell anemia, the abnormal hemoglobin causes red blood cells to become rigid, sticky and misshapen. The sickle cell gene is passed from generation to generation in a pattern of inheritance called autosomal recessive inheritance. This means that both the mother and the father must pass on the defective form of the gene for a child to be affected. If only one parent passes the sickle cell gene to the child, that child will have the sickle cell trait. With one normal hemoglobin gene and one defective form of the gene, people with the sickle cell trait make both normal hemoglobin and sickle cell hemoglobin. Their blood might contain some sickle cells, but they generally don't have symptoms. But they are carriers of the disease, which means they can pass the gene to their children. For a baby to be born with sickle cell anemia, both parents must carry a sickle cell gene. In the United States, it most commonly affects black people. Sickle cell anemia can lead to a host of complications, including: - Stroke. A stroke can occur if sickle cells block blood flow to an area of your brain. Signs of stroke include seizures, weakness or numbness of your arms and legs, sudden speech difficulties, and loss of consciousness. If your baby or child has any of these signs and symptoms, seek medical treatment immediately. A stroke can be fatal. - Acute chest syndrome. This life-threatening complication causes chest pain, fever and difficulty breathing. Acute chest syndrome can be caused by a lung infection or by sickle cells blocking blood vessels in your lungs. It might require emergency medical treatment with antibiotics and other treatments. - Pulmonary hypertension. People with sickle cell anemia can develop high blood pressure in their lungs (pulmonary hypertension). This complication usually affects adults rather than children. Shortness of breath and fatigue are common symptoms of this condition, which can be fatal. - Organ damage. Sickle cells that block blood flow through blood vessels immediately deprive the affected organ of blood and oxygen. In sickle cell anemia, blood is also chronically low on oxygen. Chronic deprivation of oxygen-rich blood can damage nerves and organs in your body, including your kidneys, liver and spleen. Organ damage can be fatal. - Blindness. Sickle cells can block tiny blood vessels that supply your eyes. Over time, this can damage the portion of the eye that processes visual images (retina) and lead to blindness. - Leg ulcers. Sickle cell anemia can cause open sores, called ulcers, on your legs. - Gallstones. The breakdown of red blood cells produces a substance called bilirubin. A high level of bilirubin in your body can lead to gallstones. - Priapism. Men with sickle cell anemia can have painful, long-lasting erections, a condition called priapism. As occurs in other parts of the body, sickle cells can block the blood vessels in the penis. This can damage the penis and lead to impotence. A blood test can check for hemoglobin S - the defective form of hemoglobin that underlies sickle cell anemia. In the United States, this blood test is part of routine newborn screening done at the hospital. But older children and adults can be tested, too. In adults, a blood sample is drawn from a vein in the arm. In young children and babies, the blood sample is usually collected from a finger or heel. The sample is then sent to a laboratory, where it's screened for hemoglobin S. If the screening test is negative, there is no sickle cell gene present. If the screening test is positive, further tests will be done to determine whether one or two sickle cell genes are present. Additional tests If you or your child has sickle cell anemia, a blood test to check for a low red blood cell count (anemia) will be done. Your doctor might suggest additional tests to check for possible complications of the disease. If you or your child carries the sickle cell gene, you'll likely be referred to a genetic counselor. Tests to detect sickle cell genes before birth Sickle cell disease can be diagnosed in an unborn baby by sampling some of the fluid surrounding the baby in the mother's womb (amniotic fluid) to look for the sickle cell gene. If you or your partner has been diagnosed with sickle cell anemia or sickle cell trait, ask your doctor about whether you should consider this screening. Ask for a referral to a genetic counselor who can help you understand the risk to your baby. Bone marrow transplant, also known as stem cell transplant, offers the only potential cure for sickle cell anemia. It's usually reserved for people younger than age 16 because the risks increase for people older than 16. Finding a donor is difficult, and the procedure has serious risks associated with it, including death. As a result, treatment for sickle cell anemia is usually aimed at avoiding crises, relieving symptoms and preventing complications. Babies and children age 2 and younger with sickle cell anemia should make frequent visits to a doctor. Children older than 2 and adults with sickle cell anemia should see a doctor at least once a year, according to the Centers for Disease Control and Prevention. Treatments might include medications to reduce pain and prevent complications, and blood transfusions, as well as a bone marrow transplant. Medications Medications used to treat sickle cell anemia include: - Antibiotics. Children with sickle cell anemia may begin taking the antibiotic penicillin when they're about 2 months old and continue taking it until they're at least 5 years old. Doing so helps prevent infections, such as pneumonia, which can be life-threatening to an infant or child with sickle cell anemia. As an adult, if you've had your spleen removed or had pneumonia, you might need to take penicillin throughout your life. - Pain-relieving medications. To relieve pain during a sickle cell crisis, your doctor might prescribe pain medications. - Hydroxyurea (Droxia, Hydrea). When taken daily, hydroxyurea reduces the frequency of painful crises and might reduce the need for blood transfusions and hospitalizations. Hydroxyurea seems to work by stimulating production of fetal hemoglobin - a type of hemoglobin found in newborns that helps prevent the formation of sickle cells. Hydroxyurea increases your risk of infections, and there is some concern that long-term use of this drug might cause problems later in life for people who take it for many years. More study is needed. Your doctor can help you determine if this drug might be beneficial for you or your child. Don't take the drug if you're pregnant. Assessing stroke risk Using a special ultrasound machine (transcranial), doctors can learn which children have a higher risk of stroke. This painless test, which uses sound waves to measure blood flow, can be used on children as young as 2 years. Regular blood transfusions can decrease stroke risk. Vaccinations to prevent infections Childhood vaccinations are important for preventing disease in all children. They're even more important for children with sickle cell anemia because their infections can be severe. Your doctor will make sure your child receives all of the recommended childhood vaccinations. Vaccinations, such as the pneumococcal vaccine and the annual flu shot, are also important for adults with sickle cell anemia. Blood transfusions In a red blood cell transfusion, red blood cells are removed from a supply of donated blood, then given intravenously to a person with sickle cell anemia. Blood transfusions increase the number of normal red blood cells in circulation, helping to relieve anemia. In children with sickle cell anemia at high risk of stroke, regular blood transfusions can decrease the risk. Transfusions can also be used to treat other complications of sickle cell anemia, or they can be given to prevent complications. Blood transfusions carry some risk, including infection and excess iron buildup in your body. Because excess iron can damage your heart, liver and other organs, people who undergo regular transfusions might need treatment to reduce iron levels. Bone marrow transplant A bone marrow transplant, also called a stem cell transplant, involves replacing bone marrow affected by sickle cell anemia with healthy bone marrow from a donor. The procedure usually uses a matched donor, such as a sibling, who doesn't have sickle cell anemia. For many, donors aren't available. But stem cells from umbilical cord blood might be an option. Because of the risks associated with a bone marrow transplant, the procedure is recommended only for people, usually children, who have significant symptoms and problems from sickle cell anemia. If a donor is found, the person with sickle cell anemia receives radiation or chemotherapy to destroy or reduce his or her bone marrow stem cells. Healthy stem cells from the donor are injected intravenously into the bloodstream of the person with sickle cell anemia, where they migrate to the bone marrow and begin generating new blood cells. The procedure requires a lengthy hospital stay. After the transplant, you'll receive drugs to help prevent rejection of the donated stem cells. Even so, your body might reject the transplant, leading to life-threatening complications. Treating sickle cell complications Doctors treat most complications of sickle cell anemia as they occur. Treatment might include antibiotics, vitamins, blood transfusions, pain-relieving medicines, other medications and possibly surgery, such as to correct vision problems or to remove a damaged spleen. Experimental treatments Scientists are studying new treatments for sickle cell anemia, including: - Gene therapy. Researchers are exploring whether inserting a normal gene into the bone marrow of people with sickle cell anemia will result in normal hemoglobin. Scientists are also exploring the possibility of turning off the defective gene while reactivating another gene responsible for the production of fetal hemoglobin - a type of hemoglobin found in newborns that prevents sickle cells from forming. Potential treatments using gene therapy are a long way off, however. - Nitric oxide. People with sickle cell anemia have low levels of nitric oxide in their blood. Nitric oxide is a gas that helps keep blood vessels open and reduces the stickiness of red blood cells. Treatment with inhaled nitric oxide might prevent sickle cells from clumping together. Studies on nitric oxide have shown little benefit so far. - Drugs to boost fetal hemoglobin production. Researchers are studying various drugs to devise a way to boost the production of fetal hemoglobin. This is a type of hemoglobin that stops sickle cells from forming. Taking the following steps to stay healthy may help you avoid complications of sickle cell anemia: - Take folic acid supplements daily, and choose a healthy diet. Bone marrow needs folic acid and other vitamins to make new red blood cells. Your doctor might recommend a folic acid supplement. Choose a diet that focuses on a variety of colorful fruits and vegetables, as well as whole grains. - Drink plenty of water. Dehydration can increase your risk of a sickle cell crisis. Drink water throughout your day, aiming for about eight glasses a day. Increase the amount of water you drink if you exercise or spend time in a hot, dry climate. - Avoid temperature extremes. Exposure to extreme heat or cold can increase your risk of a sickle cell crisis. - Exercise regularly, but don't overdo it. Talk with your doctor about how much exercise is right for you. - Use over-the-counter (OTC) medications with caution. Use OTC pain medications, such as ibuprofen (Advil, Motrin IB, Children's Motrin, others) or naproxen sodium (Aleve) sparingly, if at all, because of the possible effect on your kidneys. Ask your doctor before taking OTC drugs.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Complications): Sickle cell anemia can lead to a host of complications, including: - Stroke. A stroke can occur if sickle cells block blood flow to an area of your brain. Signs of stroke include seizures, weakness or numbness of your arms and legs, sudden speech difficulties, and loss of consciousness. If your baby or child has any of these signs and symptoms, seek medical treatment immediately. A stroke can be fatal. - Acute chest syndrome. This life-threatening complication causes chest pain, fever and difficulty breathing. Acute chest syndrome can be caused by a lung infection or by sickle cells blocking blood vessels in your lungs. It might require emergency medical treatment with antibiotics and other treatments. - Pulmonary hypertension. People with sickle cell anemia can develop high blood pressure in their lungs (pulmonary hypertension). This complication usually affects adults rather than children. Shortness of breath and fatigue are common symptoms of this condition, which can be fatal. - Organ damage. Sickle cells that block blood flow through blood vessels immediately deprive the affected organ of blood and oxygen. In sickle cell anemia, blood is also chronically low on oxygen. Chronic deprivation of oxygen-rich blood can damage nerves and organs in your body, including your kidneys, liver and spleen. Organ damage can be fatal. - Blindness. Sickle cells can block tiny blood vessels that supply your eyes. Over time, this can damage the portion of the eye that processes visual images (retina) and lead to blindness. - Leg ulcers. Sickle cell anemia can cause open sores, called ulcers, on your legs. - Gallstones. The breakdown of red blood cells produces a substance called bilirubin. A high level of bilirubin in your body can lead to gallstones. - Priapism. Men with sickle cell anemia can have painful, long-lasting erections, a condition called priapism. As occurs in other parts of the body, sickle cells can block the blood vessels in the penis. This can damage the penis and lead to impotence.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Diagnosis): A blood test can check for hemoglobin S - the defective form of hemoglobin that underlies sickle cell anemia. In the United States, this blood test is part of routine newborn screening done at the hospital. But older children and adults can be tested, too. In adults, a blood sample is drawn from a vein in the arm. In young children and babies, the blood sample is usually collected from a finger or heel. The sample is then sent to a laboratory, where it's screened for hemoglobin S. If the screening test is negative, there is no sickle cell gene present. If the screening test is positive, further tests will be done to determine whether one or two sickle cell genes are present. Additional tests If you or your child has sickle cell anemia, a blood test to check for a low red blood cell count (anemia) will be done. Your doctor might suggest additional tests to check for possible complications of the disease. If you or your child carries the sickle cell gene, you'll likely be referred to a genetic counselor. Tests to detect sickle cell genes before birth Sickle cell disease can be diagnosed in an unborn baby by sampling some of the fluid surrounding the baby in the mother's womb (amniotic fluid) to look for the sickle cell gene. If you or your partner has been diagnosed with sickle cell anemia or sickle cell trait, ask your doctor about whether you should consider this screening. Ask for a referral to a genetic counselor who can help you understand the risk to your baby.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Causes): Sickle cell anemia is caused by a mutation in the gene that tells your body to make the red, iron-rich compound that gives blood its red color (hemoglobin). Hemoglobin allows red blood cells to carry oxygen from your lungs to all parts of your body. In sickle cell anemia, the abnormal hemoglobin causes red blood cells to become rigid, sticky and misshapen. The sickle cell gene is passed from generation to generation in a pattern of inheritance called autosomal recessive inheritance. This means that both the mother and the father must pass on the defective form of the gene for a child to be affected. If only one parent passes the sickle cell gene to the child, that child will have the sickle cell trait. With one normal hemoglobin gene and one defective form of the gene, people with the sickle cell trait make both normal hemoglobin and sickle cell hemoglobin. Their blood might contain some sickle cells, but they generally don't have symptoms. But they are carriers of the disease, which means they can pass the gene to their children.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Diagnosis): A blood test can check for hemoglobin S - the defective form of hemoglobin that underlies sickle cell anemia. In the United States, this blood test is part of routine newborn screening done at the hospital. But older children and adults can be tested, too. In adults, a blood sample is drawn from a vein in the arm. In young children and babies, the blood sample is usually collected from a finger or heel. The sample is then sent to a laboratory, where it's screened for hemoglobin S. If the screening test is negative, there is no sickle cell gene present. If the screening test is positive, further tests will be done to determine whether one or two sickle cell genes are present. Additional tests If you or your child has sickle cell anemia, a blood test to check for a low red blood cell count (anemia) will be done. Your doctor might suggest additional tests to check for possible complications of the disease. If you or your child carries the sickle cell gene, you'll likely be referred to a genetic counselor. Tests to detect sickle cell genes before birth Sickle cell disease can be diagnosed in an unborn baby by sampling some of the fluid surrounding the baby in the mother's womb (amniotic fluid) to look for the sickle cell gene. If you or your partner has been diagnosed with sickle cell anemia or sickle cell trait, ask your doctor about whether you should consider this screening. Ask for a referral to a genetic counselor who can help you understand the risk to your baby.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "How to diagnose Sickle cell anemia?: Tests commonly done diagnose and monitor patients with sickle cell anemia include: - Bilirubin - Blood oxygen saturation - Complete blood count (CBC) - Hemoglobin electrophoresis - Serum creatinine - Serum potassium - Sickle cell test",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000527.htm"
+  ],
+  [
+    "Sickle cell anemia - resources (Summary): The following organizations are good resources for information on sickle cell anemia: - American Sickle Cell Anemia Association -- www.ascaa.org - US National Library of Medicine -- ghr.nlm.nih.gov/condition/sickle-cell-disease - National Heart, Lung, and Blood Institute -- www.nhlbi.nih.gov/health/health-topics/topics/sca/ - Sickle Cell Disease Association of America -- www.sicklecelldisease.org - Centers for Disease Control and Prevention -- www.cdc.gov/ncbddd/sicklecell",
+    "https://medlineplus.gov/ency/article/002200.htm"
+  ],
+  [
+    "Sickle cell anemia (Treatment): Bone marrow transplant, also known as stem cell transplant, offers the only potential cure for sickle cell anemia. It's usually reserved for people younger than age 16 because the risks increase for people older than 16. Finding a donor is difficult, and the procedure has serious risks associated with it, including death. As a result, treatment for sickle cell anemia is usually aimed at avoiding crises, relieving symptoms and preventing complications. Babies and children age 2 and younger with sickle cell anemia should make frequent visits to a doctor. Children older than 2 and adults with sickle cell anemia should see a doctor at least once a year, according to the Centers for Disease Control and Prevention. Treatments might include medications to reduce pain and prevent complications, and blood transfusions, as well as a bone marrow transplant. Medications Medications used to treat sickle cell anemia include: - Antibiotics. Children with sickle cell anemia may begin taking the antibiotic penicillin when they're about 2 months old and continue taking it until they're at least 5 years old. Doing so helps prevent infections, such as pneumonia, which can be life-threatening to an infant or child with sickle cell anemia. As an adult, if you've had your spleen removed or had pneumonia, you might need to take penicillin throughout your life. - Pain-relieving medications. To relieve pain during a sickle cell crisis, your doctor might prescribe pain medications. - Hydroxyurea (Droxia, Hydrea). When taken daily, hydroxyurea reduces the frequency of painful crises and might reduce the need for blood transfusions and hospitalizations. Hydroxyurea seems to work by stimulating production of fetal hemoglobin - a type of hemoglobin found in newborns that helps prevent the formation of sickle cells. Hydroxyurea increases your risk of infections, and there is some concern that long-term use of this drug might cause problems later in life for people who take it for many years. More study is needed. Your doctor can help you determine if this drug might be beneficial for you or your child. Don't take the drug if you're pregnant. Assessing stroke risk Using a special ultrasound machine (transcranial), doctors can learn which children have a higher risk of stroke. This painless test, which uses sound waves to measure blood flow, can be used on children as young as 2 years. Regular blood transfusions can decrease stroke risk. Vaccinations to prevent infections Childhood vaccinations are important for preventing disease in all children. They're even more important for children with sickle cell anemia because their infections can be severe. Your doctor will make sure your child receives all of the recommended childhood vaccinations. Vaccinations, such as the pneumococcal vaccine and the annual flu shot, are also important for adults with sickle cell anemia. Blood transfusions In a red blood cell transfusion, red blood cells are removed from a supply of donated blood, then given intravenously to a person with sickle cell anemia. Blood transfusions increase the number of normal red blood cells in circulation, helping to relieve anemia. In children with sickle cell anemia at high risk of stroke, regular blood transfusions can decrease the risk. Transfusions can also be used to treat other complications of sickle cell anemia, or they can be given to prevent complications. Blood transfusions carry some risk, including infection and excess iron buildup in your body. Because excess iron can damage your heart, liver and other organs, people who undergo regular transfusions might need treatment to reduce iron levels. Bone marrow transplant A bone marrow transplant, also called a stem cell transplant, involves replacing bone marrow affected by sickle cell anemia with healthy bone marrow from a donor. The procedure usually uses a matched donor, such as a sibling, who doesn't have sickle cell anemia. For many, donors aren't available. But stem cells from umbilical cord blood might be an option. Because of the risks associated with a bone marrow transplant, the procedure is recommended only for people, usually children, who have significant symptoms and problems from sickle cell anemia. If a donor is found, the person with sickle cell anemia receives radiation or chemotherapy to destroy or reduce his or her bone marrow stem cells. Healthy stem cells from the donor are injected intravenously into the bloodstream of the person with sickle cell anemia, where they migrate to the bone marrow and begin generating new blood cells. The procedure requires a lengthy hospital stay. After the transplant, you'll receive drugs to help prevent rejection of the donated stem cells. Even so, your body might reject the transplant, leading to life-threatening complications. Treating sickle cell complications Doctors treat most complications of sickle cell anemia as they occur. Treatment might include antibiotics, vitamins, blood transfusions, pain-relieving medicines, other medications and possibly surgery, such as to correct vision problems or to remove a damaged spleen. Experimental treatments Scientists are studying new treatments for sickle cell anemia, including: - Gene therapy. Researchers are exploring whether inserting a normal gene into the bone marrow of people with sickle cell anemia will result in normal hemoglobin. Scientists are also exploring the possibility of turning off the defective gene while reactivating another gene responsible for the production of fetal hemoglobin - a type of hemoglobin found in newborns that prevents sickle cells from forming. Potential treatments using gene therapy are a long way off, however. - Nitric oxide. People with sickle cell anemia have low levels of nitric oxide in their blood. Nitric oxide is a gas that helps keep blood vessels open and reduces the stickiness of red blood cells. Treatment with inhaled nitric oxide might prevent sickle cells from clumping together. Studies on nitric oxide have shown little benefit so far. - Drugs to boost fetal hemoglobin production. Researchers are studying various drugs to devise a way to boost the production of fetal hemoglobin. This is a type of hemoglobin that stops sickle cells from forming.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia: Sickle cell anemia is an inherited form of anemia - a condition in which there aren't enough healthy red blood cells to carry adequate oxygen throughout your body. Normally, your red blood cells are flexible and round, moving easily through your blood vessels. In sickle cell anemia, the red blood cells become rigid and sticky and are shaped like sickles or crescent moons. These irregularly shaped cells can get stuck in small blood vessels, which can slow or block blood flow and oxygen to parts of the body. There's no cure for most people with sickle cell anemia. But treatments can relieve pain and help prevent problems associated with the disease. Signs and symptoms of sickle cell anemia, which vary from person to person and change over time, include: - Anemia. Sickle cells break apart easily and die, leaving you without enough red blood cells. Red blood cells usually live for about 120 days before they need to be replaced. But sickle cells usually die in 10 to 20 days, leaving a shortage of red blood cells (anemia). Without enough red blood cells, your body can't get the oxygen it needs to feel energized, causing fatigue. - Episodes of pain. Periodic episodes of pain, called crises, are a major symptom of sickle cell anemia. Pain develops when sickle-shaped red blood cells block blood flow through tiny blood vessels to your chest, abdomen and joints. Pain can also occur in your bones. The pain varies in intensity and can last for a few hours to a few weeks. Some people have only a few pain episodes. Others have a dozen or more crises a year. If a crisis is severe enough, you might need to be hospitalized. Some adolescents and adults with sickle cell anemia also have chronic pain, which can result from bone and joint damage, ulcers and other causes. - Painful swelling of hands and feet. The swelling is caused by sickle-shaped red blood cells blocking blood flow to the hands and feet. - Frequent infections. Sickle cells can damage an organ that fights infection (spleen), leaving you more vulnerable to infections. Doctors commonly give infants and children with sickle cell anemia vaccinations and antibiotics to prevent potentially life-threatening infections, such as pneumonia. - Delayed growth. Red blood cells provide your body with the oxygen and nutrients you need for growth. A shortage of healthy red blood cells can slow growth in infants and children and delay puberty in teenagers. - Vision problems. Tiny blood vessels that supply your eyes may become plugged with sickle cells. This can damage the retina - the portion of the eye that processes visual images, leading to vision problems. When to see a doctor Although sickle cell anemia is usually diagnosed in infancy, if you or your child develops any of the following problems, see your doctor right away or seek emergency medical care: - Unexplained episodes of severe pain, such as pain in the abdomen, chest, bones or joints. - Swelling in the hands or feet. - Abdominal swelling, especially if the area is tender to the touch. - Fever. People with sickle cell anemia have an increased risk of infection, and fever can be the first sign of an infection. - Pale skin or nail beds. - Yellow tint to the skin or whites of the eyes. - Signs or symptoms of stroke. If you notice one-sided paralysis or weakness in the face, arms or legs; confusion; trouble walking or talking; sudden vision problems or unexplained numbness; or a headache, call 911 or your local emergency number right away. Sickle cell anemia is caused by a mutation in the gene that tells your body to make the red, iron-rich compound that gives blood its red color (hemoglobin). Hemoglobin allows red blood cells to carry oxygen from your lungs to all parts of your body. In sickle cell anemia, the abnormal hemoglobin causes red blood cells to become rigid, sticky and misshapen. The sickle cell gene is passed from generation to generation in a pattern of inheritance called autosomal recessive inheritance. This means that both the mother and the father must pass on the defective form of the gene for a child to be affected. If only one parent passes the sickle cell gene to the child, that child will have the sickle cell trait. With one normal hemoglobin gene and one defective form of the gene, people with the sickle cell trait make both normal hemoglobin and sickle cell hemoglobin. Their blood might contain some sickle cells, but they generally don't have symptoms. But they are carriers of the disease, which means they can pass the gene to their children. For a baby to be born with sickle cell anemia, both parents must carry a sickle cell gene. In the United States, it most commonly affects black people. Sickle cell anemia can lead to a host of complications, including: - Stroke. A stroke can occur if sickle cells block blood flow to an area of your brain. Signs of stroke include seizures, weakness or numbness of your arms and legs, sudden speech difficulties, and loss of consciousness. If your baby or child has any of these signs and symptoms, seek medical treatment immediately. A stroke can be fatal. - Acute chest syndrome. This life-threatening complication causes chest pain, fever and difficulty breathing. Acute chest syndrome can be caused by a lung infection or by sickle cells blocking blood vessels in your lungs. It might require emergency medical treatment with antibiotics and other treatments. - Pulmonary hypertension. People with sickle cell anemia can develop high blood pressure in their lungs (pulmonary hypertension). This complication usually affects adults rather than children. Shortness of breath and fatigue are common symptoms of this condition, which can be fatal. - Organ damage. Sickle cells that block blood flow through blood vessels immediately deprive the affected organ of blood and oxygen. In sickle cell anemia, blood is also chronically low on oxygen. Chronic deprivation of oxygen-rich blood can damage nerves and organs in your body, including your kidneys, liver and spleen. Organ damage can be fatal. - Blindness. Sickle cells can block tiny blood vessels that supply your eyes. Over time, this can damage the portion of the eye that processes visual images (retina) and lead to blindness. - Leg ulcers. Sickle cell anemia can cause open sores, called ulcers, on your legs. - Gallstones. The breakdown of red blood cells produces a substance called bilirubin. A high level of bilirubin in your body can lead to gallstones. - Priapism. Men with sickle cell anemia can have painful, long-lasting erections, a condition called priapism. As occurs in other parts of the body, sickle cells can block the blood vessels in the penis. This can damage the penis and lead to impotence. A blood test can check for hemoglobin S - the defective form of hemoglobin that underlies sickle cell anemia. In the United States, this blood test is part of routine newborn screening done at the hospital. But older children and adults can be tested, too. In adults, a blood sample is drawn from a vein in the arm. In young children and babies, the blood sample is usually collected from a finger or heel. The sample is then sent to a laboratory, where it's screened for hemoglobin S. If the screening test is negative, there is no sickle cell gene present. If the screening test is positive, further tests will be done to determine whether one or two sickle cell genes are present. Additional tests If you or your child has sickle cell anemia, a blood test to check for a low red blood cell count (anemia) will be done. Your doctor might suggest additional tests to check for possible complications of the disease. If you or your child carries the sickle cell gene, you'll likely be referred to a genetic counselor. Tests to detect sickle cell genes before birth Sickle cell disease can be diagnosed in an unborn baby by sampling some of the fluid surrounding the baby in the mother's womb (amniotic fluid) to look for the sickle cell gene. If you or your partner has been diagnosed with sickle cell anemia or sickle cell trait, ask your doctor about whether you should consider this screening. Ask for a referral to a genetic counselor who can help you understand the risk to your baby. Bone marrow transplant, also known as stem cell transplant, offers the only potential cure for sickle cell anemia. It's usually reserved for people younger than age 16 because the risks increase for people older than 16. Finding a donor is difficult, and the procedure has serious risks associated with it, including death. As a result, treatment for sickle cell anemia is usually aimed at avoiding crises, relieving symptoms and preventing complications. Babies and children age 2 and younger with sickle cell anemia should make frequent visits to a doctor. Children older than 2 and adults with sickle cell anemia should see a doctor at least once a year, according to the Centers for Disease Control and Prevention. Treatments might include medications to reduce pain and prevent complications, and blood transfusions, as well as a bone marrow transplant. Medications Medications used to treat sickle cell anemia include: - Antibiotics. Children with sickle cell anemia may begin taking the antibiotic penicillin when they're about 2 months old and continue taking it until they're at least 5 years old. Doing so helps prevent infections, such as pneumonia, which can be life-threatening to an infant or child with sickle cell anemia. As an adult, if you've had your spleen removed or had pneumonia, you might need to take penicillin throughout your life. - Pain-relieving medications. To relieve pain during a sickle cell crisis, your doctor might prescribe pain medications. - Hydroxyurea (Droxia, Hydrea). When taken daily, hydroxyurea reduces the frequency of painful crises and might reduce the need for blood transfusions and hospitalizations. Hydroxyurea seems to work by stimulating production of fetal hemoglobin - a type of hemoglobin found in newborns that helps prevent the formation of sickle cells. Hydroxyurea increases your risk of infections, and there is some concern that long-term use of this drug might cause problems later in life for people who take it for many years. More study is needed. Your doctor can help you determine if this drug might be beneficial for you or your child. Don't take the drug if you're pregnant. Assessing stroke risk Using a special ultrasound machine (transcranial), doctors can learn which children have a higher risk of stroke. This painless test, which uses sound waves to measure blood flow, can be used on children as young as 2 years. Regular blood transfusions can decrease stroke risk. Vaccinations to prevent infections Childhood vaccinations are important for preventing disease in all children. They're even more important for children with sickle cell anemia because their infections can be severe. Your doctor will make sure your child receives all of the recommended childhood vaccinations. Vaccinations, such as the pneumococcal vaccine and the annual flu shot, are also important for adults with sickle cell anemia. Blood transfusions In a red blood cell transfusion, red blood cells are removed from a supply of donated blood, then given intravenously to a person with sickle cell anemia. Blood transfusions increase the number of normal red blood cells in circulation, helping to relieve anemia. In children with sickle cell anemia at high risk of stroke, regular blood transfusions can decrease the risk. Transfusions can also be used to treat other complications of sickle cell anemia, or they can be given to prevent complications. Blood transfusions carry some risk, including infection and excess iron buildup in your body. Because excess iron can damage your heart, liver and other organs, people who undergo regular transfusions might need treatment to reduce iron levels. Bone marrow transplant A bone marrow transplant, also called a stem cell transplant, involves replacing bone marrow affected by sickle cell anemia with healthy bone marrow from a donor. The procedure usually uses a matched donor, such as a sibling, who doesn't have sickle cell anemia. For many, donors aren't available. But stem cells from umbilical cord blood might be an option. Because of the risks associated with a bone marrow transplant, the procedure is recommended only for people, usually children, who have significant symptoms and problems from sickle cell anemia. If a donor is found, the person with sickle cell anemia receives radiation or chemotherapy to destroy or reduce his or her bone marrow stem cells. Healthy stem cells from the donor are injected intravenously into the bloodstream of the person with sickle cell anemia, where they migrate to the bone marrow and begin generating new blood cells. The procedure requires a lengthy hospital stay. After the transplant, you'll receive drugs to help prevent rejection of the donated stem cells. Even so, your body might reject the transplant, leading to life-threatening complications. Treating sickle cell complications Doctors treat most complications of sickle cell anemia as they occur. Treatment might include antibiotics, vitamins, blood transfusions, pain-relieving medicines, other medications and possibly surgery, such as to correct vision problems or to remove a damaged spleen. Experimental treatments Scientists are studying new treatments for sickle cell anemia, including: - Gene therapy. Researchers are exploring whether inserting a normal gene into the bone marrow of people with sickle cell anemia will result in normal hemoglobin. Scientists are also exploring the possibility of turning off the defective gene while reactivating another gene responsible for the production of fetal hemoglobin - a type of hemoglobin found in newborns that prevents sickle cells from forming. Potential treatments using gene therapy are a long way off, however. - Nitric oxide. People with sickle cell anemia have low levels of nitric oxide in their blood. Nitric oxide is a gas that helps keep blood vessels open and reduces the stickiness of red blood cells. Treatment with inhaled nitric oxide might prevent sickle cells from clumping together. Studies on nitric oxide have shown little benefit so far. - Drugs to boost fetal hemoglobin production. Researchers are studying various drugs to devise a way to boost the production of fetal hemoglobin. This is a type of hemoglobin that stops sickle cells from forming. Taking the following steps to stay healthy may help you avoid complications of sickle cell anemia: - Take folic acid supplements daily, and choose a healthy diet. Bone marrow needs folic acid and other vitamins to make new red blood cells. Your doctor might recommend a folic acid supplement. Choose a diet that focuses on a variety of colorful fruits and vegetables, as well as whole grains. - Drink plenty of water. Dehydration can increase your risk of a sickle cell crisis. Drink water throughout your day, aiming for about eight glasses a day. Increase the amount of water you drink if you exercise or spend time in a hot, dry climate. - Avoid temperature extremes. Exposure to extreme heat or cold can increase your risk of a sickle cell crisis. - Exercise regularly, but don't overdo it. Talk with your doctor about how much exercise is right for you. - Use over-the-counter (OTC) medications with caution. Use OTC pain medications, such as ibuprofen (Advil, Motrin IB, Children's Motrin, others) or naproxen sodium (Aleve) sparingly, if at all, because of the possible effect on your kidneys. Ask your doctor before taking OTC drugs.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Causes): Sickle cell anemia is caused by a mutation in the gene that tells your body to make the red, iron-rich compound that gives blood its red color (hemoglobin). Hemoglobin allows red blood cells to carry oxygen from your lungs to all parts of your body. In sickle cell anemia, the abnormal hemoglobin causes red blood cells to become rigid, sticky and misshapen. The sickle cell gene is passed from generation to generation in a pattern of inheritance called autosomal recessive inheritance. This means that both the mother and the father must pass on the defective form of the gene for a child to be affected. If only one parent passes the sickle cell gene to the child, that child will have the sickle cell trait. With one normal hemoglobin gene and one defective form of the gene, people with the sickle cell trait make both normal hemoglobin and sickle cell hemoglobin. Their blood might contain some sickle cells, but they generally don't have symptoms. But they are carriers of the disease, which means they can pass the gene to their children.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Sickle cell anemia (Complications): Sickle cell anemia can lead to a host of complications, including: - Stroke. A stroke can occur if sickle cells block blood flow to an area of your brain. Signs of stroke include seizures, weakness or numbness of your arms and legs, sudden speech difficulties, and loss of consciousness. If your baby or child has any of these signs and symptoms, seek medical treatment immediately. A stroke can be fatal. - Acute chest syndrome. This life-threatening complication causes chest pain, fever and difficulty breathing. Acute chest syndrome can be caused by a lung infection or by sickle cells blocking blood vessels in your lungs. It might require emergency medical treatment with antibiotics and other treatments. - Pulmonary hypertension. People with sickle cell anemia can develop high blood pressure in their lungs (pulmonary hypertension). This complication usually affects adults rather than children. Shortness of breath and fatigue are common symptoms of this condition, which can be fatal. - Organ damage. Sickle cells that block blood flow through blood vessels immediately deprive the affected organ of blood and oxygen. In sickle cell anemia, blood is also chronically low on oxygen. Chronic deprivation of oxygen-rich blood can damage nerves and organs in your body, including your kidneys, liver and spleen. Organ damage can be fatal. - Blindness. Sickle cells can block tiny blood vessels that supply your eyes. Over time, this can damage the portion of the eye that processes visual images (retina) and lead to blindness. - Leg ulcers. Sickle cell anemia can cause open sores, called ulcers, on your legs. - Gallstones. The breakdown of red blood cells produces a substance called bilirubin. A high level of bilirubin in your body can lead to gallstones. - Priapism. Men with sickle cell anemia can have painful, long-lasting erections, a condition called priapism. As occurs in other parts of the body, sickle cells can block the blood vessels in the penis. This can damage the penis and lead to impotence.",
+    "https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876"
+  ],
+  [
+    "Gonorrhea: Gonorrhea is a sexually transmitted infection (STI). It is usually spread by having vaginal, oral, or anal sex. In 2014, gonorrhea affected more than 162,000 women in the United States.1 Antibiotics can treat gonorrhea. If left untreated, it can cause serious health problems, including problems getting pregnant. Gonorrhea is an STI that is caused by the bacteria Neisseria gonorrhoeae. It is an especially serious problem for women because it can damage the female reproductive organs. In 2014, gonorrhea affected more than 162,000 women in the United States.1 Gonorrhea most often affects women ages 15 to 24. But, gonorrhea is becoming more common in older women too.1 Gonorrhea is spread through: Most women with gonorrhea do not have any signs or symptoms. If you do get symptoms, they are often mild and can be mistaken for a bladder or vaginal infection. Signs or symptoms of gonorrhea depend on where you are first infected by the gonorrhea bacteria. Signs and symptoms in the genital area can include: Signs and symptoms in other parts of the body include: Gonorrhea can cause serious health problems, even if you do not have any signs or symptoms. You also need to get tested if you have any symptoms of gonorrhea. Testing is very important, because women with untreated gonorrhea can develop serious health problems. If you are tested for gonorrhea, you also need to get tested for other STIs, including chlamydia, syphilis, and HIV. There are two ways that a doctor or nurse tests for gonorrhea: A Pap test is not used to detect gonorrhea. Your doctor or nurse will give you antibiotics to treat gonorrhea. The antibiotics are usually a pill you swallow. Although antibiotics can cure gonorrhea, they cannot fix any permanent damage done to your body. For this reason, it is important to get tested and to take the antibiotics as soon as possible. For the antibiotics to work, you must finish all of the antibiotics that your doctor gives you, even if the symptoms go away. Do not share your antibiotics for gonorrhea with anyone. If symptoms do not go away after treatment, see your doctor or nurse. It is possible to get gonorrhea again if you have sex with someone who has gonorrhea. Tell your recent sex partner(s) so they can be tested and treated. Gonorrhea that is not treated can cause serious health problems in women:3 Gonorrhea is easy to treat. But you need to get tested and treated as soon as possible. If you have gonorrhea: For pregnant women, untreated gonorrhea raises the risk of: Babies born to infected mothers are at risk for: Treatment of gonorrhea as soon as it is found in pregnant women will lower the risk of these problems for both mother and baby. Your baby will get antibiotics if you have gonorrhea or if your baby has a gonorrheal eye infection. The best way to prevent gonorrhea or any STI is to not have vaginal, oral, or anal sex. If you do have sex, lower your risk of getting an STI with the following steps: The steps work best when used together. No single step can protect you from every single type of STI. Yes. It is possible to get gonorrhea, or any other STI, if you are a woman who has sex only with women. Talk to your partner about her sexual history before having sex, and ask your doctor about getting tested if you have signs or symptoms of gonorrhea. For more information about gonorrhea, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "How to diagnose Gonorrhea?: Gonorrhea can be quickly detected by looking at a sample of discharge or tissue under the microscope. This is called a gram stain. This method is fast, but it is not the most certain. Gonorrhea is most accurately detected with DNA tests. DNA tests are useful for screening. The ligase chain reaction (LCR) test is one of the tests. DNA tests are quicker than cultures. These tests can be performed on urine samples, which are easier to collect than samples from the genital area. Prior to DNA tests, cultures (cells that grow in a lab dish) were used to provide proof of gonorrhea, but are less commonly used now. Samples for a culture are most often taken from the cervix, vagina, urethra, anus, or throat. - Rarely they are taken from joint fluid or blood - Cultures can often provide an early diagnosis within 24 hours. A confirmed diagnosis is available within 72 hours. If you have gonorrhea, you should ask to be tested for other sexually transmitted infections, including chlamydia, syphilis, and HIV herpes and hepatitis.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/007267.htm"
+  ],
+  [
+    "Gonorrhea (More About Gonorrhea): Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases",
+    "https://www.niaid.nih.gov/diseases-conditions/gonorrhea More About Gonorrhea Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases"
+  ],
+  [
+    "Gonorrhea: Gonorrhea is an infection caused by a sexually transmitted bacterium that can infect both males and females. Gonorrhea most often affects the urethra, rectum or throat. In females, gonorrhea can also infect the cervix. Gonorrhea is most commonly spread during sex. But babies can be infected during childbirth if their mothers are infected. In babies, gonorrhea most commonly affects the eyes. Gonorrhea is a common infection that, in many cases, causes no symptoms. You may not even know that you're infected. Abstaining from sex, using a condom if you do have sex and being in a mutually monogamous relationship are the best ways to prevent sexually transmitted infections. In many cases, gonorrhea infection causes no symptoms. When symptoms do appear, gonorrhea infection can affect multiple sites in your body, but it commonly appears in the genital tract. Gonorrhea affecting the genital tract Signs and symptoms of gonorrhea infection in men include: - Painful urination - Pus-like discharge from the tip of the penis - Pain or swelling in one testicle Signs and symptoms of gonorrhea infection in women include: - Increased vaginal discharge - Painful urination - Vaginal bleeding between periods, such as after vaginal intercourse - Painful intercourse - Abdominal or pelvic pain Gonorrhea at other sites in the body Gonorrhea can also affect these parts of the body: - Rectum. Signs and symptoms include anal itching, pus-like discharge from the rectum, spots of bright red blood on toilet tissue and having to strain during bowel movements. - Eyes. Gonorrhea that affects your eyes may cause eye pain, sensitivity to light, and pus-like discharge from one or both eyes. - Throat. Signs and symptoms of a throat infection may include a sore throat and swollen lymph nodes in the neck. - Joints. If one or more joints become infected by bacteria (septic arthritis), the affected joints may be warm, red, swollen and extremely painful, especially when you move an affected joint. When to see your doctor Make an appointment with your doctor if you notice any troubling signs or symptoms, such as a burning sensation when you urinate or a pus-like discharge from your penis, vagina or rectum. Also make an appointment with your doctor if your partner has been diagnosed with gonorrhea. You may not experience signs or symptoms that prompt you to seek medical attention. But without treatment, you can reinfect your partner even after he or she has been treated for gonorrhea. Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. The gonorrhea bacteria are most often passed from one person to another during sexual contact, including oral, anal or vaginal intercourse. Factors that may increase your risk of gonorrhea infection include: - Younger age - A new sex partner - A sex partner who has concurrent partners - Multiple sex partners - Previous gonorrhea diagnosis - Having other sexually transmitted infections Untreated gonorrhea can lead to significant complications, such as: - Infertility in women. Untreated gonorrhea can spread into the uterus and fallopian tubes, causing pelvic inflammatory disease (PID), which may result in scarring of the tubes, greater risk of pregnancy complications and infertility. PID is a serious infection that requires immediate treatment. - Infertility in men. Men with untreated gonorrhea can experience epididymitis - inflammation of a small, coiled tube in the rear portion of the testicles where the sperm ducts are located (epididymis). Epididymitis is treatable, but if left untreated, it may lead to infertility. - Infection that spreads to the joints and other areas of your body. The bacterium that causes gonorrhea can spread through the bloodstream and infect other parts of your body, including your joints. Fever, rash, skin sores, joint pain, swelling and stiffness are possible results. - Increased risk of HIV/AIDS. Having gonorrhea makes you more susceptible to infection with human immunodeficiency virus (HIV), the virus that leads to AIDS. People who have both gonorrhea and HIV are able to pass both diseases more readily to their partners. - Complications in babies. Babies who contract gonorrhea from their mothers during birth can develop blindness, sores on the scalp and infections. To determine whether the gonorrhea bacterium is present in your body, your doctor will analyze a sample of cells. Samples can be collected by: - Urine test. This may help identify bacteria in your urethra. - Swab of affected area. A swab of your throat, urethra, vagina or rectum may collect bacteria that can be identified in a laboratory. For women, home test kits are available for gonorrhea. Home test kits include vaginal swabs for self-testing that are sent to a specified lab for testing. If you prefer, you can choose to be notified by email or text message when your results are ready. You may then view your results online or receive them by calling a toll-free hotline. Testing for other sexually transmitted infections Your doctor may recommend tests for other sexually transmitted infections. Gonorrhea increases your risk of these infections, particularly chlamydia, which often accompanies gonorrhea. Testing for HIV also is recommended for anyone diagnosed with a sexually transmitted infection. Depending on your risk factors, tests for additional sexually transmitted infections could be beneficial as well. Gonorrhea treatment in adults Adults with gonorrhea are treated with antibiotics. Due to emerging strains of drug-resistant Neisseria gonorrhoeae, the Centers for Disease Control and Prevention recommends that uncomplicated gonorrhea be treated only with the antibiotic ceftriaxone - given as an injection - in combination with either azithromycin (Zithromax, Zmax) or doxycycline (Monodox, Vibramycin, others) - two antibiotics that are taken orally. Some research indicates that oral gemifloxacin (Factive) or injectable gentamicin, combined with oral azithromycin, is highly successful in treating gonorrhea. This treatment may be helpful in treating people who are allergic to cephalosporin antibiotics, such as ceftriaxone. Gonorrhea treatment for partners Your partner also should undergo testing and treatment for gonorrhea, even if he or she has no signs or symptoms. Your partner receives the same treatment you do. Even if you've been treated for gonorrhea, you can be reinfected if your partner isn't treated. Gonorrhea treatment for babies Babies born to mothers with gonorrhea receive a medication in their eyes soon after birth to prevent infection. If an eye infection develops, babies can be treated with antibiotics.",
+    "https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774"
+  ],
+  [
+    "Gonorrhea: Gonorrhea is a sexually transmitted disease that can infect both men and women. Caused by the\u00a0Neisseria gonorrhoeae\u00a0bacterium, gonorrhea can cause infections in the genitals, rectum and throat. Although treatable, drug-resistant forms of gonorrhea are increasing. If left untreated, gonorrhea can lead to pelvic inflammatory disease, ectopic pregnancy, infertility, and increased risk of HIV infection. Gonorrhea can also be passed from mother to child and cause blindness or life-threatening infections in the infant. NIAID supports a comprehensive, multidisciplinary program of research on Neissesria gonorrhoeae (gonococci). Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases Scientists have determined the complete genetic code, or sequence (genetic blueprint), of the N. gonorrhoeae genome. They are using this information to help us better understand how the bacterium causes disease and becomes resistant to antibiotics. NIAID also supports research to develop topical microbicides (antimicrobial preparations that can be appled inside the vagina) to prevent gonococcal infections. Another important area of gonorrhea research concerns antibiotic (drug) resistance. This is particularly important because strains of N. gonorhoeae that are resistant to recommended antibiotic treatments have been increasing and are becoming widespread in the United States. These events add urgency to conduct research on and develop new antibiotics and to prevent antibiotic resistance from spreading.",
+    "https://www.niaid.nih.gov/diseases-conditions/gonorrhea More About Gonorrhea Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases"
+  ],
+  [
+    "Gonorrhea (Who gets gonorrhea?): In 2014, gonorrhea affected more than 162,000 women in the United States.1 Gonorrhea most often affects women ages 15 to 24. But, gonorrhea is becoming more common in older women too.1",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea (What should I do if I have gonorrhea?): Gonorrhea is easy to treat. But you need to get tested and treated as soon as possible. If you have gonorrhea:",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea (How do you get gonorrhea?): Gonorrhea is spread through:",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea (What is gonorrhea?): Gonorrhea is an STI that is caused by the bacteria Neisseria gonorrhoeae. It is an especially serious problem for women because it can damage the female reproductive organs.",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea (How is gonorrhea treated?): Your doctor or nurse will give you antibiotics to treat gonorrhea. The antibiotics are usually a pill you swallow. Although antibiotics can cure gonorrhea, they cannot fix any permanent damage done to your body. For this reason, it is important to get tested and to take the antibiotics as soon as possible. For the antibiotics to work, you must finish all of the antibiotics that your doctor gives you, even if the symptoms go away. Do not share your antibiotics for gonorrhea with anyone. If symptoms do not go away after treatment, see your doctor or nurse. It is possible to get gonorrhea again if you have sex with someone who has gonorrhea. Tell your recent sex partner(s) so they can be tested and treated.",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea: Gonorrhea is a sexually transmitted infection (STI). It is usually spread by having vaginal, oral, or anal sex. In 2014, gonorrhea affected more than 162,000 women in the United States.1 Antibiotics can treat gonorrhea. If left untreated, it can cause serious health problems, including problems getting pregnant. Gonorrhea is an STI that is caused by the bacteria Neisseria gonorrhoeae. It is an especially serious problem for women because it can damage the female reproductive organs. In 2014, gonorrhea affected more than 162,000 women in the United States.1 Gonorrhea most often affects women ages 15 to 24. But, gonorrhea is becoming more common in older women too.1 Gonorrhea is spread through: Most women with gonorrhea do not have any signs or symptoms. If you do get symptoms, they are often mild and can be mistaken for a bladder or vaginal infection. Signs or symptoms of gonorrhea depend on where you are first infected by the gonorrhea bacteria. Signs and symptoms in the genital area can include: Signs and symptoms in other parts of the body include: Gonorrhea can cause serious health problems, even if you do not have any signs or symptoms. You also need to get tested if you have any symptoms of gonorrhea. Testing is very important, because women with untreated gonorrhea can develop serious health problems. If you are tested for gonorrhea, you also need to get tested for other STIs, including chlamydia, syphilis, and HIV. There are two ways that a doctor or nurse tests for gonorrhea: A Pap test is not used to detect gonorrhea. Your doctor or nurse will give you antibiotics to treat gonorrhea. The antibiotics are usually a pill you swallow. Although antibiotics can cure gonorrhea, they cannot fix any permanent damage done to your body. For this reason, it is important to get tested and to take the antibiotics as soon as possible. For the antibiotics to work, you must finish all of the antibiotics that your doctor gives you, even if the symptoms go away. Do not share your antibiotics for gonorrhea with anyone. If symptoms do not go away after treatment, see your doctor or nurse. It is possible to get gonorrhea again if you have sex with someone who has gonorrhea. Tell your recent sex partner(s) so they can be tested and treated. Gonorrhea that is not treated can cause serious health problems in women:3 Gonorrhea is easy to treat. But you need to get tested and treated as soon as possible. If you have gonorrhea: For pregnant women, untreated gonorrhea raises the risk of: Babies born to infected mothers are at risk for: Treatment of gonorrhea as soon as it is found in pregnant women will lower the risk of these problems for both mother and baby. Your baby will get antibiotics if you have gonorrhea or if your baby has a gonorrheal eye infection. The best way to prevent gonorrhea or any STI is to not have vaginal, oral, or anal sex. If you do have sex, lower your risk of getting an STI with the following steps: The steps work best when used together. No single step can protect you from every single type of STI. Yes. It is possible to get gonorrhea, or any other STI, if you are a woman who has sex only with women. Talk to your partner about her sexual history before having sex, and ask your doctor about getting tested if you have signs or symptoms of gonorrhea. For more information about gonorrhea, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "How to diagnose Gonorrhea?: Gonorrhea can be quickly detected by looking at a sample of discharge or tissue under the microscope. This is called a gram stain. This method is fast, but it is not the most certain. Gonorrhea is most accurately detected with DNA tests. DNA tests are useful for screening. The ligase chain reaction (LCR) test is one of the tests. DNA tests are quicker than cultures. These tests can be performed on urine samples, which are easier to collect than samples from the genital area. Prior to DNA tests, cultures (cells that grow in a lab dish) were used to provide proof of gonorrhea, but are less commonly used now. Samples for a culture are most often taken from the cervix, vagina, urethra, anus, or throat. - Rarely they are taken from joint fluid or blood - Cultures can often provide an early diagnosis within 24 hours. A confirmed diagnosis is available within 72 hours. If you have gonorrhea, you should ask to be tested for other sexually transmitted infections, including chlamydia, syphilis, and HIV herpes and hepatitis.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/007267.htm"
+  ],
+  [
+    "Gonorrhea (More About Gonorrhea): Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases",
+    "https://www.niaid.nih.gov/diseases-conditions/gonorrhea More About Gonorrhea Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases"
+  ],
+  [
+    "Gonorrhea (Treatment): Gonorrhea treatment in adults Adults with gonorrhea are treated with antibiotics. Due to emerging strains of drug-resistant Neisseria gonorrhoeae, the Centers for Disease Control and Prevention recommends that uncomplicated gonorrhea be treated only with the antibiotic ceftriaxone - given as an injection - in combination with either azithromycin (Zithromax, Zmax) or doxycycline (Monodox, Vibramycin, others) - two antibiotics that are taken orally. Some research indicates that oral gemifloxacin (Factive) or injectable gentamicin, combined with oral azithromycin, is highly successful in treating gonorrhea. This treatment may be helpful in treating people who are allergic to cephalosporin antibiotics, such as ceftriaxone. Gonorrhea treatment for partners Your partner also should undergo testing and treatment for gonorrhea, even if he or she has no signs or symptoms. Your partner receives the same treatment you do. Even if you've been treated for gonorrhea, you can be reinfected if your partner isn't treated. Gonorrhea treatment for babies Babies born to mothers with gonorrhea receive a medication in their eyes soon after birth to prevent infection. If an eye infection develops, babies can be treated with antibiotics.",
+    "https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774"
+  ],
+  [
+    "Gonorrhea: Gonorrhea is an infection caused by a sexually transmitted bacterium that can infect both males and females. Gonorrhea most often affects the urethra, rectum or throat. In females, gonorrhea can also infect the cervix. Gonorrhea is most commonly spread during sex. But babies can be infected during childbirth if their mothers are infected. In babies, gonorrhea most commonly affects the eyes. Gonorrhea is a common infection that, in many cases, causes no symptoms. You may not even know that you're infected. Abstaining from sex, using a condom if you do have sex and being in a mutually monogamous relationship are the best ways to prevent sexually transmitted infections. In many cases, gonorrhea infection causes no symptoms. When symptoms do appear, gonorrhea infection can affect multiple sites in your body, but it commonly appears in the genital tract. Gonorrhea affecting the genital tract Signs and symptoms of gonorrhea infection in men include: - Painful urination - Pus-like discharge from the tip of the penis - Pain or swelling in one testicle Signs and symptoms of gonorrhea infection in women include: - Increased vaginal discharge - Painful urination - Vaginal bleeding between periods, such as after vaginal intercourse - Painful intercourse - Abdominal or pelvic pain Gonorrhea at other sites in the body Gonorrhea can also affect these parts of the body: - Rectum. Signs and symptoms include anal itching, pus-like discharge from the rectum, spots of bright red blood on toilet tissue and having to strain during bowel movements. - Eyes. Gonorrhea that affects your eyes may cause eye pain, sensitivity to light, and pus-like discharge from one or both eyes. - Throat. Signs and symptoms of a throat infection may include a sore throat and swollen lymph nodes in the neck. - Joints. If one or more joints become infected by bacteria (septic arthritis), the affected joints may be warm, red, swollen and extremely painful, especially when you move an affected joint. When to see your doctor Make an appointment with your doctor if you notice any troubling signs or symptoms, such as a burning sensation when you urinate or a pus-like discharge from your penis, vagina or rectum. Also make an appointment with your doctor if your partner has been diagnosed with gonorrhea. You may not experience signs or symptoms that prompt you to seek medical attention. But without treatment, you can reinfect your partner even after he or she has been treated for gonorrhea. Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. The gonorrhea bacteria are most often passed from one person to another during sexual contact, including oral, anal or vaginal intercourse. Factors that may increase your risk of gonorrhea infection include: - Younger age - A new sex partner - A sex partner who has concurrent partners - Multiple sex partners - Previous gonorrhea diagnosis - Having other sexually transmitted infections Untreated gonorrhea can lead to significant complications, such as: - Infertility in women. Untreated gonorrhea can spread into the uterus and fallopian tubes, causing pelvic inflammatory disease (PID), which may result in scarring of the tubes, greater risk of pregnancy complications and infertility. PID is a serious infection that requires immediate treatment. - Infertility in men. Men with untreated gonorrhea can experience epididymitis - inflammation of a small, coiled tube in the rear portion of the testicles where the sperm ducts are located (epididymis). Epididymitis is treatable, but if left untreated, it may lead to infertility. - Infection that spreads to the joints and other areas of your body. The bacterium that causes gonorrhea can spread through the bloodstream and infect other parts of your body, including your joints. Fever, rash, skin sores, joint pain, swelling and stiffness are possible results. - Increased risk of HIV/AIDS. Having gonorrhea makes you more susceptible to infection with human immunodeficiency virus (HIV), the virus that leads to AIDS. People who have both gonorrhea and HIV are able to pass both diseases more readily to their partners. - Complications in babies. Babies who contract gonorrhea from their mothers during birth can develop blindness, sores on the scalp and infections. To determine whether the gonorrhea bacterium is present in your body, your doctor will analyze a sample of cells. Samples can be collected by: - Urine test. This may help identify bacteria in your urethra. - Swab of affected area. A swab of your throat, urethra, vagina or rectum may collect bacteria that can be identified in a laboratory. For women, home test kits are available for gonorrhea. Home test kits include vaginal swabs for self-testing that are sent to a specified lab for testing. If you prefer, you can choose to be notified by email or text message when your results are ready. You may then view your results online or receive them by calling a toll-free hotline. Testing for other sexually transmitted infections Your doctor may recommend tests for other sexually transmitted infections. Gonorrhea increases your risk of these infections, particularly chlamydia, which often accompanies gonorrhea. Testing for HIV also is recommended for anyone diagnosed with a sexually transmitted infection. Depending on your risk factors, tests for additional sexually transmitted infections could be beneficial as well. Gonorrhea treatment in adults Adults with gonorrhea are treated with antibiotics. Due to emerging strains of drug-resistant Neisseria gonorrhoeae, the Centers for Disease Control and Prevention recommends that uncomplicated gonorrhea be treated only with the antibiotic ceftriaxone - given as an injection - in combination with either azithromycin (Zithromax, Zmax) or doxycycline (Monodox, Vibramycin, others) - two antibiotics that are taken orally. Some research indicates that oral gemifloxacin (Factive) or injectable gentamicin, combined with oral azithromycin, is highly successful in treating gonorrhea. This treatment may be helpful in treating people who are allergic to cephalosporin antibiotics, such as ceftriaxone. Gonorrhea treatment for partners Your partner also should undergo testing and treatment for gonorrhea, even if he or she has no signs or symptoms. Your partner receives the same treatment you do. Even if you've been treated for gonorrhea, you can be reinfected if your partner isn't treated. Gonorrhea treatment for babies Babies born to mothers with gonorrhea receive a medication in their eyes soon after birth to prevent infection. If an eye infection develops, babies can be treated with antibiotics.",
+    "https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774"
+  ],
+  [
+    "Gonorrhea (How is gonorrhea treated?): Your doctor or nurse will give you antibiotics to treat gonorrhea. The antibiotics are usually a pill you swallow. Although antibiotics can cure gonorrhea, they cannot fix any permanent damage done to your body. For this reason, it is important to get tested and to take the antibiotics as soon as possible. For the antibiotics to work, you must finish all of the antibiotics that your doctor gives you, even if the symptoms go away. Do not share your antibiotics for gonorrhea with anyone. If symptoms do not go away after treatment, see your doctor or nurse. It is possible to get gonorrhea again if you have sex with someone who has gonorrhea. Tell your recent sex partner(s) so they can be tested and treated.",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea: Gonorrhea is a sexually transmitted disease that can infect both men and women. Caused by the\u00a0Neisseria gonorrhoeae\u00a0bacterium, gonorrhea can cause infections in the genitals, rectum and throat. Although treatable, drug-resistant forms of gonorrhea are increasing. If left untreated, gonorrhea can lead to pelvic inflammatory disease, ectopic pregnancy, infertility, and increased risk of HIV infection. Gonorrhea can also be passed from mother to child and cause blindness or life-threatening infections in the infant. NIAID supports a comprehensive, multidisciplinary program of research on Neissesria gonorrhoeae (gonococci). Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases Scientists have determined the complete genetic code, or sequence (genetic blueprint), of the N. gonorrhoeae genome. They are using this information to help us better understand how the bacterium causes disease and becomes resistant to antibiotics. NIAID also supports research to develop topical microbicides (antimicrobial preparations that can be appled inside the vagina) to prevent gonococcal infections. Another important area of gonorrhea research concerns antibiotic (drug) resistance. This is particularly important because strains of N. gonorhoeae that are resistant to recommended antibiotic treatments have been increasing and are becoming widespread in the United States. These events add urgency to conduct research on and develop new antibiotics and to prevent antibiotic resistance from spreading.",
+    "https://www.niaid.nih.gov/diseases-conditions/gonorrhea More About Gonorrhea Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases"
+  ],
+  [
+    "Gonorrhea (What are the signs and symptoms of gonorrhea?): Most women with gonorrhea do not have any signs or symptoms. If you do get symptoms, they are often mild and can be mistaken for a bladder or vaginal infection. Signs or symptoms of gonorrhea depend on where you are first infected by the gonorrhea bacteria. Signs and symptoms in the genital area can include: Signs and symptoms in other parts of the body include: Gonorrhea can cause serious health problems, even if you do not have any signs or symptoms.",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea (Symptoms): In many cases, gonorrhea infection causes no symptoms. When symptoms do appear, gonorrhea infection can affect multiple sites in your body, but it commonly appears in the genital tract. Gonorrhea affecting the genital tract Signs and symptoms of gonorrhea infection in men include: - Painful urination - Pus-like discharge from the tip of the penis - Pain or swelling in one testicle Signs and symptoms of gonorrhea infection in women include: - Increased vaginal discharge - Painful urination - Vaginal bleeding between periods, such as after vaginal intercourse - Painful intercourse - Abdominal or pelvic pain Gonorrhea at other sites in the body Gonorrhea can also affect these parts of the body: - Rectum. Signs and symptoms include anal itching, pus-like discharge from the rectum, spots of bright red blood on toilet tissue and having to strain during bowel movements. - Eyes. Gonorrhea that affects your eyes may cause eye pain, sensitivity to light, and pus-like discharge from one or both eyes. - Throat. Signs and symptoms of a throat infection may include a sore throat and swollen lymph nodes in the neck. - Joints. If one or more joints become infected by bacteria (septic arthritis), the affected joints may be warm, red, swollen and extremely painful, especially when you move an affected joint. When to see your doctor Make an appointment with your doctor if you notice any troubling signs or symptoms, such as a burning sensation when you urinate or a pus-like discharge from your penis, vagina or rectum. Also make an appointment with your doctor if your partner has been diagnosed with gonorrhea. You may not experience signs or symptoms that prompt you to seek medical attention. But without treatment, you can reinfect your partner even after he or she has been treated for gonorrhea.",
+    "https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774"
+  ],
+  [
+    "Gonorrhea (Who gets gonorrhea?): In 2014, gonorrhea affected more than 162,000 women in the United States.1 Gonorrhea most often affects women ages 15 to 24. But, gonorrhea is becoming more common in older women too.1",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea (What are the signs and symptoms of gonorrhea?): Most women with gonorrhea do not have any signs or symptoms. If you do get symptoms, they are often mild and can be mistaken for a bladder or vaginal infection. Signs or symptoms of gonorrhea depend on where you are first infected by the gonorrhea bacteria. Signs and symptoms in the genital area can include: Signs and symptoms in other parts of the body include: Gonorrhea can cause serious health problems, even if you do not have any signs or symptoms.",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "What are the symptoms of Gonorrhea?: Symptoms of gonorrhea most often appear 2 to 5 days after infection. However, it may take up to a month for symptoms to appear in men. Some people do not have symptoms. They may not know that they have caught the infection, so do not seek treatment. This increases the risk of complications and the chances of passing the infection on to another person. Symptoms in men include: - Burning and pain while urinating - Need to urinate urgently or more often - Discharge from the penis (white, yellow, or green in color) - Red or swollen opening of penis (urethra) - Tender or swollen testicles - Sore throat (gonococcal pharyngitis) Symptoms in women can be very mild. They can be mistaken for another type of infection. They include: - Burning and pain while urinating - Sore throat - Painful sexual intercourse - Severe pain in lower abdomen (if the infection spreads to the fallopian tubes and stomach area) - Fever (if the infection spreads to the fallopian tubes and stomach area) If the infection spreads to the bloodstream, symptoms include: - Fever - Rash - Arthritis-like symptoms - Abnormal vaginal discharge with greenish, yellow or foul smelling discharge",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/007267.htm"
+  ],
+  [
+    "Gonorrhea (Symptoms): In many cases, gonorrhea infection causes no symptoms. When symptoms do appear, gonorrhea infection can affect multiple sites in your body, but it commonly appears in the genital tract. Gonorrhea affecting the genital tract Signs and symptoms of gonorrhea infection in men include: - Painful urination - Pus-like discharge from the tip of the penis - Pain or swelling in one testicle Signs and symptoms of gonorrhea infection in women include: - Increased vaginal discharge - Painful urination - Vaginal bleeding between periods, such as after vaginal intercourse - Painful intercourse - Abdominal or pelvic pain Gonorrhea at other sites in the body Gonorrhea can also affect these parts of the body: - Rectum. Signs and symptoms include anal itching, pus-like discharge from the rectum, spots of bright red blood on toilet tissue and having to strain during bowel movements. - Eyes. Gonorrhea that affects your eyes may cause eye pain, sensitivity to light, and pus-like discharge from one or both eyes. - Throat. Signs and symptoms of a throat infection may include a sore throat and swollen lymph nodes in the neck. - Joints. If one or more joints become infected by bacteria (septic arthritis), the affected joints may be warm, red, swollen and extremely painful, especially when you move an affected joint. When to see your doctor Make an appointment with your doctor if you notice any troubling signs or symptoms, such as a burning sensation when you urinate or a pus-like discharge from your penis, vagina or rectum. Also make an appointment with your doctor if your partner has been diagnosed with gonorrhea. You may not experience signs or symptoms that prompt you to seek medical attention. But without treatment, you can reinfect your partner even after he or she has been treated for gonorrhea.",
+    "https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774"
+  ],
+  [
+    "Gonorrhea: Gonorrhea is a sexually transmitted infection (STI). It is usually spread by having vaginal, oral, or anal sex. In 2014, gonorrhea affected more than 162,000 women in the United States.1 Antibiotics can treat gonorrhea. If left untreated, it can cause serious health problems, including problems getting pregnant. Gonorrhea is an STI that is caused by the bacteria Neisseria gonorrhoeae. It is an especially serious problem for women because it can damage the female reproductive organs. In 2014, gonorrhea affected more than 162,000 women in the United States.1 Gonorrhea most often affects women ages 15 to 24. But, gonorrhea is becoming more common in older women too.1 Gonorrhea is spread through: Most women with gonorrhea do not have any signs or symptoms. If you do get symptoms, they are often mild and can be mistaken for a bladder or vaginal infection. Signs or symptoms of gonorrhea depend on where you are first infected by the gonorrhea bacteria. Signs and symptoms in the genital area can include: Signs and symptoms in other parts of the body include: Gonorrhea can cause serious health problems, even if you do not have any signs or symptoms. You also need to get tested if you have any symptoms of gonorrhea. Testing is very important, because women with untreated gonorrhea can develop serious health problems. If you are tested for gonorrhea, you also need to get tested for other STIs, including chlamydia, syphilis, and HIV. There are two ways that a doctor or nurse tests for gonorrhea: A Pap test is not used to detect gonorrhea. Your doctor or nurse will give you antibiotics to treat gonorrhea. The antibiotics are usually a pill you swallow. Although antibiotics can cure gonorrhea, they cannot fix any permanent damage done to your body. For this reason, it is important to get tested and to take the antibiotics as soon as possible. For the antibiotics to work, you must finish all of the antibiotics that your doctor gives you, even if the symptoms go away. Do not share your antibiotics for gonorrhea with anyone. If symptoms do not go away after treatment, see your doctor or nurse. It is possible to get gonorrhea again if you have sex with someone who has gonorrhea. Tell your recent sex partner(s) so they can be tested and treated. Gonorrhea that is not treated can cause serious health problems in women:3 Gonorrhea is easy to treat. But you need to get tested and treated as soon as possible. If you have gonorrhea: For pregnant women, untreated gonorrhea raises the risk of: Babies born to infected mothers are at risk for: Treatment of gonorrhea as soon as it is found in pregnant women will lower the risk of these problems for both mother and baby. Your baby will get antibiotics if you have gonorrhea or if your baby has a gonorrheal eye infection. The best way to prevent gonorrhea or any STI is to not have vaginal, oral, or anal sex. If you do have sex, lower your risk of getting an STI with the following steps: The steps work best when used together. No single step can protect you from every single type of STI. Yes. It is possible to get gonorrhea, or any other STI, if you are a woman who has sex only with women. Talk to your partner about her sexual history before having sex, and ask your doctor about getting tested if you have signs or symptoms of gonorrhea. For more information about gonorrhea, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea (Can women who have sex with women get gonorrhea?): Yes. It is possible to get gonorrhea, or any other STI, if you are a woman who has sex only with women. Talk to your partner about her sexual history before having sex, and ask your doctor about getting tested if you have signs or symptoms of gonorrhea.",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea (Do I need to get tested for gonorrhea?): You also need to get tested if you have any symptoms of gonorrhea. Testing is very important, because women with untreated gonorrhea can develop serious health problems. If you are tested for gonorrhea, you also need to get tested for other STIs, including chlamydia, syphilis, and HIV.",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea (More About Gonorrhea): Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases",
+    "https://www.niaid.nih.gov/diseases-conditions/gonorrhea More About Gonorrhea Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases"
+  ],
+  [
+    "Gonorrhea: Gonorrhea is an infection caused by a sexually transmitted bacterium that can infect both males and females. Gonorrhea most often affects the urethra, rectum or throat. In females, gonorrhea can also infect the cervix. Gonorrhea is most commonly spread during sex. But babies can be infected during childbirth if their mothers are infected. In babies, gonorrhea most commonly affects the eyes. Gonorrhea is a common infection that, in many cases, causes no symptoms. You may not even know that you're infected. Abstaining from sex, using a condom if you do have sex and being in a mutually monogamous relationship are the best ways to prevent sexually transmitted infections. In many cases, gonorrhea infection causes no symptoms. When symptoms do appear, gonorrhea infection can affect multiple sites in your body, but it commonly appears in the genital tract. Gonorrhea affecting the genital tract Signs and symptoms of gonorrhea infection in men include: - Painful urination - Pus-like discharge from the tip of the penis - Pain or swelling in one testicle Signs and symptoms of gonorrhea infection in women include: - Increased vaginal discharge - Painful urination - Vaginal bleeding between periods, such as after vaginal intercourse - Painful intercourse - Abdominal or pelvic pain Gonorrhea at other sites in the body Gonorrhea can also affect these parts of the body: - Rectum. Signs and symptoms include anal itching, pus-like discharge from the rectum, spots of bright red blood on toilet tissue and having to strain during bowel movements. - Eyes. Gonorrhea that affects your eyes may cause eye pain, sensitivity to light, and pus-like discharge from one or both eyes. - Throat. Signs and symptoms of a throat infection may include a sore throat and swollen lymph nodes in the neck. - Joints. If one or more joints become infected by bacteria (septic arthritis), the affected joints may be warm, red, swollen and extremely painful, especially when you move an affected joint. When to see your doctor Make an appointment with your doctor if you notice any troubling signs or symptoms, such as a burning sensation when you urinate or a pus-like discharge from your penis, vagina or rectum. Also make an appointment with your doctor if your partner has been diagnosed with gonorrhea. You may not experience signs or symptoms that prompt you to seek medical attention. But without treatment, you can reinfect your partner even after he or she has been treated for gonorrhea. Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. The gonorrhea bacteria are most often passed from one person to another during sexual contact, including oral, anal or vaginal intercourse. Factors that may increase your risk of gonorrhea infection include: - Younger age - A new sex partner - A sex partner who has concurrent partners - Multiple sex partners - Previous gonorrhea diagnosis - Having other sexually transmitted infections Untreated gonorrhea can lead to significant complications, such as: - Infertility in women. Untreated gonorrhea can spread into the uterus and fallopian tubes, causing pelvic inflammatory disease (PID), which may result in scarring of the tubes, greater risk of pregnancy complications and infertility. PID is a serious infection that requires immediate treatment. - Infertility in men. Men with untreated gonorrhea can experience epididymitis - inflammation of a small, coiled tube in the rear portion of the testicles where the sperm ducts are located (epididymis). Epididymitis is treatable, but if left untreated, it may lead to infertility. - Infection that spreads to the joints and other areas of your body. The bacterium that causes gonorrhea can spread through the bloodstream and infect other parts of your body, including your joints. Fever, rash, skin sores, joint pain, swelling and stiffness are possible results. - Increased risk of HIV/AIDS. Having gonorrhea makes you more susceptible to infection with human immunodeficiency virus (HIV), the virus that leads to AIDS. People who have both gonorrhea and HIV are able to pass both diseases more readily to their partners. - Complications in babies. Babies who contract gonorrhea from their mothers during birth can develop blindness, sores on the scalp and infections. To determine whether the gonorrhea bacterium is present in your body, your doctor will analyze a sample of cells. Samples can be collected by: - Urine test. This may help identify bacteria in your urethra. - Swab of affected area. A swab of your throat, urethra, vagina or rectum may collect bacteria that can be identified in a laboratory. For women, home test kits are available for gonorrhea. Home test kits include vaginal swabs for self-testing that are sent to a specified lab for testing. If you prefer, you can choose to be notified by email or text message when your results are ready. You may then view your results online or receive them by calling a toll-free hotline. Testing for other sexually transmitted infections Your doctor may recommend tests for other sexually transmitted infections. Gonorrhea increases your risk of these infections, particularly chlamydia, which often accompanies gonorrhea. Testing for HIV also is recommended for anyone diagnosed with a sexually transmitted infection. Depending on your risk factors, tests for additional sexually transmitted infections could be beneficial as well. Gonorrhea treatment in adults Adults with gonorrhea are treated with antibiotics. Due to emerging strains of drug-resistant Neisseria gonorrhoeae, the Centers for Disease Control and Prevention recommends that uncomplicated gonorrhea be treated only with the antibiotic ceftriaxone - given as an injection - in combination with either azithromycin (Zithromax, Zmax) or doxycycline (Monodox, Vibramycin, others) - two antibiotics that are taken orally. Some research indicates that oral gemifloxacin (Factive) or injectable gentamicin, combined with oral azithromycin, is highly successful in treating gonorrhea. This treatment may be helpful in treating people who are allergic to cephalosporin antibiotics, such as ceftriaxone. Gonorrhea treatment for partners Your partner also should undergo testing and treatment for gonorrhea, even if he or she has no signs or symptoms. Your partner receives the same treatment you do. Even if you've been treated for gonorrhea, you can be reinfected if your partner isn't treated. Gonorrhea treatment for babies Babies born to mothers with gonorrhea receive a medication in their eyes soon after birth to prevent infection. If an eye infection develops, babies can be treated with antibiotics.",
+    "https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774"
+  ],
+  [
+    "Gonorrhea: Gonorrhea is a sexually transmitted disease that can infect both men and women. Caused by the\u00a0Neisseria gonorrhoeae\u00a0bacterium, gonorrhea can cause infections in the genitals, rectum and throat. Although treatable, drug-resistant forms of gonorrhea are increasing. If left untreated, gonorrhea can lead to pelvic inflammatory disease, ectopic pregnancy, infertility, and increased risk of HIV infection. Gonorrhea can also be passed from mother to child and cause blindness or life-threatening infections in the infant. NIAID supports a comprehensive, multidisciplinary program of research on Neissesria gonorrhoeae (gonococci). Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases Scientists have determined the complete genetic code, or sequence (genetic blueprint), of the N. gonorrhoeae genome. They are using this information to help us better understand how the bacterium causes disease and becomes resistant to antibiotics. NIAID also supports research to develop topical microbicides (antimicrobial preparations that can be appled inside the vagina) to prevent gonococcal infections. Another important area of gonorrhea research concerns antibiotic (drug) resistance. This is particularly important because strains of N. gonorhoeae that are resistant to recommended antibiotic treatments have been increasing and are becoming widespread in the United States. These events add urgency to conduct research on and develop new antibiotics and to prevent antibiotic resistance from spreading.",
+    "https://www.niaid.nih.gov/diseases-conditions/gonorrhea More About Gonorrhea Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases"
+  ],
+  [
+    "Gonorrhea (Treatment): Gonorrhea treatment in adults Adults with gonorrhea are treated with antibiotics. Due to emerging strains of drug-resistant Neisseria gonorrhoeae, the Centers for Disease Control and Prevention recommends that uncomplicated gonorrhea be treated only with the antibiotic ceftriaxone - given as an injection - in combination with either azithromycin (Zithromax, Zmax) or doxycycline (Monodox, Vibramycin, others) - two antibiotics that are taken orally. Some research indicates that oral gemifloxacin (Factive) or injectable gentamicin, combined with oral azithromycin, is highly successful in treating gonorrhea. This treatment may be helpful in treating people who are allergic to cephalosporin antibiotics, such as ceftriaxone. Gonorrhea treatment for partners Your partner also should undergo testing and treatment for gonorrhea, even if he or she has no signs or symptoms. Your partner receives the same treatment you do. Even if you've been treated for gonorrhea, you can be reinfected if your partner isn't treated. Gonorrhea treatment for babies Babies born to mothers with gonorrhea receive a medication in their eyes soon after birth to prevent infection. If an eye infection develops, babies can be treated with antibiotics.",
+    "https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774"
+  ],
+  [
+    "What are the treatments for Gonorrhea?: A number of different antibiotics may be used for treating this type of infection. - You may receive one large dose of oral antibiotics or take a smaller dose for seven days. - You may be given an antibiotic injection or shot, and then perhaps be sent home with antibiotic pills. - More severe cases of PID (pelvic inflammatory disease) may require you to stay in the hospital. Antibiotics are first given by IV. - Never treat yourself without being seen by your doctor first. Your health care provider will determine the best treatment. About half of the women with gonorrhea are also infected with chlamydia. Chlamydia is treated at the same time as a gonorrhea infection. You will need a follow-up visit 7 days after if your symptoms include joint pain, skin rash, or more severe pelvic or belly pain. Tests will be done to make sure the infection is gone. Sexual partners must be tested and treated to prevent passing the infection back and forth. You and your partner must finish all of the antibiotics. Use condoms until you both have finished taking your antibiotics. All sexual contacts of the person with gonorrhea should be contacted and tested. This helps prevent further spread of the infection. - In some places you may be able to take information and medicines to your sexual partner yourself. - In other places, the health department will contact your partner.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/007267.htm"
+  ],
+  [
+    "Gonorrhea: Gonorrhea is a sexually transmitted disease that can infect both men and women. Caused by the\u00a0Neisseria gonorrhoeae\u00a0bacterium, gonorrhea can cause infections in the genitals, rectum and throat. Although treatable, drug-resistant forms of gonorrhea are increasing. If left untreated, gonorrhea can lead to pelvic inflammatory disease, ectopic pregnancy, infertility, and increased risk of HIV infection. Gonorrhea can also be passed from mother to child and cause blindness or life-threatening infections in the infant. NIAID supports a comprehensive, multidisciplinary program of research on Neissesria gonorrhoeae (gonococci). Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases Scientists have determined the complete genetic code, or sequence (genetic blueprint), of the N. gonorrhoeae genome. They are using this information to help us better understand how the bacterium causes disease and becomes resistant to antibiotics. NIAID also supports research to develop topical microbicides (antimicrobial preparations that can be appled inside the vagina) to prevent gonococcal infections. Another important area of gonorrhea research concerns antibiotic (drug) resistance. This is particularly important because strains of N. gonorhoeae that are resistant to recommended antibiotic treatments have been increasing and are becoming widespread in the United States. These events add urgency to conduct research on and develop new antibiotics and to prevent antibiotic resistance from spreading.",
+    "https://www.niaid.nih.gov/diseases-conditions/gonorrhea More About Gonorrhea Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases"
+  ],
+  [
+    "Gonorrhea: Gonorrhea is a sexually transmitted infection (STI). It is usually spread by having vaginal, oral, or anal sex. In 2014, gonorrhea affected more than 162,000 women in the United States.1 Antibiotics can treat gonorrhea. If left untreated, it can cause serious health problems, including problems getting pregnant. Gonorrhea is an STI that is caused by the bacteria Neisseria gonorrhoeae. It is an especially serious problem for women because it can damage the female reproductive organs. In 2014, gonorrhea affected more than 162,000 women in the United States.1 Gonorrhea most often affects women ages 15 to 24. But, gonorrhea is becoming more common in older women too.1 Gonorrhea is spread through: Most women with gonorrhea do not have any signs or symptoms. If you do get symptoms, they are often mild and can be mistaken for a bladder or vaginal infection. Signs or symptoms of gonorrhea depend on where you are first infected by the gonorrhea bacteria. Signs and symptoms in the genital area can include: Signs and symptoms in other parts of the body include: Gonorrhea can cause serious health problems, even if you do not have any signs or symptoms. You also need to get tested if you have any symptoms of gonorrhea. Testing is very important, because women with untreated gonorrhea can develop serious health problems. If you are tested for gonorrhea, you also need to get tested for other STIs, including chlamydia, syphilis, and HIV. There are two ways that a doctor or nurse tests for gonorrhea: A Pap test is not used to detect gonorrhea. Your doctor or nurse will give you antibiotics to treat gonorrhea. The antibiotics are usually a pill you swallow. Although antibiotics can cure gonorrhea, they cannot fix any permanent damage done to your body. For this reason, it is important to get tested and to take the antibiotics as soon as possible. For the antibiotics to work, you must finish all of the antibiotics that your doctor gives you, even if the symptoms go away. Do not share your antibiotics for gonorrhea with anyone. If symptoms do not go away after treatment, see your doctor or nurse. It is possible to get gonorrhea again if you have sex with someone who has gonorrhea. Tell your recent sex partner(s) so they can be tested and treated. Gonorrhea that is not treated can cause serious health problems in women:3 Gonorrhea is easy to treat. But you need to get tested and treated as soon as possible. If you have gonorrhea: For pregnant women, untreated gonorrhea raises the risk of: Babies born to infected mothers are at risk for: Treatment of gonorrhea as soon as it is found in pregnant women will lower the risk of these problems for both mother and baby. Your baby will get antibiotics if you have gonorrhea or if your baby has a gonorrheal eye infection. The best way to prevent gonorrhea or any STI is to not have vaginal, oral, or anal sex. If you do have sex, lower your risk of getting an STI with the following steps: The steps work best when used together. No single step can protect you from every single type of STI. Yes. It is possible to get gonorrhea, or any other STI, if you are a woman who has sex only with women. Talk to your partner about her sexual history before having sex, and ask your doctor about getting tested if you have signs or symptoms of gonorrhea. For more information about gonorrhea, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea (How is gonorrhea treated?): Your doctor or nurse will give you antibiotics to treat gonorrhea. The antibiotics are usually a pill you swallow. Although antibiotics can cure gonorrhea, they cannot fix any permanent damage done to your body. For this reason, it is important to get tested and to take the antibiotics as soon as possible. For the antibiotics to work, you must finish all of the antibiotics that your doctor gives you, even if the symptoms go away. Do not share your antibiotics for gonorrhea with anyone. If symptoms do not go away after treatment, see your doctor or nurse. It is possible to get gonorrhea again if you have sex with someone who has gonorrhea. Tell your recent sex partner(s) so they can be tested and treated.",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea: Gonorrhea is an infection caused by a sexually transmitted bacterium that can infect both males and females. Gonorrhea most often affects the urethra, rectum or throat. In females, gonorrhea can also infect the cervix. Gonorrhea is most commonly spread during sex. But babies can be infected during childbirth if their mothers are infected. In babies, gonorrhea most commonly affects the eyes. Gonorrhea is a common infection that, in many cases, causes no symptoms. You may not even know that you're infected. Abstaining from sex, using a condom if you do have sex and being in a mutually monogamous relationship are the best ways to prevent sexually transmitted infections. In many cases, gonorrhea infection causes no symptoms. When symptoms do appear, gonorrhea infection can affect multiple sites in your body, but it commonly appears in the genital tract. Gonorrhea affecting the genital tract Signs and symptoms of gonorrhea infection in men include: - Painful urination - Pus-like discharge from the tip of the penis - Pain or swelling in one testicle Signs and symptoms of gonorrhea infection in women include: - Increased vaginal discharge - Painful urination - Vaginal bleeding between periods, such as after vaginal intercourse - Painful intercourse - Abdominal or pelvic pain Gonorrhea at other sites in the body Gonorrhea can also affect these parts of the body: - Rectum. Signs and symptoms include anal itching, pus-like discharge from the rectum, spots of bright red blood on toilet tissue and having to strain during bowel movements. - Eyes. Gonorrhea that affects your eyes may cause eye pain, sensitivity to light, and pus-like discharge from one or both eyes. - Throat. Signs and symptoms of a throat infection may include a sore throat and swollen lymph nodes in the neck. - Joints. If one or more joints become infected by bacteria (septic arthritis), the affected joints may be warm, red, swollen and extremely painful, especially when you move an affected joint. When to see your doctor Make an appointment with your doctor if you notice any troubling signs or symptoms, such as a burning sensation when you urinate or a pus-like discharge from your penis, vagina or rectum. Also make an appointment with your doctor if your partner has been diagnosed with gonorrhea. You may not experience signs or symptoms that prompt you to seek medical attention. But without treatment, you can reinfect your partner even after he or she has been treated for gonorrhea. Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. The gonorrhea bacteria are most often passed from one person to another during sexual contact, including oral, anal or vaginal intercourse. Factors that may increase your risk of gonorrhea infection include: - Younger age - A new sex partner - A sex partner who has concurrent partners - Multiple sex partners - Previous gonorrhea diagnosis - Having other sexually transmitted infections Untreated gonorrhea can lead to significant complications, such as: - Infertility in women. Untreated gonorrhea can spread into the uterus and fallopian tubes, causing pelvic inflammatory disease (PID), which may result in scarring of the tubes, greater risk of pregnancy complications and infertility. PID is a serious infection that requires immediate treatment. - Infertility in men. Men with untreated gonorrhea can experience epididymitis - inflammation of a small, coiled tube in the rear portion of the testicles where the sperm ducts are located (epididymis). Epididymitis is treatable, but if left untreated, it may lead to infertility. - Infection that spreads to the joints and other areas of your body. The bacterium that causes gonorrhea can spread through the bloodstream and infect other parts of your body, including your joints. Fever, rash, skin sores, joint pain, swelling and stiffness are possible results. - Increased risk of HIV/AIDS. Having gonorrhea makes you more susceptible to infection with human immunodeficiency virus (HIV), the virus that leads to AIDS. People who have both gonorrhea and HIV are able to pass both diseases more readily to their partners. - Complications in babies. Babies who contract gonorrhea from their mothers during birth can develop blindness, sores on the scalp and infections. To determine whether the gonorrhea bacterium is present in your body, your doctor will analyze a sample of cells. Samples can be collected by: - Urine test. This may help identify bacteria in your urethra. - Swab of affected area. A swab of your throat, urethra, vagina or rectum may collect bacteria that can be identified in a laboratory. For women, home test kits are available for gonorrhea. Home test kits include vaginal swabs for self-testing that are sent to a specified lab for testing. If you prefer, you can choose to be notified by email or text message when your results are ready. You may then view your results online or receive them by calling a toll-free hotline. Testing for other sexually transmitted infections Your doctor may recommend tests for other sexually transmitted infections. Gonorrhea increases your risk of these infections, particularly chlamydia, which often accompanies gonorrhea. Testing for HIV also is recommended for anyone diagnosed with a sexually transmitted infection. Depending on your risk factors, tests for additional sexually transmitted infections could be beneficial as well. Gonorrhea treatment in adults Adults with gonorrhea are treated with antibiotics. Due to emerging strains of drug-resistant Neisseria gonorrhoeae, the Centers for Disease Control and Prevention recommends that uncomplicated gonorrhea be treated only with the antibiotic ceftriaxone - given as an injection - in combination with either azithromycin (Zithromax, Zmax) or doxycycline (Monodox, Vibramycin, others) - two antibiotics that are taken orally. Some research indicates that oral gemifloxacin (Factive) or injectable gentamicin, combined with oral azithromycin, is highly successful in treating gonorrhea. This treatment may be helpful in treating people who are allergic to cephalosporin antibiotics, such as ceftriaxone. Gonorrhea treatment for partners Your partner also should undergo testing and treatment for gonorrhea, even if he or she has no signs or symptoms. Your partner receives the same treatment you do. Even if you've been treated for gonorrhea, you can be reinfected if your partner isn't treated. Gonorrhea treatment for babies Babies born to mothers with gonorrhea receive a medication in their eyes soon after birth to prevent infection. If an eye infection develops, babies can be treated with antibiotics.",
+    "https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774"
+  ],
+  [
+    "Gonorrhea (What should I do if I have gonorrhea?): Gonorrhea is easy to treat. But you need to get tested and treated as soon as possible. If you have gonorrhea:",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea (More About Gonorrhea): Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases",
+    "https://www.niaid.nih.gov/diseases-conditions/gonorrhea More About Gonorrhea Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases"
+  ],
+  [
+    "Gonorrhea (How does gonorrhea affect pregnancy?): For pregnant women, untreated gonorrhea raises the risk of: Babies born to infected mothers are at risk for: Treatment of gonorrhea as soon as it is found in pregnant women will lower the risk of these problems for both mother and baby. Your baby will get antibiotics if you have gonorrhea or if your baby has a gonorrheal eye infection.",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea (Diagnosis): To determine whether the gonorrhea bacterium is present in your body, your doctor will analyze a sample of cells. Samples can be collected by: - Urine test. This may help identify bacteria in your urethra. - Swab of affected area. A swab of your throat, urethra, vagina or rectum may collect bacteria that can be identified in a laboratory. For women, home test kits are available for gonorrhea. Home test kits include vaginal swabs for self-testing that are sent to a specified lab for testing. If you prefer, you can choose to be notified by email or text message when your results are ready. You may then view your results online or receive them by calling a toll-free hotline. Testing for other sexually transmitted infections Your doctor may recommend tests for other sexually transmitted infections. Gonorrhea increases your risk of these infections, particularly chlamydia, which often accompanies gonorrhea. Testing for HIV also is recommended for anyone diagnosed with a sexually transmitted infection. Depending on your risk factors, tests for additional sexually transmitted infections could be beneficial as well.",
+    "https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774"
+  ],
+  [
+    "How to diagnose Gonorrhea?: Gonorrhea can be quickly detected by looking at a sample of discharge or tissue under the microscope. This is called a gram stain. This method is fast, but it is not the most certain. Gonorrhea is most accurately detected with DNA tests. DNA tests are useful for screening. The ligase chain reaction (LCR) test is one of the tests. DNA tests are quicker than cultures. These tests can be performed on urine samples, which are easier to collect than samples from the genital area. Prior to DNA tests, cultures (cells that grow in a lab dish) were used to provide proof of gonorrhea, but are less commonly used now. Samples for a culture are most often taken from the cervix, vagina, urethra, anus, or throat. - Rarely they are taken from joint fluid or blood - Cultures can often provide an early diagnosis within 24 hours. A confirmed diagnosis is available within 72 hours. If you have gonorrhea, you should ask to be tested for other sexually transmitted infections, including chlamydia, syphilis, and HIV herpes and hepatitis.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/007267.htm"
+  ],
+  [
+    "Gonorrhea (More About Gonorrhea): Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases",
+    "https://www.niaid.nih.gov/diseases-conditions/gonorrhea More About Gonorrhea Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases"
+  ],
+  [
+    "Gonorrhea: Gonorrhea is a sexually transmitted disease that can infect both men and women. Caused by the\u00a0Neisseria gonorrhoeae\u00a0bacterium, gonorrhea can cause infections in the genitals, rectum and throat. Although treatable, drug-resistant forms of gonorrhea are increasing. If left untreated, gonorrhea can lead to pelvic inflammatory disease, ectopic pregnancy, infertility, and increased risk of HIV infection. Gonorrhea can also be passed from mother to child and cause blindness or life-threatening infections in the infant. NIAID supports a comprehensive, multidisciplinary program of research on Neissesria gonorrhoeae (gonococci). Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases Scientists have determined the complete genetic code, or sequence (genetic blueprint), of the N. gonorrhoeae genome. They are using this information to help us better understand how the bacterium causes disease and becomes resistant to antibiotics. NIAID also supports research to develop topical microbicides (antimicrobial preparations that can be appled inside the vagina) to prevent gonococcal infections. Another important area of gonorrhea research concerns antibiotic (drug) resistance. This is particularly important because strains of N. gonorhoeae that are resistant to recommended antibiotic treatments have been increasing and are becoming widespread in the United States. These events add urgency to conduct research on and develop new antibiotics and to prevent antibiotic resistance from spreading.",
+    "https://www.niaid.nih.gov/diseases-conditions/gonorrhea More About Gonorrhea Gonorrhea is a sexually transmitted disease. It is most common in young adults. The bacteria that cause gonorrhea can infect the genital tract, mouth, or anus. You can get gonorrhea during vaginal, oral, or anal sex with an infected partner. A pregnant woman can pass it to her baby during childbirth. Gonorrhea does not always cause symptoms. In men, gonorrhea can cause pain when urinating and discharge from the penis. If untreated, it can cause problems with the prostate and testicles. In women, the early symptoms of gonorrhea often are mild. Later, it can cause bleeding between periods, pain when urinating, and increased discharge from the vagina. If untreated, it can lead to pelvic inflammatory disease, which causes problems with pregnancy and infertility. Your health care provider will diagnose gonorrhea with lab tests. Treatment is with antibiotics. Treating gonorrhea is becoming more difficult because drug-resistant strains are increasing. Correct usage of latex condoms greatly reduces, but does not eliminate, the risk of catching or spreading gonorrhea. NIH: National Institute of Allergy and Infectious Diseases"
+  ],
+  [
+    "Gonorrhea (Risk factors): Factors that may increase your risk of gonorrhea infection include: - Younger age - A new sex partner - A sex partner who has concurrent partners - Multiple sex partners - Previous gonorrhea diagnosis - Having other sexually transmitted infections",
+    "https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774"
+  ],
+  [
+    "Gonorrhea: Gonorrhea is an infection caused by a sexually transmitted bacterium that can infect both males and females. Gonorrhea most often affects the urethra, rectum or throat. In females, gonorrhea can also infect the cervix. Gonorrhea is most commonly spread during sex. But babies can be infected during childbirth if their mothers are infected. In babies, gonorrhea most commonly affects the eyes. Gonorrhea is a common infection that, in many cases, causes no symptoms. You may not even know that you're infected. Abstaining from sex, using a condom if you do have sex and being in a mutually monogamous relationship are the best ways to prevent sexually transmitted infections. In many cases, gonorrhea infection causes no symptoms. When symptoms do appear, gonorrhea infection can affect multiple sites in your body, but it commonly appears in the genital tract. Gonorrhea affecting the genital tract Signs and symptoms of gonorrhea infection in men include: - Painful urination - Pus-like discharge from the tip of the penis - Pain or swelling in one testicle Signs and symptoms of gonorrhea infection in women include: - Increased vaginal discharge - Painful urination - Vaginal bleeding between periods, such as after vaginal intercourse - Painful intercourse - Abdominal or pelvic pain Gonorrhea at other sites in the body Gonorrhea can also affect these parts of the body: - Rectum. Signs and symptoms include anal itching, pus-like discharge from the rectum, spots of bright red blood on toilet tissue and having to strain during bowel movements. - Eyes. Gonorrhea that affects your eyes may cause eye pain, sensitivity to light, and pus-like discharge from one or both eyes. - Throat. Signs and symptoms of a throat infection may include a sore throat and swollen lymph nodes in the neck. - Joints. If one or more joints become infected by bacteria (septic arthritis), the affected joints may be warm, red, swollen and extremely painful, especially when you move an affected joint. When to see your doctor Make an appointment with your doctor if you notice any troubling signs or symptoms, such as a burning sensation when you urinate or a pus-like discharge from your penis, vagina or rectum. Also make an appointment with your doctor if your partner has been diagnosed with gonorrhea. You may not experience signs or symptoms that prompt you to seek medical attention. But without treatment, you can reinfect your partner even after he or she has been treated for gonorrhea. Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. The gonorrhea bacteria are most often passed from one person to another during sexual contact, including oral, anal or vaginal intercourse. Factors that may increase your risk of gonorrhea infection include: - Younger age - A new sex partner - A sex partner who has concurrent partners - Multiple sex partners - Previous gonorrhea diagnosis - Having other sexually transmitted infections Untreated gonorrhea can lead to significant complications, such as: - Infertility in women. Untreated gonorrhea can spread into the uterus and fallopian tubes, causing pelvic inflammatory disease (PID), which may result in scarring of the tubes, greater risk of pregnancy complications and infertility. PID is a serious infection that requires immediate treatment. - Infertility in men. Men with untreated gonorrhea can experience epididymitis - inflammation of a small, coiled tube in the rear portion of the testicles where the sperm ducts are located (epididymis). Epididymitis is treatable, but if left untreated, it may lead to infertility. - Infection that spreads to the joints and other areas of your body. The bacterium that causes gonorrhea can spread through the bloodstream and infect other parts of your body, including your joints. Fever, rash, skin sores, joint pain, swelling and stiffness are possible results. - Increased risk of HIV/AIDS. Having gonorrhea makes you more susceptible to infection with human immunodeficiency virus (HIV), the virus that leads to AIDS. People who have both gonorrhea and HIV are able to pass both diseases more readily to their partners. - Complications in babies. Babies who contract gonorrhea from their mothers during birth can develop blindness, sores on the scalp and infections. To determine whether the gonorrhea bacterium is present in your body, your doctor will analyze a sample of cells. Samples can be collected by: - Urine test. This may help identify bacteria in your urethra. - Swab of affected area. A swab of your throat, urethra, vagina or rectum may collect bacteria that can be identified in a laboratory. For women, home test kits are available for gonorrhea. Home test kits include vaginal swabs for self-testing that are sent to a specified lab for testing. If you prefer, you can choose to be notified by email or text message when your results are ready. You may then view your results online or receive them by calling a toll-free hotline. Testing for other sexually transmitted infections Your doctor may recommend tests for other sexually transmitted infections. Gonorrhea increases your risk of these infections, particularly chlamydia, which often accompanies gonorrhea. Testing for HIV also is recommended for anyone diagnosed with a sexually transmitted infection. Depending on your risk factors, tests for additional sexually transmitted infections could be beneficial as well. Gonorrhea treatment in adults Adults with gonorrhea are treated with antibiotics. Due to emerging strains of drug-resistant Neisseria gonorrhoeae, the Centers for Disease Control and Prevention recommends that uncomplicated gonorrhea be treated only with the antibiotic ceftriaxone - given as an injection - in combination with either azithromycin (Zithromax, Zmax) or doxycycline (Monodox, Vibramycin, others) - two antibiotics that are taken orally. Some research indicates that oral gemifloxacin (Factive) or injectable gentamicin, combined with oral azithromycin, is highly successful in treating gonorrhea. This treatment may be helpful in treating people who are allergic to cephalosporin antibiotics, such as ceftriaxone. Gonorrhea treatment for partners Your partner also should undergo testing and treatment for gonorrhea, even if he or she has no signs or symptoms. Your partner receives the same treatment you do. Even if you've been treated for gonorrhea, you can be reinfected if your partner isn't treated. Gonorrhea treatment for babies Babies born to mothers with gonorrhea receive a medication in their eyes soon after birth to prevent infection. If an eye infection develops, babies can be treated with antibiotics.",
+    "https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774"
+  ],
+  [
+    "Gonorrhea: Gonorrhea is a sexually transmitted infection (STI). It is usually spread by having vaginal, oral, or anal sex. In 2014, gonorrhea affected more than 162,000 women in the United States.1 Antibiotics can treat gonorrhea. If left untreated, it can cause serious health problems, including problems getting pregnant. Gonorrhea is an STI that is caused by the bacteria Neisseria gonorrhoeae. It is an especially serious problem for women because it can damage the female reproductive organs. In 2014, gonorrhea affected more than 162,000 women in the United States.1 Gonorrhea most often affects women ages 15 to 24. But, gonorrhea is becoming more common in older women too.1 Gonorrhea is spread through: Most women with gonorrhea do not have any signs or symptoms. If you do get symptoms, they are often mild and can be mistaken for a bladder or vaginal infection. Signs or symptoms of gonorrhea depend on where you are first infected by the gonorrhea bacteria. Signs and symptoms in the genital area can include: Signs and symptoms in other parts of the body include: Gonorrhea can cause serious health problems, even if you do not have any signs or symptoms. You also need to get tested if you have any symptoms of gonorrhea. Testing is very important, because women with untreated gonorrhea can develop serious health problems. If you are tested for gonorrhea, you also need to get tested for other STIs, including chlamydia, syphilis, and HIV. There are two ways that a doctor or nurse tests for gonorrhea: A Pap test is not used to detect gonorrhea. Your doctor or nurse will give you antibiotics to treat gonorrhea. The antibiotics are usually a pill you swallow. Although antibiotics can cure gonorrhea, they cannot fix any permanent damage done to your body. For this reason, it is important to get tested and to take the antibiotics as soon as possible. For the antibiotics to work, you must finish all of the antibiotics that your doctor gives you, even if the symptoms go away. Do not share your antibiotics for gonorrhea with anyone. If symptoms do not go away after treatment, see your doctor or nurse. It is possible to get gonorrhea again if you have sex with someone who has gonorrhea. Tell your recent sex partner(s) so they can be tested and treated. Gonorrhea that is not treated can cause serious health problems in women:3 Gonorrhea is easy to treat. But you need to get tested and treated as soon as possible. If you have gonorrhea: For pregnant women, untreated gonorrhea raises the risk of: Babies born to infected mothers are at risk for: Treatment of gonorrhea as soon as it is found in pregnant women will lower the risk of these problems for both mother and baby. Your baby will get antibiotics if you have gonorrhea or if your baby has a gonorrheal eye infection. The best way to prevent gonorrhea or any STI is to not have vaginal, oral, or anal sex. If you do have sex, lower your risk of getting an STI with the following steps: The steps work best when used together. No single step can protect you from every single type of STI. Yes. It is possible to get gonorrhea, or any other STI, if you are a woman who has sex only with women. Talk to your partner about her sexual history before having sex, and ask your doctor about getting tested if you have signs or symptoms of gonorrhea. For more information about gonorrhea, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "Gonorrhea (Treatment): Gonorrhea treatment in adults Adults with gonorrhea are treated with antibiotics. Due to emerging strains of drug-resistant Neisseria gonorrhoeae, the Centers for Disease Control and Prevention recommends that uncomplicated gonorrhea be treated only with the antibiotic ceftriaxone - given as an injection - in combination with either azithromycin (Zithromax, Zmax) or doxycycline (Monodox, Vibramycin, others) - two antibiotics that are taken orally. Some research indicates that oral gemifloxacin (Factive) or injectable gentamicin, combined with oral azithromycin, is highly successful in treating gonorrhea. This treatment may be helpful in treating people who are allergic to cephalosporin antibiotics, such as ceftriaxone. Gonorrhea treatment for partners Your partner also should undergo testing and treatment for gonorrhea, even if he or she has no signs or symptoms. Your partner receives the same treatment you do. Even if you've been treated for gonorrhea, you can be reinfected if your partner isn't treated. Gonorrhea treatment for babies Babies born to mothers with gonorrhea receive a medication in their eyes soon after birth to prevent infection. If an eye infection develops, babies can be treated with antibiotics.",
+    "https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774"
+  ],
+  [
+    "Gonorrhea (How is gonorrhea treated?): Your doctor or nurse will give you antibiotics to treat gonorrhea. The antibiotics are usually a pill you swallow. Although antibiotics can cure gonorrhea, they cannot fix any permanent damage done to your body. For this reason, it is important to get tested and to take the antibiotics as soon as possible. For the antibiotics to work, you must finish all of the antibiotics that your doctor gives you, even if the symptoms go away. Do not share your antibiotics for gonorrhea with anyone. If symptoms do not go away after treatment, see your doctor or nurse. It is possible to get gonorrhea again if you have sex with someone who has gonorrhea. Tell your recent sex partner(s) so they can be tested and treated.",
+    "https://www.womenshealth.gov/a-z-topics/gonorrhea"
+  ],
+  [
+    "HIV/AIDS: HIV, or human immunodeficiency virus, is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). HIV attacks the immune system by destroying CD4 positive (CD4+) T cells, a type of white blood cell that is vital to fighting off infection. The destruction of these cells leaves people living with HIV vulnerable to other infections, diseases and other complications. As the leading U.S. government institute for HIV/AIDS research, NIAID is committed to conducting the research necessary to successfully end the fight against HIV/AIDS.\u00a0 Nearly 37 million people are living with HIV around the world. In the United States, 1.2 million people are living with HIV, of whom 13 percent are unaware of their diagnosis. Although progress has been made in the global fight against HIV/AIDS, the epidemic continues in the United States and the international community. Globally, AIDS-related deaths have dropped by 45 percent since their peak in 2004. Yet the rate of HIV transmission remains unacceptably high, with 2.1 million new infections occurring worldwide in 2015 alone. NIAID-supported investigators are conducting an abundance of research on all areas of HIV infection, including developing and testing preventive HIV vaccines, prevention strategies, and new treatments for HIV infection and AIDS-associated opportunistic infections. Through laboratories and clinics on the National Institutes of Health campus in Bethesda, Maryland, and a vast network of supported research at universities, medical centers, and clinical trial sites around the globe, NIAID is working to better understand HIV and how it causes disease, find new tools to prevent HIV infection including a preventive vaccine, develop new and more effective treatments for people living with HIV, and hopefully, find a cure. Preventing new HIV infections is a key step toward ending the HIV pandemic as we know it. NIAID-supported researchers have worked since the early days of AIDS in the 1980s to identify prevention tools to keep people healthy. Today, an array of prevention methods are available for use in combination or on their own, and scientists continue to work to develop and improve cutting-edge tools and techniques that can work to prevent HIV in diverse populations around the world. Historically, vaccination has been the best method for protecting people from infectious diseases. While an array of techniques are available for preventing HIV infection, the development of a safe and effective HIV vaccine remains key to realizing a durable end to the HIV/AIDS pandemic. NIAID-supported scientists are working toward an HIV vaccine from two complementary angles: an empirical approach that quickly moves vaccine candidates into human testing, and a theoretical approach that designs vaccine candidates based on an understanding of the immune response to HIV infection. One of NIAID\u2019s greatest success stories is that its research led to the development of numerous antiretroviral drugs to treat HIV/AIDS, turning what was once a uniformly fatal disease into a manageable chronic condition for many. NIAID is working to find new and more effective therapeutic products, drug classes, and combinations as well as safe and effective treatments for dangerous related co-infections and complications. NIAID is exploring therapies that suppress the amount of HIV to such low levels that an HIV-infected person would no longer need treatment because his or her immune system could keep the remaining virus in check, creating in essence a \u201cfunctional cure.\u201d",
+    "https://www.niaid.nih.gov/diseases-conditions/hivaids"
+  ],
+  [
+    "What is Hearing Aids?: A hearing aid is a small electronic device that you wear in or behind your ear. It makes some sounds louder. A hearing aid can help people hear more in both quiet and noisy situations. Hearing aids help people who have hearing loss from damage to the small sensory cells in the inner ear. The damage can occur as a result of disease, aging, or injury from noise or certain medicines. Only about one out of five people who would benefit from a hearing aid actually uses one. If you think a hearing aid could help you, visit your doctor. There are different kinds of hearing aids. They differ by size, their placement on or inside the ear, and how much they amplify sound. The hearing aid that will work best for you depends on what kind of hearing loss you have, and how severe it is. NIH: National Institute on Deafness and Other Communication Disorders",
+    "https://www.nlm.nih.gov/medlineplus/hearingaids.html"
+  ],
+  [
+    "HIV/AIDS: After divorce, separation, or the death of a spouse, some older people may find themselves dating again, and possibly having sex with a new partner. It's a good idea to talk with your doctor about how safe sex can reduce your risk of sexually transmitted diseases such as HIV/AIDS. It's important to practice safe sex, no matter what your age.",
+    "https://www.nia.nih.gov/health/topics/hivaids"
+  ],
+  [
+    "HIV/AIDS: Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight the organisms that cause disease. HIV is a sexually transmitted infection (STI). It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. Without medication, it may take years before HIV weakens your immune system to the point that you have AIDS. There's no cure for HIV/AIDS, but there are medications that can dramatically slow the progression of the disease. These drugs have reduced AIDS deaths in many developed nations. The symptoms of HIV and AIDS vary, depending on the phase of infection. Primary infection (Acute HIV) Most people infected by HIV develop a flu-like illness within a month or two after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible signs and symptoms include: - Fever - Headache - Muscle aches and joint pain - Rash - Sore throat and painful mouth sores - Swollen lymph glands, mainly on the neck These symptoms can be so mild that you might not even notice them. However, the amount of virus in your bloodstream (viral load) is quite high at this time. As a result, the infection spreads more easily during primary infection than during the next stage. Clinical latent infection (Chronic HIV) In some people, persistent swelling of lymph nodes occurs during this stage. Otherwise, there are no specific signs and symptoms. HIV remains in the body and in infected white blood cells. This stage of HIV infection generally lasts around 10 years if you're not receiving antiretroviral therapy. But sometimes, even with this treatment, it lasts for decades. Some people develop more severe disease much sooner. Symptomatic HIV infection As the virus continues to multiply and destroy your immune cells - the cells in your body that help fight off germs - you may develop mild infections or chronic signs and symptoms such as: - Fever - Fatigue - Swollen lymph nodes - often one of the first signs of HIV infection - Diarrhea - Weight loss - Oral yeast infection (thrush) - Shingles (herpes zoster) Progression to AIDS Thanks to better antiviral treatments, most people with HIV in the U.S. today don't develop AIDS. Untreated, HIV typically turns into AIDS in about 10 years. When AIDS occurs, your immune system has been severely damaged. You'll be more likely to develop opportunistic infections or opportunistic cancers - diseases that wouldn't usually trouble a person with a healthy immune system. The signs and symptoms of some of these infections may include: - Soaking night sweats - Recurring fever - Chronic diarrhea - Persistent white spots or unusual lesions on your tongue or in your mouth - Persistent, unexplained fatigue - Weight loss - Skin rashes or bumps When to see a doctor If you think you may have been infected with HIV or are at risk of contracting the virus, see a health care provider as soon as possible. HIV is caused by a virus. It can spread through sexual contact or blood, or from mother to child during pregnancy, childbirth or breast-feeding. How does HIV become AIDS? HIV destroys CD4 T cells - white blood cells that play a large role in helping your body fight disease. The fewer CD4 T cells you have, the weaker your immune system becomes. You can have an HIV infection for years before it turns into AIDS. AIDS is diagnosed when the CD4 T cell count falls below 200 or you have an AIDS-defining complication. How HIV spreads To become infected with HIV, infected blood, semen or vaginal secretions must enter your body. This can happen in several ways: - By having sex. You may become infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter your body. The virus can enter your body through mouth sores or small tears that sometimes develop in the rectum or vagina during sexual activity. - From blood transfusions. In some cases, the virus may be transmitted through blood transfusions. American hospitals and blood banks now screen the blood supply for HIV antibodies, so this risk is very small. - By sharing needles. Sharing contaminated intravenous drug paraphernalia (needles and syringes) puts you at high risk of HIV and other infectious diseases, such as hepatitis. - During pregnancy or delivery or through breast-feeding. Infected mothers can pass the virus on to their babies. HIV-positive mothers who get treatment for the infection during pregnancy can significantly lower the risk to their babies. How HIV doesn't spread You can't become infected with HIV through ordinary contact. That means you can't catch HIV or AIDS by hugging, kissing, dancing or shaking hands with someone who has the infection. HIV isn't spread through the air, water or insect bites. When HIV/AIDS first appeared in the United States, it mainly affected men who had sex with men. However, now it's clear that HIV also spreads through heterosexual sex. Anyone of any age, race, sex or sexual orientation can be infected. However, you're at greatest risk of HIV/AIDS if you: - Have unprotected sex. Use a new latex or polyurethane condom every time you have sex. Anal sex is more risky than is vaginal sex. Your risk of HIV increases if you have multiple sexual partners. - Have an STI. Many STIs produce open sores on your genitals. These sores act as doorways for HIV to enter your body. - Use intravenous drugs. People who use intravenous drugs often share needles and syringes. This exposes them to droplets of other people's blood. - Are an uncircumcised man. Studies suggest that lack of circumcision increases the risk of heterosexual transmission of HIV. HIV infection weakens your immune system, making you much more likely to develop numerous infections and certain types of cancers. Infections common to HIV/AIDS - Tuberculosis (TB). In resource-limited nations, TB is the most common opportunistic infection associated with HIV. It's a leading cause of death among people with AIDS. - Cytomegalovirus. This common herpes virus is transmitted in body fluids such as saliva, blood, urine, semen and breast milk. A healthy immune system inactivates the virus, and it remains dormant in your body. If your immune system weakens, the virus resurfaces - causing damage to your eyes, digestive tract, lungs or other organs. - Candidiasis. Candidiasis is a common HIV-related infection. It causes inflammation and a thick, white coating on the mucous membranes of your mouth, tongue, esophagus or vagina. - Cryptococcal meningitis. Meningitis is an inflammation of the membranes and fluid surrounding your brain and spinal cord (meninges). Cryptococcal meningitis is a common central nervous system infection associated with HIV, caused by a fungus found in soil. - Toxoplasmosis. This potentially deadly infection is caused by Toxoplasma gondii, a parasite spread primarily by cats. Infected cats pass the parasites in their stools, which may then spread to other animals and humans. Seizures occur when it spreads to the brain. - Cryptosporidiosis. This infection is caused by an intestinal parasite that's commonly found in animals. You get it when you eat or drink contaminated food or water. The parasite grows in your intestines and bile ducts, leading to severe, chronic diarrhea in people with AIDS. Cancers common to HIV/AIDS - Kaposi's sarcoma. A tumor of the blood vessel walls, this cancer is rare in people not infected with HIV, but common in HIV-positive people. It usually appears as pink, red or purple lesions on the skin and mouth. In people with darker skin, the lesions may look dark brown or black. Kaposi's sarcoma can also affect the internal organs, including the digestive tract and lungs. - Lymphoma. This cancer starts in the white blood cells. The most common early sign is painless swelling of the lymph nodes in your neck, armpit or groin. Other complications - Wasting syndrome. Aggressive treatment approaches have reduced the number of cases of wasting syndrome, but it still affects many people with AIDS. It's defined as a loss of at least 10 percent of body weight, often accompanied by diarrhea, chronic weakness and fever. - Neurological complications. Although AIDS doesn't appear to infect the nerve cells, it can cause neurological symptoms such as confusion, forgetfulness, depression, anxiety and difficulty walking. One of the most common neurological complications is AIDS dementia complex, which leads to behavioral changes and reduced mental functioning. - Kidney disease. HIV-associated nephropathy (HIVAN) is an inflammation of the tiny filters in your kidneys that remove excess fluid and wastes from your blood and pass them to your urine. It most often affects blacks or Hispanics. Anyone with this complication should be started on antiretroviral therapy. HIV is most commonly diagnosed by testing your blood or saliva for antibodies to the virus. Unfortunately, it takes time for your body to develop these antibodies - usually up to 12 weeks. A quicker test checks for HIV antigen, a protein produced by the virus immediately after infection. It can confirm a diagnosis soon after infection and allow the person to take swifter steps to prevent the spread of the virus to others. Home testing At least two Food and Drug Administration-approved home test kits for HIV are available. Depending on which you choose, you'll need a drop of dried blood or sample of saliva. If the test is positive, you'll need to see your doctor to confirm the diagnosis and discuss your treatment options. If the test is negative, it needs to be repeated in a few months to confirm the results. Tests to stage disease and treatment If you receive a diagnosis of HIV/AIDS, several tests can help your doctor determine the stage of your disease and the best treatment. These tests include: - CD4 T cell count. CD4 T cells are white blood cells that are specifically targeted and destroyed by HIV. Even if you have no symptoms, HIV infection progresses to AIDS when your CD4 T cell count dips below 200. - Viral load (HIV RNA). This test measures the amount of virus in your blood. A higher viral load has been linked to a worse outcome. - Drug resistance. Some strains of HIV are resistant to medications. This test helps your doctor determine if your specific form of the virus has resistance and guides treatment decisions. Tests for complications Your doctor might also order lab tests to check for other infections or complications, including: - Tuberculosis - Hepatitis - Toxoplasmosis - Sexually transmitted infections - Liver or kidney damage - Urinary tract infection There's no cure for HIV/AIDS, but many different drugs are available to control the virus. Such treatment is called antiretroviral therapy, or ART. Each class of drug blocks the virus in different ways. ART is now recommended for everyone, regardless of CD4 T cell counts. It's recommended to combine three drugs from two classes to avoid creating drug-resistant strains of HIV. The classes of anti-HIV drugs include: - Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune). - Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty versions of the building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine/tenofovir (Truvada), Descovy (tenofovir alafenamide/emtricitabine), and lamivudine-zidovudine (Combivir). - Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and indinavir (Crixivan). - Entry or fusion inhibitors Tblock HIV's entry into CD4 T cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry). - Integrase inhibitors work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells. Examples include raltegravir (Isentress) and dolutegravir (Tivicay). When to start treatment Everyone with HIV infection, regardless of CD4 T cell count, should be offered antiviral medication. HIV therapy is particularly important for the following situations: - You have severe symptoms. - You have an opportunistic infection. - Your CD4 T cell count is under 350. - You're pregnant. - You have HIV-related kidney disease. - You're being treated for hepatitis B or C. Treatment can be difficult HIV treatment plans may involve taking several pills at specific times every day for the rest of your life. Each medication comes with its own unique set of side effects. It's critical to have regular follow-up appointments with your doctor to monitor your health and treatment. Some of the treatment side effects are: - Nausea, vomiting or diarrhea - Heart disease - Weakened bones or bone loss - Breakdown of muscle tissue (rhabdomyolysis) - Abnormal cholesterol levels - Higher blood sugar Treatment for age-related diseases Some health issues that are a natural part of aging may be more difficult to manage if you have HIV. Some medications that are common for age-related heart, bone or metabolic conditions, for example, may not interact well with anti-HIV medications. It's important to talk to your doctor about your other health conditions and the medications you are taking. Treatment response Your doctor will monitor your viral load and CD4 T cell counts to determine your response to HIV treatment. CD4 T cell counts should be checked every three to six months. Viral load should be tested at the start of treatment and then every three to four months during therapy. Treatment should lower your viral load so that it's undetectable. That doesn't mean your HIV is gone. It just means that the test isn't sensitive enough to detect it. Along with receiving medical treatment, it's essential to take an active role in your own care. The following suggestions may help you stay healthy longer: - Eat healthy foods. Fresh fruits and vegetables, whole grains, and lean protein help keep you strong, give you more energy and support your immune system. - Avoid raw meat, eggs and more. Foodborne illnesses can be especially severe in people who are infected with HIV. Cook meat until it's well-done. Avoid unpasteurized dairy products, raw eggs and raw seafood such as oysters, sushi or sashimi. - Get the right immunizations. These may prevent infections such as pneumonia and the flu. Make sure the vaccines don't contain live viruses, which can be dangerous for people with weakened immune systems. - Take care with companion animals. Some animals may carry parasites that can cause infections in people who are HIV-positive. Cat feces can cause toxoplasmosis, reptiles can carry salmonella, and birds can carry cryptococcus or histoplasmosis. Wash hands thoroughly after handling pets or emptying the litter box. People who are infected with HIV sometimes try dietary supplements that claim to boost the immune system or counteract side effects of anti-HIV drugs. However, there is no scientific evidence that any nutritional supplement improves immunity, and many may interfere with other medications you are taking. Supplements that may be helpful - Acetyl-L-carnitine. Researchers have used acetyl-L-carnitine to treat nerve pain in people with diabetes. It may also ease nerve pain linked to HIV if you're lacking in the substance. - Whey protein. Early evidence suggests that whey protein, a cheese byproduct, can help some people with HIV gain weight. Whey protein also appears to reduce diarrhea and increase CD4 T cell counts. Supplements that may be dangerous - St. John's wort. A common depression remedy, St. John's wort can reduce the effectiveness of several types of anti-HIV drugs by more than half. - Garlic supplements. Although garlic itself may help strengthen the immune system, garlic supplements interact with several anti-HIV drugs and reduce their ability to work. Occasionally eating garlic in food appears to be safe. Be sure to discuss the use of any dietary supplement with your doctor before trying it to ensure that it won't adversely interact with any of your medications.",
+    "https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524"
+  ],
+  [
+    "HIV/AIDS: Much of the communication between doctor and patient is personal. To have a good partnership with your doctor, it is important to talk about sensitive subjects, like sex or memory problems, even if you are embarrassed or uncomfortable. Most doctors are used to talking about personal matters and will try to ease your discomfort. Keep in mind that these topics concern many older people. You can use booklets and other materials from NIA or the organizations listed at the end of the article to help you bring up sensitive subjects when talking with your doctor.It is important to understand that problems with memory, depression, sexual function, and incontinence are not necessarily normal parts of aging. A good doctor will take your concerns about these topics seriously and not brush them off. If you think your doctor isn't taking your concerns seriously, talk to him or her about your feelings or consider looking for a new doctor. Read on for examples of ways to bring up these subjects during your appointment. Much of the communication between doctor and patient is personal. To have a good partnership with your doctor, it is important to talk about sensitive subjects, like sex or memory problems, even if you are embarrassed or uncomfortable. Most doctors are used to talking about personal matters and will try to ease your discomfort. Keep in mind that these topics concern many older people. You can use booklets and other materials from NIA or the organizations listed at the end of the article to help you bring up sensitive subjects when talking with your doctor.It is important to understand that problems with memory, depression, sexual function, and incontinence are not necessarily normal parts of aging. A good doctor will take your concerns about these topics seriously and not brush them off. If you think your doctor isn't taking your concerns seriously, talk to him or her about your feelings or consider looking for a new doctor. Read on for examples of ways to bring up these subjects during your appointment. Anyone at any age can have a drinking problem. Alcohol can have a greater effect as a person grows older because the aging process affects how the body handles alcohol. People can also develop a drinking problem later in life due to major life changes like the death of loved ones. Talk with your doctor if you think you may be developing a drinking problem. You could say: \"Lately, I've been wanting to have a drink earlier and earlier in the afternoon, and I find it's getting harder to stop after just one or two. What kind of treatments could help with this?\"Learn more about alcohol and older adults. A fall can be a serious event, often leading to injury and loss of independence, at least for a while. For this reason, many older people develop a fear of falling. Studies show that fear of falling can keep people from going about their normal activities and, as a result, they may become frailer, which actually increases their risk of falling again. If fear of falling is affecting your day-to-day life, let your doctor know. He or she may be able to recommend some things to do to reduce your chances of falling. Exercises can help you improve your balance and strengthen your muscles, at any age. Read about how to prevent falls and fractures.Regular exercise makes you stronger and can help you prevent falls. NIA's exercise and physical activity campaign, Go4Life, was designed for older adults and can help you fit exercise and physical activity into your daily life. Share this infographic to spread the word about ways older adults can get the most out of their medical visits.Misunderstandings can come up in any relationship, including between a patient and doctor or the doctor's staff. If you feel uncomfortable with something your doctor or his or her staff has said or done, be direct. For example, if the doctor does not return your telephone calls, you may want to say something like this: \"I realize that you care for a lot of patients and are very busy, but I feel frustrated when I have to wait for days for you to return my call. Is there a way we can work together to improve this?\"Being honest is much better for your health than avoiding the doctor. If you have a long-standing relationship with your doctor, working out the problem may be more useful than looking for a new doctor. As people grow older, they may lose significant people in their lives, including spouses and cherished friends. Or, they may have to move away from home or give up favorite activities. A doctor who knows about your losses is better able to understand how you are feeling. He or she can make suggestions that may be helpful to you.There is no right or wrong way to grieve. Read how you can take care of yourself while you are mourning the death of a spouse.Although it is normal to mourn when you have a loss, later life does not have to be a time of ongoing sadness. If you feel sad all the time or for more than a few weeks, let your doctor know. Also, tell your doctor about symptoms such as lack of energy, poor appetite, trouble sleeping, or little interest in life. These could be signs of depression, which is a medical condition.Depression is a common problem among older adults, but it is NOT a normal part of aging. Depression may be common, especially when people experience losses, but it is also treatable. It should not be considered normal at any age. Let your doctor know about your feelings and ask about treatment.Read more about depression in older adults. After divorce, separation, or the death of a spouse, some older people may find themselves dating again, and possibly having sex with a new partner. It's a good idea to talk with your doctor about how safe sex can reduce your risk of sexually transmitted diseases such as HIV/AIDS. It's important to practice safe sex, no matter what your age. Older people sometimes have problems controlling their bladder. This is called urinary incontinence and it can often be treated. If you have trouble controlling your bladder or bowels, it is important to let the doctor know. To bring up the topic, you could say something like: \"Since my last visit there have been several times when I couldn't control my bladder.\"Learn more about bladder health. Many older people worry about their ability to think and remember. For most older adults, thinking and memory remain relatively intact in later years. However, if you or your family notice that you are having problems remembering recent events or thinking clearly, let your doctor know. Be specific about the changes you've noticed. For example, you could say: \"I've always been able to balance my checkbook without any problems, but lately I'm very confused.\" Your doctor will probably want you to have a thorough checkup to see what might be causing your symptoms.Free Information If you are worried about memory problems and Alzheimer's disease, you can contact the Alzheimer's and related Dementias Education and Referral (ADEAR) Center, a service of the National Institute on Aging. ADEAR staff can: - Answer specific questions about Alzheimer's - Send free publications - Refer callers to local resources - Provide information about clinical trials - Help you find materials about specific issues Call toll-free 1-800-438-4380 or read about Alzheimer's and related dementias online. Even strong and loving families can have problems, especially under the stress of illness. Although family problems can be painful to discuss, talking about them can help your doctor help you.If you feel that a family member or caregiver is taking advantage of you or mistreating you, let your doctor know. Some older people are abused by family members or others. Abuse can be physical, verbal, emotional, or even financial in nature. Your doctor may be able to provide resources or referrals to other services that can help if you are being mistreated.Learn more about how to recognize elder abuse. Most health professionals now understand that sexuality remains important in later life. If you are not satisfied with your sex life, don't just assume it's due to your age. In addition to talking about age-related changes, you can ask your doctor about the effects of an illness or a disability on sexual function. Also, ask your doctor about the influence medications or surgery may have on your sex life.If you aren't sure how to bring the topic up, try saying: \"I have a personal question I would like to ask you...\" or \"I understand that this condition or medication can affect my body in many ways. Will it affect my sex life at all?\"Learn more about how growing older might affect your sex life. Like most people, you probably have heard a lot about HIV and AIDS. You may have thought that these diseases aren't your problem and that only younger people have to worry about them. But, anyone at any age can be infected with HIV. Like most people, you probably have heard a lot about HIV and AIDS. You may have thought that these diseases aren't your problem and that only younger people have to worry about them. But, anyone at any age can be infected with HIV. HIV (human immunodeficiency virus) is a virus that damages and weakens the body's immune system-the system your body uses to fight off infection and disease. Having HIV puts a person in danger of experiencing other life-threatening infections and certain cancers.When the body cannot fight off infections and some other diseases anymore, HIV can lead to a serious illness called AIDS (acquired immunodeficiency syndrome). When someone has AIDS, they are more likely to get infections, and more vulnerable to unusual forms of cancers and other serious diseases. But, with early and uninterrupted treatment, it is possible that a person with HIV will never develop AIDS.If you think you may have HIV, you should get tested. Everyone age 13 to 64 should be tested at least once for HIV. If you are over 64 and are at risk for HIV, talk with your doctor. Your doctor can help determine how often you should be tested and help find ways to reduce your risk.There are drugs that, when taken consistently, can help suppress the amount of HIV in your blood to undetectable levels, improving your health overall and making it harder to pass HIV on to your sexual partners. To get the best results, it is important to start treatment as soon as possible. If you are unsure about your HIV status, get tested. Always protect yourself and your partners when having sex or using needles. A small blood sample, mouth swab, or urine sample is used to test people for HIV. It can take as long as 3 to 6 months after initial exposure for the signs of the virus to show up in your blood, and years before you show any symptoms.You can be tested at a doctor's office, hospital, community health center, or other health clinic. Some places have mobile testing vans. AIDS services organizations also may provide testing. At-home testing kits are also available.Depending on where you go, testing may be free. You may be able to choose to take the test without giving your name. Many providers or groups that offer HIV testing also provide counseling.If you choose to take a test at home, make sure to use a test that has been approved by the U.S. Food and Drug Administration (FDA). If the test has not been approved by the FDA, it may not give accurate results. Home tests are sold at drugstores and online. Follow up with your doctor to confirm the results of at-home tests and, if necessary, begin treatment.Finding a Place to Get Tested for HIV Your doctor or other healthcare provider can test you for HIV or tell you where you can get tested. Or, the following resources can help you find a testing location: - HIV Testing and Care Locator - Centers for Disease Control and Prevention, or call 1-800-232-4636 (toll-free). - Your local health department Drugstores also sell home testing kits (such as the Home Access HIV-1 Test System or the OraQuick In-Home HIV Test). Anyone, at any age, can get HIV. People usually acquire HIV from unprotected sex with someone living with HIV, through contact with HIV-infected blood, or by sharing needles with a person living with HIV. You may be at risk if:- You had sex without a latex or polyurethane condom. The virus passes from the person living with HIV to his or her partner via blood, semen, or vaginal fluid. During sex, HIV can get into your body through body fluids and any opening, such as a tear or cut in the lining of the vagina, vulva, penis, rectum, or-rarely-the mouth. Latex condoms can help prevent HIV transmission between sexual partners. (Natural condoms, like condoms made from lambskin, are not as effective as latex and polyurethane condoms at protecting against HIV/AIDS.) - You or your sexual partners have shared needles with a person living with HIV. People who inject illegal drugs are not the only people who might share needles. For example, people with diabetes who inject insulin or draw blood to test glucose levels could also share needles. Talk to your partner(s) about their drug and sexual history, and always use a new, sterile needle for injections. - You had a blood transfusion or operation in a developing country at any time. - You had a blood transfusion in the United States between 1978 and 1985. - You were diagnosed with or treated for hepatitis or tuberculosis (TB) at any time.Talk to Your Partner(s) About Their Drug and Sexual History Learning more about HIV risks can help you stay healthy. Even though it may be hard to do, ask your partner about his or her sexual history and whether he or she has ever shared needles. You might ask: Have you been tested for HIV? Have you ever had unprotected sex? Have you injected drugs or shared needles with someone else? Many people do not notice symptoms when they first acquire HIV. It can take as little as a few weeks for minor, flu-like symptoms to show up, or more than 10 years for more serious symptoms to appear, or any time in between. Signs of early HIV infection include flu-like symptoms such as headache, muscle aches, swollen glands, sore throat, fevers, chills, and sweating, and can also include a rash or mouth ulcers. Symptoms of later-stage HIV or AIDS include swollen glands, lack of energy, loss of appetite, weight loss, chronic or recurrent diarrhea, repeated yeast infections, short-term memory loss, and blotchy lesions on the skin, inside the mouth, eyelids, nose, or genital area. A growing number of older people are living with HIV/AIDS. One reason is because improved treatments are helping people with the disease live longer. Nearly half of people living with HIV in the United States are age 50 and older. Many of them were diagnosed with HIV in their younger years. However, thousands of older people get HIV every year.Older people are less likely than younger people to get tested, so they may not know they have HIV. Signs of HIV/AIDS can be mistaken for the aches and pains of normal aging. Older adults might be coping with other diseases and the aches and pains of normal aging that can mask the signs of HIV/AIDS.Some older people may feel ashamed or afraid of being tested. Plus, doctors do not always think to test older people for HIV. By the time the older person is diagnosed, the virus may be in the late stages and more likely to progress to AIDS.Remember, if you are at risk, get tested regularly for HIV.For people who have HIV, it is important to start treatment as soon as possible after diagnosis. Treatment can help reduce the level of HIV in the blood to undetectable levels. When treatment makes HIV undetectable, the possibility of spreading the virus to a sexual partner becomes very low. This is known as treatment as prevention (TasP).Even when the disease is well controlled, people with HIV may develop aging-related conditions at a younger age. HIV and its treatment can also affect other parts of the body, such as the brain and the heart. For example, people living with HIV are significantly more likely to develop cardiovascular disease than people without HIV. Older people living with HIV also have an increased risk of dementia. Talk with your doctor if you are concerned about how living with HIV could affect you as you grow older.Facts About HIV/AIDS You may have read or heard things that are not true about how you get HIV. Here are the facts: - You cannot get HIV through casual contact, such as shaking hands or hugging a person with HIV/AIDS. - You cannot get HIV from using a public telephone, drinking fountain, restroom, swimming pool, whirlpool, or hot tub. - You cannot get HIV from sharing a drink. - You cannot get HIV from being coughed or sneezed on by a person with HIV/AIDS. - You cannot get HIV from giving blood. - You cannot get HIV from a mosquito bite. There is no cure for HIV. But if you acquire the virus, there are drugs that help suppress the level of HIV in the body and prevent its spread to other people. Doctors use a combination of drugs called HAART (highly active antiretroviral therapy) to treat HIV/AIDS. Although it is not a cure, HAART has greatly reduced the number of deaths from HIV-related complications in the United States. HIV has become like a chronic disease, and people living with HIV receiving successful treatment can live a long and healthy life. Remember, there are things you can do to keep from getting or transmitting HIV. Take the following steps to lower your risk:- If you are having sex, consider limiting your number of sexual partners. If you or your partner is having sex with other people, or if you don't know his or her sexual or drug history, always use protection. The more partners you have, the more likely you are to be exposed to a sexually transmitted infection. - Before having sex with someone, talk with them about HIV. Ask about their sexual and drug history. Get tested for sexually transmitted infections every year. - Learn about the risks of different sexual activities and reduce your risk. (See the CDC's HIV Risk Reduction Tool for information about the risk associated with specific sexual behaviors.) - Use male or female condoms (latex or polyurethane) during sexual intercourse. - Do not share needles or any other equipment used to inject drugs. Always use new, sterile needles for injection. - Get tested if you or your partner has had an operation or blood transfusion in a developing country at any time. - Get tested if you or your partner had a blood transfusion between 1978 and 1985 in the United States.If you are at very high risk for HIV infection through sex or injection drug use, you may prevent it by taking an anti-HIV medication daily, called pre-exposure prophylaxis, or PrEP. PrEP is effective at reducing the risk of acquiring HIV, but it must be taken every day. Talk with your doctor to find out whether PreP is right for you.Read about this topic in Spanish. Lea sobre este tema en espanol. Many people want and need to be close to others as they grow older. For some, this includes the desire to continue an active, satisfying sex life. With aging, that may mean adapting sexual activity to accommodate physical, health, and other changes.There are many different ways to have sex and be intimate-alone or with a partner. The expression of your sexuality could include many types of touch or stimulation. Some adults may choose not to engage in sexual activity, and that's also normal.Here, we explore some of the common problems older adults may face with sex. Many people want and need to be close to others as they grow older. For some, this includes the desire to continue an active, satisfying sex life. With aging, that may mean adapting sexual activity to accommodate physical, health, and other changes.There are many different ways to have sex and be intimate-alone or with a partner. The expression of your sexuality could include many types of touch or stimulation. Some adults may choose not to engage in sexual activity, and that's also normal.Here, we explore some of the common problems older adults may face with sex. Normal aging brings physical changes in both men and women. These changes sometimes affect the ability to have and enjoy sex.A woman may notice changes in her vagina. As a woman ages, her vagina can shorten and narrow. Her vaginal walls can become thinner and a little stiffer. Most women will have less vaginal lubrication, and it may take more time for the vagina to naturally lubricate itself. These changes could make certain types of sexual activity, such as vaginal penetration, painful or less desirable. If vaginal dryness is an issue, using water-based lubricating jelly or lubricated condoms may be more comfortable. If a woman is using hormone therapy to treat hot flashes or other menopausal symptoms, she may want to have sex more often than she did before hormone therapy.As men get older, impotence (also called erectile dysfunction, or ED) becomes more common. ED is the loss of ability to have and keep an erection. ED may cause a man to take longer to have an erection. His erection may not be as firm or as large as it used to be. The loss of erection after orgasm may happen more quickly, or it may take longer before another erection is possible. ED is not a problem if it happens every now and then, but if it occurs often, talk with your doctor.Talk with your partner about these changes and how you are feeling. Your doctor may have suggestions to help make sex easier. Some illnesses, disabilities, medicines, and surgeries can affect your ability to have and enjoy sex.Arthritis. Joint pain due to arthritis can make sexual contact uncomfortable. Exercise, drugs, and possibly joint replacement surgery may help relieve this pain. Rest, warm baths, and changing the position or timing of sexual activity can be helpful.Chronic pain. Pain can interfere with intimacy between older people. Chronic pain does not have to be part of growing older and can often be treated. But, some pain medicines can interfere with sexual function. Always talk with your doctor if you have side effects from any medication.Dementia. Some people with dementia show increased interest in sex and physical closeness, but they may not be able to judge what is appropriate sexual behavior. Those with severe dementia may not recognize their spouse or partner, but they still desire sexual contact and may seek it with someone else. It can be confusing and difficult to know how to handle this situation. Here, too, talking with a doctor, nurse, or social worker with training in dementia care may be helpful.Diabetes. This is one of the illnesses that can cause ED in some men. In most cases, medical treatment can help. Less is known about how diabetes affects sexuality in older women. Women with diabetes are more likely to have vaginal yeast infections, which can cause itching and irritation and make sex uncomfortable or undesirable. Yeast infections can be treated.Heart disease. Narrowing and hardening of the arteries can change blood vessels so that blood does not flow freely. As a result, men and women may have problems with orgasms. For both men and women, it may take longer to become aroused, and for some men, it may be difficult to have or maintain an erection. People who have had a heart attack, or their partners, may be afraid that having sex will cause another attack. Even though sexual activity is generally safe, always follow your doctor's advice. If your heart problems get worse and you have chest pain or shortness of breath even while resting, your doctor may want to change your treatment plan.Incontinence. Loss of bladder control or leaking of urine is more common as people, especially women, grow older. Extra pressure on the belly during sex can cause loss of urine. This can be helped by changing positions or by emptying the bladder before and after sex. The good news is that incontinence can usually be treated.Stroke. The ability to have sex is sometimes affected by a stroke. A change in positions or medical devices may help people with ongoing weakness or paralysis to have sex. Some people with paralysis from the waist down are still able to experience orgasm and pleasure.Depression. Lack of interest in activities you used to enjoy, such as intimacy and sexual activity, can be a symptom of depression. It's sometimes hard to know if you're depressed. Talk with your doctor. Depression can be treated.Surgery. Many of us worry about having any kind of surgery-it may be even more troubling when the breasts or genital area are involved. Most people do return to the kind of sex life they enjoyed before surgery.Hysterectomy is surgery to remove a woman's uterus because of pain, bleeding, fibroids, or other reasons. Often, when an older woman has a hysterectomy, the ovaries are also removed. Deciding whether to have this surgery can leave both women and their partners worried about their future sex life. If you're concerned about any changes you might experience with a hysterectomy, talk with your gynecologist or surgeon.Mastectomy is surgery to remove all or part of a woman's breast because of breast cancer. This surgery may cause some women to lose their sexual interest, or it may leave them feeling less desirable or attractive to their partners. In addition to talking with your doctor, sometimes it is useful to talk with other women who have had this surgery. Programs like the American Cancer Society's \"Reach to Recovery\" can be helpful for both women and men. If you want your breast rebuilt (reconstruction), talk to your cancer doctor or surgeon.Prostatectomy is surgery that removes all or part of a man's prostate because of cancer or an enlarged prostate. It may cause urinary incontinence or ED. If you need this operation, talk with your doctor before surgery about your concerns.Medications. Some drugs can cause sexual problems. These include some blood pressure medicines, antihistamines, antidepressants, tranquilizers, Parkinson's disease or cancer medications, appetite suppressants, drugs for mental problems, and ulcer drugs. Some can lead to ED or make it hard for men to ejaculate. Some drugs can reduce a woman's sexual desire or cause vaginal dryness or difficulty with arousal and orgasm. Check with your doctor to see if there is a different drug without this side effect.Alcohol. Too much alcohol can cause erection problems in men and delay orgasm in women. Age does not protect you from sexually transmitted diseases. Older people who are sexually active may be at risk for diseases such as syphilis, gonorrhea, chlamydial infection, genital herpes, hepatitis B, genital warts, and trichomoniasis.Almost anyone who is sexually active is also at risk of being infected with HIV, the virus that causes AIDS. The number of older people with HIV/AIDS is growing. You are at risk for HIV/AIDS if you or your partner has more than one sexual partner, if you are having unprotected sex, or if either you or your partner is sharing needles. To protect yourself, always use a condom during sex that involves vaginal or anal penetration.A man needs to have a full erection before putting on a condom.Talk with your doctor about ways to protect yourself from all sexually transmitted diseases and infections. Go for regular checkups and testing. Talk with your partner. You are never too old to be at risk. Sexuality is often a delicate balance of emotional and physical issues. How you feel may affect what you are able to do and what you want to do. Many older couples find greater satisfaction in their sex lives than they did when they were younger. In many cases, they have fewer distractions, more time and privacy, no worries about getting pregnant, and greater intimacy with a lifelong partner.As we age, our bodies change, including our weight, skin, and muscle tone, and some older adults don't feel as comfortable in their aging bodies. Older adults, men and women alike, may worry that their partners will no longer find them attractive. Aging-related sexual problems like the ones listed above can cause stress and worry. This worry can get in the way of enjoying a fulfilling sex life.Older couples face the same daily stresses that affect people of any age. They may also have the added concerns of illness, retirement, and lifestyle changes, all of which may lead to sexual difficulties. Talk openly with your partner, and try not to blame yourself or your partner. You may also find it helpful to talk with a therapist, either alone or with your partner. Some therapists have special training in helping with sexual problems. If you sense changes in your partner's attitude toward sex, don't assume they are no longer interested in you or in an active sex life. Talk about it. Many of the things that cause sexual problems in older adults can be helped. There are things you can do on your own for an active and enjoyable sex life. If you have a long-term partner, take time to enjoy each other and to understand the changes you both are facing.Don't be afraid to talk with your doctor if you have a problem that affects your sex life. He or she may be able to suggest a treatment. For example, the most common sexual difficulty of older women is painful intercourse caused by vaginal dryness. Your doctor or a pharmacist can suggest over-the-counter vaginal lubricants or moisturizers to use. Water-based lubricants are helpful when needed to make sex more comfortable. Moisturizers are used on a regular basis, every 2 or 3 days. Or, your doctor might suggest a form of vaginal estrogen.If ED is the problem, it can often be managed and perhaps even reversed with medication or other treatments. There are pills that can help. They should not be used by men taking medicines containing nitrates, such as nitroglycerin. The pills do have possible side effects. Be wary of any dietary or herbal supplements promising to treat ED. Always talk to your doctor before taking any herb or supplement.Physical problems can change your sex life as you get older. If you are single, dating and meeting new people may be easier later in life when you're more sure of yourself and what you want. If you're in a relationship, you and your partner may discover new ways to be together as you get older. Talk to your partner or partners about your needs. You may find that affection-hugging, kissing, touching, and spending time together-can be just what you need, or a path to greater intimacy and sex.Read about this topic in Spanish. Lea sobre este tema en espanol.",
+    "https://www.nia.nih.gov/health/topics/hivaids"
+  ],
+  [
+    "HIV/AIDS (Is HIV/AIDS Different in Older People?): A growing number of older people are living with HIV/AIDS. One reason is because improved treatments are helping people with the disease live longer. Nearly half of people living with HIV in the United States are age 50 and older. Many of them were diagnosed with HIV in their younger years. However, thousands of older people get HIV every year.Older people are less likely than younger people to get tested, so they may not know they have HIV. Signs of HIV/AIDS can be mistaken for the aches and pains of normal aging. Older adults might be coping with other diseases and the aches and pains of normal aging that can mask the signs of HIV/AIDS.Some older people may feel ashamed or afraid of being tested. Plus, doctors do not always think to test older people for HIV. By the time the older person is diagnosed, the virus may be in the late stages and more likely to progress to AIDS.Remember, if you are at risk, get tested regularly for HIV.For people who have HIV, it is important to start treatment as soon as possible after diagnosis. Treatment can help reduce the level of HIV in the blood to undetectable levels. When treatment makes HIV undetectable, the possibility of spreading the virus to a sexual partner becomes very low. This is known as treatment as prevention (TasP).Even when the disease is well controlled, people with HIV may develop aging-related conditions at a younger age. HIV and its treatment can also affect other parts of the body, such as the brain and the heart. For example, people living with HIV are significantly more likely to develop cardiovascular disease than people without HIV. Older people living with HIV also have an increased risk of dementia. Talk with your doctor if you are concerned about how living with HIV could affect you as you grow older.Facts About HIV/AIDS You may have read or heard things that are not true about how you get HIV. Here are the facts: - You cannot get HIV through casual contact, such as shaking hands or hugging a person with HIV/AIDS. - You cannot get HIV from using a public telephone, drinking fountain, restroom, swimming pool, whirlpool, or hot tub. - You cannot get HIV from sharing a drink. - You cannot get HIV from being coughed or sneezed on by a person with HIV/AIDS. - You cannot get HIV from giving blood. - You cannot get HIV from a mosquito bite.",
+    "https://www.nia.nih.gov/health/topics/hivaids"
+  ],
+  [
+    "HIV/AIDS - resources: The following organizations are good resources for information on AIDS: - AIDS.gov -- www.aids.gov - AIDS Info -- aidsinfo.nih.gov - The Henry J. Kaiser Family Foundation -- www.kff.org/hivaids - US Centers for Disease Control and Prevention -- www.cdc.gov/hiv Updated by: Jennifer K. Mannheim, ARNP, Medical Staff, Department of Psychiatry and Behavioral Health, Seattle Children's Hospital, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/002187.htm"
+  ],
+  [
+    "HIV/AIDS (Why Is the Study of HIV/AIDS a Priority for NIAID?): Nearly 37 million people are living with HIV around the world. In the United States, 1.2 million people are living with HIV, of whom 13 percent are unaware of their diagnosis. Although progress has been made in the global fight against HIV/AIDS, the epidemic continues in the United States and the international community. Globally, AIDS-related deaths have dropped by 45 percent since their peak in 2004. Yet the rate of HIV transmission remains unacceptably high, with 2.1 million new infections occurring worldwide in 2015 alone.",
+    "https://www.niaid.nih.gov/diseases-conditions/hivaids"
+  ],
+  [
+    "HIV/AIDS (HIV, AIDS, AND OLDER PEOPLE): Like most people, you probably have heard a lot about HIV and AIDS. You may have thought that these diseases aren't your problem and that only younger people have to worry about them. But, anyone at any age can be infected with HIV.",
+    "https://www.nia.nih.gov/health/topics/hivaids"
+  ],
+  [
+    "HIV/AIDS (What Is HIV? What Is AIDS?): HIV (human immunodeficiency virus) is a virus that damages and weakens the body's immune system-the system your body uses to fight off infection and disease. Having HIV puts a person in danger of experiencing other life-threatening infections and certain cancers.When the body cannot fight off infections and some other diseases anymore, HIV can lead to a serious illness called AIDS (acquired immunodeficiency syndrome). When someone has AIDS, they are more likely to get infections, and more vulnerable to unusual forms of cancers and other serious diseases. But, with early and uninterrupted treatment, it is possible that a person with HIV will never develop AIDS.If you think you may have HIV, you should get tested. Everyone age 13 to 64 should be tested at least once for HIV. If you are over 64 and are at risk for HIV, talk with your doctor. Your doctor can help determine how often you should be tested and help find ways to reduce your risk.There are drugs that, when taken consistently, can help suppress the amount of HIV in your blood to undetectable levels, improving your health overall and making it harder to pass HIV on to your sexual partners. To get the best results, it is important to start treatment as soon as possible. If you are unsure about your HIV status, get tested. Always protect yourself and your partners when having sex or using needles.",
+    "https://www.nia.nih.gov/health/topics/hivaids"
+  ],
+  [
+    "HIV/AIDS (Overview): HIV, or human immunodeficiency virus, is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). HIV attacks the immune system by destroying CD4 positive (CD4+) T cells, a type of white blood cell that is vital to fighting off infection. The destruction of these cells leaves people living with HIV vulnerable to other infections, diseases and other complications. As the leading U.S. government institute for HIV/AIDS research, NIAID is committed to conducting the research necessary to successfully end the fight against HIV/AIDS.",
+    "https://www.niaid.nih.gov/diseases-conditions/hivaids"
+  ],
+  [
+    "What causes HIV/AIDS?: The virus is spread (transmitted) person-to-person in any of the following ways: - Through sexual contact - Through blood -- by blood transfusions (now extremely rare in the U.S.) or more often by needle sharing - From mother to child -- a pregnant woman can spread the virus to her fetus through their shared blood circulation, or a nursing mother can pass it to her baby through her breast milk The virus is NOT spread by: - Casual contact, such as hugging - Mosquitoes - Participating in sports - Touching items that were touched by a person infected with the virus HIV and blood or organ donation: - HIV is not spread to a person who donates blood or organs. People who donate organs are never in direct contact with the people who receive them. Likewise, a person who donates blood is never in contact with the person receiving it. In all of these procedures, sterile needles and instruments are used. - But HIV can be spread to a person receiving blood or organs from an infected donor. To reduce this risk, blood banks and organ donor programs check (screen) donors, blood, and tissues thoroughly. People at high risk of getting HIV include: - Drug users who inject and then share needles - Infants born to mothers with HIV who did not receive HIV treatment during pregnancy - People who have unprotected sex, especially with people who have other high-risk behaviors, are HIV-positive, or have AIDS - People who received blood transfusions or clotting products between 1977 and 1985, before screening for the virus became standard practice - Sexual partners of those who engage in high-risk activities (such as injection drug use or anal sex) After HIV infects the body, the virus can be found in many different fluids and tissues in the body. - Only blood, semen, fluids from the vagina, and breast milk have been shown to transmit infection to others. - The virus may also be found in saliva, tears, and spinal fluid.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000594.htm"
+  ],
+  [
+    "HIV/AIDS (Is HIV/AIDS Different in Older People?): A growing number of older people are living with HIV/AIDS. One reason is because improved treatments are helping people with the disease live longer. Nearly half of people living with HIV in the United States are age 50 and older. Many of them were diagnosed with HIV in their younger years. However, thousands of older people get HIV every year.Older people are less likely than younger people to get tested, so they may not know they have HIV. Signs of HIV/AIDS can be mistaken for the aches and pains of normal aging. Older adults might be coping with other diseases and the aches and pains of normal aging that can mask the signs of HIV/AIDS.Some older people may feel ashamed or afraid of being tested. Plus, doctors do not always think to test older people for HIV. By the time the older person is diagnosed, the virus may be in the late stages and more likely to progress to AIDS.Remember, if you are at risk, get tested regularly for HIV.For people who have HIV, it is important to start treatment as soon as possible after diagnosis. Treatment can help reduce the level of HIV in the blood to undetectable levels. When treatment makes HIV undetectable, the possibility of spreading the virus to a sexual partner becomes very low. This is known as treatment as prevention (TasP).Even when the disease is well controlled, people with HIV may develop aging-related conditions at a younger age. HIV and its treatment can also affect other parts of the body, such as the brain and the heart. For example, people living with HIV are significantly more likely to develop cardiovascular disease than people without HIV. Older people living with HIV also have an increased risk of dementia. Talk with your doctor if you are concerned about how living with HIV could affect you as you grow older.Facts About HIV/AIDS You may have read or heard things that are not true about how you get HIV. Here are the facts: - You cannot get HIV through casual contact, such as shaking hands or hugging a person with HIV/AIDS. - You cannot get HIV from using a public telephone, drinking fountain, restroom, swimming pool, whirlpool, or hot tub. - You cannot get HIV from sharing a drink. - You cannot get HIV from being coughed or sneezed on by a person with HIV/AIDS. - You cannot get HIV from giving blood. - You cannot get HIV from a mosquito bite.",
+    "https://www.nia.nih.gov/health/topics/hivaids"
+  ],
+  [
+    "HIV/AIDS (Am I Too Old to Worry About Safe Sex?): Age does not protect you from sexually transmitted diseases. Older people who are sexually active may be at risk for diseases such as syphilis, gonorrhea, chlamydial infection, genital herpes, hepatitis B, genital warts, and trichomoniasis.Almost anyone who is sexually active is also at risk of being infected with HIV, the virus that causes AIDS. The number of older people with HIV/AIDS is growing. You are at risk for HIV/AIDS if you or your partner has more than one sexual partner, if you are having unprotected sex, or if either you or your partner is sharing needles. To protect yourself, always use a condom during sex that involves vaginal or anal penetration.A man needs to have a full erection before putting on a condom.Talk with your doctor about ways to protect yourself from all sexually transmitted diseases and infections. Go for regular checkups and testing. Talk with your partner. You are never too old to be at risk.",
+    "https://www.nia.nih.gov/health/topics/hivaids"
+  ],
+  [
+    "HIV/AIDS (Overview): Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight the organisms that cause disease. HIV is a sexually transmitted infection (STI). It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. Without medication, it may take years before HIV weakens your immune system to the point that you have AIDS. There's no cure for HIV/AIDS, but there are medications that can dramatically slow the progression of the disease. These drugs have reduced AIDS deaths in many developed nations.",
+    "https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524"
+  ],
+  [
+    "HIV/AIDS (Risk factors): When HIV/AIDS first appeared in the United States, it mainly affected men who had sex with men. However, now it's clear that HIV also spreads through heterosexual sex. Anyone of any age, race, sex or sexual orientation can be infected. However, you're at greatest risk of HIV/AIDS if you: - Have unprotected sex. Use a new latex or polyurethane condom every time you have sex. Anal sex is more risky than is vaginal sex. Your risk of HIV increases if you have multiple sexual partners. - Have an STI. Many STIs produce open sores on your genitals. These sores act as doorways for HIV to enter your body. - Use intravenous drugs. People who use intravenous drugs often share needles and syringes. This exposes them to droplets of other people's blood. - Are an uncircumcised man. Studies suggest that lack of circumcision increases the risk of heterosexual transmission of HIV.",
+    "https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524"
+  ],
+  [
+    "HIV/AIDS (Why Is the Study of HIV/AIDS a Priority for NIAID?): Nearly 37 million people are living with HIV around the world. In the United States, 1.2 million people are living with HIV, of whom 13 percent are unaware of their diagnosis. Although progress has been made in the global fight against HIV/AIDS, the epidemic continues in the United States and the international community. Globally, AIDS-related deaths have dropped by 45 percent since their peak in 2004. Yet the rate of HIV transmission remains unacceptably high, with 2.1 million new infections occurring worldwide in 2015 alone.",
+    "https://www.niaid.nih.gov/diseases-conditions/hivaids"
+  ],
+  [
+    "HIV/AIDS - resources (Summary): The following organizations are good resources for information on AIDS: - AIDS.gov -- www.aids.gov - AIDS Info -- aidsinfo.nih.gov - The Henry J. Kaiser Family Foundation -- www.kff.org/hivaids - US Centers for Disease Control and Prevention -- www.cdc.gov/hiv",
+    "https://medlineplus.gov/ency/article/002187.htm"
+  ],
+  [
+    "HIV/AIDS (Is There a Cure for HIV?): There is no cure for HIV. But if you acquire the virus, there are drugs that help suppress the level of HIV in the body and prevent its spread to other people. Doctors use a combination of drugs called HAART (highly active antiretroviral therapy) to treat HIV/AIDS. Although it is not a cure, HAART has greatly reduced the number of deaths from HIV-related complications in the United States. HIV has become like a chronic disease, and people living with HIV receiving successful treatment can live a long and healthy life.",
+    "https://www.nia.nih.gov/health/topics/hivaids"
+  ],
+  [
+    "HIV/AIDS (Vaccine Development): Historically, vaccination has been the best method for protecting people from infectious diseases. While an array of techniques are available for preventing HIV infection, the development of a safe and effective HIV vaccine remains key to realizing a durable end to the HIV/AIDS pandemic. NIAID-supported scientists are working toward an HIV vaccine from two complementary angles: an empirical approach that quickly moves vaccine candidates into human testing, and a theoretical approach that designs vaccine candidates based on an understanding of the immune response to HIV infection.",
+    "https://www.niaid.nih.gov/diseases-conditions/hivaids"
+  ],
+  [
+    "HIV/AIDS (Symptoms): The symptoms of HIV and AIDS vary, depending on the phase of infection. Primary infection (Acute HIV) Most people infected by HIV develop a flu-like illness within a month or two after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible signs and symptoms include: - Fever - Headache - Muscle aches and joint pain - Rash - Sore throat and painful mouth sores - Swollen lymph glands, mainly on the neck These symptoms can be so mild that you might not even notice them. However, the amount of virus in your bloodstream (viral load) is quite high at this time. As a result, the infection spreads more easily during primary infection than during the next stage. Clinical latent infection (Chronic HIV) In some people, persistent swelling of lymph nodes occurs during this stage. Otherwise, there are no specific signs and symptoms. HIV remains in the body and in infected white blood cells. This stage of HIV infection generally lasts around 10 years if you're not receiving antiretroviral therapy. But sometimes, even with this treatment, it lasts for decades. Some people develop more severe disease much sooner. Symptomatic HIV infection As the virus continues to multiply and destroy your immune cells - the cells in your body that help fight off germs - you may develop mild infections or chronic signs and symptoms such as: - Fever - Fatigue - Swollen lymph nodes - often one of the first signs of HIV infection - Diarrhea - Weight loss - Oral yeast infection (thrush) - Shingles (herpes zoster) Progression to AIDS Thanks to better antiviral treatments, most people with HIV in the U.S. today don't develop AIDS. Untreated, HIV typically turns into AIDS in about 10 years. When AIDS occurs, your immune system has been severely damaged. You'll be more likely to develop opportunistic infections or opportunistic cancers - diseases that wouldn't usually trouble a person with a healthy immune system. The signs and symptoms of some of these infections may include: - Soaking night sweats - Recurring fever - Chronic diarrhea - Persistent white spots or unusual lesions on your tongue or in your mouth - Persistent, unexplained fatigue - Weight loss - Skin rashes or bumps When to see a doctor If you think you may have been infected with HIV or are at risk of contracting the virus, see a health care provider as soon as possible.",
+    "https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524"
+  ],
+  [
+    "HIV/AIDS (What Are the Symptoms of HIV?): Many people do not notice symptoms when they first acquire HIV. It can take as little as a few weeks for minor, flu-like symptoms to show up, or more than 10 years for more serious symptoms to appear, or any time in between. Signs of early HIV infection include flu-like symptoms such as headache, muscle aches, swollen glands, sore throat, fevers, chills, and sweating, and can also include a rash or mouth ulcers. Symptoms of later-stage HIV or AIDS include swollen glands, lack of energy, loss of appetite, weight loss, chronic or recurrent diarrhea, repeated yeast infections, short-term memory loss, and blotchy lesions on the skin, inside the mouth, eyelids, nose, or genital area.",
+    "https://www.nia.nih.gov/health/topics/hivaids"
+  ],
+  [
+    "HIV/AIDS (Is HIV/AIDS Different in Older People?): A growing number of older people are living with HIV/AIDS. One reason is because improved treatments are helping people with the disease live longer. Nearly half of people living with HIV in the United States are age 50 and older. Many of them were diagnosed with HIV in their younger years. However, thousands of older people get HIV every year.Older people are less likely than younger people to get tested, so they may not know they have HIV. Signs of HIV/AIDS can be mistaken for the aches and pains of normal aging. Older adults might be coping with other diseases and the aches and pains of normal aging that can mask the signs of HIV/AIDS.Some older people may feel ashamed or afraid of being tested. Plus, doctors do not always think to test older people for HIV. By the time the older person is diagnosed, the virus may be in the late stages and more likely to progress to AIDS.Remember, if you are at risk, get tested regularly for HIV.For people who have HIV, it is important to start treatment as soon as possible after diagnosis. Treatment can help reduce the level of HIV in the blood to undetectable levels. When treatment makes HIV undetectable, the possibility of spreading the virus to a sexual partner becomes very low. This is known as treatment as prevention (TasP).Even when the disease is well controlled, people with HIV may develop aging-related conditions at a younger age. HIV and its treatment can also affect other parts of the body, such as the brain and the heart. For example, people living with HIV are significantly more likely to develop cardiovascular disease than people without HIV. Older people living with HIV also have an increased risk of dementia. Talk with your doctor if you are concerned about how living with HIV could affect you as you grow older.Facts About HIV/AIDS You may have read or heard things that are not true about how you get HIV. Here are the facts: - You cannot get HIV through casual contact, such as shaking hands or hugging a person with HIV/AIDS. - You cannot get HIV from using a public telephone, drinking fountain, restroom, swimming pool, whirlpool, or hot tub. - You cannot get HIV from sharing a drink. - You cannot get HIV from being coughed or sneezed on by a person with HIV/AIDS. - You cannot get HIV from giving blood. - You cannot get HIV from a mosquito bite.",
+    "https://www.nia.nih.gov/health/topics/hivaids"
+  ],
+  [
+    "HIV/AIDS (Overview): HIV, or human immunodeficiency virus, is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). HIV attacks the immune system by destroying CD4 positive (CD4+) T cells, a type of white blood cell that is vital to fighting off infection. The destruction of these cells leaves people living with HIV vulnerable to other infections, diseases and other complications. As the leading U.S. government institute for HIV/AIDS research, NIAID is committed to conducting the research necessary to successfully end the fight against HIV/AIDS.",
+    "https://www.niaid.nih.gov/diseases-conditions/hivaids"
+  ],
+  [
+    "HIV/AIDS (Am I Too Old to Worry About Safe Sex?): Age does not protect you from sexually transmitted diseases. Older people who are sexually active may be at risk for diseases such as syphilis, gonorrhea, chlamydial infection, genital herpes, hepatitis B, genital warts, and trichomoniasis.Almost anyone who is sexually active is also at risk of being infected with HIV, the virus that causes AIDS. The number of older people with HIV/AIDS is growing. You are at risk for HIV/AIDS if you or your partner has more than one sexual partner, if you are having unprotected sex, or if either you or your partner is sharing needles. To protect yourself, always use a condom during sex that involves vaginal or anal penetration.A man needs to have a full erection before putting on a condom.Talk with your doctor about ways to protect yourself from all sexually transmitted diseases and infections. Go for regular checkups and testing. Talk with your partner. You are never too old to be at risk.",
+    "https://www.nia.nih.gov/health/topics/hivaids"
+  ],
+  [
+    "HIV/AIDS (Overview): Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight the organisms that cause disease. HIV is a sexually transmitted infection (STI). It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. Without medication, it may take years before HIV weakens your immune system to the point that you have AIDS. There's no cure for HIV/AIDS, but there are medications that can dramatically slow the progression of the disease. These drugs have reduced AIDS deaths in many developed nations.",
+    "https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524"
+  ],
+  [
+    "HIV/AIDS (Risk factors): When HIV/AIDS first appeared in the United States, it mainly affected men who had sex with men. However, now it's clear that HIV also spreads through heterosexual sex. Anyone of any age, race, sex or sexual orientation can be infected. However, you're at greatest risk of HIV/AIDS if you: - Have unprotected sex. Use a new latex or polyurethane condom every time you have sex. Anal sex is more risky than is vaginal sex. Your risk of HIV increases if you have multiple sexual partners. - Have an STI. Many STIs produce open sores on your genitals. These sores act as doorways for HIV to enter your body. - Use intravenous drugs. People who use intravenous drugs often share needles and syringes. This exposes them to droplets of other people's blood. - Are an uncircumcised man. Studies suggest that lack of circumcision increases the risk of heterosexual transmission of HIV.",
+    "https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524"
+  ],
+  [
+    "HIV/AIDS (Why Is the Study of HIV/AIDS a Priority for NIAID?): Nearly 37 million people are living with HIV around the world. In the United States, 1.2 million people are living with HIV, of whom 13 percent are unaware of their diagnosis. Although progress has been made in the global fight against HIV/AIDS, the epidemic continues in the United States and the international community. Globally, AIDS-related deaths have dropped by 45 percent since their peak in 2004. Yet the rate of HIV transmission remains unacceptably high, with 2.1 million new infections occurring worldwide in 2015 alone.",
+    "https://www.niaid.nih.gov/diseases-conditions/hivaids"
+  ],
+  [
+    "HIV/AIDS (Treatment): One of NIAID\u2019s greatest success stories is that its research led to the development of numerous antiretroviral drugs to treat HIV/AIDS, turning what was once a uniformly fatal disease into a manageable chronic condition for many. NIAID is working to find new and more effective therapeutic products, drug classes, and combinations as well as safe and effective treatments for dangerous related co-infections and complications.",
+    "https://www.niaid.nih.gov/diseases-conditions/hivaids"
+  ],
+  [
+    "What are the treatments for HIV/AIDS?: HIV/AIDS is treated with medicines that stop the virus from multiplying. This treatment is called antiretroviral therapy (ART). In the past, people with HIV infection would start antiretroviral treatment after their CD4 count dropped or they developed HIV complications. Today, HIV treatment is recommended for all people with HIV infection, even if their CD4 count is still normal. Regular blood tests are needed to make sure the virus level in the blood (viral load) is kept low, or suppressed. The goal of treatment is to lower the HIV virus in the blood to a level that is so low that the test can't detect it. This is called an undetectable viral load. If the CD4 count already dropped before treatment was started, it will usually slowly go up. HIV complications often disappear as the immune system recovers.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000594.htm"
+  ],
+  [
+    "HIV/AIDS (Is There a Cure for HIV?): There is no cure for HIV. But if you acquire the virus, there are drugs that help suppress the level of HIV in the body and prevent its spread to other people. Doctors use a combination of drugs called HAART (highly active antiretroviral therapy) to treat HIV/AIDS. Although it is not a cure, HAART has greatly reduced the number of deaths from HIV-related complications in the United States. HIV has become like a chronic disease, and people living with HIV receiving successful treatment can live a long and healthy life.",
+    "https://www.nia.nih.gov/health/topics/hivaids"
+  ],
+  [
+    "HIV/AIDS (Treatment): There's no cure for HIV/AIDS, but many different drugs are available to control the virus. Such treatment is called antiretroviral therapy, or ART. Each class of drug blocks the virus in different ways. ART is now recommended for everyone, regardless of CD4 T cell counts. It's recommended to combine three drugs from two classes to avoid creating drug-resistant strains of HIV. The classes of anti-HIV drugs include: - Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune). - Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty versions of the building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine/tenofovir (Truvada), Descovy (tenofovir alafenamide/emtricitabine), and lamivudine-zidovudine (Combivir). - Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and indinavir (Crixivan). - Entry or fusion inhibitors Tblock HIV's entry into CD4 T cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry). - Integrase inhibitors work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells. Examples include raltegravir (Isentress) and dolutegravir (Tivicay). When to start treatment Everyone with HIV infection, regardless of CD4 T cell count, should be offered antiviral medication. HIV therapy is particularly important for the following situations: - You have severe symptoms. - You have an opportunistic infection. - Your CD4 T cell count is under 350. - You're pregnant. - You have HIV-related kidney disease. - You're being treated for hepatitis B or C. Treatment can be difficult HIV treatment plans may involve taking several pills at specific times every day for the rest of your life. Each medication comes with its own unique set of side effects. It's critical to have regular follow-up appointments with your doctor to monitor your health and treatment. Some of the treatment side effects are: - Nausea, vomiting or diarrhea - Heart disease - Weakened bones or bone loss - Breakdown of muscle tissue (rhabdomyolysis) - Abnormal cholesterol levels - Higher blood sugar Treatment for age-related diseases Some health issues that are a natural part of aging may be more difficult to manage if you have HIV. Some medications that are common for age-related heart, bone or metabolic conditions, for example, may not interact well with anti-HIV medications. It's important to talk to your doctor about your other health conditions and the medications you are taking. Treatment response Your doctor will monitor your viral load and CD4 T cell counts to determine your response to HIV treatment. CD4 T cell counts should be checked every three to six months. Viral load should be tested at the start of treatment and then every three to four months during therapy. Treatment should lower your viral load so that it's undetectable. That doesn't mean your HIV is gone. It just means that the test isn't sensitive enough to detect it.",
+    "https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524"
+  ],
+  [
+    "HIV/AIDS (Is HIV/AIDS Different in Older People?): A growing number of older people are living with HIV/AIDS. One reason is because improved treatments are helping people with the disease live longer. Nearly half of people living with HIV in the United States are age 50 and older. Many of them were diagnosed with HIV in their younger years. However, thousands of older people get HIV every year.Older people are less likely than younger people to get tested, so they may not know they have HIV. Signs of HIV/AIDS can be mistaken for the aches and pains of normal aging. Older adults might be coping with other diseases and the aches and pains of normal aging that can mask the signs of HIV/AIDS.Some older people may feel ashamed or afraid of being tested. Plus, doctors do not always think to test older people for HIV. By the time the older person is diagnosed, the virus may be in the late stages and more likely to progress to AIDS.Remember, if you are at risk, get tested regularly for HIV.For people who have HIV, it is important to start treatment as soon as possible after diagnosis. Treatment can help reduce the level of HIV in the blood to undetectable levels. When treatment makes HIV undetectable, the possibility of spreading the virus to a sexual partner becomes very low. This is known as treatment as prevention (TasP).Even when the disease is well controlled, people with HIV may develop aging-related conditions at a younger age. HIV and its treatment can also affect other parts of the body, such as the brain and the heart. For example, people living with HIV are significantly more likely to develop cardiovascular disease than people without HIV. Older people living with HIV also have an increased risk of dementia. Talk with your doctor if you are concerned about how living with HIV could affect you as you grow older.Facts About HIV/AIDS You may have read or heard things that are not true about how you get HIV. Here are the facts: - You cannot get HIV through casual contact, such as shaking hands or hugging a person with HIV/AIDS. - You cannot get HIV from using a public telephone, drinking fountain, restroom, swimming pool, whirlpool, or hot tub. - You cannot get HIV from sharing a drink. - You cannot get HIV from being coughed or sneezed on by a person with HIV/AIDS. - You cannot get HIV from giving blood. - You cannot get HIV from a mosquito bite.",
+    "https://www.nia.nih.gov/health/topics/hivaids"
+  ],
+  [
+    "HIV/AIDS: HIV, or human immunodeficiency virus, is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). HIV attacks the immune system by destroying CD4 positive (CD4+) T cells, a type of white blood cell that is vital to fighting off infection. The destruction of these cells leaves people living with HIV vulnerable to other infections, diseases and other complications. As the leading U.S. government institute for HIV/AIDS research, NIAID is committed to conducting the research necessary to successfully end the fight against HIV/AIDS.\u00a0 Nearly 37 million people are living with HIV around the world. In the United States, 1.2 million people are living with HIV, of whom 13 percent are unaware of their diagnosis. Although progress has been made in the global fight against HIV/AIDS, the epidemic continues in the United States and the international community. Globally, AIDS-related deaths have dropped by 45 percent since their peak in 2004. Yet the rate of HIV transmission remains unacceptably high, with 2.1 million new infections occurring worldwide in 2015 alone. NIAID-supported investigators are conducting an abundance of research on all areas of HIV infection, including developing and testing preventive HIV vaccines, prevention strategies, and new treatments for HIV infection and AIDS-associated opportunistic infections. Through laboratories and clinics on the National Institutes of Health campus in Bethesda, Maryland, and a vast network of supported research at universities, medical centers, and clinical trial sites around the globe, NIAID is working to better understand HIV and how it causes disease, find new tools to prevent HIV infection including a preventive vaccine, develop new and more effective treatments for people living with HIV, and hopefully, find a cure. Preventing new HIV infections is a key step toward ending the HIV pandemic as we know it. NIAID-supported researchers have worked since the early days of AIDS in the 1980s to identify prevention tools to keep people healthy. Today, an array of prevention methods are available for use in combination or on their own, and scientists continue to work to develop and improve cutting-edge tools and techniques that can work to prevent HIV in diverse populations around the world. Historically, vaccination has been the best method for protecting people from infectious diseases. While an array of techniques are available for preventing HIV infection, the development of a safe and effective HIV vaccine remains key to realizing a durable end to the HIV/AIDS pandemic. NIAID-supported scientists are working toward an HIV vaccine from two complementary angles: an empirical approach that quickly moves vaccine candidates into human testing, and a theoretical approach that designs vaccine candidates based on an understanding of the immune response to HIV infection. One of NIAID\u2019s greatest success stories is that its research led to the development of numerous antiretroviral drugs to treat HIV/AIDS, turning what was once a uniformly fatal disease into a manageable chronic condition for many. NIAID is working to find new and more effective therapeutic products, drug classes, and combinations as well as safe and effective treatments for dangerous related co-infections and complications. NIAID is exploring therapies that suppress the amount of HIV to such low levels that an HIV-infected person would no longer need treatment because his or her immune system could keep the remaining virus in check, creating in essence a \u201cfunctional cure.\u201d",
+    "https://www.niaid.nih.gov/diseases-conditions/hivaids"
+  ],
+  [
+    "HIV/AIDS (Finding a Cure): NIAID is exploring therapies that suppress the amount of HIV to such low levels that an HIV-infected person would no longer need treatment because his or her immune system could keep the remaining virus in check, creating in essence a \u201cfunctional cure.\u201d",
+    "https://www.niaid.nih.gov/diseases-conditions/hivaids"
+  ],
+  [
+    "HIV/AIDS (Overview): Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight the organisms that cause disease. HIV is a sexually transmitted infection (STI). It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. Without medication, it may take years before HIV weakens your immune system to the point that you have AIDS. There's no cure for HIV/AIDS, but there are medications that can dramatically slow the progression of the disease. These drugs have reduced AIDS deaths in many developed nations.",
+    "https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524"
+  ],
+  [
+    "HIV/AIDS (Am I Too Old to Worry About Safe Sex?): Age does not protect you from sexually transmitted diseases. Older people who are sexually active may be at risk for diseases such as syphilis, gonorrhea, chlamydial infection, genital herpes, hepatitis B, genital warts, and trichomoniasis.Almost anyone who is sexually active is also at risk of being infected with HIV, the virus that causes AIDS. The number of older people with HIV/AIDS is growing. You are at risk for HIV/AIDS if you or your partner has more than one sexual partner, if you are having unprotected sex, or if either you or your partner is sharing needles. To protect yourself, always use a condom during sex that involves vaginal or anal penetration.A man needs to have a full erection before putting on a condom.Talk with your doctor about ways to protect yourself from all sexually transmitted diseases and infections. Go for regular checkups and testing. Talk with your partner. You are never too old to be at risk.",
+    "https://www.nia.nih.gov/health/topics/hivaids"
+  ],
+  [
+    "HIV/AIDS (Diagnosis): HIV is most commonly diagnosed by testing your blood or saliva for antibodies to the virus. Unfortunately, it takes time for your body to develop these antibodies - usually up to 12 weeks. A quicker test checks for HIV antigen, a protein produced by the virus immediately after infection. It can confirm a diagnosis soon after infection and allow the person to take swifter steps to prevent the spread of the virus to others. Home testing At least two Food and Drug Administration-approved home test kits for HIV are available. Depending on which you choose, you'll need a drop of dried blood or sample of saliva. If the test is positive, you'll need to see your doctor to confirm the diagnosis and discuss your treatment options. If the test is negative, it needs to be repeated in a few months to confirm the results. Tests to stage disease and treatment If you receive a diagnosis of HIV/AIDS, several tests can help your doctor determine the stage of your disease and the best treatment. These tests include: - CD4 T cell count. CD4 T cells are white blood cells that are specifically targeted and destroyed by HIV. Even if you have no symptoms, HIV infection progresses to AIDS when your CD4 T cell count dips below 200. - Viral load (HIV RNA). This test measures the amount of virus in your blood. A higher viral load has been linked to a worse outcome. - Drug resistance. Some strains of HIV are resistant to medications. This test helps your doctor determine if your specific form of the virus has resistance and guides treatment decisions. Tests for complications Your doctor might also order lab tests to check for other infections or complications, including: - Tuberculosis - Hepatitis - Toxoplasmosis - Sexually transmitted infections - Liver or kidney damage - Urinary tract infection",
+    "https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524"
+  ],
+  [
+    "How to diagnose HIV/AIDS?: DIAGNOSTIC TESTS These are tests that are done to check if you've been infected with the virus. In general, testing is a 2-step process: - Screening test -- There are several kinds of tests. Some are blood tests, others are mouth fluid tests. They check for antibodies to the HIV virus, HIV antigen, or both. Some screening tests can give results in 30 minutes or less. - Follow-up test -- This is also called a confirmatory test. It is often done when the screening test is positive. Home tests are available to test for HIV. If you plan to use one, checkto make sureit's approved by the FDA. Follow instructions on the packaging to ensure the results are as accurate as possible. The Centers for Disease Control and Prevention (CDC) recommends that everyone ages 15 to 65 have a screening test for HIV. People with risky behaviors should be tested regularly. Pregnant women should also have a screening test. TESTS AFTER BEING DIAGNOSED WITH HIV People with AIDS usually have regular blood tests to check their CD4 cell count: - CD4 cells are the blood cells that HIV attacks. They are also called T4 cells or \"helper T cells.\" - As HIV damages the immune system, the CD4 count drops. A normal CD4 count is from 500 to 1,500 cells/mm3 of blood. - People usually develop symptoms when their CD4 count drops below 350. More serious complications occur when the CD4 count drops to 200. When the count is below 200, the person is said to have AIDS. Other tests include: - HIV RNA level, or viral load, to check how much HIV is in the blood - A resistance test to see if the virus has any resistance to the medicines used to treat HIV - Complete blood count, blood chemistry, and urine test - Tests for other sexually transmitted infections - TB test - Pap smear to check for cervical cancer - Anal pap smear to check for cancer of the anus",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000594.htm"
+  ],
+  [
+    "HIV/AIDS (Why Is the Study of HIV/AIDS a Priority for NIAID?): Nearly 37 million people are living with HIV around the world. In the United States, 1.2 million people are living with HIV, of whom 13 percent are unaware of their diagnosis. Although progress has been made in the global fight against HIV/AIDS, the epidemic continues in the United States and the international community. Globally, AIDS-related deaths have dropped by 45 percent since their peak in 2004. Yet the rate of HIV transmission remains unacceptably high, with 2.1 million new infections occurring worldwide in 2015 alone.",
+    "https://www.niaid.nih.gov/diseases-conditions/hivaids"
+  ],
+  [
+    "HIV/AIDS (Is HIV/AIDS Different in Older People?): A growing number of older people are living with HIV/AIDS. One reason is because improved treatments are helping people with the disease live longer. Nearly half of people living with HIV in the United States are age 50 and older. Many of them were diagnosed with HIV in their younger years. However, thousands of older people get HIV every year.Older people are less likely than younger people to get tested, so they may not know they have HIV. Signs of HIV/AIDS can be mistaken for the aches and pains of normal aging. Older adults might be coping with other diseases and the aches and pains of normal aging that can mask the signs of HIV/AIDS.Some older people may feel ashamed or afraid of being tested. Plus, doctors do not always think to test older people for HIV. By the time the older person is diagnosed, the virus may be in the late stages and more likely to progress to AIDS.Remember, if you are at risk, get tested regularly for HIV.For people who have HIV, it is important to start treatment as soon as possible after diagnosis. Treatment can help reduce the level of HIV in the blood to undetectable levels. When treatment makes HIV undetectable, the possibility of spreading the virus to a sexual partner becomes very low. This is known as treatment as prevention (TasP).Even when the disease is well controlled, people with HIV may develop aging-related conditions at a younger age. HIV and its treatment can also affect other parts of the body, such as the brain and the heart. For example, people living with HIV are significantly more likely to develop cardiovascular disease than people without HIV. Older people living with HIV also have an increased risk of dementia. Talk with your doctor if you are concerned about how living with HIV could affect you as you grow older.Facts About HIV/AIDS You may have read or heard things that are not true about how you get HIV. Here are the facts: - You cannot get HIV through casual contact, such as shaking hands or hugging a person with HIV/AIDS. - You cannot get HIV from using a public telephone, drinking fountain, restroom, swimming pool, whirlpool, or hot tub. - You cannot get HIV from sharing a drink. - You cannot get HIV from being coughed or sneezed on by a person with HIV/AIDS. - You cannot get HIV from giving blood. - You cannot get HIV from a mosquito bite.",
+    "https://www.nia.nih.gov/health/topics/hivaids"
+  ],
+  [
+    "HIV/AIDS: HIV, or human immunodeficiency virus, is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). HIV attacks the immune system by destroying CD4 positive (CD4+) T cells, a type of white blood cell that is vital to fighting off infection. The destruction of these cells leaves people living with HIV vulnerable to other infections, diseases and other complications. As the leading U.S. government institute for HIV/AIDS research, NIAID is committed to conducting the research necessary to successfully end the fight against HIV/AIDS.\u00a0 Nearly 37 million people are living with HIV around the world. In the United States, 1.2 million people are living with HIV, of whom 13 percent are unaware of their diagnosis. Although progress has been made in the global fight against HIV/AIDS, the epidemic continues in the United States and the international community. Globally, AIDS-related deaths have dropped by 45 percent since their peak in 2004. Yet the rate of HIV transmission remains unacceptably high, with 2.1 million new infections occurring worldwide in 2015 alone. NIAID-supported investigators are conducting an abundance of research on all areas of HIV infection, including developing and testing preventive HIV vaccines, prevention strategies, and new treatments for HIV infection and AIDS-associated opportunistic infections. Through laboratories and clinics on the National Institutes of Health campus in Bethesda, Maryland, and a vast network of supported research at universities, medical centers, and clinical trial sites around the globe, NIAID is working to better understand HIV and how it causes disease, find new tools to prevent HIV infection including a preventive vaccine, develop new and more effective treatments for people living with HIV, and hopefully, find a cure. Preventing new HIV infections is a key step toward ending the HIV pandemic as we know it. NIAID-supported researchers have worked since the early days of AIDS in the 1980s to identify prevention tools to keep people healthy. Today, an array of prevention methods are available for use in combination or on their own, and scientists continue to work to develop and improve cutting-edge tools and techniques that can work to prevent HIV in diverse populations around the world. Historically, vaccination has been the best method for protecting people from infectious diseases. While an array of techniques are available for preventing HIV infection, the development of a safe and effective HIV vaccine remains key to realizing a durable end to the HIV/AIDS pandemic. NIAID-supported scientists are working toward an HIV vaccine from two complementary angles: an empirical approach that quickly moves vaccine candidates into human testing, and a theoretical approach that designs vaccine candidates based on an understanding of the immune response to HIV infection. One of NIAID\u2019s greatest success stories is that its research led to the development of numerous antiretroviral drugs to treat HIV/AIDS, turning what was once a uniformly fatal disease into a manageable chronic condition for many. NIAID is working to find new and more effective therapeutic products, drug classes, and combinations as well as safe and effective treatments for dangerous related co-infections and complications. NIAID is exploring therapies that suppress the amount of HIV to such low levels that an HIV-infected person would no longer need treatment because his or her immune system could keep the remaining virus in check, creating in essence a \u201cfunctional cure.\u201d",
+    "https://www.niaid.nih.gov/diseases-conditions/hivaids"
+  ],
+  [
+    "HIV/AIDS - resources (Summary): The following organizations are good resources for information on AIDS: - AIDS.gov -- www.aids.gov - AIDS Info -- aidsinfo.nih.gov - The Henry J. Kaiser Family Foundation -- www.kff.org/hivaids - US Centers for Disease Control and Prevention -- www.cdc.gov/hiv",
+    "https://medlineplus.gov/ency/article/002187.htm"
+  ],
+  [
+    "HIV/AIDS: Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight the organisms that cause disease. HIV is a sexually transmitted infection (STI). It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. Without medication, it may take years before HIV weakens your immune system to the point that you have AIDS. There's no cure for HIV/AIDS, but there are medications that can dramatically slow the progression of the disease. These drugs have reduced AIDS deaths in many developed nations. The symptoms of HIV and AIDS vary, depending on the phase of infection. Primary infection (Acute HIV) Most people infected by HIV develop a flu-like illness within a month or two after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible signs and symptoms include: - Fever - Headache - Muscle aches and joint pain - Rash - Sore throat and painful mouth sores - Swollen lymph glands, mainly on the neck These symptoms can be so mild that you might not even notice them. However, the amount of virus in your bloodstream (viral load) is quite high at this time. As a result, the infection spreads more easily during primary infection than during the next stage. Clinical latent infection (Chronic HIV) In some people, persistent swelling of lymph nodes occurs during this stage. Otherwise, there are no specific signs and symptoms. HIV remains in the body and in infected white blood cells. This stage of HIV infection generally lasts around 10 years if you're not receiving antiretroviral therapy. But sometimes, even with this treatment, it lasts for decades. Some people develop more severe disease much sooner. Symptomatic HIV infection As the virus continues to multiply and destroy your immune cells - the cells in your body that help fight off germs - you may develop mild infections or chronic signs and symptoms such as: - Fever - Fatigue - Swollen lymph nodes - often one of the first signs of HIV infection - Diarrhea - Weight loss - Oral yeast infection (thrush) - Shingles (herpes zoster) Progression to AIDS Thanks to better antiviral treatments, most people with HIV in the U.S. today don't develop AIDS. Untreated, HIV typically turns into AIDS in about 10 years. When AIDS occurs, your immune system has been severely damaged. You'll be more likely to develop opportunistic infections or opportunistic cancers - diseases that wouldn't usually trouble a person with a healthy immune system. The signs and symptoms of some of these infections may include: - Soaking night sweats - Recurring fever - Chronic diarrhea - Persistent white spots or unusual lesions on your tongue or in your mouth - Persistent, unexplained fatigue - Weight loss - Skin rashes or bumps When to see a doctor If you think you may have been infected with HIV or are at risk of contracting the virus, see a health care provider as soon as possible. HIV is caused by a virus. It can spread through sexual contact or blood, or from mother to child during pregnancy, childbirth or breast-feeding. How does HIV become AIDS? HIV destroys CD4 T cells - white blood cells that play a large role in helping your body fight disease. The fewer CD4 T cells you have, the weaker your immune system becomes. You can have an HIV infection for years before it turns into AIDS. AIDS is diagnosed when the CD4 T cell count falls below 200 or you have an AIDS-defining complication. How HIV spreads To become infected with HIV, infected blood, semen or vaginal secretions must enter your body. This can happen in several ways: - By having sex. You may become infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter your body. The virus can enter your body through mouth sores or small tears that sometimes develop in the rectum or vagina during sexual activity. - From blood transfusions. In some cases, the virus may be transmitted through blood transfusions. American hospitals and blood banks now screen the blood supply for HIV antibodies, so this risk is very small. - By sharing needles. Sharing contaminated intravenous drug paraphernalia (needles and syringes) puts you at high risk of HIV and other infectious diseases, such as hepatitis. - During pregnancy or delivery or through breast-feeding. Infected mothers can pass the virus on to their babies. HIV-positive mothers who get treatment for the infection during pregnancy can significantly lower the risk to their babies. How HIV doesn't spread You can't become infected with HIV through ordinary contact. That means you can't catch HIV or AIDS by hugging, kissing, dancing or shaking hands with someone who has the infection. HIV isn't spread through the air, water or insect bites. When HIV/AIDS first appeared in the United States, it mainly affected men who had sex with men. However, now it's clear that HIV also spreads through heterosexual sex. Anyone of any age, race, sex or sexual orientation can be infected. However, you're at greatest risk of HIV/AIDS if you: - Have unprotected sex. Use a new latex or polyurethane condom every time you have sex. Anal sex is more risky than is vaginal sex. Your risk of HIV increases if you have multiple sexual partners. - Have an STI. Many STIs produce open sores on your genitals. These sores act as doorways for HIV to enter your body. - Use intravenous drugs. People who use intravenous drugs often share needles and syringes. This exposes them to droplets of other people's blood. - Are an uncircumcised man. Studies suggest that lack of circumcision increases the risk of heterosexual transmission of HIV. HIV infection weakens your immune system, making you much more likely to develop numerous infections and certain types of cancers. Infections common to HIV/AIDS - Tuberculosis (TB). In resource-limited nations, TB is the most common opportunistic infection associated with HIV. It's a leading cause of death among people with AIDS. - Cytomegalovirus. This common herpes virus is transmitted in body fluids such as saliva, blood, urine, semen and breast milk. A healthy immune system inactivates the virus, and it remains dormant in your body. If your immune system weakens, the virus resurfaces - causing damage to your eyes, digestive tract, lungs or other organs. - Candidiasis. Candidiasis is a common HIV-related infection. It causes inflammation and a thick, white coating on the mucous membranes of your mouth, tongue, esophagus or vagina. - Cryptococcal meningitis. Meningitis is an inflammation of the membranes and fluid surrounding your brain and spinal cord (meninges). Cryptococcal meningitis is a common central nervous system infection associated with HIV, caused by a fungus found in soil. - Toxoplasmosis. This potentially deadly infection is caused by Toxoplasma gondii, a parasite spread primarily by cats. Infected cats pass the parasites in their stools, which may then spread to other animals and humans. Seizures occur when it spreads to the brain. - Cryptosporidiosis. This infection is caused by an intestinal parasite that's commonly found in animals. You get it when you eat or drink contaminated food or water. The parasite grows in your intestines and bile ducts, leading to severe, chronic diarrhea in people with AIDS. Cancers common to HIV/AIDS - Kaposi's sarcoma. A tumor of the blood vessel walls, this cancer is rare in people not infected with HIV, but common in HIV-positive people. It usually appears as pink, red or purple lesions on the skin and mouth. In people with darker skin, the lesions may look dark brown or black. Kaposi's sarcoma can also affect the internal organs, including the digestive tract and lungs. - Lymphoma. This cancer starts in the white blood cells. The most common early sign is painless swelling of the lymph nodes in your neck, armpit or groin. Other complications - Wasting syndrome. Aggressive treatment approaches have reduced the number of cases of wasting syndrome, but it still affects many people with AIDS. It's defined as a loss of at least 10 percent of body weight, often accompanied by diarrhea, chronic weakness and fever. - Neurological complications. Although AIDS doesn't appear to infect the nerve cells, it can cause neurological symptoms such as confusion, forgetfulness, depression, anxiety and difficulty walking. One of the most common neurological complications is AIDS dementia complex, which leads to behavioral changes and reduced mental functioning. - Kidney disease. HIV-associated nephropathy (HIVAN) is an inflammation of the tiny filters in your kidneys that remove excess fluid and wastes from your blood and pass them to your urine. It most often affects blacks or Hispanics. Anyone with this complication should be started on antiretroviral therapy. HIV is most commonly diagnosed by testing your blood or saliva for antibodies to the virus. Unfortunately, it takes time for your body to develop these antibodies - usually up to 12 weeks. A quicker test checks for HIV antigen, a protein produced by the virus immediately after infection. It can confirm a diagnosis soon after infection and allow the person to take swifter steps to prevent the spread of the virus to others. Home testing At least two Food and Drug Administration-approved home test kits for HIV are available. Depending on which you choose, you'll need a drop of dried blood or sample of saliva. If the test is positive, you'll need to see your doctor to confirm the diagnosis and discuss your treatment options. If the test is negative, it needs to be repeated in a few months to confirm the results. Tests to stage disease and treatment If you receive a diagnosis of HIV/AIDS, several tests can help your doctor determine the stage of your disease and the best treatment. These tests include: - CD4 T cell count. CD4 T cells are white blood cells that are specifically targeted and destroyed by HIV. Even if you have no symptoms, HIV infection progresses to AIDS when your CD4 T cell count dips below 200. - Viral load (HIV RNA). This test measures the amount of virus in your blood. A higher viral load has been linked to a worse outcome. - Drug resistance. Some strains of HIV are resistant to medications. This test helps your doctor determine if your specific form of the virus has resistance and guides treatment decisions. Tests for complications Your doctor might also order lab tests to check for other infections or complications, including: - Tuberculosis - Hepatitis - Toxoplasmosis - Sexually transmitted infections - Liver or kidney damage - Urinary tract infection There's no cure for HIV/AIDS, but many different drugs are available to control the virus. Such treatment is called antiretroviral therapy, or ART. Each class of drug blocks the virus in different ways. ART is now recommended for everyone, regardless of CD4 T cell counts. It's recommended to combine three drugs from two classes to avoid creating drug-resistant strains of HIV. The classes of anti-HIV drugs include: - Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune). - Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty versions of the building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine/tenofovir (Truvada), Descovy (tenofovir alafenamide/emtricitabine), and lamivudine-zidovudine (Combivir). - Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and indinavir (Crixivan). - Entry or fusion inhibitors Tblock HIV's entry into CD4 T cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry). - Integrase inhibitors work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells. Examples include raltegravir (Isentress) and dolutegravir (Tivicay). When to start treatment Everyone with HIV infection, regardless of CD4 T cell count, should be offered antiviral medication. HIV therapy is particularly important for the following situations: - You have severe symptoms. - You have an opportunistic infection. - Your CD4 T cell count is under 350. - You're pregnant. - You have HIV-related kidney disease. - You're being treated for hepatitis B or C. Treatment can be difficult HIV treatment plans may involve taking several pills at specific times every day for the rest of your life. Each medication comes with its own unique set of side effects. It's critical to have regular follow-up appointments with your doctor to monitor your health and treatment. Some of the treatment side effects are: - Nausea, vomiting or diarrhea - Heart disease - Weakened bones or bone loss - Breakdown of muscle tissue (rhabdomyolysis) - Abnormal cholesterol levels - Higher blood sugar Treatment for age-related diseases Some health issues that are a natural part of aging may be more difficult to manage if you have HIV. Some medications that are common for age-related heart, bone or metabolic conditions, for example, may not interact well with anti-HIV medications. It's important to talk to your doctor about your other health conditions and the medications you are taking. Treatment response Your doctor will monitor your viral load and CD4 T cell counts to determine your response to HIV treatment. CD4 T cell counts should be checked every three to six months. Viral load should be tested at the start of treatment and then every three to four months during therapy. Treatment should lower your viral load so that it's undetectable. That doesn't mean your HIV is gone. It just means that the test isn't sensitive enough to detect it. Along with receiving medical treatment, it's essential to take an active role in your own care. The following suggestions may help you stay healthy longer: - Eat healthy foods. Fresh fruits and vegetables, whole grains, and lean protein help keep you strong, give you more energy and support your immune system. - Avoid raw meat, eggs and more. Foodborne illnesses can be especially severe in people who are infected with HIV. Cook meat until it's well-done. Avoid unpasteurized dairy products, raw eggs and raw seafood such as oysters, sushi or sashimi. - Get the right immunizations. These may prevent infections such as pneumonia and the flu. Make sure the vaccines don't contain live viruses, which can be dangerous for people with weakened immune systems. - Take care with companion animals. Some animals may carry parasites that can cause infections in people who are HIV-positive. Cat feces can cause toxoplasmosis, reptiles can carry salmonella, and birds can carry cryptococcus or histoplasmosis. Wash hands thoroughly after handling pets or emptying the litter box. People who are infected with HIV sometimes try dietary supplements that claim to boost the immune system or counteract side effects of anti-HIV drugs. However, there is no scientific evidence that any nutritional supplement improves immunity, and many may interfere with other medications you are taking. Supplements that may be helpful - Acetyl-L-carnitine. Researchers have used acetyl-L-carnitine to treat nerve pain in people with diabetes. It may also ease nerve pain linked to HIV if you're lacking in the substance. - Whey protein. Early evidence suggests that whey protein, a cheese byproduct, can help some people with HIV gain weight. Whey protein also appears to reduce diarrhea and increase CD4 T cell counts. Supplements that may be dangerous - St. John's wort. A common depression remedy, St. John's wort can reduce the effectiveness of several types of anti-HIV drugs by more than half. - Garlic supplements. Although garlic itself may help strengthen the immune system, garlic supplements interact with several anti-HIV drugs and reduce their ability to work. Occasionally eating garlic in food appears to be safe. Be sure to discuss the use of any dietary supplement with your doctor before trying it to ensure that it won't adversely interact with any of your medications.",
+    "https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524"
+  ],
+  [
+    "HIV/AIDS (Causes): HIV is caused by a virus. It can spread through sexual contact or blood, or from mother to child during pregnancy, childbirth or breast-feeding. How does HIV become AIDS? HIV destroys CD4 T cells - white blood cells that play a large role in helping your body fight disease. The fewer CD4 T cells you have, the weaker your immune system becomes. You can have an HIV infection for years before it turns into AIDS. AIDS is diagnosed when the CD4 T cell count falls below 200 or you have an AIDS-defining complication. How HIV spreads To become infected with HIV, infected blood, semen or vaginal secretions must enter your body. This can happen in several ways: - By having sex. You may become infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter your body. The virus can enter your body through mouth sores or small tears that sometimes develop in the rectum or vagina during sexual activity. - From blood transfusions. In some cases, the virus may be transmitted through blood transfusions. American hospitals and blood banks now screen the blood supply for HIV antibodies, so this risk is very small. - By sharing needles. Sharing contaminated intravenous drug paraphernalia (needles and syringes) puts you at high risk of HIV and other infectious diseases, such as hepatitis. - During pregnancy or delivery or through breast-feeding. Infected mothers can pass the virus on to their babies. HIV-positive mothers who get treatment for the infection during pregnancy can significantly lower the risk to their babies. How HIV doesn't spread You can't become infected with HIV through ordinary contact. That means you can't catch HIV or AIDS by hugging, kissing, dancing or shaking hands with someone who has the infection. HIV isn't spread through the air, water or insect bites.",
+    "https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524"
+  ],
+  [
+    "Ectopic pregnancy: An ectopic pregnancy occurs when a fertilized egg implants somewhere other than the main cavity of the uterus. Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches itself to the lining of the uterus. An ectopic pregnancy most often occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes). This type of ectopic pregnancy is known as a tubal pregnancy. In some cases, however, an ectopic pregnancy occurs in the abdominal cavity, ovary or neck of the uterus (cervix). An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue might destroy various maternal structures. Left untreated, life-threatening blood loss is possible. Early treatment of an ectopic pregnancy can help preserve the chance for future healthy pregnancies. At first, an ectopic pregnancy might not cause any signs or symptoms. In other cases, early signs and symptoms of an ectopic pregnancy might be the same as those of any pregnancy - a missed period, breast tenderness and nausea. If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can't continue as normal. Light vaginal bleeding with abdominal or pelvic pain is often the first warning sign of an ectopic pregnancy. If blood leaks from the fallopian tube, it's also possible to feel shoulder pain or an urge to have a bowel movement - depending on where the blood pools or which nerves are irritated. If the fallopian tube ruptures, heavy bleeding inside the abdomen is likely - followed by lightheadedness, fainting and shock. When to see a doctor Seek emergency medical help if you experience any signs or symptoms of an ectopic pregnancy, including: - Severe abdominal or pelvic pain accompanied by vaginal bleeding - Extreme lightheadedness or fainting - Shoulder pain A tubal pregnancy - the most common type of ectopic pregnancy - happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilized egg also might play a role. Up to an estimated 20 in every 1,000 pregnancies are ectopic. Various factors are associated with ectopic pregnancy, including: - Previous ectopic pregnancy. If you've had one ectopic pregnancy, you're more likely to have another. - Inflammation or infection. Inflammation of the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease) increases the risk of ectopic pregnancy. Often, these infections are caused by gonorrhea or chlamydia. - Fertility issues. Some research suggests an association between difficulties with fertility - as well as use of fertility drugs - and ectopic pregnancy. - Structural concerns. An ectopic pregnancy is more likely if you have an unusually shaped fallopian tube or the fallopian tube was damaged, possibly during surgery. Even surgery to reconstruct the fallopian tube can increase the risk of ectopic pregnancy. - Contraceptive choice. Pregnancy when using an intrauterine device (IUD) is rare. If pregnancy occurs, however, it's more likely to be ectopic. The same goes for pregnancy after tubal ligation - a permanent method of birth control commonly known as \"having your tubes tied.\" Although pregnancy after tubal ligation is rare, if it happens, it's more likely to be ectopic. - Smoking. Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy. And the more you smoke, the greater the risk. When you have an ectopic pregnancy, the stakes are high. Without treatment, a ruptured fallopian tube could lead to life-threatening bleeding. If your doctor suspects an ectopic pregnancy, he or she might do a pelvic exam to check for pain, tenderness, or a mass in the fallopian tube or ovary. A physical exam alone usually isn't enough to diagnose an ectopic pregnancy, however. The diagnosis is typically confirmed with blood tests and imaging studies, such as an ultrasound. With a standard ultrasound, high-frequency sound waves are directed at the tissues in the abdominal area. During early pregnancy, however, the uterus and fallopian tubes are closer to the vagina than to the abdominal surface. The ultrasound will likely be done using a wandlike device placed in your vagina (transvaginal ultrasound). Sometimes it's too soon to detect a pregnancy through ultrasound. If the diagnosis is in question, your doctor might monitor your condition with blood tests until the ectopic pregnancy can be confirmed or ruled out through ultrasound - usually by four to five weeks after conception. In an emergency situation - if you're bleeding heavily, for example - an ectopic pregnancy might be diagnosed and treated surgically. A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed. If the ectopic pregnancy is detected early, an injection of the drug methotrexate is sometimes used to stop cell growth and dissolve existing cells. It's imperative that the diagnosis of ectopic pregnancy is certain before this treatment is undertaken. After the injection, your doctor will monitor your blood for the pregnancy hormone human chorionic gonadotropin (HCG). If the HCG level remains high, you might need another injection of methotrexate. In other cases, ectopic pregnancy is usually treated with laparoscopic surgery. In this procedure, a small incision is made in the abdomen, near or in the navel. Then your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the area. Other instruments can be inserted into the tube or through other small incisions to remove the ectopic tissue and repair the fallopian tube. If the fallopian tube is significantly damaged, it might need to be removed. If the ectopic pregnancy is causing heavy bleeding or the fallopian tube has ruptured, you might need emergency surgery through an abdominal incision (laparotomy). In some cases, the fallopian tube can be repaired. Typically, however, a ruptured tube must be removed. Your doctor will monitor your HCG levels after surgery to be sure all of the ectopic tissue was removed. If HCG levels don't come down quickly, an injection of methotrexate may be needed.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "How to diagnose Ectopic pregnancy?: The health care provider will do a pelvic exam. The exam may show tenderness in the pelvic area. A pregnancy test and vaginal ultrasound will be done. HCG is a hormone normally produced during pregnancy. Checking the blood level of this hormone (quantitative HCG blood test) can diagnose pregnancy. If the blood level of HCG is not rising fast enough, your doctor may suspect an ectopic pregnancy.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000895.htm"
+  ],
+  [
+    "Ectopic pregnancy: An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus). It is life-threatening to the mother. In most pregnancies, the fertilized egg travels through the fallopian tube to the womb (uterus). If the movement of the egg is blocked or slowed through the tubes, it can lead to an ectopic pregnancy. Things that may cause this problem include: - Birth defect in the fallopian tubes - Scarring after a ruptured appendix - Endometriosis - Having had an ectopic pregnancy in the past - Scarring from past infections or surgery of the female organs The following also increase risk of an ectopic pregnancy: - Age over 35 - Getting pregnant while having an intrauterine device (IUD) - Having your tubes tied. This is more likely 2 or more years after the procedure - Having had surgery to untie tubes to become pregnant - Having had many sexual partners - Some infertility treatments Sometimes, the cause is unknown. Hormones may play a role. The most common site for an ectopic pregnancy is within 1 of the 2 fallopian tubes. In rare cases, ectopic pregnancies can occur in the ovary, abdomen, or cervix. An ectopic pregnancy can occur even if you use birth control. You may have early pregnancy symptoms, such as breast tenderness or nausea. Other symptoms may include: - Abnormal vaginal bleeding - Low back pain - Mild cramping on one side of the pelvis - No periods - Pain in the lower belly or pelvic area If the area around the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include: - Fainting or feeling faint - Intense pressure in the rectum - Low blood pressure - Pain in the shoulder area - Severe, sharp, and sudden pain in the lower abdomen The health care provider will do a pelvic exam. The exam may show tenderness in the pelvic area. A pregnancy test and vaginal ultrasound will be done. HCG is a hormone normally produced during pregnancy. Checking the blood level of this hormone can diagnose pregnancy. If the blood level of HCG is not rising fast enough, your provider may suspect an ectopic pregnancy. Ectopic pregnancy is life threatening. The pregnancy cannot continue to birth (term). The developing cells must be removed to save the mother's life. If the ectopic pregnancy has not ruptured, treatment may include: - Surgery - Medicine that ends the pregnancy, along with close monitoring by your doctor You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to bleeding and shock. Treatment for shock may include: - Blood transfusion - Fluids given through a vein - Keeping warm - Oxygen - Raising the legs If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. In some cases, the doctor may have to remove the fallopian tube. One out of three women who have had 1 ectopic pregnancy are later able to have a baby. Another ectopic pregnancy is more likely to occur. Some women do not become pregnant again. The likelihood of a successful pregnancy after an ectopic pregnancy depends on: - The woman's age - Whether she has already had children - Why the first ectopic pregnancy occurred Call your provider if you have: - Abnormal vaginal bleeding - Lower abdominal or pelvic pain Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. You may be able to reduce your risk by avoiding conditions that may scar the fallopian tubes. These steps include: - Practicing safer sex by taking steps before and during sex, which can prevent you from getting an infection - Getting early diagnosis and treatment of all infections caused by sexual relations (STDs) - Stopping smoking Updated by: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000895.htm"
+  ],
+  [
+    "Ectopic pregnancy (Risk factors): Up to an estimated 20 in every 1,000 pregnancies are ectopic. Various factors are associated with ectopic pregnancy, including: - Previous ectopic pregnancy. If you've had one ectopic pregnancy, you're more likely to have another. - Inflammation or infection. Inflammation of the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease) increases the risk of ectopic pregnancy. Often, these infections are caused by gonorrhea or chlamydia. - Fertility issues. Some research suggests an association between difficulties with fertility - as well as use of fertility drugs - and ectopic pregnancy. - Structural concerns. An ectopic pregnancy is more likely if you have an unusually shaped fallopian tube or the fallopian tube was damaged, possibly during surgery. Even surgery to reconstruct the fallopian tube can increase the risk of ectopic pregnancy. - Contraceptive choice. Pregnancy when using an intrauterine device (IUD) is rare. If pregnancy occurs, however, it's more likely to be ectopic. The same goes for pregnancy after tubal ligation - a permanent method of birth control commonly known as \"having your tubes tied.\" Although pregnancy after tubal ligation is rare, if it happens, it's more likely to be ectopic. - Smoking. Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy. And the more you smoke, the greater the risk.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy (Symptoms): At first, an ectopic pregnancy might not cause any signs or symptoms. In other cases, early signs and symptoms of an ectopic pregnancy might be the same as those of any pregnancy - a missed period, breast tenderness and nausea. If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can't continue as normal. Light vaginal bleeding with abdominal or pelvic pain is often the first warning sign of an ectopic pregnancy. If blood leaks from the fallopian tube, it's also possible to feel shoulder pain or an urge to have a bowel movement - depending on where the blood pools or which nerves are irritated. If the fallopian tube ruptures, heavy bleeding inside the abdomen is likely - followed by lightheadedness, fainting and shock. When to see a doctor Seek emergency medical help if you experience any signs or symptoms of an ectopic pregnancy, including: - Severe abdominal or pelvic pain accompanied by vaginal bleeding - Extreme lightheadedness or fainting - Shoulder pain",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy (Diagnosis): If your doctor suspects an ectopic pregnancy, he or she might do a pelvic exam to check for pain, tenderness, or a mass in the fallopian tube or ovary. A physical exam alone usually isn't enough to diagnose an ectopic pregnancy, however. The diagnosis is typically confirmed with blood tests and imaging studies, such as an ultrasound. With a standard ultrasound, high-frequency sound waves are directed at the tissues in the abdominal area. During early pregnancy, however, the uterus and fallopian tubes are closer to the vagina than to the abdominal surface. The ultrasound will likely be done using a wandlike device placed in your vagina (transvaginal ultrasound). Sometimes it's too soon to detect a pregnancy through ultrasound. If the diagnosis is in question, your doctor might monitor your condition with blood tests until the ectopic pregnancy can be confirmed or ruled out through ultrasound - usually by four to five weeks after conception. In an emergency situation - if you're bleeding heavily, for example - an ectopic pregnancy might be diagnosed and treated surgically.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy (Treatment): A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed. If the ectopic pregnancy is detected early, an injection of the drug methotrexate is sometimes used to stop cell growth and dissolve existing cells. It's imperative that the diagnosis of ectopic pregnancy is certain before this treatment is undertaken. After the injection, your doctor will monitor your blood for the pregnancy hormone human chorionic gonadotropin (HCG). If the HCG level remains high, you might need another injection of methotrexate. In other cases, ectopic pregnancy is usually treated with laparoscopic surgery. In this procedure, a small incision is made in the abdomen, near or in the navel. Then your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the area. Other instruments can be inserted into the tube or through other small incisions to remove the ectopic tissue and repair the fallopian tube. If the fallopian tube is significantly damaged, it might need to be removed. If the ectopic pregnancy is causing heavy bleeding or the fallopian tube has ruptured, you might need emergency surgery through an abdominal incision (laparotomy). In some cases, the fallopian tube can be repaired. Typically, however, a ruptured tube must be removed. Your doctor will monitor your HCG levels after surgery to be sure all of the ectopic tissue was removed. If HCG levels don't come down quickly, an injection of methotrexate may be needed.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy (Treatment): Ectopic pregnancy is life threatening. The pregnancy cannot continue to birth (term). The developing cells must be removed to save the mother's life. If the ectopic pregnancy has not ruptured, treatment may include: - Surgery - Medicine that ends the pregnancy, along with close monitoring by your doctor You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to bleeding and shock. Treatment for shock may include: - Blood transfusion - Fluids given through a vein - Keeping warm - Oxygen - Raising the legs If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. In some cases, the doctor may have to remove the fallopian tube.",
+    "https://medlineplus.gov/ency/article/000895.htm"
+  ],
+  [
+    "Ectopic pregnancy (Risk factors): Up to an estimated 20 in every 1,000 pregnancies are ectopic. Various factors are associated with ectopic pregnancy, including: - Previous ectopic pregnancy. If you've had one ectopic pregnancy, you're more likely to have another. - Inflammation or infection. Inflammation of the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease) increases the risk of ectopic pregnancy. Often, these infections are caused by gonorrhea or chlamydia. - Fertility issues. Some research suggests an association between difficulties with fertility - as well as use of fertility drugs - and ectopic pregnancy. - Structural concerns. An ectopic pregnancy is more likely if you have an unusually shaped fallopian tube or the fallopian tube was damaged, possibly during surgery. Even surgery to reconstruct the fallopian tube can increase the risk of ectopic pregnancy. - Contraceptive choice. Pregnancy when using an intrauterine device (IUD) is rare. If pregnancy occurs, however, it's more likely to be ectopic. The same goes for pregnancy after tubal ligation - a permanent method of birth control commonly known as \"having your tubes tied.\" Although pregnancy after tubal ligation is rare, if it happens, it's more likely to be ectopic. - Smoking. Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy. And the more you smoke, the greater the risk.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "How to diagnose Ectopic pregnancy?: The health care provider will do a pelvic exam. The exam may show tenderness in the pelvic area. A pregnancy test and vaginal ultrasound will be done. HCG is a hormone normally produced during pregnancy. Checking the blood level of this hormone (quantitative HCG blood test) can diagnose pregnancy. If the blood level of HCG is not rising fast enough, your doctor may suspect an ectopic pregnancy.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000895.htm"
+  ],
+  [
+    "Ectopic pregnancy: An ectopic pregnancy occurs when a fertilized egg implants somewhere other than the main cavity of the uterus. Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches itself to the lining of the uterus. An ectopic pregnancy most often occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes). This type of ectopic pregnancy is known as a tubal pregnancy. In some cases, however, an ectopic pregnancy occurs in the abdominal cavity, ovary or neck of the uterus (cervix). An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue might destroy various maternal structures. Left untreated, life-threatening blood loss is possible. Early treatment of an ectopic pregnancy can help preserve the chance for future healthy pregnancies. At first, an ectopic pregnancy might not cause any signs or symptoms. In other cases, early signs and symptoms of an ectopic pregnancy might be the same as those of any pregnancy - a missed period, breast tenderness and nausea. If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can't continue as normal. Light vaginal bleeding with abdominal or pelvic pain is often the first warning sign of an ectopic pregnancy. If blood leaks from the fallopian tube, it's also possible to feel shoulder pain or an urge to have a bowel movement - depending on where the blood pools or which nerves are irritated. If the fallopian tube ruptures, heavy bleeding inside the abdomen is likely - followed by lightheadedness, fainting and shock. When to see a doctor Seek emergency medical help if you experience any signs or symptoms of an ectopic pregnancy, including: - Severe abdominal or pelvic pain accompanied by vaginal bleeding - Extreme lightheadedness or fainting - Shoulder pain A tubal pregnancy - the most common type of ectopic pregnancy - happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilized egg also might play a role. Up to an estimated 20 in every 1,000 pregnancies are ectopic. Various factors are associated with ectopic pregnancy, including: - Previous ectopic pregnancy. If you've had one ectopic pregnancy, you're more likely to have another. - Inflammation or infection. Inflammation of the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease) increases the risk of ectopic pregnancy. Often, these infections are caused by gonorrhea or chlamydia. - Fertility issues. Some research suggests an association between difficulties with fertility - as well as use of fertility drugs - and ectopic pregnancy. - Structural concerns. An ectopic pregnancy is more likely if you have an unusually shaped fallopian tube or the fallopian tube was damaged, possibly during surgery. Even surgery to reconstruct the fallopian tube can increase the risk of ectopic pregnancy. - Contraceptive choice. Pregnancy when using an intrauterine device (IUD) is rare. If pregnancy occurs, however, it's more likely to be ectopic. The same goes for pregnancy after tubal ligation - a permanent method of birth control commonly known as \"having your tubes tied.\" Although pregnancy after tubal ligation is rare, if it happens, it's more likely to be ectopic. - Smoking. Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy. And the more you smoke, the greater the risk. When you have an ectopic pregnancy, the stakes are high. Without treatment, a ruptured fallopian tube could lead to life-threatening bleeding. If your doctor suspects an ectopic pregnancy, he or she might do a pelvic exam to check for pain, tenderness, or a mass in the fallopian tube or ovary. A physical exam alone usually isn't enough to diagnose an ectopic pregnancy, however. The diagnosis is typically confirmed with blood tests and imaging studies, such as an ultrasound. With a standard ultrasound, high-frequency sound waves are directed at the tissues in the abdominal area. During early pregnancy, however, the uterus and fallopian tubes are closer to the vagina than to the abdominal surface. The ultrasound will likely be done using a wandlike device placed in your vagina (transvaginal ultrasound). Sometimes it's too soon to detect a pregnancy through ultrasound. If the diagnosis is in question, your doctor might monitor your condition with blood tests until the ectopic pregnancy can be confirmed or ruled out through ultrasound - usually by four to five weeks after conception. In an emergency situation - if you're bleeding heavily, for example - an ectopic pregnancy might be diagnosed and treated surgically. A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed. If the ectopic pregnancy is detected early, an injection of the drug methotrexate is sometimes used to stop cell growth and dissolve existing cells. It's imperative that the diagnosis of ectopic pregnancy is certain before this treatment is undertaken. After the injection, your doctor will monitor your blood for the pregnancy hormone human chorionic gonadotropin (HCG). If the HCG level remains high, you might need another injection of methotrexate. In other cases, ectopic pregnancy is usually treated with laparoscopic surgery. In this procedure, a small incision is made in the abdomen, near or in the navel. Then your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the area. Other instruments can be inserted into the tube or through other small incisions to remove the ectopic tissue and repair the fallopian tube. If the fallopian tube is significantly damaged, it might need to be removed. If the ectopic pregnancy is causing heavy bleeding or the fallopian tube has ruptured, you might need emergency surgery through an abdominal incision (laparotomy). In some cases, the fallopian tube can be repaired. Typically, however, a ruptured tube must be removed. Your doctor will monitor your HCG levels after surgery to be sure all of the ectopic tissue was removed. If HCG levels don't come down quickly, an injection of methotrexate may be needed.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy (Symptoms): At first, an ectopic pregnancy might not cause any signs or symptoms. In other cases, early signs and symptoms of an ectopic pregnancy might be the same as those of any pregnancy - a missed period, breast tenderness and nausea. If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can't continue as normal. Light vaginal bleeding with abdominal or pelvic pain is often the first warning sign of an ectopic pregnancy. If blood leaks from the fallopian tube, it's also possible to feel shoulder pain or an urge to have a bowel movement - depending on where the blood pools or which nerves are irritated. If the fallopian tube ruptures, heavy bleeding inside the abdomen is likely - followed by lightheadedness, fainting and shock. When to see a doctor Seek emergency medical help if you experience any signs or symptoms of an ectopic pregnancy, including: - Severe abdominal or pelvic pain accompanied by vaginal bleeding - Extreme lightheadedness or fainting - Shoulder pain",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy (Diagnosis): If your doctor suspects an ectopic pregnancy, he or she might do a pelvic exam to check for pain, tenderness, or a mass in the fallopian tube or ovary. A physical exam alone usually isn't enough to diagnose an ectopic pregnancy, however. The diagnosis is typically confirmed with blood tests and imaging studies, such as an ultrasound. With a standard ultrasound, high-frequency sound waves are directed at the tissues in the abdominal area. During early pregnancy, however, the uterus and fallopian tubes are closer to the vagina than to the abdominal surface. The ultrasound will likely be done using a wandlike device placed in your vagina (transvaginal ultrasound). Sometimes it's too soon to detect a pregnancy through ultrasound. If the diagnosis is in question, your doctor might monitor your condition with blood tests until the ectopic pregnancy can be confirmed or ruled out through ultrasound - usually by four to five weeks after conception. In an emergency situation - if you're bleeding heavily, for example - an ectopic pregnancy might be diagnosed and treated surgically.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy (Treatment): A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed. If the ectopic pregnancy is detected early, an injection of the drug methotrexate is sometimes used to stop cell growth and dissolve existing cells. It's imperative that the diagnosis of ectopic pregnancy is certain before this treatment is undertaken. After the injection, your doctor will monitor your blood for the pregnancy hormone human chorionic gonadotropin (HCG). If the HCG level remains high, you might need another injection of methotrexate. In other cases, ectopic pregnancy is usually treated with laparoscopic surgery. In this procedure, a small incision is made in the abdomen, near or in the navel. Then your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the area. Other instruments can be inserted into the tube or through other small incisions to remove the ectopic tissue and repair the fallopian tube. If the fallopian tube is significantly damaged, it might need to be removed. If the ectopic pregnancy is causing heavy bleeding or the fallopian tube has ruptured, you might need emergency surgery through an abdominal incision (laparotomy). In some cases, the fallopian tube can be repaired. Typically, however, a ruptured tube must be removed. Your doctor will monitor your HCG levels after surgery to be sure all of the ectopic tissue was removed. If HCG levels don't come down quickly, an injection of methotrexate may be needed.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy: An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus). It is life-threatening to the mother. In most pregnancies, the fertilized egg travels through the fallopian tube to the womb (uterus). If the movement of the egg is blocked or slowed through the tubes, it can lead to an ectopic pregnancy. Things that may cause this problem include: - Birth defect in the fallopian tubes - Scarring after a ruptured appendix - Endometriosis - Having had an ectopic pregnancy in the past - Scarring from past infections or surgery of the female organs The following also increase risk of an ectopic pregnancy: - Age over 35 - Getting pregnant while having an intrauterine device (IUD) - Having your tubes tied. This is more likely 2 or more years after the procedure - Having had surgery to untie tubes to become pregnant - Having had many sexual partners - Some infertility treatments Sometimes, the cause is unknown. Hormones may play a role. The most common site for an ectopic pregnancy is within 1 of the 2 fallopian tubes. In rare cases, ectopic pregnancies can occur in the ovary, abdomen, or cervix. An ectopic pregnancy can occur even if you use birth control. You may have early pregnancy symptoms, such as breast tenderness or nausea. Other symptoms may include: - Abnormal vaginal bleeding - Low back pain - Mild cramping on one side of the pelvis - No periods - Pain in the lower belly or pelvic area If the area around the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include: - Fainting or feeling faint - Intense pressure in the rectum - Low blood pressure - Pain in the shoulder area - Severe, sharp, and sudden pain in the lower abdomen The health care provider will do a pelvic exam. The exam may show tenderness in the pelvic area. A pregnancy test and vaginal ultrasound will be done. HCG is a hormone normally produced during pregnancy. Checking the blood level of this hormone can diagnose pregnancy. If the blood level of HCG is not rising fast enough, your provider may suspect an ectopic pregnancy. Ectopic pregnancy is life threatening. The pregnancy cannot continue to birth (term). The developing cells must be removed to save the mother's life. If the ectopic pregnancy has not ruptured, treatment may include: - Surgery - Medicine that ends the pregnancy, along with close monitoring by your doctor You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to bleeding and shock. Treatment for shock may include: - Blood transfusion - Fluids given through a vein - Keeping warm - Oxygen - Raising the legs If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. In some cases, the doctor may have to remove the fallopian tube. One out of three women who have had 1 ectopic pregnancy are later able to have a baby. Another ectopic pregnancy is more likely to occur. Some women do not become pregnant again. The likelihood of a successful pregnancy after an ectopic pregnancy depends on: - The woman's age - Whether she has already had children - Why the first ectopic pregnancy occurred Call your provider if you have: - Abnormal vaginal bleeding - Lower abdominal or pelvic pain Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. You may be able to reduce your risk by avoiding conditions that may scar the fallopian tubes. These steps include: - Practicing safer sex by taking steps before and during sex, which can prevent you from getting an infection - Getting early diagnosis and treatment of all infections caused by sexual relations (STDs) - Stopping smoking Updated by: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000895.htm"
+  ],
+  [
+    "Ectopic pregnancy (Treatment): Ectopic pregnancy is life threatening. The pregnancy cannot continue to birth (term). The developing cells must be removed to save the mother's life. If the ectopic pregnancy has not ruptured, treatment may include: - Surgery - Medicine that ends the pregnancy, along with close monitoring by your doctor You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to bleeding and shock. Treatment for shock may include: - Blood transfusion - Fluids given through a vein - Keeping warm - Oxygen - Raising the legs If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. In some cases, the doctor may have to remove the fallopian tube.",
+    "https://medlineplus.gov/ency/article/000895.htm"
+  ],
+  [
+    "Ectopic pregnancy (Symptoms): At first, an ectopic pregnancy might not cause any signs or symptoms. In other cases, early signs and symptoms of an ectopic pregnancy might be the same as those of any pregnancy - a missed period, breast tenderness and nausea. If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can't continue as normal. Light vaginal bleeding with abdominal or pelvic pain is often the first warning sign of an ectopic pregnancy. If blood leaks from the fallopian tube, it's also possible to feel shoulder pain or an urge to have a bowel movement - depending on where the blood pools or which nerves are irritated. If the fallopian tube ruptures, heavy bleeding inside the abdomen is likely - followed by lightheadedness, fainting and shock. When to see a doctor Seek emergency medical help if you experience any signs or symptoms of an ectopic pregnancy, including: - Severe abdominal or pelvic pain accompanied by vaginal bleeding - Extreme lightheadedness or fainting - Shoulder pain",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "What are the symptoms of Ectopic pregnancy?: You may have early pregnancy symptoms, such as breast tenderness or nausea. Other symptoms may include: - Abnormal vaginal bleeding - Low back pain - Mild cramping on one side of the pelvis - No periods - Pain in the lower belly or pelvic area If the area around the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include: - Fainting or feeling faint - Intense pressure in the rectum - Low blood pressure - Pain in the shoulder area - Severe, sharp, and sudden pain in the lower abdomen",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000895.htm"
+  ],
+  [
+    "Ectopic pregnancy: An ectopic pregnancy occurs when a fertilized egg implants somewhere other than the main cavity of the uterus. Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches itself to the lining of the uterus. An ectopic pregnancy most often occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes). This type of ectopic pregnancy is known as a tubal pregnancy. In some cases, however, an ectopic pregnancy occurs in the abdominal cavity, ovary or neck of the uterus (cervix). An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue might destroy various maternal structures. Left untreated, life-threatening blood loss is possible. Early treatment of an ectopic pregnancy can help preserve the chance for future healthy pregnancies. At first, an ectopic pregnancy might not cause any signs or symptoms. In other cases, early signs and symptoms of an ectopic pregnancy might be the same as those of any pregnancy - a missed period, breast tenderness and nausea. If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can't continue as normal. Light vaginal bleeding with abdominal or pelvic pain is often the first warning sign of an ectopic pregnancy. If blood leaks from the fallopian tube, it's also possible to feel shoulder pain or an urge to have a bowel movement - depending on where the blood pools or which nerves are irritated. If the fallopian tube ruptures, heavy bleeding inside the abdomen is likely - followed by lightheadedness, fainting and shock. When to see a doctor Seek emergency medical help if you experience any signs or symptoms of an ectopic pregnancy, including: - Severe abdominal or pelvic pain accompanied by vaginal bleeding - Extreme lightheadedness or fainting - Shoulder pain A tubal pregnancy - the most common type of ectopic pregnancy - happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilized egg also might play a role. Up to an estimated 20 in every 1,000 pregnancies are ectopic. Various factors are associated with ectopic pregnancy, including: - Previous ectopic pregnancy. If you've had one ectopic pregnancy, you're more likely to have another. - Inflammation or infection. Inflammation of the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease) increases the risk of ectopic pregnancy. Often, these infections are caused by gonorrhea or chlamydia. - Fertility issues. Some research suggests an association between difficulties with fertility - as well as use of fertility drugs - and ectopic pregnancy. - Structural concerns. An ectopic pregnancy is more likely if you have an unusually shaped fallopian tube or the fallopian tube was damaged, possibly during surgery. Even surgery to reconstruct the fallopian tube can increase the risk of ectopic pregnancy. - Contraceptive choice. Pregnancy when using an intrauterine device (IUD) is rare. If pregnancy occurs, however, it's more likely to be ectopic. The same goes for pregnancy after tubal ligation - a permanent method of birth control commonly known as \"having your tubes tied.\" Although pregnancy after tubal ligation is rare, if it happens, it's more likely to be ectopic. - Smoking. Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy. And the more you smoke, the greater the risk. When you have an ectopic pregnancy, the stakes are high. Without treatment, a ruptured fallopian tube could lead to life-threatening bleeding. If your doctor suspects an ectopic pregnancy, he or she might do a pelvic exam to check for pain, tenderness, or a mass in the fallopian tube or ovary. A physical exam alone usually isn't enough to diagnose an ectopic pregnancy, however. The diagnosis is typically confirmed with blood tests and imaging studies, such as an ultrasound. With a standard ultrasound, high-frequency sound waves are directed at the tissues in the abdominal area. During early pregnancy, however, the uterus and fallopian tubes are closer to the vagina than to the abdominal surface. The ultrasound will likely be done using a wandlike device placed in your vagina (transvaginal ultrasound). Sometimes it's too soon to detect a pregnancy through ultrasound. If the diagnosis is in question, your doctor might monitor your condition with blood tests until the ectopic pregnancy can be confirmed or ruled out through ultrasound - usually by four to five weeks after conception. In an emergency situation - if you're bleeding heavily, for example - an ectopic pregnancy might be diagnosed and treated surgically. A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed. If the ectopic pregnancy is detected early, an injection of the drug methotrexate is sometimes used to stop cell growth and dissolve existing cells. It's imperative that the diagnosis of ectopic pregnancy is certain before this treatment is undertaken. After the injection, your doctor will monitor your blood for the pregnancy hormone human chorionic gonadotropin (HCG). If the HCG level remains high, you might need another injection of methotrexate. In other cases, ectopic pregnancy is usually treated with laparoscopic surgery. In this procedure, a small incision is made in the abdomen, near or in the navel. Then your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the area. Other instruments can be inserted into the tube or through other small incisions to remove the ectopic tissue and repair the fallopian tube. If the fallopian tube is significantly damaged, it might need to be removed. If the ectopic pregnancy is causing heavy bleeding or the fallopian tube has ruptured, you might need emergency surgery through an abdominal incision (laparotomy). In some cases, the fallopian tube can be repaired. Typically, however, a ruptured tube must be removed. Your doctor will monitor your HCG levels after surgery to be sure all of the ectopic tissue was removed. If HCG levels don't come down quickly, an injection of methotrexate may be needed.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy (Risk factors): Up to an estimated 20 in every 1,000 pregnancies are ectopic. Various factors are associated with ectopic pregnancy, including: - Previous ectopic pregnancy. If you've had one ectopic pregnancy, you're more likely to have another. - Inflammation or infection. Inflammation of the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease) increases the risk of ectopic pregnancy. Often, these infections are caused by gonorrhea or chlamydia. - Fertility issues. Some research suggests an association between difficulties with fertility - as well as use of fertility drugs - and ectopic pregnancy. - Structural concerns. An ectopic pregnancy is more likely if you have an unusually shaped fallopian tube or the fallopian tube was damaged, possibly during surgery. Even surgery to reconstruct the fallopian tube can increase the risk of ectopic pregnancy. - Contraceptive choice. Pregnancy when using an intrauterine device (IUD) is rare. If pregnancy occurs, however, it's more likely to be ectopic. The same goes for pregnancy after tubal ligation - a permanent method of birth control commonly known as \"having your tubes tied.\" Although pregnancy after tubal ligation is rare, if it happens, it's more likely to be ectopic. - Smoking. Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy. And the more you smoke, the greater the risk.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy: An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus). It is life-threatening to the mother. In most pregnancies, the fertilized egg travels through the fallopian tube to the womb (uterus). If the movement of the egg is blocked or slowed through the tubes, it can lead to an ectopic pregnancy. Things that may cause this problem include: - Birth defect in the fallopian tubes - Scarring after a ruptured appendix - Endometriosis - Having had an ectopic pregnancy in the past - Scarring from past infections or surgery of the female organs The following also increase risk of an ectopic pregnancy: - Age over 35 - Getting pregnant while having an intrauterine device (IUD) - Having your tubes tied. This is more likely 2 or more years after the procedure - Having had surgery to untie tubes to become pregnant - Having had many sexual partners - Some infertility treatments Sometimes, the cause is unknown. Hormones may play a role. The most common site for an ectopic pregnancy is within 1 of the 2 fallopian tubes. In rare cases, ectopic pregnancies can occur in the ovary, abdomen, or cervix. An ectopic pregnancy can occur even if you use birth control. You may have early pregnancy symptoms, such as breast tenderness or nausea. Other symptoms may include: - Abnormal vaginal bleeding - Low back pain - Mild cramping on one side of the pelvis - No periods - Pain in the lower belly or pelvic area If the area around the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include: - Fainting or feeling faint - Intense pressure in the rectum - Low blood pressure - Pain in the shoulder area - Severe, sharp, and sudden pain in the lower abdomen The health care provider will do a pelvic exam. The exam may show tenderness in the pelvic area. A pregnancy test and vaginal ultrasound will be done. HCG is a hormone normally produced during pregnancy. Checking the blood level of this hormone can diagnose pregnancy. If the blood level of HCG is not rising fast enough, your provider may suspect an ectopic pregnancy. Ectopic pregnancy is life threatening. The pregnancy cannot continue to birth (term). The developing cells must be removed to save the mother's life. If the ectopic pregnancy has not ruptured, treatment may include: - Surgery - Medicine that ends the pregnancy, along with close monitoring by your doctor You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to bleeding and shock. Treatment for shock may include: - Blood transfusion - Fluids given through a vein - Keeping warm - Oxygen - Raising the legs If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. In some cases, the doctor may have to remove the fallopian tube. One out of three women who have had 1 ectopic pregnancy are later able to have a baby. Another ectopic pregnancy is more likely to occur. Some women do not become pregnant again. The likelihood of a successful pregnancy after an ectopic pregnancy depends on: - The woman's age - Whether she has already had children - Why the first ectopic pregnancy occurred Call your provider if you have: - Abnormal vaginal bleeding - Lower abdominal or pelvic pain Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. You may be able to reduce your risk by avoiding conditions that may scar the fallopian tubes. These steps include: - Practicing safer sex by taking steps before and during sex, which can prevent you from getting an infection - Getting early diagnosis and treatment of all infections caused by sexual relations (STDs) - Stopping smoking Updated by: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000895.htm"
+  ],
+  [
+    "Ectopic pregnancy (Diagnosis): If your doctor suspects an ectopic pregnancy, he or she might do a pelvic exam to check for pain, tenderness, or a mass in the fallopian tube or ovary. A physical exam alone usually isn't enough to diagnose an ectopic pregnancy, however. The diagnosis is typically confirmed with blood tests and imaging studies, such as an ultrasound. With a standard ultrasound, high-frequency sound waves are directed at the tissues in the abdominal area. During early pregnancy, however, the uterus and fallopian tubes are closer to the vagina than to the abdominal surface. The ultrasound will likely be done using a wandlike device placed in your vagina (transvaginal ultrasound). Sometimes it's too soon to detect a pregnancy through ultrasound. If the diagnosis is in question, your doctor might monitor your condition with blood tests until the ectopic pregnancy can be confirmed or ruled out through ultrasound - usually by four to five weeks after conception. In an emergency situation - if you're bleeding heavily, for example - an ectopic pregnancy might be diagnosed and treated surgically.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy (Treatment): A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed. If the ectopic pregnancy is detected early, an injection of the drug methotrexate is sometimes used to stop cell growth and dissolve existing cells. It's imperative that the diagnosis of ectopic pregnancy is certain before this treatment is undertaken. After the injection, your doctor will monitor your blood for the pregnancy hormone human chorionic gonadotropin (HCG). If the HCG level remains high, you might need another injection of methotrexate. In other cases, ectopic pregnancy is usually treated with laparoscopic surgery. In this procedure, a small incision is made in the abdomen, near or in the navel. Then your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the area. Other instruments can be inserted into the tube or through other small incisions to remove the ectopic tissue and repair the fallopian tube. If the fallopian tube is significantly damaged, it might need to be removed. If the ectopic pregnancy is causing heavy bleeding or the fallopian tube has ruptured, you might need emergency surgery through an abdominal incision (laparotomy). In some cases, the fallopian tube can be repaired. Typically, however, a ruptured tube must be removed. Your doctor will monitor your HCG levels after surgery to be sure all of the ectopic tissue was removed. If HCG levels don't come down quickly, an injection of methotrexate may be needed.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy (Treatment): Ectopic pregnancy is life threatening. The pregnancy cannot continue to birth (term). The developing cells must be removed to save the mother's life. If the ectopic pregnancy has not ruptured, treatment may include: - Surgery - Medicine that ends the pregnancy, along with close monitoring by your doctor You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to bleeding and shock. Treatment for shock may include: - Blood transfusion - Fluids given through a vein - Keeping warm - Oxygen - Raising the legs If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. In some cases, the doctor may have to remove the fallopian tube.",
+    "https://medlineplus.gov/ency/article/000895.htm"
+  ],
+  [
+    "Ectopic pregnancy (Treatment): A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed. If the ectopic pregnancy is detected early, an injection of the drug methotrexate is sometimes used to stop cell growth and dissolve existing cells. It's imperative that the diagnosis of ectopic pregnancy is certain before this treatment is undertaken. After the injection, your doctor will monitor your blood for the pregnancy hormone human chorionic gonadotropin (HCG). If the HCG level remains high, you might need another injection of methotrexate. In other cases, ectopic pregnancy is usually treated with laparoscopic surgery. In this procedure, a small incision is made in the abdomen, near or in the navel. Then your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the area. Other instruments can be inserted into the tube or through other small incisions to remove the ectopic tissue and repair the fallopian tube. If the fallopian tube is significantly damaged, it might need to be removed. If the ectopic pregnancy is causing heavy bleeding or the fallopian tube has ruptured, you might need emergency surgery through an abdominal incision (laparotomy). In some cases, the fallopian tube can be repaired. Typically, however, a ruptured tube must be removed. Your doctor will monitor your HCG levels after surgery to be sure all of the ectopic tissue was removed. If HCG levels don't come down quickly, an injection of methotrexate may be needed.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "What are the treatments for Ectopic pregnancy?: Ectopic pregnancy is life-threatening. The pregnancy cannot continue to birth (term). The developing cells must be removed to save the mother's life. You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to bleeding and shock, an emergency condition. Treatment for shock may include: - Blood transfusion - Fluids given through a vein - Keeping warm - Oxygen - Raising the legs If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. In some cases, the doctor may have to remove the fallopian tube. If the ectopic pregnancy has not ruptured, treatment may include: - Surgery - Medicine that ends the pregnancy, along with close monitoring by your doctor",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000895.htm"
+  ],
+  [
+    "Ectopic pregnancy (Risk factors): Up to an estimated 20 in every 1,000 pregnancies are ectopic. Various factors are associated with ectopic pregnancy, including: - Previous ectopic pregnancy. If you've had one ectopic pregnancy, you're more likely to have another. - Inflammation or infection. Inflammation of the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease) increases the risk of ectopic pregnancy. Often, these infections are caused by gonorrhea or chlamydia. - Fertility issues. Some research suggests an association between difficulties with fertility - as well as use of fertility drugs - and ectopic pregnancy. - Structural concerns. An ectopic pregnancy is more likely if you have an unusually shaped fallopian tube or the fallopian tube was damaged, possibly during surgery. Even surgery to reconstruct the fallopian tube can increase the risk of ectopic pregnancy. - Contraceptive choice. Pregnancy when using an intrauterine device (IUD) is rare. If pregnancy occurs, however, it's more likely to be ectopic. The same goes for pregnancy after tubal ligation - a permanent method of birth control commonly known as \"having your tubes tied.\" Although pregnancy after tubal ligation is rare, if it happens, it's more likely to be ectopic. - Smoking. Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy. And the more you smoke, the greater the risk.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy: An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus). It is life-threatening to the mother. In most pregnancies, the fertilized egg travels through the fallopian tube to the womb (uterus). If the movement of the egg is blocked or slowed through the tubes, it can lead to an ectopic pregnancy. Things that may cause this problem include: - Birth defect in the fallopian tubes - Scarring after a ruptured appendix - Endometriosis - Having had an ectopic pregnancy in the past - Scarring from past infections or surgery of the female organs The following also increase risk of an ectopic pregnancy: - Age over 35 - Getting pregnant while having an intrauterine device (IUD) - Having your tubes tied. This is more likely 2 or more years after the procedure - Having had surgery to untie tubes to become pregnant - Having had many sexual partners - Some infertility treatments Sometimes, the cause is unknown. Hormones may play a role. The most common site for an ectopic pregnancy is within 1 of the 2 fallopian tubes. In rare cases, ectopic pregnancies can occur in the ovary, abdomen, or cervix. An ectopic pregnancy can occur even if you use birth control. You may have early pregnancy symptoms, such as breast tenderness or nausea. Other symptoms may include: - Abnormal vaginal bleeding - Low back pain - Mild cramping on one side of the pelvis - No periods - Pain in the lower belly or pelvic area If the area around the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include: - Fainting or feeling faint - Intense pressure in the rectum - Low blood pressure - Pain in the shoulder area - Severe, sharp, and sudden pain in the lower abdomen The health care provider will do a pelvic exam. The exam may show tenderness in the pelvic area. A pregnancy test and vaginal ultrasound will be done. HCG is a hormone normally produced during pregnancy. Checking the blood level of this hormone can diagnose pregnancy. If the blood level of HCG is not rising fast enough, your provider may suspect an ectopic pregnancy. Ectopic pregnancy is life threatening. The pregnancy cannot continue to birth (term). The developing cells must be removed to save the mother's life. If the ectopic pregnancy has not ruptured, treatment may include: - Surgery - Medicine that ends the pregnancy, along with close monitoring by your doctor You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to bleeding and shock. Treatment for shock may include: - Blood transfusion - Fluids given through a vein - Keeping warm - Oxygen - Raising the legs If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. In some cases, the doctor may have to remove the fallopian tube. One out of three women who have had 1 ectopic pregnancy are later able to have a baby. Another ectopic pregnancy is more likely to occur. Some women do not become pregnant again. The likelihood of a successful pregnancy after an ectopic pregnancy depends on: - The woman's age - Whether she has already had children - Why the first ectopic pregnancy occurred Call your provider if you have: - Abnormal vaginal bleeding - Lower abdominal or pelvic pain Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. You may be able to reduce your risk by avoiding conditions that may scar the fallopian tubes. These steps include: - Practicing safer sex by taking steps before and during sex, which can prevent you from getting an infection - Getting early diagnosis and treatment of all infections caused by sexual relations (STDs) - Stopping smoking Updated by: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000895.htm"
+  ],
+  [
+    "Ectopic pregnancy (Symptoms): At first, an ectopic pregnancy might not cause any signs or symptoms. In other cases, early signs and symptoms of an ectopic pregnancy might be the same as those of any pregnancy - a missed period, breast tenderness and nausea. If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can't continue as normal. Light vaginal bleeding with abdominal or pelvic pain is often the first warning sign of an ectopic pregnancy. If blood leaks from the fallopian tube, it's also possible to feel shoulder pain or an urge to have a bowel movement - depending on where the blood pools or which nerves are irritated. If the fallopian tube ruptures, heavy bleeding inside the abdomen is likely - followed by lightheadedness, fainting and shock. When to see a doctor Seek emergency medical help if you experience any signs or symptoms of an ectopic pregnancy, including: - Severe abdominal or pelvic pain accompanied by vaginal bleeding - Extreme lightheadedness or fainting - Shoulder pain",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy (Diagnosis): If your doctor suspects an ectopic pregnancy, he or she might do a pelvic exam to check for pain, tenderness, or a mass in the fallopian tube or ovary. A physical exam alone usually isn't enough to diagnose an ectopic pregnancy, however. The diagnosis is typically confirmed with blood tests and imaging studies, such as an ultrasound. With a standard ultrasound, high-frequency sound waves are directed at the tissues in the abdominal area. During early pregnancy, however, the uterus and fallopian tubes are closer to the vagina than to the abdominal surface. The ultrasound will likely be done using a wandlike device placed in your vagina (transvaginal ultrasound). Sometimes it's too soon to detect a pregnancy through ultrasound. If the diagnosis is in question, your doctor might monitor your condition with blood tests until the ectopic pregnancy can be confirmed or ruled out through ultrasound - usually by four to five weeks after conception. In an emergency situation - if you're bleeding heavily, for example - an ectopic pregnancy might be diagnosed and treated surgically.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy (Diagnosis): If your doctor suspects an ectopic pregnancy, he or she might do a pelvic exam to check for pain, tenderness, or a mass in the fallopian tube or ovary. A physical exam alone usually isn't enough to diagnose an ectopic pregnancy, however. The diagnosis is typically confirmed with blood tests and imaging studies, such as an ultrasound. With a standard ultrasound, high-frequency sound waves are directed at the tissues in the abdominal area. During early pregnancy, however, the uterus and fallopian tubes are closer to the vagina than to the abdominal surface. The ultrasound will likely be done using a wandlike device placed in your vagina (transvaginal ultrasound). Sometimes it's too soon to detect a pregnancy through ultrasound. If the diagnosis is in question, your doctor might monitor your condition with blood tests until the ectopic pregnancy can be confirmed or ruled out through ultrasound - usually by four to five weeks after conception. In an emergency situation - if you're bleeding heavily, for example - an ectopic pregnancy might be diagnosed and treated surgically.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "How to diagnose Ectopic pregnancy?: The health care provider will do a pelvic exam. The exam may show tenderness in the pelvic area. A pregnancy test and vaginal ultrasound will be done. HCG is a hormone normally produced during pregnancy. Checking the blood level of this hormone (quantitative HCG blood test) can diagnose pregnancy. If the blood level of HCG is not rising fast enough, your doctor may suspect an ectopic pregnancy.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000895.htm"
+  ],
+  [
+    "Ectopic pregnancy: An ectopic pregnancy occurs when a fertilized egg implants somewhere other than the main cavity of the uterus. Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches itself to the lining of the uterus. An ectopic pregnancy most often occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes). This type of ectopic pregnancy is known as a tubal pregnancy. In some cases, however, an ectopic pregnancy occurs in the abdominal cavity, ovary or neck of the uterus (cervix). An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue might destroy various maternal structures. Left untreated, life-threatening blood loss is possible. Early treatment of an ectopic pregnancy can help preserve the chance for future healthy pregnancies. At first, an ectopic pregnancy might not cause any signs or symptoms. In other cases, early signs and symptoms of an ectopic pregnancy might be the same as those of any pregnancy - a missed period, breast tenderness and nausea. If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can't continue as normal. Light vaginal bleeding with abdominal or pelvic pain is often the first warning sign of an ectopic pregnancy. If blood leaks from the fallopian tube, it's also possible to feel shoulder pain or an urge to have a bowel movement - depending on where the blood pools or which nerves are irritated. If the fallopian tube ruptures, heavy bleeding inside the abdomen is likely - followed by lightheadedness, fainting and shock. When to see a doctor Seek emergency medical help if you experience any signs or symptoms of an ectopic pregnancy, including: - Severe abdominal or pelvic pain accompanied by vaginal bleeding - Extreme lightheadedness or fainting - Shoulder pain A tubal pregnancy - the most common type of ectopic pregnancy - happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilized egg also might play a role. Up to an estimated 20 in every 1,000 pregnancies are ectopic. Various factors are associated with ectopic pregnancy, including: - Previous ectopic pregnancy. If you've had one ectopic pregnancy, you're more likely to have another. - Inflammation or infection. Inflammation of the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease) increases the risk of ectopic pregnancy. Often, these infections are caused by gonorrhea or chlamydia. - Fertility issues. Some research suggests an association between difficulties with fertility - as well as use of fertility drugs - and ectopic pregnancy. - Structural concerns. An ectopic pregnancy is more likely if you have an unusually shaped fallopian tube or the fallopian tube was damaged, possibly during surgery. Even surgery to reconstruct the fallopian tube can increase the risk of ectopic pregnancy. - Contraceptive choice. Pregnancy when using an intrauterine device (IUD) is rare. If pregnancy occurs, however, it's more likely to be ectopic. The same goes for pregnancy after tubal ligation - a permanent method of birth control commonly known as \"having your tubes tied.\" Although pregnancy after tubal ligation is rare, if it happens, it's more likely to be ectopic. - Smoking. Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy. And the more you smoke, the greater the risk. When you have an ectopic pregnancy, the stakes are high. Without treatment, a ruptured fallopian tube could lead to life-threatening bleeding. If your doctor suspects an ectopic pregnancy, he or she might do a pelvic exam to check for pain, tenderness, or a mass in the fallopian tube or ovary. A physical exam alone usually isn't enough to diagnose an ectopic pregnancy, however. The diagnosis is typically confirmed with blood tests and imaging studies, such as an ultrasound. With a standard ultrasound, high-frequency sound waves are directed at the tissues in the abdominal area. During early pregnancy, however, the uterus and fallopian tubes are closer to the vagina than to the abdominal surface. The ultrasound will likely be done using a wandlike device placed in your vagina (transvaginal ultrasound). Sometimes it's too soon to detect a pregnancy through ultrasound. If the diagnosis is in question, your doctor might monitor your condition with blood tests until the ectopic pregnancy can be confirmed or ruled out through ultrasound - usually by four to five weeks after conception. In an emergency situation - if you're bleeding heavily, for example - an ectopic pregnancy might be diagnosed and treated surgically. A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed. If the ectopic pregnancy is detected early, an injection of the drug methotrexate is sometimes used to stop cell growth and dissolve existing cells. It's imperative that the diagnosis of ectopic pregnancy is certain before this treatment is undertaken. After the injection, your doctor will monitor your blood for the pregnancy hormone human chorionic gonadotropin (HCG). If the HCG level remains high, you might need another injection of methotrexate. In other cases, ectopic pregnancy is usually treated with laparoscopic surgery. In this procedure, a small incision is made in the abdomen, near or in the navel. Then your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the area. Other instruments can be inserted into the tube or through other small incisions to remove the ectopic tissue and repair the fallopian tube. If the fallopian tube is significantly damaged, it might need to be removed. If the ectopic pregnancy is causing heavy bleeding or the fallopian tube has ruptured, you might need emergency surgery through an abdominal incision (laparotomy). In some cases, the fallopian tube can be repaired. Typically, however, a ruptured tube must be removed. Your doctor will monitor your HCG levels after surgery to be sure all of the ectopic tissue was removed. If HCG levels don't come down quickly, an injection of methotrexate may be needed.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy: An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus). It is life-threatening to the mother. In most pregnancies, the fertilized egg travels through the fallopian tube to the womb (uterus). If the movement of the egg is blocked or slowed through the tubes, it can lead to an ectopic pregnancy. Things that may cause this problem include: - Birth defect in the fallopian tubes - Scarring after a ruptured appendix - Endometriosis - Having had an ectopic pregnancy in the past - Scarring from past infections or surgery of the female organs The following also increase risk of an ectopic pregnancy: - Age over 35 - Getting pregnant while having an intrauterine device (IUD) - Having your tubes tied. This is more likely 2 or more years after the procedure - Having had surgery to untie tubes to become pregnant - Having had many sexual partners - Some infertility treatments Sometimes, the cause is unknown. Hormones may play a role. The most common site for an ectopic pregnancy is within 1 of the 2 fallopian tubes. In rare cases, ectopic pregnancies can occur in the ovary, abdomen, or cervix. An ectopic pregnancy can occur even if you use birth control. You may have early pregnancy symptoms, such as breast tenderness or nausea. Other symptoms may include: - Abnormal vaginal bleeding - Low back pain - Mild cramping on one side of the pelvis - No periods - Pain in the lower belly or pelvic area If the area around the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include: - Fainting or feeling faint - Intense pressure in the rectum - Low blood pressure - Pain in the shoulder area - Severe, sharp, and sudden pain in the lower abdomen The health care provider will do a pelvic exam. The exam may show tenderness in the pelvic area. A pregnancy test and vaginal ultrasound will be done. HCG is a hormone normally produced during pregnancy. Checking the blood level of this hormone can diagnose pregnancy. If the blood level of HCG is not rising fast enough, your provider may suspect an ectopic pregnancy. Ectopic pregnancy is life threatening. The pregnancy cannot continue to birth (term). The developing cells must be removed to save the mother's life. If the ectopic pregnancy has not ruptured, treatment may include: - Surgery - Medicine that ends the pregnancy, along with close monitoring by your doctor You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to bleeding and shock. Treatment for shock may include: - Blood transfusion - Fluids given through a vein - Keeping warm - Oxygen - Raising the legs If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. In some cases, the doctor may have to remove the fallopian tube. One out of three women who have had 1 ectopic pregnancy are later able to have a baby. Another ectopic pregnancy is more likely to occur. Some women do not become pregnant again. The likelihood of a successful pregnancy after an ectopic pregnancy depends on: - The woman's age - Whether she has already had children - Why the first ectopic pregnancy occurred Call your provider if you have: - Abnormal vaginal bleeding - Lower abdominal or pelvic pain Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. You may be able to reduce your risk by avoiding conditions that may scar the fallopian tubes. These steps include: - Practicing safer sex by taking steps before and during sex, which can prevent you from getting an infection - Getting early diagnosis and treatment of all infections caused by sexual relations (STDs) - Stopping smoking Updated by: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000895.htm"
+  ],
+  [
+    "Ectopic pregnancy (Risk factors): Up to an estimated 20 in every 1,000 pregnancies are ectopic. Various factors are associated with ectopic pregnancy, including: - Previous ectopic pregnancy. If you've had one ectopic pregnancy, you're more likely to have another. - Inflammation or infection. Inflammation of the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease) increases the risk of ectopic pregnancy. Often, these infections are caused by gonorrhea or chlamydia. - Fertility issues. Some research suggests an association between difficulties with fertility - as well as use of fertility drugs - and ectopic pregnancy. - Structural concerns. An ectopic pregnancy is more likely if you have an unusually shaped fallopian tube or the fallopian tube was damaged, possibly during surgery. Even surgery to reconstruct the fallopian tube can increase the risk of ectopic pregnancy. - Contraceptive choice. Pregnancy when using an intrauterine device (IUD) is rare. If pregnancy occurs, however, it's more likely to be ectopic. The same goes for pregnancy after tubal ligation - a permanent method of birth control commonly known as \"having your tubes tied.\" Although pregnancy after tubal ligation is rare, if it happens, it's more likely to be ectopic. - Smoking. Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy. And the more you smoke, the greater the risk.",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Ectopic pregnancy (Symptoms): At first, an ectopic pregnancy might not cause any signs or symptoms. In other cases, early signs and symptoms of an ectopic pregnancy might be the same as those of any pregnancy - a missed period, breast tenderness and nausea. If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can't continue as normal. Light vaginal bleeding with abdominal or pelvic pain is often the first warning sign of an ectopic pregnancy. If blood leaks from the fallopian tube, it's also possible to feel shoulder pain or an urge to have a bowel movement - depending on where the blood pools or which nerves are irritated. If the fallopian tube ruptures, heavy bleeding inside the abdomen is likely - followed by lightheadedness, fainting and shock. When to see a doctor Seek emergency medical help if you experience any signs or symptoms of an ectopic pregnancy, including: - Severe abdominal or pelvic pain accompanied by vaginal bleeding - Extreme lightheadedness or fainting - Shoulder pain",
+    "https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088"
+  ],
+  [
+    "Appendicitis: Appendicitis is inflammation of the appendix. The appendix is a small pouch attached to the large intestine. Appendicitis is a very common cause of emergency surgery. The problem most often occurs when the appendix becomes blocked by feces, a foreign object, or rarely, a tumor. The symptoms of appendicitis can vary. It can be hard to diagnose appendicitis in young children, older people, and women of childbearing age. The first symptom is often pain around the belly button or mid upper abdomen. Pain may be minor at first, but becomes more sharp and severe. You may also have a loss of appetite, nausea, vomiting, and a low-grade fever. The pain tends to move into the right lower part of your belly. The pain tends to focus at a spot directly above the appendix called McBurney point. This most often occurs 12 to 24 hours after the illness starts. Your pain may be worse when you walk, cough, or make sudden movements. Later symptoms include: - Chills and shaking - Hard stools - Diarrhea - Fever - Nausea and vomiting Your health care provider may suspect appendicitis based on the symptoms you describe. Your provider will do a physical exam. - If you have appendicitis, your pain will increase when your lower right belly area is pressed. - If your appendix has ruptured, touching the belly area may cause a lot of pain and lead you to tighten your muscles. - A rectal exam may find tenderness on the right side of your rectum. A blood test will often show a high white blood cell count. Imaging tests may also help diagnose appendicitis. Imaging tests include: - CT scan of the abdomen - Ultrasound of the abdomen Most of the time, a surgeon will remove your appendix as soon as you are diagnosed. If a CT scan shows that you have an abscess, you may be treated with antibiotics first. You will have your appendix removed after the infection and swelling have gone away. The tests used to diagnose appendicitis are not perfect. As a result, the operation may show that your appendix is normal. In that case, the surgeon\u00a0will remove your appendix and explore the rest of your abdomen for other causes of your pain. Most people recover quickly after surgery if the appendix is removed before it ruptures. If your appendix ruptures before surgery, recovery may take longer. You are also more likely to develop problems, such as: - An abscess - Blockage of the intestine - Infection inside the abdomen (peritonitis) - Infection of the wound after surgery Call your provider if you have abdominal pain in the lower-right portion of your belly, or other symptoms of appendicitis. Updated by: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000256.htm"
+  ],
+  [
+    "How to diagnose Appendicitis?: How you describe your symptoms can lead your health care provider to suspect appendicitis. Your provider will do a physical exam. - If you have appendicitis, your pain will increase when your lower right belly area is pressed. - If your appendix has ruptured, touching the belly area may cause a lot of pain and lead you to tighten your muscles. - A rectal exam may find tenderness on the right side of your rectum. A blood test will often show a high white blood cell count. Imaging tests may also help diagnose appendicitis. Imaging tests include: - CT scan of the abdomen - Ultrasound of the abdomen",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000256.htm"
+  ],
+  [
+    "Appendicitis: Appendicitis is inflammation of your appendix. Appendicitis is inflammation of your appendix. In the United States, appendicitis is the most common cause of acute abdominal pain requiring surgery. Over 5% of the population develops appendicitis at some point.1 Appendicitis most commonly occurs in the teens and twenties but may occur at any age.1 If appendicitis is not treated, it may lead to complications. The complications of a ruptured appendix areperitonitis, which can be a dangerous condition. Peritonitis happens if your appendix bursts and infection spreads in your abdomen. If you have peritonitis, you may be very ill and have fever nausea severe tenderness in your abdomen vomiting an abscess of the appendix called an appendiceal abscess. The most common symptom of appendicitis is pain in your abdomen.If you have appendicitis, you\u2019ll most often have pain in your abdomen thatbegins near your belly button and then moves lower and to your right gets worse in a matter of hours gets worse when you move around, take deep breaths, cough, or sneeze is severe and often described as different from any pain you\u2019ve felt before occurs suddenly and may even wake you up if you\u2019re sleeping occurs before other symptomsOther symptoms of appendicitis may includeloss of appetite nausea vomiting constipation or diarrhea an inability to pass gas a low-grade fever swelling in your abdomen the feeling that having a bowel movement will relieve discomfortSymptoms can be different for each person and can seem like the following conditions that also cause pain in the abdomen:abdominal adhesions constipation inflammatory bowel disease, which includes Crohn\u2019s disease and ulcerative colitis, long-lasting disorders that cause irritation and ulcers in the GI tract intestinal obstruction pelvic inflammatory disease The most common symptom of appendicitis is pain in your abdomen.If you have appendicitis, you\u2019ll most often have pain in your abdomen thatbegins near your belly button and then moves lower and to your right gets worse in a matter of hours gets worse when you move around, take deep breaths, cough, or sneeze is severe and often described as different from any pain you\u2019ve felt before occurs suddenly and may even wake you up if you\u2019re sleeping occurs before other symptomsOther symptoms of appendicitis may includeloss of appetite nausea vomiting constipation or diarrhea an inability to pass gas a low-grade fever swelling in your abdomen the feeling that having a bowel movement will relieve discomfortSymptoms can be different for each person and can seem like the following conditions that also cause pain in the abdomen:abdominal adhesions constipation inflammatory bowel disease, which includes Crohn\u2019s disease and ulcerative colitis, long-lasting disorders that cause irritation and ulcers in the GI tract intestinal obstruction pelvic inflammatory disease Appendicitis can have more than one cause, and in many cases the cause is not clear. Possible causes include:Blockage of the opening inside the appendix enlarged tissue in the wall of your appendix, caused by infection in the gastrointestinal (GI) tract or elsewhere in your body inflammatory bowel disease stool, parasites, or growths that can clog your appendiceal lumen trauma to your abdomen Appendicitis is a medical emergency that requires immediate care. See a health care professional or go to the emergency room right away if you think you or a child has appendicitis. A doctor can help treat the appendicitis and reduce symptoms and the chance of complications. Most often, health care professionals suspect the diagnosis of appendicitis based on your symptoms, your medical history, and a physical exam. A doctor can confirm the diagnosis with an ultrasound, x-ray, or MRI exam.A health care professional will ask specific questions about your symptoms and health history to help rule out other health problems. The health care professional will want to knowwhen your abdominal pain began the exact location and severity of your pain when your other symptoms appeared your other medical conditions, previous illnesses, and surgical procedures whether you use medicines, alcohol, or illegal drugsHealth care professionals need specific details about the pain in your abdomen to diagnose appendicitis correctly. A health care professional will assess your pain by touching or applying pressure to specific areas of your abdomen.The following responses to touch or pressure may indicate that you have appendicitis:Rovsing's sign Psoas sign Obturator sign Guarding Rebound tenderness Digital rectal exam Pelvic examDoctors use lab tests to help confirm the diagnosis of appendicitis or find other causes of abdominal pain.Blood tests. A health care professional draws your blood for a blood test at a doctor\u2019s office or a commercial facility. The health care professional sends the blood sample to a lab for testing. Blood tests can show a high white blood cell count, a sign of infection. Blood tests also may show dehydration or fluid and electrolyte imbalances.Urinalysis. Urinalysis is testing of a urine sample. You will provide a urine sample in a special container in a doctor\u2019s office, a commercial facility, or a hospital. Health care professionals can test the urine in the same location or send it to a lab for testing. Doctors use urinalysis to rule out a urinary tract infection or a kidney stone.Pregnancy test. For women, health care professionals also may order blood or urine samples to check for pregnancy.Doctors use imaging tests to confirm the diagnosis of appendicitis or find other causes of pain in the abdomen.Abdominal ultrasound. In an ultrasound, a health care professional uses a device, called a transducer, to bounce safe, painless sound waves off of your organs to create an image of their structure. He or she can move the transducer to different angles to examine different organs.In an abdominal ultrasound, a health care professional applies a gel to your abdomen and moves a hand-held transducer over your skin. A health care professional performs this procedure in a doctor\u2019s office, an outpatient center, or a hospital, and you don\u2019t need anesthesia.A radiologist reviews the images, which can show signs ofa blockage in your appendiceal lumen a burst appendix inflammation other sources of abdominal painHealth care professionals use an ultrasound as the first imaging test for possible appendicitis in infants, children, young adults, and pregnant women.Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of your body\u2019s internal organs and soft tissues without using x-rays.A health care professional performs the procedure in an outpatient center or a hospital. A radiologist reviews the images. Patients don\u2019t need anesthesia, although a health care professional may give light sedation, taken by mouth, to children and people with a fear of small spaces. A health care professional may inject a special dye, called contrast medium, into your body.In most cases, you\u2019ll lie on a table that slides into a tunnel-shaped device. The tunnel may be open ended or closed at one end.An MRI can show signs ofa blockage in your appendiceal lumen a burst appendix inflammation other sources of abdominal painWhen diagnosing appendicitis and other sources of abdominal pain, doctors can use an MRI as a safe, reliable alternative to a computerized tomography (CT) scan.2CT scan. CT scans use x-rays and computer technology to create images.A health care professional may give you a solution to drink and an injection of contrast medium. You\u2019ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. X-ray technicians perform CT scans in an outpatient center or a hospital. Radiologists review the images.Patients don\u2019t need anesthesia, although health care professionals may give children a sedative to help them fall asleep for the test.A CT scan of the abdomen can show signs of inflammation, such asan enlarged or a burst appendix an appendiceal abscess a blockage in your appendiceal lumenWomen of childbearing age should have a pregnancy test before having a CT scan. The radiation from CT scans can be harmful to a developing fetus. Most often, health care professionals suspect the diagnosis of appendicitis based on your symptoms, your medical history, and a physical exam. A doctor can confirm the diagnosis with an ultrasound, x-ray, or MRI exam.A health care professional will ask specific questions about your symptoms and health history to help rule out other health problems. The health care professional will want to knowwhen your abdominal pain began the exact location and severity of your pain when your other symptoms appeared your other medical conditions, previous illnesses, and surgical procedures whether you use medicines, alcohol, or illegal drugsHealth care professionals need specific details about the pain in your abdomen to diagnose appendicitis correctly. A health care professional will assess your pain by touching or applying pressure to specific areas of your abdomen.The following responses to touch or pressure may indicate that you have appendicitis:Rovsing's sign Psoas sign Obturator sign Guarding Rebound tenderness Digital rectal exam Pelvic examDoctors use lab tests to help confirm the diagnosis of appendicitis or find other causes of abdominal pain.Blood tests. A health care professional draws your blood for a blood test at a doctor\u2019s office or a commercial facility. The health care professional sends the blood sample to a lab for testing. Blood tests can show a high white blood cell count, a sign of infection. Blood tests also may show dehydration or fluid and electrolyte imbalances.Urinalysis. Urinalysis is testing of a urine sample. You will provide a urine sample in a special container in a doctor\u2019s office, a commercial facility, or a hospital. Health care professionals can test the urine in the same location or send it to a lab for testing. Doctors use urinalysis to rule out a urinary tract infection or a kidney stone.Pregnancy test. For women, health care professionals also may order blood or urine samples to check for pregnancy.Doctors use imaging tests to confirm the diagnosis of appendicitis or find other causes of pain in the abdomen.Abdominal ultrasound. In an ultrasound, a health care professional uses a device, called a transducer, to bounce safe, painless sound waves off of your organs to create an image of their structure. He or she can move the transducer to different angles to examine different organs.In an abdominal ultrasound, a health care professional applies a gel to your abdomen and moves a hand-held transducer over your skin. A health care professional performs this procedure in a doctor\u2019s office, an outpatient center, or a hospital, and you don\u2019t need anesthesia.A radiologist reviews the images, which can show signs ofa blockage in your appendiceal lumen a burst appendix inflammation other sources of abdominal painHealth care professionals use an ultrasound as the first imaging test for possible appendicitis in infants, children, young adults, and pregnant women.Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of your body\u2019s internal organs and soft tissues without using x-rays.A health care professional performs the procedure in an outpatient center or a hospital. A radiologist reviews the images. Patients don\u2019t need anesthesia, although a health care professional may give light sedation, taken by mouth, to children and people with a fear of small spaces. A health care professional may inject a special dye, called contrast medium, into your body.In most cases, you\u2019ll lie on a table that slides into a tunnel-shaped device. The tunnel may be open ended or closed at one end.An MRI can show signs ofa blockage in your appendiceal lumen a burst appendix inflammation other sources of abdominal painWhen diagnosing appendicitis and other sources of abdominal pain, doctors can use an MRI as a safe, reliable alternative to a computerized tomography (CT) scan.2CT scan. CT scans use x-rays and computer technology to create images.A health care professional may give you a solution to drink and an injection of contrast medium. You\u2019ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. X-ray technicians perform CT scans in an outpatient center or a hospital. Radiologists review the images.Patients don\u2019t need anesthesia, although health care professionals may give children a sedative to help them fall asleep for the test.A CT scan of the abdomen can show signs of inflammation, such asan enlarged or a burst appendix an appendiceal abscess a blockage in your appendiceal lumenWomen of childbearing age should have a pregnancy test before having a CT scan. The radiation from CT scans can be harmful to a developing fetus. Doctors typically treat appendicitis with surgery to remove the appendix. Surgeons perform the surgery in a hospital with general anesthesia. Your doctor will recommend surgery if you have continuous abdominal pain and fever, or signs of a burst appendix and infection. Prompt surgery decreases the chance that your appendix will burst.Health care professionals call the surgery to remove the appendix an appendectomy. A surgeon performs the surgery using one of the following methods:Laparoscopic surgery. During laparoscopic surgery, surgeons use several smaller incisions and special surgical tools that they feed through the incisions to remove your appendix. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time. Laparotomy. Surgeons use laparotomy to remove the appendix through a single incision in the lower right area of your abdomen.After surgery, most patients completely recover from appendicitis and don\u2019t need to make changes to their diet, exercise, or lifestyle. Surgeons recommend that you limit physical activity for the first 10 to 14 days after a laparotomy and for the first 3 to 5 days after laparoscopic surgery. Doctors typically treat appendicitis with surgery to remove the appendix. Surgeons perform the surgery in a hospital with general anesthesia. Your doctor will recommend surgery if you have continuous abdominal pain and fever, or signs of a burst appendix and infection. Prompt surgery decreases the chance that your appendix will burst.Health care professionals call the surgery to remove the appendix an appendectomy. A surgeon performs the surgery using one of the following methods:Laparoscopic surgery. During laparoscopic surgery, surgeons use several smaller incisions and special surgical tools that they feed through the incisions to remove your appendix. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time. Laparotomy. Surgeons use laparotomy to remove the appendix through a single incision in the lower right area of your abdomen.After surgery, most patients completely recover from appendicitis and don\u2019t need to make changes to their diet, exercise, or lifestyle. Surgeons recommend that you limit physical activity for the first 10 to 14 days after a laparotomy and for the first 3 to 5 days after laparoscopic surgery. In some cases, a surgeon finds a normal appendix during surgery. In this case, many surgeons will remove it to eliminate the future possibility of appendicitis. Sometimes surgeons find a different problem, which they may correct during surgery. Some cases of mild appendicitis may be cured with antibiotics alone. All patients suspected of having appendicitis are treated with antibiotics before surgery, and some patients may improve completely before surgery is performed. Treating the complications of a burst appendix will depend on the type of complication. In most cases of peritonitis, a surgeon will remove your appendix immediately with surgery. The surgeon will use laparotomy to clean the inside of your abdomen to prevent infection and then remove your appendix. Without prompt treatment, peritonitis can cause death.A surgeon may drain the pus from an appendiceal abscess during surgery or, more commonly, before surgery. To drain an abscess, the surgeon places a tube in the abscess through the abdominal wall. You leave the drainage tube in place for about 2 weeks while you take antibiotics to treat infection. When the infection and inflammation are under control, about 6 to 8 weeks later, surgeons operate to remove what remains of the burst appendix.",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Appendicitis: Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. The appendix doesn't seem to have a specific purpose. Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe. Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix. Signs and symptoms of appendicitis may include: - Sudden pain that begins on the right side of the lower abdomen - Sudden pain that begins around your navel and often shifts to your lower right abdomen - Pain that worsens if you cough, walk or make other jarring movements - Nausea and vomiting - Loss of appetite - Low-grade fever that may worsen as the illness progresses - Constipation or diarrhea - Abdominal bloating The site of your pain may vary, depending on your age and the position of your appendix. When you're pregnant, the pain may seem to come from your upper abdomen because your appendix is higher during pregnancy. When to see a doctor Make an appointment with a doctor if you or your child has worrisome signs or symptoms. Severe abdominal pain requires immediate medical attention. A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture. To help diagnose appendicitis, your doctor will likely take a history of your signs and symptoms and examine your abdomen. Tests and procedures used to diagnose appendicitis include: - Physical exam to assess your pain. Your doctor may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is inflamed. Your doctor also may look for abdominal rigidity and a tendency for you to stiffen your abdominal muscles in response to pressure over the inflamed appendix (guarding). Your doctor may use a lubricated, gloved finger to examine your lower rectum (digital rectal exam). Women of childbearing age may be given a pelvic exam to check for possible gynecological problems that could be causing the pain. - Blood test. This allows your doctor to check for a high white blood cell count, which may indicate an infection. - Urine test. Your doctor may want you to have a urinalysis to make sure that a urinary tract infection or a kidney stone isn't causing your pain. - Imaging tests. Your doctor may also recommend an abdominal X-ray, an abdominal ultrasound or a computerized tomography (CT) scan to help confirm appendicitis or find other causes for your pain. Appendicitis treatment usually involves surgery to remove the inflamed appendix. Before surgery you may be given a dose of antibiotics to prevent infection. Surgery to remove the appendix (appendectomy) Appendectomy can be performed as open surgery using one abdominal incision about 2 to 4 inches (5 to 10 centimeters) long (laparotomy). Or the surgery can be done through a few small abdominal incisions (laparoscopic surgery). During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a video camera into your abdomen to remove your appendix. In general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be better for people who are elderly or obese. But laparoscopic surgery isn't appropriate for everyone. If your appendix has ruptured and infection has spread beyond the appendix or you have an abscess, you may need an open appendectomy, which allows your surgeon to clean the abdominal cavity. Expect to spend one or two days in the hospital after your appendectomy. Draining an abscess before appendix surgery If your appendix has burst and an abscess has formed around it, the abscess may be drained by placing a tube through your skin into the abscess. Appendectomy can be performed several weeks later after controlling the infection. Expect a few weeks of recovery from an appendectomy, or longer if your appendix burst. To help your body heal: - Avoid strenuous activity at first. If your appendectomy was done laparoscopically, limit your activity for three to five days. If you had an open appendectomy, limit your activity for 10 to 14 days. Always ask your doctor about limitations on your activity and when you can resume normal activities following surgery. - Support your abdomen when you cough. Place a pillow over your abdomen and apply pressure before you cough, laugh or move to help reduce pain. - Call your doctor if your pain medications aren't helping. Being in pain puts extra stress on your body and slows the healing process. If you're still in pain despite your pain medications, call your doctor. - Get up and move when you're ready. Start slowly and increase your activity as you feel up to it. Start with short walks. - Sleep when tired. As your body heals, you may find you feel sleepier than usual. Take it easy and rest when you need to. - Discuss returning to work or school with your doctor. You can return to work when you feel up to it. Children may be able to return to school less than a week after surgery. They should wait two to four weeks to resume strenuous activity, such as gym classes or sports. Your doctor will prescribe medications to help you control your pain after your appendectomy. Some complementary and alternative treatments, when used with your medications, can help control pain. Ask your doctor about safe options, such as: - Distracting activities, such as listening to music and talking with friends, that take your mind off your pain. Distraction can be especially effective with children. - Guided imagery, such as closing your eyes and thinking about a favorite place.",
+    "https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/syc-20369543"
+  ],
+  [
+    "Appendicitis (What causes appendicitis?): Appendicitis can have more than one cause, and in many cases the cause is not clear. Possible causes include:Blockage of the opening inside the appendix enlarged tissue in the wall of your appendix, caused by infection in the gastrointestinal (GI) tract or elsewhere in your body inflammatory bowel disease stool, parasites, or growths that can clog your appendiceal lumen trauma to your abdomen",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Appendicitis (What are the symptoms of appendicitis?): The most common symptom of appendicitis is pain in your abdomen.If you have appendicitis, you\u2019ll most often have pain in your abdomen thatbegins near your belly button and then moves lower and to your right gets worse in a matter of hours gets worse when you move around, take deep breaths, cough, or sneeze is severe and often described as different from any pain you\u2019ve felt before occurs suddenly and may even wake you up if you\u2019re sleeping occurs before other symptomsOther symptoms of appendicitis may includeloss of appetite nausea vomiting constipation or diarrhea an inability to pass gas a low-grade fever swelling in your abdomen the feeling that having a bowel movement will relieve discomfortSymptoms can be different for each person and can seem like the following conditions that also cause pain in the abdomen:abdominal adhesions constipation inflammatory bowel disease, which includes Crohn\u2019s disease and ulcerative colitis, long-lasting disorders that cause irritation and ulcers in the GI tract intestinal obstruction pelvic inflammatory disease",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Appendicitis (Who is more likely to develop appendicitis?): Appendicitis most commonly occurs in the teens and twenties but may occur at any age.1",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Appendicitis (What are the complications of appendicitis?): If appendicitis is not treated, it may lead to complications. The complications of a ruptured appendix areperitonitis, which can be a dangerous condition. Peritonitis happens if your appendix bursts and infection spreads in your abdomen. If you have peritonitis, you may be very ill and have fever nausea severe tenderness in your abdomen vomiting an abscess of the appendix called an appendiceal abscess.",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Appendicitis (Can doctors treat appendicitis without surgery?): Some cases of mild appendicitis may be cured with antibiotics alone. All patients suspected of having appendicitis are treated with antibiotics before surgery, and some patients may improve completely before surgery is performed.",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Appendicitis (Symptoms and Causes): Appendicitis is a medical emergency that requires immediate care. See a health care professional or go to the emergency room right away if you think you or a child has appendicitis. A doctor can help treat the appendicitis and reduce symptoms and the chance of complications.",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "How to diagnose Appendicitis?: How you describe your symptoms can lead your health care provider to suspect appendicitis. Your provider will do a physical exam. - If you have appendicitis, your pain will increase when your lower right belly area is pressed. - If your appendix has ruptured, touching the belly area may cause a lot of pain and lead you to tighten your muscles. - A rectal exam may find tenderness on the right side of your rectum. A blood test will often show a high white blood cell count. Imaging tests may also help diagnose appendicitis. Imaging tests include: - CT scan of the abdomen - Ultrasound of the abdomen",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000256.htm"
+  ],
+  [
+    "Appendicitis (Overview): Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. The appendix doesn't seem to have a specific purpose. Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe. Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix.",
+    "https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/syc-20369543"
+  ],
+  [
+    "Appendicitis (How common is appendicitis?): In the United States, appendicitis is the most common cause of acute abdominal pain requiring surgery. Over 5% of the population develops appendicitis at some point.1",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Appendicitis (Can doctors treat appendicitis without surgery?): Some cases of mild appendicitis may be cured with antibiotics alone. All patients suspected of having appendicitis are treated with antibiotics before surgery, and some patients may improve completely before surgery is performed.",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Appendicitis (Summary): Summary The appendix is a small, tube-like organ attached to the first part of the large intestine. It is located in the lower right part of the abdomen. It has no known function. A blockage inside of the appendix causes appendicitis. The blockage leads to increased pressure, problems with blood flow, and inflammation. If the blockage is not treated, the appendix can burst and spread infection into the abdomen. This causes a condition called peritonitis. The main symptom is pain in the abdomen, often on the right side. It is usually sudden and gets worse over time. Other symptoms may include - Swelling in the abdomen - Loss of appetite - Nausea and vomiting - Constipation or diarrhea - Inability to pass gas - Low fever Not everyone with appendicitis has all these symptoms. Appendicitis is a medical emergency. Treatment almost always involves removing the appendix. Anyone can get appendicitis, but it is more common among people 10 to 30 years old. NIH: National Institute of Diabetes and Digestive and Kidney Diseases",
+    "#"
+  ],
+  [
+    "Appendicitis: Appendicitis is inflammation of the appendix. The appendix is a small pouch attached to the large intestine. Appendicitis is a very common cause of emergency surgery. The problem most often occurs when the appendix becomes blocked by feces, a foreign object, or rarely, a tumor. The symptoms of appendicitis can vary. It can be hard to diagnose appendicitis in young children, older people, and women of childbearing age. The first symptom is often pain around the belly button or mid upper abdomen. Pain may be minor at first, but becomes more sharp and severe. You may also have a loss of appetite, nausea, vomiting, and a low-grade fever. The pain tends to move into the right lower part of your belly. The pain tends to focus at a spot directly above the appendix called McBurney point. This most often occurs 12 to 24 hours after the illness starts. Your pain may be worse when you walk, cough, or make sudden movements. Later symptoms include: - Chills and shaking - Hard stools - Diarrhea - Fever - Nausea and vomiting Your health care provider may suspect appendicitis based on the symptoms you describe. Your provider will do a physical exam. - If you have appendicitis, your pain will increase when your lower right belly area is pressed. - If your appendix has ruptured, touching the belly area may cause a lot of pain and lead you to tighten your muscles. - A rectal exam may find tenderness on the right side of your rectum. A blood test will often show a high white blood cell count. Imaging tests may also help diagnose appendicitis. Imaging tests include: - CT scan of the abdomen - Ultrasound of the abdomen Most of the time, a surgeon will remove your appendix as soon as you are diagnosed. If a CT scan shows that you have an abscess, you may be treated with antibiotics first. You will have your appendix removed after the infection and swelling have gone away. The tests used to diagnose appendicitis are not perfect. As a result, the operation may show that your appendix is normal. In that case, the surgeon\u00a0will remove your appendix and explore the rest of your abdomen for other causes of your pain. Most people recover quickly after surgery if the appendix is removed before it ruptures. If your appendix ruptures before surgery, recovery may take longer. You are also more likely to develop problems, such as: - An abscess - Blockage of the intestine - Infection inside the abdomen (peritonitis) - Infection of the wound after surgery Call your provider if you have abdominal pain in the lower-right portion of your belly, or other symptoms of appendicitis. Updated by: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000256.htm"
+  ],
+  [
+    "Appendicitis (Diagnosis): To help diagnose appendicitis, your doctor will likely take a history of your signs and symptoms and examine your abdomen. Tests and procedures used to diagnose appendicitis include: - Physical exam to assess your pain. Your doctor may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is inflamed. Your doctor also may look for abdominal rigidity and a tendency for you to stiffen your abdominal muscles in response to pressure over the inflamed appendix (guarding). Your doctor may use a lubricated, gloved finger to examine your lower rectum (digital rectal exam). Women of childbearing age may be given a pelvic exam to check for possible gynecological problems that could be causing the pain. - Blood test. This allows your doctor to check for a high white blood cell count, which may indicate an infection. - Urine test. Your doctor may want you to have a urinalysis to make sure that a urinary tract infection or a kidney stone isn't causing your pain. - Imaging tests. Your doctor may also recommend an abdominal X-ray, an abdominal ultrasound or a computerized tomography (CT) scan to help confirm appendicitis or find other causes for your pain.",
+    "https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/syc-20369543"
+  ],
+  [
+    "Appendicitis (Symptoms and Causes): The most common symptom of appendicitis is pain in your abdomen.If you have appendicitis, you\u2019ll most often have pain in your abdomen thatbegins near your belly button and then moves lower and to your right gets worse in a matter of hours gets worse when you move around, take deep breaths, cough, or sneeze is severe and often described as different from any pain you\u2019ve felt before occurs suddenly and may even wake you up if you\u2019re sleeping occurs before other symptomsOther symptoms of appendicitis may includeloss of appetite nausea vomiting constipation or diarrhea an inability to pass gas a low-grade fever swelling in your abdomen the feeling that having a bowel movement will relieve discomfortSymptoms can be different for each person and can seem like the following conditions that also cause pain in the abdomen:abdominal adhesions constipation inflammatory bowel disease, which includes Crohn\u2019s disease and ulcerative colitis, long-lasting disorders that cause irritation and ulcers in the GI tract intestinal obstruction pelvic inflammatory disease",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Appendicitis (Symptoms): The symptoms of appendicitis can vary. It can be hard to diagnose appendicitis in young children, older people, and women of childbearing age. The first symptom is often pain around the belly button or mid upper abdomen. Pain may be minor at first, but becomes more sharp and severe. You may also have a loss of appetite, nausea, vomiting, and a low-grade fever. The pain tends to move into the right lower part of your belly. The pain tends to focus at a spot directly above the appendix called McBurney point. This most often occurs 12 to 24 hours after the illness starts. Your pain may be worse when you walk, cough, or make sudden movements. Later symptoms include: - Chills and shaking - Hard stools - Diarrhea - Fever - Nausea and vomiting",
+    "https://medlineplus.gov/ency/article/000256.htm"
+  ],
+  [
+    "Appendicitis (Symptoms and Causes): The most common symptom of appendicitis is pain in your abdomen.If you have appendicitis, you\u2019ll most often have pain in your abdomen thatbegins near your belly button and then moves lower and to your right gets worse in a matter of hours gets worse when you move around, take deep breaths, cough, or sneeze is severe and often described as different from any pain you\u2019ve felt before occurs suddenly and may even wake you up if you\u2019re sleeping occurs before other symptomsOther symptoms of appendicitis may includeloss of appetite nausea vomiting constipation or diarrhea an inability to pass gas a low-grade fever swelling in your abdomen the feeling that having a bowel movement will relieve discomfortSymptoms can be different for each person and can seem like the following conditions that also cause pain in the abdomen:abdominal adhesions constipation inflammatory bowel disease, which includes Crohn\u2019s disease and ulcerative colitis, long-lasting disorders that cause irritation and ulcers in the GI tract intestinal obstruction pelvic inflammatory disease",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Appendicitis (Symptoms): Signs and symptoms of appendicitis may include: - Sudden pain that begins on the right side of the lower abdomen - Sudden pain that begins around your navel and often shifts to your lower right abdomen - Pain that worsens if you cough, walk or make other jarring movements - Nausea and vomiting - Loss of appetite - Low-grade fever that may worsen as the illness progresses - Constipation or diarrhea - Abdominal bloating The site of your pain may vary, depending on your age and the position of your appendix. When you're pregnant, the pain may seem to come from your upper abdomen because your appendix is higher during pregnancy. When to see a doctor Make an appointment with a doctor if you or your child has worrisome signs or symptoms. Severe abdominal pain requires immediate medical attention.",
+    "https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/syc-20369543"
+  ],
+  [
+    "Appendicitis (Symptoms and Causes): Appendicitis is a medical emergency that requires immediate care. See a health care professional or go to the emergency room right away if you think you or a child has appendicitis. A doctor can help treat the appendicitis and reduce symptoms and the chance of complications.",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Appendicitis (When to Contact a Medical Professional): Call your provider if you have abdominal pain in the lower-right portion of your belly, or other symptoms of appendicitis.",
+    "https://medlineplus.gov/ency/article/000256.htm"
+  ],
+  [
+    "Appendicitis: Appendicitis is inflammation of the appendix. The appendix is a small pouch attached to the large intestine. Appendicitis is a very common cause of emergency surgery. The problem most often occurs when the appendix becomes blocked by feces, a foreign object, or rarely, a tumor. The symptoms of appendicitis can vary. It can be hard to diagnose appendicitis in young children, older people, and women of childbearing age. The first symptom is often pain around the belly button or mid upper abdomen. Pain may be minor at first, but becomes more sharp and severe. You may also have a loss of appetite, nausea, vomiting, and a low-grade fever. The pain tends to move into the right lower part of your belly. The pain tends to focus at a spot directly above the appendix called McBurney point. This most often occurs 12 to 24 hours after the illness starts. Your pain may be worse when you walk, cough, or make sudden movements. Later symptoms include: - Chills and shaking - Hard stools - Diarrhea - Fever - Nausea and vomiting Your health care provider may suspect appendicitis based on the symptoms you describe. Your provider will do a physical exam. - If you have appendicitis, your pain will increase when your lower right belly area is pressed. - If your appendix has ruptured, touching the belly area may cause a lot of pain and lead you to tighten your muscles. - A rectal exam may find tenderness on the right side of your rectum. A blood test will often show a high white blood cell count. Imaging tests may also help diagnose appendicitis. Imaging tests include: - CT scan of the abdomen - Ultrasound of the abdomen Most of the time, a surgeon will remove your appendix as soon as you are diagnosed. If a CT scan shows that you have an abscess, you may be treated with antibiotics first. You will have your appendix removed after the infection and swelling have gone away. The tests used to diagnose appendicitis are not perfect. As a result, the operation may show that your appendix is normal. In that case, the surgeon\u00a0will remove your appendix and explore the rest of your abdomen for other causes of your pain. Most people recover quickly after surgery if the appendix is removed before it ruptures. If your appendix ruptures before surgery, recovery may take longer. You are also more likely to develop problems, such as: - An abscess - Blockage of the intestine - Infection inside the abdomen (peritonitis) - Infection of the wound after surgery Call your provider if you have abdominal pain in the lower-right portion of your belly, or other symptoms of appendicitis. Updated by: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000256.htm"
+  ],
+  [
+    "Appendicitis: Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. The appendix doesn't seem to have a specific purpose. Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe. Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix. Signs and symptoms of appendicitis may include: - Sudden pain that begins on the right side of the lower abdomen - Sudden pain that begins around your navel and often shifts to your lower right abdomen - Pain that worsens if you cough, walk or make other jarring movements - Nausea and vomiting - Loss of appetite - Low-grade fever that may worsen as the illness progresses - Constipation or diarrhea - Abdominal bloating The site of your pain may vary, depending on your age and the position of your appendix. When you're pregnant, the pain may seem to come from your upper abdomen because your appendix is higher during pregnancy. When to see a doctor Make an appointment with a doctor if you or your child has worrisome signs or symptoms. Severe abdominal pain requires immediate medical attention. A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture. To help diagnose appendicitis, your doctor will likely take a history of your signs and symptoms and examine your abdomen. Tests and procedures used to diagnose appendicitis include: - Physical exam to assess your pain. Your doctor may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is inflamed. Your doctor also may look for abdominal rigidity and a tendency for you to stiffen your abdominal muscles in response to pressure over the inflamed appendix (guarding). Your doctor may use a lubricated, gloved finger to examine your lower rectum (digital rectal exam). Women of childbearing age may be given a pelvic exam to check for possible gynecological problems that could be causing the pain. - Blood test. This allows your doctor to check for a high white blood cell count, which may indicate an infection. - Urine test. Your doctor may want you to have a urinalysis to make sure that a urinary tract infection or a kidney stone isn't causing your pain. - Imaging tests. Your doctor may also recommend an abdominal X-ray, an abdominal ultrasound or a computerized tomography (CT) scan to help confirm appendicitis or find other causes for your pain. Appendicitis treatment usually involves surgery to remove the inflamed appendix. Before surgery you may be given a dose of antibiotics to prevent infection. Surgery to remove the appendix (appendectomy) Appendectomy can be performed as open surgery using one abdominal incision about 2 to 4 inches (5 to 10 centimeters) long (laparotomy). Or the surgery can be done through a few small abdominal incisions (laparoscopic surgery). During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a video camera into your abdomen to remove your appendix. In general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be better for people who are elderly or obese. But laparoscopic surgery isn't appropriate for everyone. If your appendix has ruptured and infection has spread beyond the appendix or you have an abscess, you may need an open appendectomy, which allows your surgeon to clean the abdominal cavity. Expect to spend one or two days in the hospital after your appendectomy. Draining an abscess before appendix surgery If your appendix has burst and an abscess has formed around it, the abscess may be drained by placing a tube through your skin into the abscess. Appendectomy can be performed several weeks later after controlling the infection. Expect a few weeks of recovery from an appendectomy, or longer if your appendix burst. To help your body heal: - Avoid strenuous activity at first. If your appendectomy was done laparoscopically, limit your activity for three to five days. If you had an open appendectomy, limit your activity for 10 to 14 days. Always ask your doctor about limitations on your activity and when you can resume normal activities following surgery. - Support your abdomen when you cough. Place a pillow over your abdomen and apply pressure before you cough, laugh or move to help reduce pain. - Call your doctor if your pain medications aren't helping. Being in pain puts extra stress on your body and slows the healing process. If you're still in pain despite your pain medications, call your doctor. - Get up and move when you're ready. Start slowly and increase your activity as you feel up to it. Start with short walks. - Sleep when tired. As your body heals, you may find you feel sleepier than usual. Take it easy and rest when you need to. - Discuss returning to work or school with your doctor. You can return to work when you feel up to it. Children may be able to return to school less than a week after surgery. They should wait two to four weeks to resume strenuous activity, such as gym classes or sports. Your doctor will prescribe medications to help you control your pain after your appendectomy. Some complementary and alternative treatments, when used with your medications, can help control pain. Ask your doctor about safe options, such as: - Distracting activities, such as listening to music and talking with friends, that take your mind off your pain. Distraction can be especially effective with children. - Guided imagery, such as closing your eyes and thinking about a favorite place.",
+    "https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/syc-20369543"
+  ],
+  [
+    "Appendicitis: Appendicitis is inflammation of your appendix. Appendicitis is inflammation of your appendix. In the United States, appendicitis is the most common cause of acute abdominal pain requiring surgery. Over 5% of the population develops appendicitis at some point.1 Appendicitis most commonly occurs in the teens and twenties but may occur at any age.1 If appendicitis is not treated, it may lead to complications. The complications of a ruptured appendix areperitonitis, which can be a dangerous condition. Peritonitis happens if your appendix bursts and infection spreads in your abdomen. If you have peritonitis, you may be very ill and have fever nausea severe tenderness in your abdomen vomiting an abscess of the appendix called an appendiceal abscess. The most common symptom of appendicitis is pain in your abdomen.If you have appendicitis, you\u2019ll most often have pain in your abdomen thatbegins near your belly button and then moves lower and to your right gets worse in a matter of hours gets worse when you move around, take deep breaths, cough, or sneeze is severe and often described as different from any pain you\u2019ve felt before occurs suddenly and may even wake you up if you\u2019re sleeping occurs before other symptomsOther symptoms of appendicitis may includeloss of appetite nausea vomiting constipation or diarrhea an inability to pass gas a low-grade fever swelling in your abdomen the feeling that having a bowel movement will relieve discomfortSymptoms can be different for each person and can seem like the following conditions that also cause pain in the abdomen:abdominal adhesions constipation inflammatory bowel disease, which includes Crohn\u2019s disease and ulcerative colitis, long-lasting disorders that cause irritation and ulcers in the GI tract intestinal obstruction pelvic inflammatory disease The most common symptom of appendicitis is pain in your abdomen.If you have appendicitis, you\u2019ll most often have pain in your abdomen thatbegins near your belly button and then moves lower and to your right gets worse in a matter of hours gets worse when you move around, take deep breaths, cough, or sneeze is severe and often described as different from any pain you\u2019ve felt before occurs suddenly and may even wake you up if you\u2019re sleeping occurs before other symptomsOther symptoms of appendicitis may includeloss of appetite nausea vomiting constipation or diarrhea an inability to pass gas a low-grade fever swelling in your abdomen the feeling that having a bowel movement will relieve discomfortSymptoms can be different for each person and can seem like the following conditions that also cause pain in the abdomen:abdominal adhesions constipation inflammatory bowel disease, which includes Crohn\u2019s disease and ulcerative colitis, long-lasting disorders that cause irritation and ulcers in the GI tract intestinal obstruction pelvic inflammatory disease Appendicitis can have more than one cause, and in many cases the cause is not clear. Possible causes include:Blockage of the opening inside the appendix enlarged tissue in the wall of your appendix, caused by infection in the gastrointestinal (GI) tract or elsewhere in your body inflammatory bowel disease stool, parasites, or growths that can clog your appendiceal lumen trauma to your abdomen Appendicitis is a medical emergency that requires immediate care. See a health care professional or go to the emergency room right away if you think you or a child has appendicitis. A doctor can help treat the appendicitis and reduce symptoms and the chance of complications. Most often, health care professionals suspect the diagnosis of appendicitis based on your symptoms, your medical history, and a physical exam. A doctor can confirm the diagnosis with an ultrasound, x-ray, or MRI exam.A health care professional will ask specific questions about your symptoms and health history to help rule out other health problems. The health care professional will want to knowwhen your abdominal pain began the exact location and severity of your pain when your other symptoms appeared your other medical conditions, previous illnesses, and surgical procedures whether you use medicines, alcohol, or illegal drugsHealth care professionals need specific details about the pain in your abdomen to diagnose appendicitis correctly. A health care professional will assess your pain by touching or applying pressure to specific areas of your abdomen.The following responses to touch or pressure may indicate that you have appendicitis:Rovsing's sign Psoas sign Obturator sign Guarding Rebound tenderness Digital rectal exam Pelvic examDoctors use lab tests to help confirm the diagnosis of appendicitis or find other causes of abdominal pain.Blood tests. A health care professional draws your blood for a blood test at a doctor\u2019s office or a commercial facility. The health care professional sends the blood sample to a lab for testing. Blood tests can show a high white blood cell count, a sign of infection. Blood tests also may show dehydration or fluid and electrolyte imbalances.Urinalysis. Urinalysis is testing of a urine sample. You will provide a urine sample in a special container in a doctor\u2019s office, a commercial facility, or a hospital. Health care professionals can test the urine in the same location or send it to a lab for testing. Doctors use urinalysis to rule out a urinary tract infection or a kidney stone.Pregnancy test. For women, health care professionals also may order blood or urine samples to check for pregnancy.Doctors use imaging tests to confirm the diagnosis of appendicitis or find other causes of pain in the abdomen.Abdominal ultrasound. In an ultrasound, a health care professional uses a device, called a transducer, to bounce safe, painless sound waves off of your organs to create an image of their structure. He or she can move the transducer to different angles to examine different organs.In an abdominal ultrasound, a health care professional applies a gel to your abdomen and moves a hand-held transducer over your skin. A health care professional performs this procedure in a doctor\u2019s office, an outpatient center, or a hospital, and you don\u2019t need anesthesia.A radiologist reviews the images, which can show signs ofa blockage in your appendiceal lumen a burst appendix inflammation other sources of abdominal painHealth care professionals use an ultrasound as the first imaging test for possible appendicitis in infants, children, young adults, and pregnant women.Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of your body\u2019s internal organs and soft tissues without using x-rays.A health care professional performs the procedure in an outpatient center or a hospital. A radiologist reviews the images. Patients don\u2019t need anesthesia, although a health care professional may give light sedation, taken by mouth, to children and people with a fear of small spaces. A health care professional may inject a special dye, called contrast medium, into your body.In most cases, you\u2019ll lie on a table that slides into a tunnel-shaped device. The tunnel may be open ended or closed at one end.An MRI can show signs ofa blockage in your appendiceal lumen a burst appendix inflammation other sources of abdominal painWhen diagnosing appendicitis and other sources of abdominal pain, doctors can use an MRI as a safe, reliable alternative to a computerized tomography (CT) scan.2CT scan. CT scans use x-rays and computer technology to create images.A health care professional may give you a solution to drink and an injection of contrast medium. You\u2019ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. X-ray technicians perform CT scans in an outpatient center or a hospital. Radiologists review the images.Patients don\u2019t need anesthesia, although health care professionals may give children a sedative to help them fall asleep for the test.A CT scan of the abdomen can show signs of inflammation, such asan enlarged or a burst appendix an appendiceal abscess a blockage in your appendiceal lumenWomen of childbearing age should have a pregnancy test before having a CT scan. The radiation from CT scans can be harmful to a developing fetus. Most often, health care professionals suspect the diagnosis of appendicitis based on your symptoms, your medical history, and a physical exam. A doctor can confirm the diagnosis with an ultrasound, x-ray, or MRI exam.A health care professional will ask specific questions about your symptoms and health history to help rule out other health problems. The health care professional will want to knowwhen your abdominal pain began the exact location and severity of your pain when your other symptoms appeared your other medical conditions, previous illnesses, and surgical procedures whether you use medicines, alcohol, or illegal drugsHealth care professionals need specific details about the pain in your abdomen to diagnose appendicitis correctly. A health care professional will assess your pain by touching or applying pressure to specific areas of your abdomen.The following responses to touch or pressure may indicate that you have appendicitis:Rovsing's sign Psoas sign Obturator sign Guarding Rebound tenderness Digital rectal exam Pelvic examDoctors use lab tests to help confirm the diagnosis of appendicitis or find other causes of abdominal pain.Blood tests. A health care professional draws your blood for a blood test at a doctor\u2019s office or a commercial facility. The health care professional sends the blood sample to a lab for testing. Blood tests can show a high white blood cell count, a sign of infection. Blood tests also may show dehydration or fluid and electrolyte imbalances.Urinalysis. Urinalysis is testing of a urine sample. You will provide a urine sample in a special container in a doctor\u2019s office, a commercial facility, or a hospital. Health care professionals can test the urine in the same location or send it to a lab for testing. Doctors use urinalysis to rule out a urinary tract infection or a kidney stone.Pregnancy test. For women, health care professionals also may order blood or urine samples to check for pregnancy.Doctors use imaging tests to confirm the diagnosis of appendicitis or find other causes of pain in the abdomen.Abdominal ultrasound. In an ultrasound, a health care professional uses a device, called a transducer, to bounce safe, painless sound waves off of your organs to create an image of their structure. He or she can move the transducer to different angles to examine different organs.In an abdominal ultrasound, a health care professional applies a gel to your abdomen and moves a hand-held transducer over your skin. A health care professional performs this procedure in a doctor\u2019s office, an outpatient center, or a hospital, and you don\u2019t need anesthesia.A radiologist reviews the images, which can show signs ofa blockage in your appendiceal lumen a burst appendix inflammation other sources of abdominal painHealth care professionals use an ultrasound as the first imaging test for possible appendicitis in infants, children, young adults, and pregnant women.Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of your body\u2019s internal organs and soft tissues without using x-rays.A health care professional performs the procedure in an outpatient center or a hospital. A radiologist reviews the images. Patients don\u2019t need anesthesia, although a health care professional may give light sedation, taken by mouth, to children and people with a fear of small spaces. A health care professional may inject a special dye, called contrast medium, into your body.In most cases, you\u2019ll lie on a table that slides into a tunnel-shaped device. The tunnel may be open ended or closed at one end.An MRI can show signs ofa blockage in your appendiceal lumen a burst appendix inflammation other sources of abdominal painWhen diagnosing appendicitis and other sources of abdominal pain, doctors can use an MRI as a safe, reliable alternative to a computerized tomography (CT) scan.2CT scan. CT scans use x-rays and computer technology to create images.A health care professional may give you a solution to drink and an injection of contrast medium. You\u2019ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. X-ray technicians perform CT scans in an outpatient center or a hospital. Radiologists review the images.Patients don\u2019t need anesthesia, although health care professionals may give children a sedative to help them fall asleep for the test.A CT scan of the abdomen can show signs of inflammation, such asan enlarged or a burst appendix an appendiceal abscess a blockage in your appendiceal lumenWomen of childbearing age should have a pregnancy test before having a CT scan. The radiation from CT scans can be harmful to a developing fetus. Doctors typically treat appendicitis with surgery to remove the appendix. Surgeons perform the surgery in a hospital with general anesthesia. Your doctor will recommend surgery if you have continuous abdominal pain and fever, or signs of a burst appendix and infection. Prompt surgery decreases the chance that your appendix will burst.Health care professionals call the surgery to remove the appendix an appendectomy. A surgeon performs the surgery using one of the following methods:Laparoscopic surgery. During laparoscopic surgery, surgeons use several smaller incisions and special surgical tools that they feed through the incisions to remove your appendix. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time. Laparotomy. Surgeons use laparotomy to remove the appendix through a single incision in the lower right area of your abdomen.After surgery, most patients completely recover from appendicitis and don\u2019t need to make changes to their diet, exercise, or lifestyle. Surgeons recommend that you limit physical activity for the first 10 to 14 days after a laparotomy and for the first 3 to 5 days after laparoscopic surgery. Doctors typically treat appendicitis with surgery to remove the appendix. Surgeons perform the surgery in a hospital with general anesthesia. Your doctor will recommend surgery if you have continuous abdominal pain and fever, or signs of a burst appendix and infection. Prompt surgery decreases the chance that your appendix will burst.Health care professionals call the surgery to remove the appendix an appendectomy. A surgeon performs the surgery using one of the following methods:Laparoscopic surgery. During laparoscopic surgery, surgeons use several smaller incisions and special surgical tools that they feed through the incisions to remove your appendix. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time. Laparotomy. Surgeons use laparotomy to remove the appendix through a single incision in the lower right area of your abdomen.After surgery, most patients completely recover from appendicitis and don\u2019t need to make changes to their diet, exercise, or lifestyle. Surgeons recommend that you limit physical activity for the first 10 to 14 days after a laparotomy and for the first 3 to 5 days after laparoscopic surgery. In some cases, a surgeon finds a normal appendix during surgery. In this case, many surgeons will remove it to eliminate the future possibility of appendicitis. Sometimes surgeons find a different problem, which they may correct during surgery. Some cases of mild appendicitis may be cured with antibiotics alone. All patients suspected of having appendicitis are treated with antibiotics before surgery, and some patients may improve completely before surgery is performed. Treating the complications of a burst appendix will depend on the type of complication. In most cases of peritonitis, a surgeon will remove your appendix immediately with surgery. The surgeon will use laparotomy to clean the inside of your abdomen to prevent infection and then remove your appendix. Without prompt treatment, peritonitis can cause death.A surgeon may drain the pus from an appendiceal abscess during surgery or, more commonly, before surgery. To drain an abscess, the surgeon places a tube in the abscess through the abdominal wall. You leave the drainage tube in place for about 2 weeks while you take antibiotics to treat infection. When the infection and inflammation are under control, about 6 to 8 weeks later, surgeons operate to remove what remains of the burst appendix.",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Myopathy with extrapyramidal signs (Symptoms): The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Ataxia Occasional Microcephaly Occasional Ophthalmoplegia Occasional Optic atrophy Occasional Peripheral axonal neuropathy Occasional Ptosis Occasional Abnormality of extrapyramidal motor function Very rare Chorea Very rare Dystonia Very rare Orofacial dyskinesia Very rare Proximal muscle weakness Very rare Specific learning disability Very rare Tremor Very rare Autosomal recessive inheritance - Difficulty running - Difficulty walking - Elevated serum creatine phosphokinase - Motor delay - View complete list of signs and symptoms...",
+    "https://rarediseases.info.nih.gov/diseases/12978/myopathy-with-extrapyramidal-signs"
+  ],
+  [
+    "Appendicitis (Treatment): Doctors typically treat appendicitis with surgery to remove the appendix. Surgeons perform the surgery in a hospital with general anesthesia. Your doctor will recommend surgery if you have continuous abdominal pain and fever, or signs of a burst appendix and infection. Prompt surgery decreases the chance that your appendix will burst.Health care professionals call the surgery to remove the appendix an appendectomy. A surgeon performs the surgery using one of the following methods:Laparoscopic surgery. During laparoscopic surgery, surgeons use several smaller incisions and special surgical tools that they feed through the incisions to remove your appendix. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time. Laparotomy. Surgeons use laparotomy to remove the appendix through a single incision in the lower right area of your abdomen.After surgery, most patients completely recover from appendicitis and don\u2019t need to make changes to their diet, exercise, or lifestyle. Surgeons recommend that you limit physical activity for the first 10 to 14 days after a laparotomy and for the first 3 to 5 days after laparoscopic surgery.",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "What are the treatments for Appendicitis?: Most of the time, a surgeon will remove your appendix as soon as you are diagnosed. If a CT scan shows that you have an abscess, you may be treated with antibiotics first. You will have your appendix removed after the infection and swelling have gone away. The tests used to diagnose appendicitis are not perfect. As a result, the operation may show that your appendix is normal. In that case, the surgeonwill remove your appendix and explore the rest of your abdomen for other causes of your pain.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000256.htm"
+  ],
+  [
+    "Appendicitis (Can doctors treat appendicitis without surgery?): Some cases of mild appendicitis may be cured with antibiotics alone. All patients suspected of having appendicitis are treated with antibiotics before surgery, and some patients may improve completely before surgery is performed.",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Appendicitis (Treatment): Appendicitis treatment usually involves surgery to remove the inflamed appendix. Before surgery you may be given a dose of antibiotics to prevent infection. Surgery to remove the appendix (appendectomy) Appendectomy can be performed as open surgery using one abdominal incision about 2 to 4 inches (5 to 10 centimeters) long (laparotomy). Or the surgery can be done through a few small abdominal incisions (laparoscopic surgery). During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a video camera into your abdomen to remove your appendix. In general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be better for people who are elderly or obese. But laparoscopic surgery isn't appropriate for everyone. If your appendix has ruptured and infection has spread beyond the appendix or you have an abscess, you may need an open appendectomy, which allows your surgeon to clean the abdominal cavity. Expect to spend one or two days in the hospital after your appendectomy. Draining an abscess before appendix surgery If your appendix has burst and an abscess has formed around it, the abscess may be drained by placing a tube through your skin into the abscess. Appendectomy can be performed several weeks later after controlling the infection.",
+    "https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/syc-20369543"
+  ],
+  [
+    "Appendicitis (Symptoms and Causes): Appendicitis is a medical emergency that requires immediate care. See a health care professional or go to the emergency room right away if you think you or a child has appendicitis. A doctor can help treat the appendicitis and reduce symptoms and the chance of complications.",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Appendicitis (Overview): Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. The appendix doesn't seem to have a specific purpose. Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe. Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix.",
+    "https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/syc-20369543"
+  ],
+  [
+    "Appendicitis (Summary): Summary The appendix is a small, tube-like organ attached to the first part of the large intestine. It is located in the lower right part of the abdomen. It has no known function. A blockage inside of the appendix causes appendicitis. The blockage leads to increased pressure, problems with blood flow, and inflammation. If the blockage is not treated, the appendix can burst and spread infection into the abdomen. This causes a condition called peritonitis. The main symptom is pain in the abdomen, often on the right side. It is usually sudden and gets worse over time. Other symptoms may include - Swelling in the abdomen - Loss of appetite - Nausea and vomiting - Constipation or diarrhea - Inability to pass gas - Low fever Not everyone with appendicitis has all these symptoms. Appendicitis is a medical emergency. Treatment almost always involves removing the appendix. Anyone can get appendicitis, but it is more common among people 10 to 30 years old. NIH: National Institute of Diabetes and Digestive and Kidney Diseases",
+    "#"
+  ],
+  [
+    "Appendicitis (Treatment): Treating the complications of a burst appendix will depend on the type of complication. In most cases of peritonitis, a surgeon will remove your appendix immediately with surgery. The surgeon will use laparotomy to clean the inside of your abdomen to prevent infection and then remove your appendix. Without prompt treatment, peritonitis can cause death.A surgeon may drain the pus from an appendiceal abscess during surgery or, more commonly, before surgery. To drain an abscess, the surgeon places a tube in the abscess through the abdominal wall. You leave the drainage tube in place for about 2 weeks while you take antibiotics to treat infection. When the infection and inflammation are under control, about 6 to 8 weeks later, surgeons operate to remove what remains of the burst appendix.",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Appendicitis (Diagnosis): To help diagnose appendicitis, your doctor will likely take a history of your signs and symptoms and examine your abdomen. Tests and procedures used to diagnose appendicitis include: - Physical exam to assess your pain. Your doctor may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is inflamed. Your doctor also may look for abdominal rigidity and a tendency for you to stiffen your abdominal muscles in response to pressure over the inflamed appendix (guarding). Your doctor may use a lubricated, gloved finger to examine your lower rectum (digital rectal exam). Women of childbearing age may be given a pelvic exam to check for possible gynecological problems that could be causing the pain. - Blood test. This allows your doctor to check for a high white blood cell count, which may indicate an infection. - Urine test. Your doctor may want you to have a urinalysis to make sure that a urinary tract infection or a kidney stone isn't causing your pain. - Imaging tests. Your doctor may also recommend an abdominal X-ray, an abdominal ultrasound or a computerized tomography (CT) scan to help confirm appendicitis or find other causes for your pain.",
+    "https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/syc-20369543"
+  ],
+  [
+    "What is Appendicitis?: Appendicitis is swelling (inflammation) of the appendix. The appendix is a small pouch attached to the large intestine.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000256.htm"
+  ],
+  [
+    "Appendicitis (Diagnosis): Most often, health care professionals suspect the diagnosis of appendicitis based on your symptoms, your medical history, and a physical exam. A doctor can confirm the diagnosis with an ultrasound, x-ray, or MRI exam.A health care professional will ask specific questions about your symptoms and health history to help rule out other health problems. The health care professional will want to knowwhen your abdominal pain began the exact location and severity of your pain when your other symptoms appeared your other medical conditions, previous illnesses, and surgical procedures whether you use medicines, alcohol, or illegal drugsHealth care professionals need specific details about the pain in your abdomen to diagnose appendicitis correctly. A health care professional will assess your pain by touching or applying pressure to specific areas of your abdomen.The following responses to touch or pressure may indicate that you have appendicitis:Rovsing's sign Psoas sign Obturator sign Guarding Rebound tenderness Digital rectal exam Pelvic examDoctors use lab tests to help confirm the diagnosis of appendicitis or find other causes of abdominal pain.Blood tests. A health care professional draws your blood for a blood test at a doctor\u2019s office or a commercial facility. The health care professional sends the blood sample to a lab for testing. Blood tests can show a high white blood cell count, a sign of infection. Blood tests also may show dehydration or fluid and electrolyte imbalances.Urinalysis. Urinalysis is testing of a urine sample. You will provide a urine sample in a special container in a doctor\u2019s office, a commercial facility, or a hospital. Health care professionals can test the urine in the same location or send it to a lab for testing. Doctors use urinalysis to rule out a urinary tract infection or a kidney stone.Pregnancy test. For women, health care professionals also may order blood or urine samples to check for pregnancy.Doctors use imaging tests to confirm the diagnosis of appendicitis or find other causes of pain in the abdomen.Abdominal ultrasound. In an ultrasound, a health care professional uses a device, called a transducer, to bounce safe, painless sound waves off of your organs to create an image of their structure. He or she can move the transducer to different angles to examine different organs.In an abdominal ultrasound, a health care professional applies a gel to your abdomen and moves a hand-held transducer over your skin. A health care professional performs this procedure in a doctor\u2019s office, an outpatient center, or a hospital, and you don\u2019t need anesthesia.A radiologist reviews the images, which can show signs ofa blockage in your appendiceal lumen a burst appendix inflammation other sources of abdominal painHealth care professionals use an ultrasound as the first imaging test for possible appendicitis in infants, children, young adults, and pregnant women.Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of your body\u2019s internal organs and soft tissues without using x-rays.A health care professional performs the procedure in an outpatient center or a hospital. A radiologist reviews the images. Patients don\u2019t need anesthesia, although a health care professional may give light sedation, taken by mouth, to children and people with a fear of small spaces. A health care professional may inject a special dye, called contrast medium, into your body.In most cases, you\u2019ll lie on a table that slides into a tunnel-shaped device. The tunnel may be open ended or closed at one end.An MRI can show signs ofa blockage in your appendiceal lumen a burst appendix inflammation other sources of abdominal painWhen diagnosing appendicitis and other sources of abdominal pain, doctors can use an MRI as a safe, reliable alternative to a computerized tomography (CT) scan.2CT scan. CT scans use x-rays and computer technology to create images.A health care professional may give you a solution to drink and an injection of contrast medium. You\u2019ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. X-ray technicians perform CT scans in an outpatient center or a hospital. Radiologists review the images.Patients don\u2019t need anesthesia, although health care professionals may give children a sedative to help them fall asleep for the test.A CT scan of the abdomen can show signs of inflammation, such asan enlarged or a burst appendix an appendiceal abscess a blockage in your appendiceal lumenWomen of childbearing age should have a pregnancy test before having a CT scan. The radiation from CT scans can be harmful to a developing fetus.",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "What is Appendicitis?: The appendix is a small, tube-like organ attached to the first part of the large intestine. It is located in the lower right part of the abdomen. It has no known function. A blockage inside of the appendix causes appendicitis. The blockage leads to increased pressure, problems with blood flow, and inflammation. If the blockage is not treated, the appendix can burst and spread infection into the abdomen. This causes a condition called peritonitis. The main symptom is pain in the abdomen, often on the right side. It is usually sudden and gets worse over time. Other symptoms may include - Swelling in the abdomen - Loss of appetite - Nausea and vomiting - Constipation or diarrhea - Inability to pass gas - Low fever Not everyone with appendicitis has all these symptoms. Appendicitis is a medical emergency. Treatment almost always involves removing the appendix. Anyone can get appendicitis, but it is more common among people 10 to 30 years old. NIH: National Institute of Diabetes and Digestive and Kidney Diseases",
+    "https://www.nlm.nih.gov/medlineplus/appendicitis.html"
+  ],
+  [
+    "Appendicitis (Exams and Tests): Your health care provider may suspect appendicitis based on the symptoms you describe. Your provider will do a physical exam. - If you have appendicitis, your pain will increase when your lower right belly area is pressed. - If your appendix has ruptured, touching the belly area may cause a lot of pain and lead you to tighten your muscles. - A rectal exam may find tenderness on the right side of your rectum. A blood test will often show a high white blood cell count. Imaging tests may also help diagnose appendicitis. Imaging tests include: - CT scan of the abdomen - Ultrasound of the abdomen",
+    "https://medlineplus.gov/ency/article/000256.htm"
+  ],
+  [
+    "Appendicitis (Treatment): Most of the time, a surgeon will remove your appendix as soon as you are diagnosed. If a CT scan shows that you have an abscess, you may be treated with antibiotics first. You will have your appendix removed after the infection and swelling have gone away. The tests used to diagnose appendicitis are not perfect. As a result, the operation may show that your appendix is normal. In that case, the surgeon\u00a0will remove your appendix and explore the rest of your abdomen for other causes of your pain.",
+    "https://medlineplus.gov/ency/article/000256.htm"
+  ],
+  [
+    "Appendicitis (Symptoms): The symptoms of appendicitis can vary. It can be hard to diagnose appendicitis in young children, older people, and women of childbearing age. The first symptom is often pain around the belly button or mid upper abdomen. Pain may be minor at first, but becomes more sharp and severe. You may also have a loss of appetite, nausea, vomiting, and a low-grade fever. The pain tends to move into the right lower part of your belly. The pain tends to focus at a spot directly above the appendix called McBurney point. This most often occurs 12 to 24 hours after the illness starts. Your pain may be worse when you walk, cough, or make sudden movements. Later symptoms include: - Chills and shaking - Hard stools - Diarrhea - Fever - Nausea and vomiting",
+    "https://medlineplus.gov/ency/article/000256.htm"
+  ],
+  [
+    "Appendicitis: Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. The appendix doesn't seem to have a specific purpose. Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe. Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix. Signs and symptoms of appendicitis may include: - Sudden pain that begins on the right side of the lower abdomen - Sudden pain that begins around your navel and often shifts to your lower right abdomen - Pain that worsens if you cough, walk or make other jarring movements - Nausea and vomiting - Loss of appetite - Low-grade fever that may worsen as the illness progresses - Constipation or diarrhea - Abdominal bloating The site of your pain may vary, depending on your age and the position of your appendix. When you're pregnant, the pain may seem to come from your upper abdomen because your appendix is higher during pregnancy. When to see a doctor Make an appointment with a doctor if you or your child has worrisome signs or symptoms. Severe abdominal pain requires immediate medical attention. A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture. To help diagnose appendicitis, your doctor will likely take a history of your signs and symptoms and examine your abdomen. Tests and procedures used to diagnose appendicitis include: - Physical exam to assess your pain. Your doctor may apply gentle pressure on the painful area. When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is inflamed. Your doctor also may look for abdominal rigidity and a tendency for you to stiffen your abdominal muscles in response to pressure over the inflamed appendix (guarding). Your doctor may use a lubricated, gloved finger to examine your lower rectum (digital rectal exam). Women of childbearing age may be given a pelvic exam to check for possible gynecological problems that could be causing the pain. - Blood test. This allows your doctor to check for a high white blood cell count, which may indicate an infection. - Urine test. Your doctor may want you to have a urinalysis to make sure that a urinary tract infection or a kidney stone isn't causing your pain. - Imaging tests. Your doctor may also recommend an abdominal X-ray, an abdominal ultrasound or a computerized tomography (CT) scan to help confirm appendicitis or find other causes for your pain. Appendicitis treatment usually involves surgery to remove the inflamed appendix. Before surgery you may be given a dose of antibiotics to prevent infection. Surgery to remove the appendix (appendectomy) Appendectomy can be performed as open surgery using one abdominal incision about 2 to 4 inches (5 to 10 centimeters) long (laparotomy). Or the surgery can be done through a few small abdominal incisions (laparoscopic surgery). During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a video camera into your abdomen to remove your appendix. In general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be better for people who are elderly or obese. But laparoscopic surgery isn't appropriate for everyone. If your appendix has ruptured and infection has spread beyond the appendix or you have an abscess, you may need an open appendectomy, which allows your surgeon to clean the abdominal cavity. Expect to spend one or two days in the hospital after your appendectomy. Draining an abscess before appendix surgery If your appendix has burst and an abscess has formed around it, the abscess may be drained by placing a tube through your skin into the abscess. Appendectomy can be performed several weeks later after controlling the infection. Expect a few weeks of recovery from an appendectomy, or longer if your appendix burst. To help your body heal: - Avoid strenuous activity at first. If your appendectomy was done laparoscopically, limit your activity for three to five days. If you had an open appendectomy, limit your activity for 10 to 14 days. Always ask your doctor about limitations on your activity and when you can resume normal activities following surgery. - Support your abdomen when you cough. Place a pillow over your abdomen and apply pressure before you cough, laugh or move to help reduce pain. - Call your doctor if your pain medications aren't helping. Being in pain puts extra stress on your body and slows the healing process. If you're still in pain despite your pain medications, call your doctor. - Get up and move when you're ready. Start slowly and increase your activity as you feel up to it. Start with short walks. - Sleep when tired. As your body heals, you may find you feel sleepier than usual. Take it easy and rest when you need to. - Discuss returning to work or school with your doctor. You can return to work when you feel up to it. Children may be able to return to school less than a week after surgery. They should wait two to four weeks to resume strenuous activity, such as gym classes or sports. Your doctor will prescribe medications to help you control your pain after your appendectomy. Some complementary and alternative treatments, when used with your medications, can help control pain. Ask your doctor about safe options, such as: - Distracting activities, such as listening to music and talking with friends, that take your mind off your pain. Distraction can be especially effective with children. - Guided imagery, such as closing your eyes and thinking about a favorite place.",
+    "https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/syc-20369543"
+  ],
+  [
+    "Appendicitis: Appendicitis is inflammation of your appendix. Appendicitis is inflammation of your appendix. In the United States, appendicitis is the most common cause of acute abdominal pain requiring surgery. Over 5% of the population develops appendicitis at some point.1 Appendicitis most commonly occurs in the teens and twenties but may occur at any age.1 If appendicitis is not treated, it may lead to complications. The complications of a ruptured appendix areperitonitis, which can be a dangerous condition. Peritonitis happens if your appendix bursts and infection spreads in your abdomen. If you have peritonitis, you may be very ill and have fever nausea severe tenderness in your abdomen vomiting an abscess of the appendix called an appendiceal abscess. The most common symptom of appendicitis is pain in your abdomen.If you have appendicitis, you\u2019ll most often have pain in your abdomen thatbegins near your belly button and then moves lower and to your right gets worse in a matter of hours gets worse when you move around, take deep breaths, cough, or sneeze is severe and often described as different from any pain you\u2019ve felt before occurs suddenly and may even wake you up if you\u2019re sleeping occurs before other symptomsOther symptoms of appendicitis may includeloss of appetite nausea vomiting constipation or diarrhea an inability to pass gas a low-grade fever swelling in your abdomen the feeling that having a bowel movement will relieve discomfortSymptoms can be different for each person and can seem like the following conditions that also cause pain in the abdomen:abdominal adhesions constipation inflammatory bowel disease, which includes Crohn\u2019s disease and ulcerative colitis, long-lasting disorders that cause irritation and ulcers in the GI tract intestinal obstruction pelvic inflammatory disease The most common symptom of appendicitis is pain in your abdomen.If you have appendicitis, you\u2019ll most often have pain in your abdomen thatbegins near your belly button and then moves lower and to your right gets worse in a matter of hours gets worse when you move around, take deep breaths, cough, or sneeze is severe and often described as different from any pain you\u2019ve felt before occurs suddenly and may even wake you up if you\u2019re sleeping occurs before other symptomsOther symptoms of appendicitis may includeloss of appetite nausea vomiting constipation or diarrhea an inability to pass gas a low-grade fever swelling in your abdomen the feeling that having a bowel movement will relieve discomfortSymptoms can be different for each person and can seem like the following conditions that also cause pain in the abdomen:abdominal adhesions constipation inflammatory bowel disease, which includes Crohn\u2019s disease and ulcerative colitis, long-lasting disorders that cause irritation and ulcers in the GI tract intestinal obstruction pelvic inflammatory disease Appendicitis can have more than one cause, and in many cases the cause is not clear. Possible causes include:Blockage of the opening inside the appendix enlarged tissue in the wall of your appendix, caused by infection in the gastrointestinal (GI) tract or elsewhere in your body inflammatory bowel disease stool, parasites, or growths that can clog your appendiceal lumen trauma to your abdomen Appendicitis is a medical emergency that requires immediate care. See a health care professional or go to the emergency room right away if you think you or a child has appendicitis. A doctor can help treat the appendicitis and reduce symptoms and the chance of complications. Most often, health care professionals suspect the diagnosis of appendicitis based on your symptoms, your medical history, and a physical exam. A doctor can confirm the diagnosis with an ultrasound, x-ray, or MRI exam.A health care professional will ask specific questions about your symptoms and health history to help rule out other health problems. The health care professional will want to knowwhen your abdominal pain began the exact location and severity of your pain when your other symptoms appeared your other medical conditions, previous illnesses, and surgical procedures whether you use medicines, alcohol, or illegal drugsHealth care professionals need specific details about the pain in your abdomen to diagnose appendicitis correctly. A health care professional will assess your pain by touching or applying pressure to specific areas of your abdomen.The following responses to touch or pressure may indicate that you have appendicitis:Rovsing's sign Psoas sign Obturator sign Guarding Rebound tenderness Digital rectal exam Pelvic examDoctors use lab tests to help confirm the diagnosis of appendicitis or find other causes of abdominal pain.Blood tests. A health care professional draws your blood for a blood test at a doctor\u2019s office or a commercial facility. The health care professional sends the blood sample to a lab for testing. Blood tests can show a high white blood cell count, a sign of infection. Blood tests also may show dehydration or fluid and electrolyte imbalances.Urinalysis. Urinalysis is testing of a urine sample. You will provide a urine sample in a special container in a doctor\u2019s office, a commercial facility, or a hospital. Health care professionals can test the urine in the same location or send it to a lab for testing. Doctors use urinalysis to rule out a urinary tract infection or a kidney stone.Pregnancy test. For women, health care professionals also may order blood or urine samples to check for pregnancy.Doctors use imaging tests to confirm the diagnosis of appendicitis or find other causes of pain in the abdomen.Abdominal ultrasound. In an ultrasound, a health care professional uses a device, called a transducer, to bounce safe, painless sound waves off of your organs to create an image of their structure. He or she can move the transducer to different angles to examine different organs.In an abdominal ultrasound, a health care professional applies a gel to your abdomen and moves a hand-held transducer over your skin. A health care professional performs this procedure in a doctor\u2019s office, an outpatient center, or a hospital, and you don\u2019t need anesthesia.A radiologist reviews the images, which can show signs ofa blockage in your appendiceal lumen a burst appendix inflammation other sources of abdominal painHealth care professionals use an ultrasound as the first imaging test for possible appendicitis in infants, children, young adults, and pregnant women.Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of your body\u2019s internal organs and soft tissues without using x-rays.A health care professional performs the procedure in an outpatient center or a hospital. A radiologist reviews the images. Patients don\u2019t need anesthesia, although a health care professional may give light sedation, taken by mouth, to children and people with a fear of small spaces. A health care professional may inject a special dye, called contrast medium, into your body.In most cases, you\u2019ll lie on a table that slides into a tunnel-shaped device. The tunnel may be open ended or closed at one end.An MRI can show signs ofa blockage in your appendiceal lumen a burst appendix inflammation other sources of abdominal painWhen diagnosing appendicitis and other sources of abdominal pain, doctors can use an MRI as a safe, reliable alternative to a computerized tomography (CT) scan.2CT scan. CT scans use x-rays and computer technology to create images.A health care professional may give you a solution to drink and an injection of contrast medium. You\u2019ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. X-ray technicians perform CT scans in an outpatient center or a hospital. Radiologists review the images.Patients don\u2019t need anesthesia, although health care professionals may give children a sedative to help them fall asleep for the test.A CT scan of the abdomen can show signs of inflammation, such asan enlarged or a burst appendix an appendiceal abscess a blockage in your appendiceal lumenWomen of childbearing age should have a pregnancy test before having a CT scan. The radiation from CT scans can be harmful to a developing fetus. Most often, health care professionals suspect the diagnosis of appendicitis based on your symptoms, your medical history, and a physical exam. A doctor can confirm the diagnosis with an ultrasound, x-ray, or MRI exam.A health care professional will ask specific questions about your symptoms and health history to help rule out other health problems. The health care professional will want to knowwhen your abdominal pain began the exact location and severity of your pain when your other symptoms appeared your other medical conditions, previous illnesses, and surgical procedures whether you use medicines, alcohol, or illegal drugsHealth care professionals need specific details about the pain in your abdomen to diagnose appendicitis correctly. A health care professional will assess your pain by touching or applying pressure to specific areas of your abdomen.The following responses to touch or pressure may indicate that you have appendicitis:Rovsing's sign Psoas sign Obturator sign Guarding Rebound tenderness Digital rectal exam Pelvic examDoctors use lab tests to help confirm the diagnosis of appendicitis or find other causes of abdominal pain.Blood tests. A health care professional draws your blood for a blood test at a doctor\u2019s office or a commercial facility. The health care professional sends the blood sample to a lab for testing. Blood tests can show a high white blood cell count, a sign of infection. Blood tests also may show dehydration or fluid and electrolyte imbalances.Urinalysis. Urinalysis is testing of a urine sample. You will provide a urine sample in a special container in a doctor\u2019s office, a commercial facility, or a hospital. Health care professionals can test the urine in the same location or send it to a lab for testing. Doctors use urinalysis to rule out a urinary tract infection or a kidney stone.Pregnancy test. For women, health care professionals also may order blood or urine samples to check for pregnancy.Doctors use imaging tests to confirm the diagnosis of appendicitis or find other causes of pain in the abdomen.Abdominal ultrasound. In an ultrasound, a health care professional uses a device, called a transducer, to bounce safe, painless sound waves off of your organs to create an image of their structure. He or she can move the transducer to different angles to examine different organs.In an abdominal ultrasound, a health care professional applies a gel to your abdomen and moves a hand-held transducer over your skin. A health care professional performs this procedure in a doctor\u2019s office, an outpatient center, or a hospital, and you don\u2019t need anesthesia.A radiologist reviews the images, which can show signs ofa blockage in your appendiceal lumen a burst appendix inflammation other sources of abdominal painHealth care professionals use an ultrasound as the first imaging test for possible appendicitis in infants, children, young adults, and pregnant women.Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of your body\u2019s internal organs and soft tissues without using x-rays.A health care professional performs the procedure in an outpatient center or a hospital. A radiologist reviews the images. Patients don\u2019t need anesthesia, although a health care professional may give light sedation, taken by mouth, to children and people with a fear of small spaces. A health care professional may inject a special dye, called contrast medium, into your body.In most cases, you\u2019ll lie on a table that slides into a tunnel-shaped device. The tunnel may be open ended or closed at one end.An MRI can show signs ofa blockage in your appendiceal lumen a burst appendix inflammation other sources of abdominal painWhen diagnosing appendicitis and other sources of abdominal pain, doctors can use an MRI as a safe, reliable alternative to a computerized tomography (CT) scan.2CT scan. CT scans use x-rays and computer technology to create images.A health care professional may give you a solution to drink and an injection of contrast medium. You\u2019ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. X-ray technicians perform CT scans in an outpatient center or a hospital. Radiologists review the images.Patients don\u2019t need anesthesia, although health care professionals may give children a sedative to help them fall asleep for the test.A CT scan of the abdomen can show signs of inflammation, such asan enlarged or a burst appendix an appendiceal abscess a blockage in your appendiceal lumenWomen of childbearing age should have a pregnancy test before having a CT scan. The radiation from CT scans can be harmful to a developing fetus. Doctors typically treat appendicitis with surgery to remove the appendix. Surgeons perform the surgery in a hospital with general anesthesia. Your doctor will recommend surgery if you have continuous abdominal pain and fever, or signs of a burst appendix and infection. Prompt surgery decreases the chance that your appendix will burst.Health care professionals call the surgery to remove the appendix an appendectomy. A surgeon performs the surgery using one of the following methods:Laparoscopic surgery. During laparoscopic surgery, surgeons use several smaller incisions and special surgical tools that they feed through the incisions to remove your appendix. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time. Laparotomy. Surgeons use laparotomy to remove the appendix through a single incision in the lower right area of your abdomen.After surgery, most patients completely recover from appendicitis and don\u2019t need to make changes to their diet, exercise, or lifestyle. Surgeons recommend that you limit physical activity for the first 10 to 14 days after a laparotomy and for the first 3 to 5 days after laparoscopic surgery. Doctors typically treat appendicitis with surgery to remove the appendix. Surgeons perform the surgery in a hospital with general anesthesia. Your doctor will recommend surgery if you have continuous abdominal pain and fever, or signs of a burst appendix and infection. Prompt surgery decreases the chance that your appendix will burst.Health care professionals call the surgery to remove the appendix an appendectomy. A surgeon performs the surgery using one of the following methods:Laparoscopic surgery. During laparoscopic surgery, surgeons use several smaller incisions and special surgical tools that they feed through the incisions to remove your appendix. Laparoscopic surgery leads to fewer complications, such as hospital-related infections, and has a shorter recovery time. Laparotomy. Surgeons use laparotomy to remove the appendix through a single incision in the lower right area of your abdomen.After surgery, most patients completely recover from appendicitis and don\u2019t need to make changes to their diet, exercise, or lifestyle. Surgeons recommend that you limit physical activity for the first 10 to 14 days after a laparotomy and for the first 3 to 5 days after laparoscopic surgery. In some cases, a surgeon finds a normal appendix during surgery. In this case, many surgeons will remove it to eliminate the future possibility of appendicitis. Sometimes surgeons find a different problem, which they may correct during surgery. Some cases of mild appendicitis may be cured with antibiotics alone. All patients suspected of having appendicitis are treated with antibiotics before surgery, and some patients may improve completely before surgery is performed. Treating the complications of a burst appendix will depend on the type of complication. In most cases of peritonitis, a surgeon will remove your appendix immediately with surgery. The surgeon will use laparotomy to clean the inside of your abdomen to prevent infection and then remove your appendix. Without prompt treatment, peritonitis can cause death.A surgeon may drain the pus from an appendiceal abscess during surgery or, more commonly, before surgery. To drain an abscess, the surgeon places a tube in the abscess through the abdominal wall. You leave the drainage tube in place for about 2 weeks while you take antibiotics to treat infection. When the infection and inflammation are under control, about 6 to 8 weeks later, surgeons operate to remove what remains of the burst appendix.",
+    "https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis"
+  ],
+  [
+    "Ear Infections in Children: An ear infection is an inflammation of the middle ear, usually caused by bacteria, that occurs when fluid builds up behind the eardrum. Anyone can get an ear infection, but children get them more often than adults. Five out of six children will have at least one ear infection by their third birthday. In fact, ear infections are the most common reason parents bring their child to a doctor. The scientific name for an ear infection is otitis media (OM). There are three main types of ear infections. Each has a different combination of symptoms. - Acute otitis media (AOM) is the most common ear infection. Parts of the middle ear are infected and swollen and fluid is trapped behind the eardrum. This causes pain in the ear\u2014commonly called an earache. Your child might also have a fever. - Otitis media with effusion (OME) sometimes happens after an ear infection has run its course and fluid stays trapped behind the eardrum. A child with OME may have no symptoms, but a doctor will be able to see the fluid behind the eardrum with a special instrument. - Chronic otitis media with effusion (COME) happens when fluid remains in the middle ear for a long time or returns over and over again, even though there is no infection. COME makes it harder for children to fight new infections and also can affect their hearing. Most ear infections happen to children before they\u2019ve learned how to talk. If your child isn\u2019t old enough to say \u201cMy ear hurts,\u201d here are a few things to look for: - Tugging or pulling at the ear(s) - Fussiness and crying - Trouble sleeping - Fever (especially in infants and younger children) - Fluid draining from the ear - Clumsiness or problems with balance - Trouble hearing or responding to quiet sounds An ear infection usually is caused by bacteria and often begins after a child has a sore throat, cold, or other upper respiratory infection. If the upper respiratory infection is bacterial, these same bacteria may spread to the middle ear; if the upper respiratory infection is caused by a virus, such as a cold, bacteria may be drawn to the microbe-friendly environment and move into the middle ear as a secondary infection. Because of the infection, fluid builds up behind the eardrum. Parts of the ear The ear has three major parts: the outer ear, the middle ear, and the inner ear. The outer ear, also called the pinna, includes everything we see on the outside\u2014the curved flap of the ear leading down to the earlobe\u2014but it also includes the ear canal, which begins at the opening to the ear and extends to the eardrum. The eardrum is a membrane that separates the outer ear from the middle ear. \u00a0 The middle ear\u2014which is where ear infections occur\u2014is located between the eardrum and the inner ear. Within the middle ear are three tiny bones called the malleus, incus, and stapes that transmit sound vibrations from the eardrum to the inner ear. The bones of the middle ear are surrounded by air. The inner ear contains the labyrinth, which help us keep our balance. The cochlea, a part of the labyrinth, is a snail-shaped organ that converts sound vibrations from the middle ear into electrical signals. The auditory nerve carries these signals from the cochlea to the brain. Other nearby parts of the ear also can be involved in ear infections. The eustachian tube is a small passageway that connects the upper part of the throat to the middle ear. Its job is to supply fresh air to the middle ear, drain fluid, and keep air pressure at a steady level between the nose and the ear. Adenoids are small pads of tissue located behind the back of the nose, above the throat, and near the eustachian tubes. Adenoids are mostly made up of immune system cells. They fight off infection by trapping bacteria that enter through the mouth. There are several reasons why children are more likely than adults to get ear infections. Eustachian tubes are smaller and more level in children than they are in adults. This makes it difficult for fluid to drain out of the ear, even under normal conditions. If the eustachian tubes are swollen or blocked with mucus due to a cold or other respiratory illness, fluid may not be able to drain. A child\u2019s immune system isn\u2019t as effective as an adult\u2019s because it\u2019s still developing. This makes it harder for children to fight infections. As part of the immune system, the adenoids respond to bacteria passing through the nose and mouth. Sometimes bacteria get trapped in the adenoids, causing a chronic infection that can then pass on to the eustachian tubes and the middle ear. The first thing a doctor will do is ask you about your child\u2019s health. Has your child had a head cold or sore throat recently? Is he having trouble sleeping? Is she pulling at her ears? If an ear infection seems likely, the simplest way for a doctor to tell is to use a lighted instrument, called an otoscope, to look at the eardrum. A red, bulging eardrum indicates an infection. A doctor also may use a pneumatic otoscope, which blows a puff of air into the ear canal, to check for fluid behind the eardrum. A normal eardrum will move back and forth more easily than an eardrum with fluid behind it. Tympanometry, which uses sound tones and air pressure, is a diagnostic test a doctor might use if the diagnosis still isn\u2019t clear. A tympanometer is a small, soft plug that contains a tiny microphone and speaker as well as a device that varies air pressure in the ear. It measures how flexible the eardrum is at different pressures. Many doctors will prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days. Your doctor also may recommend over-the-counter pain relievers such as acetaminophen or ibuprofen, or eardrops, to help with fever and pain. (Because aspirin is considered a major preventable risk factor for Reye\u2019s syndrome, a child who has a fever or other flu-like symptoms should not be given aspirin unless instructed to by your doctor.) If your doctor isn\u2019t able to make a definite diagnosis of OM and your child doesn\u2019t have severe ear pain or a fever, your doctor might ask you to wait a day or two to see if the earache goes away. The American Academy of Pediatrics issued guidelines in 2013 that encourage doctors to observe and closely follow these children with ear infections that can\u2019t be definitively diagnosed, especially those between the ages of 6 months to 2 years. If there\u2019s no improvement within 48 to 72 hours from when symptoms began, the guidelines recommend doctors start antibiotic therapy. Sometimes ear pain isn\u2019t caused by infection, and some ear infections may get better without antibiotics. Using antibiotics cautiously and with good reason helps prevent the development of bacteria that become resistant to antibiotics. If your doctor prescribes an antibiotic, it\u2019s important to make sure your child takes it exactly as prescribed and for the full amount of time. Even though your child may seem better in a few days, the infection still hasn\u2019t completely cleared from the ear. Stopping the medicine too soon could allow the infection to come back. It\u2019s also important to return for your child\u2019s follow-up visit, so that the doctor can check if the infection is gone. Your child should start feeling better within a few days after visiting the doctor. If it\u2019s been several days and your child still seems sick, call your doctor. Your child might need a different antibiotic. Once the infection clears, fluid may still remain in the middle ear but usually disappears within three to six weeks. To keep a middle ear infection from coming back, it helps to limit some of the factors that might put your child at risk, such as not being around people who smoke and not going to bed with a bottle. In spite of these precautions, some children may continue to have middle ear infections, sometimes as many as five or six a year. Your doctor may want to wait for several months to see if things get better on their own but, if the infections keep coming back and antibiotics aren\u2019t helping, many doctors will recommend a surgical procedure that places a small ventilation tube in the eardrum to improve air flow and prevent fluid backup in the middle ear. The most commonly used tubes stay in place for six to nine months and require follow-up visits until they fall out. If placement of the tubes still doesn\u2019t prevent infections, a doctor may consider removing the adenoids to prevent infection from spreading to the eustachian tubes. Currently, the best way to prevent ear infections is to reduce the risk factors associated with them. Here are some things you might want to do to lower your child\u2019s risk for ear infections. - Vaccinate your child against the flu. Make sure your child gets the influenza, or flu, vaccine every year. - It is recommended that you vaccinate your child with the 13-valent pneumococcal conjugate vaccine (PCV13). The PCV13 protects against more types of infection-causing bacteria than the previous vaccine, the PCV7. If your child already has begun PCV7 vaccination, consult your physician about how to transition to PCV13. The Centers for Disease Control and Prevention (CDC) recommends that children under age 2 be vaccinated, starting at 2 months of age. Studies have shown that vaccinated children get far fewer ear infections than children who aren\u2019t vaccinated. The vaccine is strongly recommended for children in daycare. - Wash hands frequently. Washing hands prevents the spread of germs and can help keep your child from catching a cold or the flu. - Avoid exposing your baby to cigarette smoke. Studies have shown that babies who are around smokers have more ear infections. - Never put your baby down for a nap, or for the night, with a bottle. - Don\u2019t allow sick children to spend time together. As much as possible, limit your child\u2019s exposure to other children when your child or your child\u2019s playmates are sick. Researchers sponsored by the National Institute on Deafness and Other Communication Disorders (NIDCD) are exploring many areas to improve the prevention, diagnosis, and treatment of middle ear infections. For example, finding better ways to predict which children are at higher risk of developing an ear infection could lead to successful prevention tactics. Another area that needs exploration is why some children have more ear infections than others. For example, Native American and Hispanic children have more infections than do children in other ethnic groups. What kinds of preventive measures could be taken to lower the risks? Doctors also are beginning to learn more about what happens in the ears of children who have recurring ear infections. They have identified colonies of antibiotic-resistant bacteria, called biofilms, that are present in the middle ears of most children with chronic ear infections. Understanding how to attack and kill these biofilms would be one way to successfully treat chronic ear infections and avoid surgery. Understanding the impact that ear infections have on a child\u2019s speech and language development is another important area of study. Creating more accurate methods to diagnose middle ear infections would help doctors prescribe more targeted treatments. Researchers also are evaluating drugs currently being used to treat ear infections, and developing new, more effective and easier ways to administer medicines. NIDCD-supported investigators continue to explore vaccines against some of the most common bacteria and viruses that cause middle ear infections, such as nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis. One team is conducting studies on a method for delivering a possible vaccine without a needle.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (Can ear infections be prevented?): Currently, the best way to prevent ear infections is to reduce the risk factors associated with them. Here are some things you might want to do to lower your child\u2019s risk for ear infections. - Vaccinate your child against the flu. Make sure your child gets the influenza, or flu, vaccine every year. - It is recommended that you vaccinate your child with the 13-valent pneumococcal conjugate vaccine (PCV13). The PCV13 protects against more types of infection-causing bacteria than the previous vaccine, the PCV7. If your child already has begun PCV7 vaccination, consult your physician about how to transition to PCV13. The Centers for Disease Control and Prevention (CDC) recommends that children under age 2 be vaccinated, starting at 2 months of age. Studies have shown that vaccinated children get far fewer ear infections than children who aren\u2019t vaccinated. The vaccine is strongly recommended for children in daycare. - Wash hands frequently. Washing hands prevents the spread of germs and can help keep your child from catching a cold or the flu. - Avoid exposing your baby to cigarette smoke. Studies have shown that babies who are around smokers have more ear infections. - Never put your baby down for a nap, or for the night, with a bottle. - Don\u2019t allow sick children to spend time together. As much as possible, limit your child\u2019s exposure to other children when your child or your child\u2019s playmates are sick.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (What research is being done on middle ear infections?): Researchers sponsored by the National Institute on Deafness and Other Communication Disorders (NIDCD) are exploring many areas to improve the prevention, diagnosis, and treatment of middle ear infections. For example, finding better ways to predict which children are at higher risk of developing an ear infection could lead to successful prevention tactics. Another area that needs exploration is why some children have more ear infections than others. For example, Native American and Hispanic children have more infections than do children in other ethnic groups. What kinds of preventive measures could be taken to lower the risks? Doctors also are beginning to learn more about what happens in the ears of children who have recurring ear infections. They have identified colonies of antibiotic-resistant bacteria, called biofilms, that are present in the middle ears of most children with chronic ear infections. Understanding how to attack and kill these biofilms would be one way to successfully treat chronic ear infections and avoid surgery. Understanding the impact that ear infections have on a child\u2019s speech and language development is another important area of study. Creating more accurate methods to diagnose middle ear infections would help doctors prescribe more targeted treatments. Researchers also are evaluating drugs currently being used to treat ear infections, and developing new, more effective and easier ways to administer medicines. NIDCD-supported investigators continue to explore vaccines against some of the most common bacteria and viruses that cause middle ear infections, such as nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis. One team is conducting studies on a method for delivering a possible vaccine without a needle.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (What happens if my child keeps getting ear infections?): To keep a middle ear infection from coming back, it helps to limit some of the factors that might put your child at risk, such as not being around people who smoke and not going to bed with a bottle. In spite of these precautions, some children may continue to have middle ear infections, sometimes as many as five or six a year. Your doctor may want to wait for several months to see if things get better on their own but, if the infections keep coming back and antibiotics aren\u2019t helping, many doctors will recommend a surgical procedure that places a small ventilation tube in the eardrum to improve air flow and prevent fluid backup in the middle ear. The most commonly used tubes stay in place for six to nine months and require follow-up visits until they fall out. If placement of the tubes still doesn\u2019t prevent infections, a doctor may consider removing the adenoids to prevent infection from spreading to the eustachian tubes.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (Why are children more likely than adults to get ear infections?): There are several reasons why children are more likely than adults to get ear infections. Eustachian tubes are smaller and more level in children than they are in adults. This makes it difficult for fluid to drain out of the ear, even under normal conditions. If the eustachian tubes are swollen or blocked with mucus due to a cold or other respiratory illness, fluid may not be able to drain. A child\u2019s immune system isn\u2019t as effective as an adult\u2019s because it\u2019s still developing. This makes it harder for children to fight infections. As part of the immune system, the adenoids respond to bacteria passing through the nose and mouth. Sometimes bacteria get trapped in the adenoids, causing a chronic infection that can then pass on to the eustachian tubes and the middle ear.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (How can I tell if my child has an ear infection?): Most ear infections happen to children before they\u2019ve learned how to talk. If your child isn\u2019t old enough to say \u201cMy ear hurts,\u201d here are a few things to look for: - Tugging or pulling at the ear(s) - Fussiness and crying - Trouble sleeping - Fever (especially in infants and younger children) - Fluid draining from the ear - Clumsiness or problems with balance - Trouble hearing or responding to quiet sounds",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (What are the symptoms of an ear infection?): There are three main types of ear infections. Each has a different combination of symptoms. - Acute otitis media (AOM) is the most common ear infection. Parts of the middle ear are infected and swollen and fluid is trapped behind the eardrum. This causes pain in the ear\u2014commonly called an earache. Your child might also have a fever. - Otitis media with effusion (OME) sometimes happens after an ear infection has run its course and fluid stays trapped behind the eardrum. A child with OME may have no symptoms, but a doctor will be able to see the fluid behind the eardrum with a special instrument. - Chronic otitis media with effusion (COME) happens when fluid remains in the middle ear for a long time or returns over and over again, even though there is no infection. COME makes it harder for children to fight new infections and also can affect their hearing.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (How is an acute middle ear infection treated?): Many doctors will prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days. Your doctor also may recommend over-the-counter pain relievers such as acetaminophen or ibuprofen, or eardrops, to help with fever and pain. (Because aspirin is considered a major preventable risk factor for Reye\u2019s syndrome, a child who has a fever or other flu-like symptoms should not be given aspirin unless instructed to by your doctor.) If your doctor isn\u2019t able to make a definite diagnosis of OM and your child doesn\u2019t have severe ear pain or a fever, your doctor might ask you to wait a day or two to see if the earache goes away. The American Academy of Pediatrics issued guidelines in 2013 that encourage doctors to observe and closely follow these children with ear infections that can\u2019t be definitively diagnosed, especially those between the ages of 6 months to 2 years. If there\u2019s no improvement within 48 to 72 hours from when symptoms began, the guidelines recommend doctors start antibiotic therapy. Sometimes ear pain isn\u2019t caused by infection, and some ear infections may get better without antibiotics. Using antibiotics cautiously and with good reason helps prevent the development of bacteria that become resistant to antibiotics. If your doctor prescribes an antibiotic, it\u2019s important to make sure your child takes it exactly as prescribed and for the full amount of time. Even though your child may seem better in a few days, the infection still hasn\u2019t completely cleared from the ear. Stopping the medicine too soon could allow the infection to come back. It\u2019s also important to return for your child\u2019s follow-up visit, so that the doctor can check if the infection is gone.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (What research is being done on middle ear infections?): Researchers sponsored by the National Institute on Deafness and Other Communication Disorders (NIDCD) are exploring many areas to improve the prevention, diagnosis, and treatment of middle ear infections. For example, finding better ways to predict which children are at higher risk of developing an ear infection could lead to successful prevention tactics. Another area that needs exploration is why some children have more ear infections than others. For example, Native American and Hispanic children have more infections than do children in other ethnic groups. What kinds of preventive measures could be taken to lower the risks? Doctors also are beginning to learn more about what happens in the ears of children who have recurring ear infections. They have identified colonies of antibiotic-resistant bacteria, called biofilms, that are present in the middle ears of most children with chronic ear infections. Understanding how to attack and kill these biofilms would be one way to successfully treat chronic ear infections and avoid surgery. Understanding the impact that ear infections have on a child\u2019s speech and language development is another important area of study. Creating more accurate methods to diagnose middle ear infections would help doctors prescribe more targeted treatments. Researchers also are evaluating drugs currently being used to treat ear infections, and developing new, more effective and easier ways to administer medicines. NIDCD-supported investigators continue to explore vaccines against some of the most common bacteria and viruses that cause middle ear infections, such as nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis. One team is conducting studies on a method for delivering a possible vaccine without a needle.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "What are Ear Infections?: Ear infections are the most common reason parents bring their child to a doctor. Three out of four children will have at least one ear infection by their third birthday. Adults can also get ear infections, but they are less common. The infection usually affects the middle ear and is called otitis media. The tubes inside the ears become clogged with fluid and mucus. This can affect hearing, because sound cannot get through all that fluid. If your child isn't old enough to say \"My ear hurts,\" here are a few things to look for - Tugging at ears - Crying more than usual - Fluid draining from the ear - Trouble sleeping - Balance difficulties - Hearing problems Your health care provider will diagnose an ear infection by looking inside the ear with an instrument called an otoscope. Often, ear infections go away on their own. Your health care provider may recommend pain relievers. Severe infections and infections in young babies may require antibiotics. Children who get infections often may need surgery to place small tubes inside their ears. The tubes relieve pressure in the ears so that the child can hear again. NIH: National Institute on Deafness and Other Communication Disorders",
+    "https://www.nlm.nih.gov/medlineplus/earinfections.html"
+  ],
+  [
+    "Ear Infections in Children (Can ear infections be prevented?): Currently, the best way to prevent ear infections is to reduce the risk factors associated with them. Here are some things you might want to do to lower your child\u2019s risk for ear infections. - Vaccinate your child against the flu. Make sure your child gets the influenza, or flu, vaccine every year. - It is recommended that you vaccinate your child with the 13-valent pneumococcal conjugate vaccine (PCV13). The PCV13 protects against more types of infection-causing bacteria than the previous vaccine, the PCV7. If your child already has begun PCV7 vaccination, consult your physician about how to transition to PCV13. The Centers for Disease Control and Prevention (CDC) recommends that children under age 2 be vaccinated, starting at 2 months of age. Studies have shown that vaccinated children get far fewer ear infections than children who aren\u2019t vaccinated. The vaccine is strongly recommended for children in daycare. - Wash hands frequently. Washing hands prevents the spread of germs and can help keep your child from catching a cold or the flu. - Avoid exposing your baby to cigarette smoke. Studies have shown that babies who are around smokers have more ear infections. - Never put your baby down for a nap, or for the night, with a bottle. - Don\u2019t allow sick children to spend time together. As much as possible, limit your child\u2019s exposure to other children when your child or your child\u2019s playmates are sick.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (How can I tell if my child has an ear infection?): Most ear infections happen to children before they\u2019ve learned how to talk. If your child isn\u2019t old enough to say \u201cMy ear hurts,\u201d here are a few things to look for: - Tugging or pulling at the ear(s) - Fussiness and crying - Trouble sleeping - Fever (especially in infants and younger children) - Fluid draining from the ear - Clumsiness or problems with balance - Trouble hearing or responding to quiet sounds",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (What are the symptoms of an ear infection?): There are three main types of ear infections. Each has a different combination of symptoms. - Acute otitis media (AOM) is the most common ear infection. Parts of the middle ear are infected and swollen and fluid is trapped behind the eardrum. This causes pain in the ear\u2014commonly called an earache. Your child might also have a fever. - Otitis media with effusion (OME) sometimes happens after an ear infection has run its course and fluid stays trapped behind the eardrum. A child with OME may have no symptoms, but a doctor will be able to see the fluid behind the eardrum with a special instrument. - Chronic otitis media with effusion (COME) happens when fluid remains in the middle ear for a long time or returns over and over again, even though there is no infection. COME makes it harder for children to fight new infections and also can affect their hearing.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (Why are children more likely than adults to get ear infections?): There are several reasons why children are more likely than adults to get ear infections. Eustachian tubes are smaller and more level in children than they are in adults. This makes it difficult for fluid to drain out of the ear, even under normal conditions. If the eustachian tubes are swollen or blocked with mucus due to a cold or other respiratory illness, fluid may not be able to drain. A child\u2019s immune system isn\u2019t as effective as an adult\u2019s because it\u2019s still developing. This makes it harder for children to fight infections. As part of the immune system, the adenoids respond to bacteria passing through the nose and mouth. Sometimes bacteria get trapped in the adenoids, causing a chronic infection that can then pass on to the eustachian tubes and the middle ear.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (What happens if my child keeps getting ear infections?): To keep a middle ear infection from coming back, it helps to limit some of the factors that might put your child at risk, such as not being around people who smoke and not going to bed with a bottle. In spite of these precautions, some children may continue to have middle ear infections, sometimes as many as five or six a year. Your doctor may want to wait for several months to see if things get better on their own but, if the infections keep coming back and antibiotics aren\u2019t helping, many doctors will recommend a surgical procedure that places a small ventilation tube in the eardrum to improve air flow and prevent fluid backup in the middle ear. The most commonly used tubes stay in place for six to nine months and require follow-up visits until they fall out. If placement of the tubes still doesn\u2019t prevent infections, a doctor may consider removing the adenoids to prevent infection from spreading to the eustachian tubes.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (How is an acute middle ear infection treated?): Many doctors will prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days. Your doctor also may recommend over-the-counter pain relievers such as acetaminophen or ibuprofen, or eardrops, to help with fever and pain. (Because aspirin is considered a major preventable risk factor for Reye\u2019s syndrome, a child who has a fever or other flu-like symptoms should not be given aspirin unless instructed to by your doctor.) If your doctor isn\u2019t able to make a definite diagnosis of OM and your child doesn\u2019t have severe ear pain or a fever, your doctor might ask you to wait a day or two to see if the earache goes away. The American Academy of Pediatrics issued guidelines in 2013 that encourage doctors to observe and closely follow these children with ear infections that can\u2019t be definitively diagnosed, especially those between the ages of 6 months to 2 years. If there\u2019s no improvement within 48 to 72 hours from when symptoms began, the guidelines recommend doctors start antibiotic therapy. Sometimes ear pain isn\u2019t caused by infection, and some ear infections may get better without antibiotics. Using antibiotics cautiously and with good reason helps prevent the development of bacteria that become resistant to antibiotics. If your doctor prescribes an antibiotic, it\u2019s important to make sure your child takes it exactly as prescribed and for the full amount of time. Even though your child may seem better in a few days, the infection still hasn\u2019t completely cleared from the ear. Stopping the medicine too soon could allow the infection to come back. It\u2019s also important to return for your child\u2019s follow-up visit, so that the doctor can check if the infection is gone.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (What are the symptoms of an ear infection?): There are three main types of ear infections. Each has a different combination of symptoms. - Acute otitis media (AOM) is the most common ear infection. Parts of the middle ear are infected and swollen and fluid is trapped behind the eardrum. This causes pain in the ear\u2014commonly called an earache. Your child might also have a fever. - Otitis media with effusion (OME) sometimes happens after an ear infection has run its course and fluid stays trapped behind the eardrum. A child with OME may have no symptoms, but a doctor will be able to see the fluid behind the eardrum with a special instrument. - Chronic otitis media with effusion (COME) happens when fluid remains in the middle ear for a long time or returns over and over again, even though there is no infection. COME makes it harder for children to fight new infections and also can affect their hearing.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "What are Ear Infections?: Ear infections are the most common reason parents bring their child to a doctor. Three out of four children will have at least one ear infection by their third birthday. Adults can also get ear infections, but they are less common. The infection usually affects the middle ear and is called otitis media. The tubes inside the ears become clogged with fluid and mucus. This can affect hearing, because sound cannot get through all that fluid. If your child isn't old enough to say \"My ear hurts,\" here are a few things to look for - Tugging at ears - Crying more than usual - Fluid draining from the ear - Trouble sleeping - Balance difficulties - Hearing problems Your health care provider will diagnose an ear infection by looking inside the ear with an instrument called an otoscope. Often, ear infections go away on their own. Your health care provider may recommend pain relievers. Severe infections and infections in young babies may require antibiotics. Children who get infections often may need surgery to place small tubes inside their ears. The tubes relieve pressure in the ears so that the child can hear again. NIH: National Institute on Deafness and Other Communication Disorders",
+    "https://www.nlm.nih.gov/medlineplus/earinfections.html"
+  ],
+  [
+    "Ear Infections in Children (What research is being done on middle ear infections?): Researchers sponsored by the National Institute on Deafness and Other Communication Disorders (NIDCD) are exploring many areas to improve the prevention, diagnosis, and treatment of middle ear infections. For example, finding better ways to predict which children are at higher risk of developing an ear infection could lead to successful prevention tactics. Another area that needs exploration is why some children have more ear infections than others. For example, Native American and Hispanic children have more infections than do children in other ethnic groups. What kinds of preventive measures could be taken to lower the risks? Doctors also are beginning to learn more about what happens in the ears of children who have recurring ear infections. They have identified colonies of antibiotic-resistant bacteria, called biofilms, that are present in the middle ears of most children with chronic ear infections. Understanding how to attack and kill these biofilms would be one way to successfully treat chronic ear infections and avoid surgery. Understanding the impact that ear infections have on a child\u2019s speech and language development is another important area of study. Creating more accurate methods to diagnose middle ear infections would help doctors prescribe more targeted treatments. Researchers also are evaluating drugs currently being used to treat ear infections, and developing new, more effective and easier ways to administer medicines. NIDCD-supported investigators continue to explore vaccines against some of the most common bacteria and viruses that cause middle ear infections, such as nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis. One team is conducting studies on a method for delivering a possible vaccine without a needle.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (How is an acute middle ear infection treated?): Many doctors will prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days. Your doctor also may recommend over-the-counter pain relievers such as acetaminophen or ibuprofen, or eardrops, to help with fever and pain. (Because aspirin is considered a major preventable risk factor for Reye\u2019s syndrome, a child who has a fever or other flu-like symptoms should not be given aspirin unless instructed to by your doctor.) If your doctor isn\u2019t able to make a definite diagnosis of OM and your child doesn\u2019t have severe ear pain or a fever, your doctor might ask you to wait a day or two to see if the earache goes away. The American Academy of Pediatrics issued guidelines in 2013 that encourage doctors to observe and closely follow these children with ear infections that can\u2019t be definitively diagnosed, especially those between the ages of 6 months to 2 years. If there\u2019s no improvement within 48 to 72 hours from when symptoms began, the guidelines recommend doctors start antibiotic therapy. Sometimes ear pain isn\u2019t caused by infection, and some ear infections may get better without antibiotics. Using antibiotics cautiously and with good reason helps prevent the development of bacteria that become resistant to antibiotics. If your doctor prescribes an antibiotic, it\u2019s important to make sure your child takes it exactly as prescribed and for the full amount of time. Even though your child may seem better in a few days, the infection still hasn\u2019t completely cleared from the ear. Stopping the medicine too soon could allow the infection to come back. It\u2019s also important to return for your child\u2019s follow-up visit, so that the doctor can check if the infection is gone.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (Can ear infections be prevented?): Currently, the best way to prevent ear infections is to reduce the risk factors associated with them. Here are some things you might want to do to lower your child\u2019s risk for ear infections. - Vaccinate your child against the flu. Make sure your child gets the influenza, or flu, vaccine every year. - It is recommended that you vaccinate your child with the 13-valent pneumococcal conjugate vaccine (PCV13). The PCV13 protects against more types of infection-causing bacteria than the previous vaccine, the PCV7. If your child already has begun PCV7 vaccination, consult your physician about how to transition to PCV13. The Centers for Disease Control and Prevention (CDC) recommends that children under age 2 be vaccinated, starting at 2 months of age. Studies have shown that vaccinated children get far fewer ear infections than children who aren\u2019t vaccinated. The vaccine is strongly recommended for children in daycare. - Wash hands frequently. Washing hands prevents the spread of germs and can help keep your child from catching a cold or the flu. - Avoid exposing your baby to cigarette smoke. Studies have shown that babies who are around smokers have more ear infections. - Never put your baby down for a nap, or for the night, with a bottle. - Don\u2019t allow sick children to spend time together. As much as possible, limit your child\u2019s exposure to other children when your child or your child\u2019s playmates are sick.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (How can I tell if my child has an ear infection?): Most ear infections happen to children before they\u2019ve learned how to talk. If your child isn\u2019t old enough to say \u201cMy ear hurts,\u201d here are a few things to look for: - Tugging or pulling at the ear(s) - Fussiness and crying - Trouble sleeping - Fever (especially in infants and younger children) - Fluid draining from the ear - Clumsiness or problems with balance - Trouble hearing or responding to quiet sounds",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (Why are children more likely than adults to get ear infections?): There are several reasons why children are more likely than adults to get ear infections. Eustachian tubes are smaller and more level in children than they are in adults. This makes it difficult for fluid to drain out of the ear, even under normal conditions. If the eustachian tubes are swollen or blocked with mucus due to a cold or other respiratory illness, fluid may not be able to drain. A child\u2019s immune system isn\u2019t as effective as an adult\u2019s because it\u2019s still developing. This makes it harder for children to fight infections. As part of the immune system, the adenoids respond to bacteria passing through the nose and mouth. Sometimes bacteria get trapped in the adenoids, causing a chronic infection that can then pass on to the eustachian tubes and the middle ear.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (What happens if my child keeps getting ear infections?): To keep a middle ear infection from coming back, it helps to limit some of the factors that might put your child at risk, such as not being around people who smoke and not going to bed with a bottle. In spite of these precautions, some children may continue to have middle ear infections, sometimes as many as five or six a year. Your doctor may want to wait for several months to see if things get better on their own but, if the infections keep coming back and antibiotics aren\u2019t helping, many doctors will recommend a surgical procedure that places a small ventilation tube in the eardrum to improve air flow and prevent fluid backup in the middle ear. The most commonly used tubes stay in place for six to nine months and require follow-up visits until they fall out. If placement of the tubes still doesn\u2019t prevent infections, a doctor may consider removing the adenoids to prevent infection from spreading to the eustachian tubes.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (What research is being done on middle ear infections?): Researchers sponsored by the National Institute on Deafness and Other Communication Disorders (NIDCD) are exploring many areas to improve the prevention, diagnosis, and treatment of middle ear infections. For example, finding better ways to predict which children are at higher risk of developing an ear infection could lead to successful prevention tactics. Another area that needs exploration is why some children have more ear infections than others. For example, Native American and Hispanic children have more infections than do children in other ethnic groups. What kinds of preventive measures could be taken to lower the risks? Doctors also are beginning to learn more about what happens in the ears of children who have recurring ear infections. They have identified colonies of antibiotic-resistant bacteria, called biofilms, that are present in the middle ears of most children with chronic ear infections. Understanding how to attack and kill these biofilms would be one way to successfully treat chronic ear infections and avoid surgery. Understanding the impact that ear infections have on a child\u2019s speech and language development is another important area of study. Creating more accurate methods to diagnose middle ear infections would help doctors prescribe more targeted treatments. Researchers also are evaluating drugs currently being used to treat ear infections, and developing new, more effective and easier ways to administer medicines. NIDCD-supported investigators continue to explore vaccines against some of the most common bacteria and viruses that cause middle ear infections, such as nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis. One team is conducting studies on a method for delivering a possible vaccine without a needle.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "What are the treatments for Ear infection - acute?: Some ear infections clear on their own without antibiotics. Often, treating the pain and allowing the body time to heal itself is all that is needed: - Apply a warm cloth or warm water bottle to the affected ear. - Use over-the-counter pain relief drops for ears. Or, ask the provider about prescription eardrops to relieve pain. - Take over-the-counter medicines such as ibuprofen or acetaminophen for pain or fever. Do NOT give aspirin to children. All children younger than 6 months with a fever or symptoms of an ear infection should see a provider. Children who are older than 6 months may be watched at home if they do NOT have: - A fever higher than 102F (38.9C) - More severe pain or other symptoms - Other medical problems If there is no improvement or if symptoms get worse, schedule an appointment with the provider to determine whether antibiotics are needed. ANTIBIOTICS A virus or bacteria can cause ear infections. Antibiotics will not help an infection that is caused by a virus. Most providers don't prescribe antibiotics for every ear infection. However, all children younger than 6 months with an ear infection are treated with antibiotics. Your health care provider is more likely to prescribe antibiotics if your child: - Is under age 2 - Has a fever - Appears sick - Does not improve in 24 to 48 hours If antibiotics are prescribed, it is important to take them every day and to take all of the medicine. Do NOT stop the medicine when symptoms go away. If the antibiotics do not seem to be working within 48 to 72 hours, contact your provider. You may need to switch to a different antibiotic. Side effects of antibiotics may include nausea, vomiting, and diarrhea. Although rare, serious allergic reactions may also occur. Some children have repeat ear infections that seem to go away between episodes. They may receive a smaller, daily dose of antibiotics to prevent new infections. SURGERY If an infection does not go away with the usual medical treatment, or if a child has many ear infections over a short period of time, the provider may recommend ear tubes: - A tiny tube is inserted into the eardrum, keeping open a small hole that allows air to get in so fluids can drain more easily. - Usually the tubes fall out by themselves. Those that don't fall out may be removed in the provider's office. If the adenoids are enlarged, removing them with surgery may be considered if ear infections continue to occur. Removing tonsils does not seem to help prevent ear infections.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000638.htm"
+  ],
+  [
+    "Ear Infections in Children: An ear infection is an inflammation of the middle ear, usually caused by bacteria, that occurs when fluid builds up behind the eardrum. Anyone can get an ear infection, but children get them more often than adults. Five out of six children will have at least one ear infection by their third birthday. In fact, ear infections are the most common reason parents bring their child to a doctor. The scientific name for an ear infection is otitis media (OM). There are three main types of ear infections. Each has a different combination of symptoms. - Acute otitis media (AOM) is the most common ear infection. Parts of the middle ear are infected and swollen and fluid is trapped behind the eardrum. This causes pain in the ear\u2014commonly called an earache. Your child might also have a fever. - Otitis media with effusion (OME) sometimes happens after an ear infection has run its course and fluid stays trapped behind the eardrum. A child with OME may have no symptoms, but a doctor will be able to see the fluid behind the eardrum with a special instrument. - Chronic otitis media with effusion (COME) happens when fluid remains in the middle ear for a long time or returns over and over again, even though there is no infection. COME makes it harder for children to fight new infections and also can affect their hearing. Most ear infections happen to children before they\u2019ve learned how to talk. If your child isn\u2019t old enough to say \u201cMy ear hurts,\u201d here are a few things to look for: - Tugging or pulling at the ear(s) - Fussiness and crying - Trouble sleeping - Fever (especially in infants and younger children) - Fluid draining from the ear - Clumsiness or problems with balance - Trouble hearing or responding to quiet sounds An ear infection usually is caused by bacteria and often begins after a child has a sore throat, cold, or other upper respiratory infection. If the upper respiratory infection is bacterial, these same bacteria may spread to the middle ear; if the upper respiratory infection is caused by a virus, such as a cold, bacteria may be drawn to the microbe-friendly environment and move into the middle ear as a secondary infection. Because of the infection, fluid builds up behind the eardrum. Parts of the ear The ear has three major parts: the outer ear, the middle ear, and the inner ear. The outer ear, also called the pinna, includes everything we see on the outside\u2014the curved flap of the ear leading down to the earlobe\u2014but it also includes the ear canal, which begins at the opening to the ear and extends to the eardrum. The eardrum is a membrane that separates the outer ear from the middle ear. \u00a0 The middle ear\u2014which is where ear infections occur\u2014is located between the eardrum and the inner ear. Within the middle ear are three tiny bones called the malleus, incus, and stapes that transmit sound vibrations from the eardrum to the inner ear. The bones of the middle ear are surrounded by air. The inner ear contains the labyrinth, which help us keep our balance. The cochlea, a part of the labyrinth, is a snail-shaped organ that converts sound vibrations from the middle ear into electrical signals. The auditory nerve carries these signals from the cochlea to the brain. Other nearby parts of the ear also can be involved in ear infections. The eustachian tube is a small passageway that connects the upper part of the throat to the middle ear. Its job is to supply fresh air to the middle ear, drain fluid, and keep air pressure at a steady level between the nose and the ear. Adenoids are small pads of tissue located behind the back of the nose, above the throat, and near the eustachian tubes. Adenoids are mostly made up of immune system cells. They fight off infection by trapping bacteria that enter through the mouth. There are several reasons why children are more likely than adults to get ear infections. Eustachian tubes are smaller and more level in children than they are in adults. This makes it difficult for fluid to drain out of the ear, even under normal conditions. If the eustachian tubes are swollen or blocked with mucus due to a cold or other respiratory illness, fluid may not be able to drain. A child\u2019s immune system isn\u2019t as effective as an adult\u2019s because it\u2019s still developing. This makes it harder for children to fight infections. As part of the immune system, the adenoids respond to bacteria passing through the nose and mouth. Sometimes bacteria get trapped in the adenoids, causing a chronic infection that can then pass on to the eustachian tubes and the middle ear. The first thing a doctor will do is ask you about your child\u2019s health. Has your child had a head cold or sore throat recently? Is he having trouble sleeping? Is she pulling at her ears? If an ear infection seems likely, the simplest way for a doctor to tell is to use a lighted instrument, called an otoscope, to look at the eardrum. A red, bulging eardrum indicates an infection. A doctor also may use a pneumatic otoscope, which blows a puff of air into the ear canal, to check for fluid behind the eardrum. A normal eardrum will move back and forth more easily than an eardrum with fluid behind it. Tympanometry, which uses sound tones and air pressure, is a diagnostic test a doctor might use if the diagnosis still isn\u2019t clear. A tympanometer is a small, soft plug that contains a tiny microphone and speaker as well as a device that varies air pressure in the ear. It measures how flexible the eardrum is at different pressures. Many doctors will prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days. Your doctor also may recommend over-the-counter pain relievers such as acetaminophen or ibuprofen, or eardrops, to help with fever and pain. (Because aspirin is considered a major preventable risk factor for Reye\u2019s syndrome, a child who has a fever or other flu-like symptoms should not be given aspirin unless instructed to by your doctor.) If your doctor isn\u2019t able to make a definite diagnosis of OM and your child doesn\u2019t have severe ear pain or a fever, your doctor might ask you to wait a day or two to see if the earache goes away. The American Academy of Pediatrics issued guidelines in 2013 that encourage doctors to observe and closely follow these children with ear infections that can\u2019t be definitively diagnosed, especially those between the ages of 6 months to 2 years. If there\u2019s no improvement within 48 to 72 hours from when symptoms began, the guidelines recommend doctors start antibiotic therapy. Sometimes ear pain isn\u2019t caused by infection, and some ear infections may get better without antibiotics. Using antibiotics cautiously and with good reason helps prevent the development of bacteria that become resistant to antibiotics. If your doctor prescribes an antibiotic, it\u2019s important to make sure your child takes it exactly as prescribed and for the full amount of time. Even though your child may seem better in a few days, the infection still hasn\u2019t completely cleared from the ear. Stopping the medicine too soon could allow the infection to come back. It\u2019s also important to return for your child\u2019s follow-up visit, so that the doctor can check if the infection is gone. Your child should start feeling better within a few days after visiting the doctor. If it\u2019s been several days and your child still seems sick, call your doctor. Your child might need a different antibiotic. Once the infection clears, fluid may still remain in the middle ear but usually disappears within three to six weeks. To keep a middle ear infection from coming back, it helps to limit some of the factors that might put your child at risk, such as not being around people who smoke and not going to bed with a bottle. In spite of these precautions, some children may continue to have middle ear infections, sometimes as many as five or six a year. Your doctor may want to wait for several months to see if things get better on their own but, if the infections keep coming back and antibiotics aren\u2019t helping, many doctors will recommend a surgical procedure that places a small ventilation tube in the eardrum to improve air flow and prevent fluid backup in the middle ear. The most commonly used tubes stay in place for six to nine months and require follow-up visits until they fall out. If placement of the tubes still doesn\u2019t prevent infections, a doctor may consider removing the adenoids to prevent infection from spreading to the eustachian tubes. Currently, the best way to prevent ear infections is to reduce the risk factors associated with them. Here are some things you might want to do to lower your child\u2019s risk for ear infections. - Vaccinate your child against the flu. Make sure your child gets the influenza, or flu, vaccine every year. - It is recommended that you vaccinate your child with the 13-valent pneumococcal conjugate vaccine (PCV13). The PCV13 protects against more types of infection-causing bacteria than the previous vaccine, the PCV7. If your child already has begun PCV7 vaccination, consult your physician about how to transition to PCV13. The Centers for Disease Control and Prevention (CDC) recommends that children under age 2 be vaccinated, starting at 2 months of age. Studies have shown that vaccinated children get far fewer ear infections than children who aren\u2019t vaccinated. The vaccine is strongly recommended for children in daycare. - Wash hands frequently. Washing hands prevents the spread of germs and can help keep your child from catching a cold or the flu. - Avoid exposing your baby to cigarette smoke. Studies have shown that babies who are around smokers have more ear infections. - Never put your baby down for a nap, or for the night, with a bottle. - Don\u2019t allow sick children to spend time together. As much as possible, limit your child\u2019s exposure to other children when your child or your child\u2019s playmates are sick. Researchers sponsored by the National Institute on Deafness and Other Communication Disorders (NIDCD) are exploring many areas to improve the prevention, diagnosis, and treatment of middle ear infections. For example, finding better ways to predict which children are at higher risk of developing an ear infection could lead to successful prevention tactics. Another area that needs exploration is why some children have more ear infections than others. For example, Native American and Hispanic children have more infections than do children in other ethnic groups. What kinds of preventive measures could be taken to lower the risks? Doctors also are beginning to learn more about what happens in the ears of children who have recurring ear infections. They have identified colonies of antibiotic-resistant bacteria, called biofilms, that are present in the middle ears of most children with chronic ear infections. Understanding how to attack and kill these biofilms would be one way to successfully treat chronic ear infections and avoid surgery. Understanding the impact that ear infections have on a child\u2019s speech and language development is another important area of study. Creating more accurate methods to diagnose middle ear infections would help doctors prescribe more targeted treatments. Researchers also are evaluating drugs currently being used to treat ear infections, and developing new, more effective and easier ways to administer medicines. NIDCD-supported investigators continue to explore vaccines against some of the most common bacteria and viruses that cause middle ear infections, such as nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis. One team is conducting studies on a method for delivering a possible vaccine without a needle.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (Can ear infections be prevented?): Currently, the best way to prevent ear infections is to reduce the risk factors associated with them. Here are some things you might want to do to lower your child\u2019s risk for ear infections. - Vaccinate your child against the flu. Make sure your child gets the influenza, or flu, vaccine every year. - It is recommended that you vaccinate your child with the 13-valent pneumococcal conjugate vaccine (PCV13). The PCV13 protects against more types of infection-causing bacteria than the previous vaccine, the PCV7. If your child already has begun PCV7 vaccination, consult your physician about how to transition to PCV13. The Centers for Disease Control and Prevention (CDC) recommends that children under age 2 be vaccinated, starting at 2 months of age. Studies have shown that vaccinated children get far fewer ear infections than children who aren\u2019t vaccinated. The vaccine is strongly recommended for children in daycare. - Wash hands frequently. Washing hands prevents the spread of germs and can help keep your child from catching a cold or the flu. - Avoid exposing your baby to cigarette smoke. Studies have shown that babies who are around smokers have more ear infections. - Never put your baby down for a nap, or for the night, with a bottle. - Don\u2019t allow sick children to spend time together. As much as possible, limit your child\u2019s exposure to other children when your child or your child\u2019s playmates are sick.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (How can I tell if my child has an ear infection?): Most ear infections happen to children before they\u2019ve learned how to talk. If your child isn\u2019t old enough to say \u201cMy ear hurts,\u201d here are a few things to look for: - Tugging or pulling at the ear(s) - Fussiness and crying - Trouble sleeping - Fever (especially in infants and younger children) - Fluid draining from the ear - Clumsiness or problems with balance - Trouble hearing or responding to quiet sounds",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (What are the symptoms of an ear infection?): There are three main types of ear infections. Each has a different combination of symptoms. - Acute otitis media (AOM) is the most common ear infection. Parts of the middle ear are infected and swollen and fluid is trapped behind the eardrum. This causes pain in the ear\u2014commonly called an earache. Your child might also have a fever. - Otitis media with effusion (OME) sometimes happens after an ear infection has run its course and fluid stays trapped behind the eardrum. A child with OME may have no symptoms, but a doctor will be able to see the fluid behind the eardrum with a special instrument. - Chronic otitis media with effusion (COME) happens when fluid remains in the middle ear for a long time or returns over and over again, even though there is no infection. COME makes it harder for children to fight new infections and also can affect their hearing.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (Why are children more likely than adults to get ear infections?): There are several reasons why children are more likely than adults to get ear infections. Eustachian tubes are smaller and more level in children than they are in adults. This makes it difficult for fluid to drain out of the ear, even under normal conditions. If the eustachian tubes are swollen or blocked with mucus due to a cold or other respiratory illness, fluid may not be able to drain. A child\u2019s immune system isn\u2019t as effective as an adult\u2019s because it\u2019s still developing. This makes it harder for children to fight infections. As part of the immune system, the adenoids respond to bacteria passing through the nose and mouth. Sometimes bacteria get trapped in the adenoids, causing a chronic infection that can then pass on to the eustachian tubes and the middle ear.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (What happens if my child keeps getting ear infections?): To keep a middle ear infection from coming back, it helps to limit some of the factors that might put your child at risk, such as not being around people who smoke and not going to bed with a bottle. In spite of these precautions, some children may continue to have middle ear infections, sometimes as many as five or six a year. Your doctor may want to wait for several months to see if things get better on their own but, if the infections keep coming back and antibiotics aren\u2019t helping, many doctors will recommend a surgical procedure that places a small ventilation tube in the eardrum to improve air flow and prevent fluid backup in the middle ear. The most commonly used tubes stay in place for six to nine months and require follow-up visits until they fall out. If placement of the tubes still doesn\u2019t prevent infections, a doctor may consider removing the adenoids to prevent infection from spreading to the eustachian tubes.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (How is an acute middle ear infection treated?): Many doctors will prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days. Your doctor also may recommend over-the-counter pain relievers such as acetaminophen or ibuprofen, or eardrops, to help with fever and pain. (Because aspirin is considered a major preventable risk factor for Reye\u2019s syndrome, a child who has a fever or other flu-like symptoms should not be given aspirin unless instructed to by your doctor.) If your doctor isn\u2019t able to make a definite diagnosis of OM and your child doesn\u2019t have severe ear pain or a fever, your doctor might ask you to wait a day or two to see if the earache goes away. The American Academy of Pediatrics issued guidelines in 2013 that encourage doctors to observe and closely follow these children with ear infections that can\u2019t be definitively diagnosed, especially those between the ages of 6 months to 2 years. If there\u2019s no improvement within 48 to 72 hours from when symptoms began, the guidelines recommend doctors start antibiotic therapy. Sometimes ear pain isn\u2019t caused by infection, and some ear infections may get better without antibiotics. Using antibiotics cautiously and with good reason helps prevent the development of bacteria that become resistant to antibiotics. If your doctor prescribes an antibiotic, it\u2019s important to make sure your child takes it exactly as prescribed and for the full amount of time. Even though your child may seem better in a few days, the infection still hasn\u2019t completely cleared from the ear. Stopping the medicine too soon could allow the infection to come back. It\u2019s also important to return for your child\u2019s follow-up visit, so that the doctor can check if the infection is gone.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (What research is being done on middle ear infections?): Researchers sponsored by the National Institute on Deafness and Other Communication Disorders (NIDCD) are exploring many areas to improve the prevention, diagnosis, and treatment of middle ear infections. For example, finding better ways to predict which children are at higher risk of developing an ear infection could lead to successful prevention tactics. Another area that needs exploration is why some children have more ear infections than others. For example, Native American and Hispanic children have more infections than do children in other ethnic groups. What kinds of preventive measures could be taken to lower the risks? Doctors also are beginning to learn more about what happens in the ears of children who have recurring ear infections. They have identified colonies of antibiotic-resistant bacteria, called biofilms, that are present in the middle ears of most children with chronic ear infections. Understanding how to attack and kill these biofilms would be one way to successfully treat chronic ear infections and avoid surgery. Understanding the impact that ear infections have on a child\u2019s speech and language development is another important area of study. Creating more accurate methods to diagnose middle ear infections would help doctors prescribe more targeted treatments. Researchers also are evaluating drugs currently being used to treat ear infections, and developing new, more effective and easier ways to administer medicines. NIDCD-supported investigators continue to explore vaccines against some of the most common bacteria and viruses that cause middle ear infections, such as nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis. One team is conducting studies on a method for delivering a possible vaccine without a needle.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "What are Ear Infections?: Ear infections are the most common reason parents bring their child to a doctor. Three out of four children will have at least one ear infection by their third birthday. Adults can also get ear infections, but they are less common. The infection usually affects the middle ear and is called otitis media. The tubes inside the ears become clogged with fluid and mucus. This can affect hearing, because sound cannot get through all that fluid. If your child isn't old enough to say \"My ear hurts,\" here are a few things to look for - Tugging at ears - Crying more than usual - Fluid draining from the ear - Trouble sleeping - Balance difficulties - Hearing problems Your health care provider will diagnose an ear infection by looking inside the ear with an instrument called an otoscope. Often, ear infections go away on their own. Your health care provider may recommend pain relievers. Severe infections and infections in young babies may require antibiotics. Children who get infections often may need surgery to place small tubes inside their ears. The tubes relieve pressure in the ears so that the child can hear again. NIH: National Institute on Deafness and Other Communication Disorders",
+    "https://www.nlm.nih.gov/medlineplus/earinfections.html"
+  ],
+  [
+    "Ear infection (middle ear) (Diagnosis): Your doctor can usually diagnose an ear infection or another condition based on the symptoms you describe and an exam. The doctor will likely use a lighted instrument (an otoscope) to look at the ears, throat and nasal passage. He or she will also likely listen to your child breathe with a stethoscope. Pneumatic otoscope An instrument called a pneumatic otoscope is often the only specialized tool a doctor needs to make a diagnosis of an ear infection. This instrument enables the doctor to look in the ear and judge whether there is fluid behind the eardrum. With the pneumatic otoscope, the doctor gently puffs air against the eardrum. Normally, this puff of air would cause the eardrum to move. If the middle ear is filled with fluid, your doctor will observe little to no movement of the eardrum. Additional tests Your doctor may perform other diagnostic tests if there is any doubt about a diagnosis, if the condition hasn't responded to previous treatments, or if there are other persistent or serious problems. - Tympanometry. This test measures the movement of the eardrum. The device, which seals off the ear canal, adjusts air pressure in the canal, thereby causing the eardrum to move. The device quantifies how well the eardrum moves and provides an indirect measure of pressure within the middle ear. - Acoustic reflectometry. This test measures how much sound emitted from a device is reflected back from the eardrum - an indirect measure of fluids in the middle ear. Normally, the eardrum absorbs most of the sound. However, the more pressure there is from fluid in the middle ear, the more sound the eardrum will reflect. - Tympanocentesis. Rarely, a doctor may use a tiny tube that pierces the eardrum to drain fluid from the middle ear - a procedure called tympanocentesis. Tests to determine the infectious agent in the fluid may be beneficial if an infection hasn't responded well to previous treatments. - Other tests. If your child has had persistent ear infections or persistent fluid buildup in the middle ear, your doctor may refer you to a hearing specialist (audiologist), speech therapist or developmental therapist for tests of hearing, speech skills, language comprehension or developmental abilities. What a diagnosis means - Acute otitis media. The diagnosis of \"ear infection\" is generally shorthand for acute otitis media. Your doctor likely makes this diagnosis if he or she observes signs of fluid in the middle ear, if there are signs or symptoms of an infection, and if the onset of symptoms was relatively sudden. - Otitis media with effusion. If the diagnosis is otitis media with effusion, the doctor has found evidence of fluid in the middle ear, but there are presently no signs or symptoms of infection. - Chronic suppurative otitis media. If the doctor makes a diagnosis of chronic suppurative otitis media, he or she has found that a persistent ear infection resulted in tearing or perforation of the eardrum.",
+    "https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616"
+  ],
+  [
+    "Ear Infections in Children (How is an acute middle ear infection treated?): Many doctors will prescribe an antibiotic, such as amoxicillin, to be taken over seven to 10 days. Your doctor also may recommend over-the-counter pain relievers such as acetaminophen or ibuprofen, or eardrops, to help with fever and pain. (Because aspirin is considered a major preventable risk factor for Reye\u2019s syndrome, a child who has a fever or other flu-like symptoms should not be given aspirin unless instructed to by your doctor.) If your doctor isn\u2019t able to make a definite diagnosis of OM and your child doesn\u2019t have severe ear pain or a fever, your doctor might ask you to wait a day or two to see if the earache goes away. The American Academy of Pediatrics issued guidelines in 2013 that encourage doctors to observe and closely follow these children with ear infections that can\u2019t be definitively diagnosed, especially those between the ages of 6 months to 2 years. If there\u2019s no improvement within 48 to 72 hours from when symptoms began, the guidelines recommend doctors start antibiotic therapy. Sometimes ear pain isn\u2019t caused by infection, and some ear infections may get better without antibiotics. Using antibiotics cautiously and with good reason helps prevent the development of bacteria that become resistant to antibiotics. If your doctor prescribes an antibiotic, it\u2019s important to make sure your child takes it exactly as prescribed and for the full amount of time. Even though your child may seem better in a few days, the infection still hasn\u2019t completely cleared from the ear. Stopping the medicine too soon could allow the infection to come back. It\u2019s also important to return for your child\u2019s follow-up visit, so that the doctor can check if the infection is gone.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (What are the symptoms of an ear infection?): There are three main types of ear infections. Each has a different combination of symptoms. - Acute otitis media (AOM) is the most common ear infection. Parts of the middle ear are infected and swollen and fluid is trapped behind the eardrum. This causes pain in the ear\u2014commonly called an earache. Your child might also have a fever. - Otitis media with effusion (OME) sometimes happens after an ear infection has run its course and fluid stays trapped behind the eardrum. A child with OME may have no symptoms, but a doctor will be able to see the fluid behind the eardrum with a special instrument. - Chronic otitis media with effusion (COME) happens when fluid remains in the middle ear for a long time or returns over and over again, even though there is no infection. COME makes it harder for children to fight new infections and also can affect their hearing.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (How can I tell if my child has an ear infection?): Most ear infections happen to children before they\u2019ve learned how to talk. If your child isn\u2019t old enough to say \u201cMy ear hurts,\u201d here are a few things to look for: - Tugging or pulling at the ear(s) - Fussiness and crying - Trouble sleeping - Fever (especially in infants and younger children) - Fluid draining from the ear - Clumsiness or problems with balance - Trouble hearing or responding to quiet sounds",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Ear Infections in Children (What happens if my child keeps getting ear infections?): To keep a middle ear infection from coming back, it helps to limit some of the factors that might put your child at risk, such as not being around people who smoke and not going to bed with a bottle. In spite of these precautions, some children may continue to have middle ear infections, sometimes as many as five or six a year. Your doctor may want to wait for several months to see if things get better on their own but, if the infections keep coming back and antibiotics aren\u2019t helping, many doctors will recommend a surgical procedure that places a small ventilation tube in the eardrum to improve air flow and prevent fluid backup in the middle ear. The most commonly used tubes stay in place for six to nine months and require follow-up visits until they fall out. If placement of the tubes still doesn\u2019t prevent infections, a doctor may consider removing the adenoids to prevent infection from spreading to the eustachian tubes.",
+    "https://www.nidcd.nih.gov/health/ear-infections-children-0"
+  ],
+  [
+    "Cervical cancer: Cervical cancer is cancer that starts in the cervix. The cervix is\u00a0the lower part of the uterus (womb) that opens at the top of the vagina. Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of the routine use of Pap smears. Cervical cancer starts in the cells on the surface of the cervix. There are 2 types of cells on the surface of the cervix, squamous and columnar. Most cervical cancers are from squamous cells. Cervical cancer\u00a0usually develops slowly. It starts as a precancerous condition called dysplasia. This condition can be detected by a Pap smear and is 100% treatable. It can take years for dysplasia to develop into cervical cancer. Most women who are diagnosed with cervical cancer today have not had regular Pap smears, or they have not followed up on abnormal Pap smear results. Almost all cervical cancers are caused by HPV (human papillomavirus). HPV is a common virus that is spread through sexual intercourse. There are many different types (strains) of HPV. Some strains lead to cervical cancer. Other strains can cause genital warts. Others do not cause any problems at all. A woman's sexual habits and patterns can increase her risk of developing cervical cancer. Risky sexual practices include: - Having sex at an early age - Having multiple sexual partners - Having a partner or many partners who take part in high-risk sexual activities Other risk factors for cervical cancer include: - Not getting the HPV vaccine - Being economically disadvantaged - Having a mother who took the drug diethylstilbestrol (DES) during pregnancy in the early 1960s to prevent miscarriage - Having a weakened immune system Most of the time, early cervical cancer has no symptoms. Symptoms that may occur include: - Abnormal vaginal bleeding between periods, after intercourse, or after menopause - Vaginal discharge that does not stop, and may be pale, watery, pink, brown, bloody, or foul-smelling - Periods that become heavier and last longer than usual Cervical cancer may spread to the bladder, intestines, lungs, and liver. Often, there are no problems until the cancer is advanced and has spread. Symptoms of advanced cervical cancer may include: - Back pain - Bone pain or fractures - Fatigue - Leaking of urine or feces from the vagina - Leg pain - Loss of appetite - Pelvic pain - Single swollen leg - Weight loss Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions: - A Pap smear screens for precancers and cancer, but does not make a final diagnosis. - The human papillomavirus (HPV) DNA test may be done along with a Pap test. Or it may be used after a woman has had an abnormal Pap test result. It may also be used as the first test. - If abnormal changes are found, the cervix is usually examined under magnification. This procedure is called colposcopy. Pieces of tissue are removed (biopsied) during this procedure. This tissue is then sent to a lab for examination. - A procedure called a\u00a0cone biopsy may also be done. If cervical cancer is diagnosed, the health care provider will order more tests. These help determine how far the cancer has spread. This is called staging. Tests may include: - Chest x-ray - CT scan of the pelvis - Cystoscopy - Intravenous pyelogram (IVP) - MRI of the pelvis Treatment of cervical cancer depends on: - The stage of the cancer - The size and shape of the tumor - The woman's age and general health - Her desire to have children in the future Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. This is why routine Pap smears are so important to prevent cervical cancer. There are surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future. Types of surgery for early cervical cancer include: - Loop electrosurgical excision procedure (LEEP): Uses electricity to remove abnormal tissue - Cryotherapy: Freezes abnormal cells - Laser therapy: Uses light to burn abnormal tissue A hysterectomy (surgery to remove the uterus but not the ovaries) is not often done for cervical cancer that has not spread. It may be done in women who have had repeated LEEP procedures. Treatment for more advanced cervical cancer may include: - Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina. - Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed. Radiation may be used to treat cancer that has spread beyond the cervix or cancer that has returned. Chemotherapy uses drugs to kill cancer. It may be given alone or with surgery or radiation. You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone. How well the person does depends on many things, including: - Type of cervical cancer - Stage of cancer (how far it has spread) - Age and general health - If the cancer comes back after treatment Precancerous conditions can be completely cured when followed up and treated properly. Most women are alive in 5 years (5-year survival rate) for cancer that has spread to the inside of the cervix walls but not outside the cervix area. The 5-year survival rate falls as the cancer spreads outside the walls of the cervix into other areas. Complications can include: - Risk of the cancer coming back in women who have treatment to save the uterus - Problems with sexual, bowel, and bladder function after surgery or radiation Call your provider if you: - Have not had regular Pap smears - Have abnormal vaginal bleeding or discharge Cervical cancer can be prevented by doing the following: - Get the HPV vaccine. The vaccine prevents most types of HPV infection that cause cervical cancer. Your provider can tell you if the vaccine is right for you. - Practice safer sex. Using condoms during sex reduces the risk for HPV and other sexually transmitted infections (STIs). - Limit the number of sexual partners you have. Avoid partners who are active in high-risk sexual behaviors. - Get Pap smears as often as your provider recommends. Pap smears can help detect early changes, which can be treated before they turn into cervical cancer. - Get the HPV test if recommended by your provider. It can be used along with the Pap test to screen for cervical cancer in women 30 years and older. - If you smoke, quit. Smoking increases your chance of getting cervical cancer. Updated by: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "How to diagnose Cervical cancer?: Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions: - A Pap smear screens for precancers and cancer, but does not make a final diagnosis. - The human papillomavirus (HPV) DNA test may be done along with a Pap test. Or it may be used after a woman has had an abnormal Pap test result. It may also be used as a main test. - If abnormal changes are found, the cervix is usually examined under magnification. This procedure is called colposcopy. Pieces of tissue are removed (biopsied) during this procedure. This tissue is then sent to a lab for examination. - A procedure called cone biopsy may also be done. If cervical cancer is diagnosed, the health care provider will order more tests. These help determine how far the cancer has spread. This is called staging. Tests may include: - Chest x-ray - CT scan of the pelvis - Cystoscopy - Intravenous pyelogram (IVP) - MRI of the pelvis",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000893.htm"
+  ],
+  [
+    "Cervical Cancer: The cervix is the lower, narrow end of the uterus (the organ where a fetus grows). The cervix leads from the uterus to the vagina (birth canal). The main types of cervical cancer are squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma begins in the thin, flat cells that line the cervix. Adenocarcinoma begins in cervical cells that make mucus and other fluids. Long-lasting infections with certain types of human papillomavirus (HPV) cause almost all cases of cervical cancer. Vaccines that protect against infection with these types of HPV can greatly reduce the risk of cervical cancer. Having a Pap test to check for abnormal cells in the cervix or a test to check for HPV can find cells that may become cervical cancer. These cells can be treated before cancer forms. Cervical cancer can usually be cured if it is found and treated in the early stages. - Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix. - Human papillomavirus (HPV) infection is the major risk factor for cervical cancer. - There are usually no signs or symptoms of early cervical cancer but it can be detected early with regular check-ups. - Signs and symptoms of cervical cancer include vaginal bleeding and pelvic pain. - Tests that examine the cervix are used to detect (find) and diagnose cervical cancer. - Certain factors affect prognosis (chance of recovery) and treatment options. - Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix. - Human papillomavirus (HPV) infection is the major risk factor for cervical cancer. - There are usually no signs or symptoms of early cervical cancer but it can be detected early with regular check-ups. - Signs and symptoms of cervical cancer include vaginal bleeding and pelvic pain. - Tests that examine the cervix are used to detect (find) and diagnose cervical cancer. - Certain factors affect prognosis (chance of recovery) and treatment options. - After cervical cancer has been diagnosed, tests are done to find out if cancer cells have spread within the cervix or to other parts of the body. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - The following stages are used for cervical cancer: - Carcinoma in Situ (Stage 0) - Stage I - Stage II - Stage III - Stage IV - After cervical cancer has been diagnosed, tests are done to find out if cancer cells have spread within the cervix or to other parts of the body. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - The following stages are used for cervical cancer: - Carcinoma in Situ (Stage 0) - Stage I - Stage II - Stage III - Stage IV - There are different types of treatment for patients with cervical cancer. - Four types of standard treatment are used: - Surgery - Radiation therapy - Chemotherapy - Targeted therapy - New types of treatment are being tested in clinical trials. - Treatment for cervical cancer may cause side effects. - Patients may want to think about taking part in a clinical trial. - Patients can enter clinical trials before, during, or after starting their cancer treatment. - Follow-up tests may be needed. - There are different types of treatment for patients with cervical cancer. - Four types of standard treatment are used: - Surgery - Radiation therapy - Chemotherapy - Targeted therapy - New types of treatment are being tested in clinical trials. - Treatment for cervical cancer may cause side effects. - Patients may want to think about taking part in a clinical trial. - Patients can enter clinical trials before, during, or after starting their cancer treatment. - Follow-up tests may be needed. Carcinoma in Situ (Stage 0) Treatment of carcinoma in situ (stage 0) may include the following: - Conization, such as cold-knife conization, loop electrosurgical excision procedure (LEEP), or laser surgery. - Hysterectomy for women who cannot or no longer want to have children. This is done only if the tumor cannot be completely removed by conization. - Internal radiation therapy for women who cannot have surgery. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stage IA Cervical Cancer Stage IA cervical cancer is separated into stage IA1 and IA2. Treatment for stage IA1 may include the following: - Conization. - Total hysterectomy with or without bilateral salpingo-oophorectomy. Treatment for stage IA2 may include the following: - Modified radical hysterectomy and removal of lymph nodes. - Radical trachelectomy. - Internal radiation therapy for women who cannot have surgery. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stages IB and IIA Cervical Cancer Treatment of stage IB and stage IIA cervical cancer may include the following: - Radiation therapy with chemotherapy given at the same time. - Radical hysterectomy and removal of pelvic lymph nodes with or without radiation therapy to the pelvis, plus chemotherapy. - Radical trachelectomy. - Chemotherapy followed by surgery. - Radiation therapy alone. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stages IIB, III, and IVA Cervical Cancer Treatment of stage IIB, stage III, and stage IVA cervical cancer may include the following: - Radiation therapy with chemotherapy given at the same time. - Surgery to remove pelvic lymph nodes followed by radiation therapy with or without chemotherapy. - Internal radiation therapy. - A clinical trial of chemotherapy to shrink the tumor followed by surgery. - A clinical trial of chemotherapy and radiation therapy given at the same time, followed by chemotherapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stage IVB Cervical Cancer Treatment of stage IVB cervical cancer may include the following: - Radiation therapy as palliative therapy to relieve symptoms caused by the cancer and improve quality of life. - Chemotherapy and targeted therapy. - Chemotherapy as palliative therapy to relieve symptoms caused by the cancer and improve quality of life. - Clinical trials of new anticancer drugs or drug combinations. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. General Information About Cervical Cancer During Pregnancy Treatment of cervical cancer during pregnancy depends on the stage of the cancer and how long the patient has been pregnant. A biopsy and imaging tests may be done to determine the stage of the disease. To avoid exposing the fetus to radiation, MRI (magnetic resonance imaging) is used. Treatment Options for Cervical Cancer During Pregnancy For information about the treatments listed below, see the Treatment Option Overview section. Carcinoma in Situ (Stage 0) During Pregnancy Usually, no treatment is needed for carcinoma in situ (stage 0) during pregnancy. A colposcopy may be done to check for invasive cancer. Stage I Cervical Cancer During Pregnancy Pregnant women with slow-growing stage I cervical cancer may be able to delay treatment until the second trimester of pregnancy or after delivery. Pregnant women with fast-growing stage I cervical cancer may need immediate treatment. Treatment may include: - Conization. - Radical trachelectomy. Women should be tested to find out if the cancer has spread to the lymph nodes. If cancer has spread to the lymph nodes, immediate treatment may be needed. Stage II, III, and IV Cervical Cancer During Pregnancy Treatment for stage II, stage III, and stage IV cervical cancer during pregnancy may include the following: - Chemotherapy to shrink the tumor in the second or third trimester of pregnancy. Surgery or radiation therapy may be done after delivery. - Radiation therapy plus chemotherapy. Talk with your doctor about the effects of radiation on the fetus. It may be necessary to end the pregnancy before treatment begins. Carcinoma in Situ (Stage 0) During Pregnancy Usually, no treatment is needed for carcinoma in situ (stage 0) during pregnancy. A colposcopy may be done to check for invasive cancer. Stage I Cervical Cancer During Pregnancy Pregnant women with slow-growing stage I cervical cancer may be able to delay treatment until the second trimester of pregnancy or after delivery. Pregnant women with fast-growing stage I cervical cancer may need immediate treatment. Treatment may include: - Conization. - Radical trachelectomy. Women should be tested to find out if the cancer has spread to the lymph nodes. If cancer has spread to the lymph nodes, immediate treatment may be needed. Stage II, III, and IV Cervical Cancer During Pregnancy Treatment for stage II, stage III, and stage IV cervical cancer during pregnancy may include the following: - Chemotherapy to shrink the tumor in the second or third trimester of pregnancy. Surgery or radiation therapy may be done after delivery. - Radiation therapy plus chemotherapy. Talk with your doctor about the effects of radiation on the fetus. It may be necessary to end the pregnancy before treatment begins.",
+    "https://www.cancer.gov/types/cervical"
+  ],
+  [
+    "Cervical cancer (Who gets cervical cancer?): Each year, about 12,000 women in the United States get cervical cancer. Cervical cancer happens most often in women 30 years or older, but all women are at risk.",
+    "https://www.womenshealth.gov/cancer/cervical-cancer"
+  ],
+  [
+    "Cervical cancer (What causes cervical cancer?): Most cases of cervical cancer are caused by a high-risk type of HPV. HPV is a virus that is passed from person to person through genital contact, such as vaginal, anal, or oral sex. If the HPV infection does not go away on its own, it may cause cervical cancer over time. Other things may increase the risk of developing cancer following a high-risk HPV infection. These other things include:",
+    "https://www.womenshealth.gov/cancer/cervical-cancer"
+  ],
+  [
+    "Cervical cancer (What can I do to prevent cervical cancer?): You can lower your risk of getting cervical cancer with the following steps. The steps work best when used together. No single step can protect you from cervical cancer. The best ways to prevent cervical cancer include:",
+    "https://www.womenshealth.gov/cancer/cervical-cancer"
+  ],
+  [
+    "Cervical cancer (What are the symptoms of cervical cancer?): You may not notice any signs or symptoms of cervical cancer. Signs of advanced cervical cancer may include bleeding or discharge from the vagina. These symptoms may not be caused by cervical cancer, but the only way to be sure is to see your doctor.",
+    "https://www.womenshealth.gov/cancer/cervical-cancer"
+  ],
+  [
+    "Cervical Cancer (Cervical Cancer During Pregnancy): General Information About Cervical Cancer During Pregnancy Treatment of cervical cancer during pregnancy depends on the stage of the cancer and how long the patient has been pregnant. A biopsy and imaging tests may be done to determine the stage of the disease. To avoid exposing the fetus to radiation, MRI (magnetic resonance imaging) is used. Treatment Options for Cervical Cancer During Pregnancy For information about the treatments listed below, see the Treatment Option Overview section. Carcinoma in Situ (Stage 0) During Pregnancy Usually, no treatment is needed for carcinoma in situ (stage 0) during pregnancy. A colposcopy may be done to check for invasive cancer. Stage I Cervical Cancer During Pregnancy Pregnant women with slow-growing stage I cervical cancer may be able to delay treatment until the second trimester of pregnancy or after delivery. Pregnant women with fast-growing stage I cervical cancer may need immediate treatment. Treatment may include: - Conization. - Radical trachelectomy. Women should be tested to find out if the cancer has spread to the lymph nodes. If cancer has spread to the lymph nodes, immediate treatment may be needed. Stage II, III, and IV Cervical Cancer During Pregnancy Treatment for stage II, stage III, and stage IV cervical cancer during pregnancy may include the following: - Chemotherapy to shrink the tumor in the second or third trimester of pregnancy. Surgery or radiation therapy may be done after delivery. - Radiation therapy plus chemotherapy. Talk with your doctor about the effects of radiation on the fetus. It may be necessary to end the pregnancy before treatment begins. Carcinoma in Situ (Stage 0) During Pregnancy Usually, no treatment is needed for carcinoma in situ (stage 0) during pregnancy. A colposcopy may be done to check for invasive cancer. Stage I Cervical Cancer During Pregnancy Pregnant women with slow-growing stage I cervical cancer may be able to delay treatment until the second trimester of pregnancy or after delivery. Pregnant women with fast-growing stage I cervical cancer may need immediate treatment. Treatment may include: - Conization. - Radical trachelectomy. Women should be tested to find out if the cancer has spread to the lymph nodes. If cancer has spread to the lymph nodes, immediate treatment may be needed. Stage II, III, and IV Cervical Cancer During Pregnancy Treatment for stage II, stage III, and stage IV cervical cancer during pregnancy may include the following: - Chemotherapy to shrink the tumor in the second or third trimester of pregnancy. Surgery or radiation therapy may be done after delivery. - Radiation therapy plus chemotherapy. Talk with your doctor about the effects of radiation on the fetus. It may be necessary to end the pregnancy before treatment begins.",
+    "https://www.cancer.gov/types/cervical"
+  ],
+  [
+    "Cervical cancer (Causes): Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of the routine use of Pap smears. Cervical cancer starts in the cells on the surface of the cervix. There are 2 types of cells on the surface of the cervix, squamous and columnar. Most cervical cancers are from squamous cells. Cervical cancer\u00a0usually develops slowly. It starts as a precancerous condition called dysplasia. This condition can be detected by a Pap smear and is 100% treatable. It can take years for dysplasia to develop into cervical cancer. Most women who are diagnosed with cervical cancer today have not had regular Pap smears, or they have not followed up on abnormal Pap smear results. Almost all cervical cancers are caused by HPV (human papillomavirus). HPV is a common virus that is spread through sexual intercourse. There are many different types (strains) of HPV. Some strains lead to cervical cancer. Other strains can cause genital warts. Others do not cause any problems at all. A woman's sexual habits and patterns can increase her risk of developing cervical cancer. Risky sexual practices include: - Having sex at an early age - Having multiple sexual partners - Having a partner or many partners who take part in high-risk sexual activities Other risk factors for cervical cancer include: - Not getting the HPV vaccine - Being economically disadvantaged - Having a mother who took the drug diethylstilbestrol (DES) during pregnancy in the early 1960s to prevent miscarriage - Having a weakened immune system",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "How to diagnose Cervical cancer?: Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions: - A Pap smear screens for precancers and cancer, but does not make a final diagnosis. - The human papillomavirus (HPV) DNA test may be done along with a Pap test. Or it may be used after a woman has had an abnormal Pap test result. It may also be used as a main test. - If abnormal changes are found, the cervix is usually examined under magnification. This procedure is called colposcopy. Pieces of tissue are removed (biopsied) during this procedure. This tissue is then sent to a lab for examination. - A procedure called cone biopsy may also be done. If cervical cancer is diagnosed, the health care provider will order more tests. These help determine how far the cancer has spread. This is called staging. Tests may include: - Chest x-ray - CT scan of the pelvis - Cystoscopy - Intravenous pyelogram (IVP) - MRI of the pelvis",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000893.htm"
+  ],
+  [
+    "Cervical cancer (Prevention): Cervical cancer can be prevented by doing the following: - Get the HPV vaccine. The vaccine prevents most types of HPV infection that cause cervical cancer. Your provider can tell you if the vaccine is right for you. - Practice safer sex. Using condoms during sex reduces the risk for HPV and other sexually transmitted infections (STIs). - Limit the number of sexual partners you have. Avoid partners who are active in high-risk sexual behaviors. - Get Pap smears as often as your provider recommends. Pap smears can help detect early changes, which can be treated before they turn into cervical cancer. - Get the HPV test if recommended by your provider. It can be used along with the Pap test to screen for cervical cancer in women 30 years and older. - If you smoke, quit. Smoking increases your chance of getting cervical cancer.",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "Cervical cancer (Treatment): Treatment of cervical cancer depends on: - The stage of the cancer - The size and shape of the tumor - The woman's age and general health - Her desire to have children in the future Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. This is why routine Pap smears are so important to prevent cervical cancer. There are surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future. Types of surgery for early cervical cancer include: - Loop electrosurgical excision procedure (LEEP): Uses electricity to remove abnormal tissue - Cryotherapy: Freezes abnormal cells - Laser therapy: Uses light to burn abnormal tissue A hysterectomy (surgery to remove the uterus but not the ovaries) is not often done for cervical cancer that has not spread. It may be done in women who have had repeated LEEP procedures. Treatment for more advanced cervical cancer may include: - Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina. - Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed. Radiation may be used to treat cancer that has spread beyond the cervix or cancer that has returned. Chemotherapy uses drugs to kill cancer. It may be given alone or with surgery or radiation.",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "Cervical cancer (Symptoms): Most of the time, early cervical cancer has no symptoms. Symptoms that may occur include: - Abnormal vaginal bleeding between periods, after intercourse, or after menopause - Vaginal discharge that does not stop, and may be pale, watery, pink, brown, bloody, or foul-smelling - Periods that become heavier and last longer than usual Cervical cancer may spread to the bladder, intestines, lungs, and liver. Often, there are no problems until the cancer is advanced and has spread. Symptoms of advanced cervical cancer may include: - Back pain - Bone pain or fractures - Fatigue - Leaking of urine or feces from the vagina - Leg pain - Loss of appetite - Pelvic pain - Single swollen leg - Weight loss",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "Cervical cancer (Summary): Cervical cancer is cancer that starts in the cervix. The cervix is\u00a0the lower part of the uterus (womb) that opens at the top of the vagina.",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "Cervical cancer (Causes): Cervical cancer begins when healthy cells acquire a genetic change (mutation) that causes them to turn into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a set time. Cancer cells grow and multiply out of control, and they don't die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from a tumor to spread (metastasize) elsewhere in the body. It isn't clear what causes cervical cancer, but it's certain that HPV plays a role. HPV is very common, and most women with the virus never develop cervical cancer. This means other factors - such as your environment or your lifestyle choices - also determine whether you'll develop cervical cancer. The type of cervical cancer that you have helps determine your prognosis and treatment. The main types of cervical cancer are: - Squamous cell carcinoma. This type of cervical cancer begins in the thin, flat cells (squamous cells) lining the outer part of the cervix, which projects into the vagina. Most cervical cancers are squamous cell carcinomas. - Adenocarcinoma. This type of cervical cancer begins in the column-shaped glandular cells that line the cervical canal. Sometimes, both types of cells are involved in cervical cancer. Very rarely, cancer occurs in other cells in the cervix.",
+    "https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501"
+  ],
+  [
+    "Cervical cancer: Cervical cancer is cancer that starts in the cervix, the lower, narrow part of the uterus (womb). Most cervical cancers are caused by the human papillomavirus (HPV). Cervical cancer is the easiest gynecological cancer to prevent with regular screening tests and vaccination. It is also very curable when found and treated early. Learn more about cervical cancer at the National Cancer Institute. Cervical cancer is cancer that starts in the cervix, the lower, narrow part of the uterus. It happens when the body's cervical cells divide very fast and grow out of control. These extra cells form a tumor. Each year, about 12,000 women in the United States get cervical cancer. Cervical cancer happens most often in women 30 years or older, but all women are at risk. Most cases of cervical cancer are caused by a high-risk type of HPV. HPV is a virus that is passed from person to person through genital contact, such as vaginal, anal, or oral sex. If the HPV infection does not go away on its own, it may cause cervical cancer over time. Other things may increase the risk of developing cancer following a high-risk HPV infection. These other things include: You may not notice any signs or symptoms of cervical cancer. Signs of advanced cervical cancer may include bleeding or discharge from the vagina. These symptoms may not be caused by cervical cancer, but the only way to be sure is to see your doctor. Women should start getting screened at age 21. You can get a Pap test to look for changes in cervical cells that could become cancer-ous if not treated. If the Pap test finds major changes in the cells of the cervix, your doctor may suggest more tests to look for cancer. Women between the ages of 30 and 65 can also get an HPV test with your Pap test to see if you have HPV. The Pap test and the HPV test look for different things. A Pap test checks the cervix for abnormal cell changes that, if not found and treated, can lead to cervical cancer. Your doctor takes cells from your cervix to examine under a microscope. How often you need a Pap test depends on your age and health history. Talk with your doctor about what is best for you. Learn more about Pap tests on our Pap test page. An HPV test looks for HPV on a woman's cervix. Certain types of HPV can lead to cervical cancer. Your doctor will swab the cervix for cells. An HPV test is not the same as the HPV vaccine. According to the U.S. Preventive Services Task Force (USPSTF), women ages 30 to 65 can combine the HPV test with a Pap test every 5 years. The USPSTF does not recommend the HPV test for women under age 30. Learn more about HPV and the HPV test on our HPV page. How often you need to be screened depends on your age and health history. Talk with your doctor about what is best for you. Most women can follow these guidelines: If you had a hysterectomy, you should follow these guidelines: You can lower your risk of getting cervical cancer with the following steps. The steps work best when used together. No single step can protect you from cervical cancer. The best ways to prevent cervical cancer include: HPV vaccines are approved for girls and young women from 9 through 26. Experts recommend that all girls get an HPV vaccine before any sexual activity, by the time they are 11 or 12. The Gardasil 9 HPV vaccine gives the most protection against cervical cancer for girls and women. Some girls younger than 15 may be able to get just two doses of the HPV vaccine, but others may need three doses of the HPV vaccine. The HPV vaccine is not recommended for pregnant women. Talk to your doctor to find out how many doses are best for you. Yes. You can still benefit from the HPV vaccine if you have already had sexual contact before getting all three doses. This only applies if you have not been infected with the HPV types included in the vaccine. For more information about cervical cancer, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:",
+    "https://www.womenshealth.gov/cancer/cervical-cancer"
+  ],
+  [
+    "Cervical cancer (Symptoms): Most of the time, early cervical cancer has no symptoms. Symptoms that may occur include: - Abnormal vaginal bleeding between periods, after intercourse, or after menopause - Vaginal discharge that does not stop, and may be pale, watery, pink, brown, bloody, or foul-smelling - Periods that become heavier and last longer than usual Cervical cancer may spread to the bladder, intestines, lungs, and liver. Often, there are no problems until the cancer is advanced and has spread. Symptoms of advanced cervical cancer may include: - Back pain - Bone pain or fractures - Fatigue - Leaking of urine or feces from the vagina - Leg pain - Loss of appetite - Pelvic pain - Single swollen leg - Weight loss",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "Cervical cancer (Symptoms): Early-stage cervical cancer generally produces no signs or symptoms. Signs and symptoms of more-advanced cervical cancer include: - Vaginal bleeding after intercourse, between periods or after menopause - Watery, bloody vaginal discharge that may be heavy and have a foul odor - Pelvic pain or pain during intercourse Make an appointment with your doctor if you have any signs or symptoms that concern you.",
+    "https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501"
+  ],
+  [
+    "Cervical cancer (What are the symptoms of cervical cancer?): You may not notice any signs or symptoms of cervical cancer. Signs of advanced cervical cancer may include bleeding or discharge from the vagina. These symptoms may not be caused by cervical cancer, but the only way to be sure is to see your doctor.",
+    "https://www.womenshealth.gov/cancer/cervical-cancer"
+  ],
+  [
+    "Cervical cancer: Cervical cancer is cancer that starts in the cervix. The cervix is\u00a0the lower part of the uterus (womb) that opens at the top of the vagina. Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of the routine use of Pap smears. Cervical cancer starts in the cells on the surface of the cervix. There are 2 types of cells on the surface of the cervix, squamous and columnar. Most cervical cancers are from squamous cells. Cervical cancer\u00a0usually develops slowly. It starts as a precancerous condition called dysplasia. This condition can be detected by a Pap smear and is 100% treatable. It can take years for dysplasia to develop into cervical cancer. Most women who are diagnosed with cervical cancer today have not had regular Pap smears, or they have not followed up on abnormal Pap smear results. Almost all cervical cancers are caused by HPV (human papillomavirus). HPV is a common virus that is spread through sexual intercourse. There are many different types (strains) of HPV. Some strains lead to cervical cancer. Other strains can cause genital warts. Others do not cause any problems at all. A woman's sexual habits and patterns can increase her risk of developing cervical cancer. Risky sexual practices include: - Having sex at an early age - Having multiple sexual partners - Having a partner or many partners who take part in high-risk sexual activities Other risk factors for cervical cancer include: - Not getting the HPV vaccine - Being economically disadvantaged - Having a mother who took the drug diethylstilbestrol (DES) during pregnancy in the early 1960s to prevent miscarriage - Having a weakened immune system Most of the time, early cervical cancer has no symptoms. Symptoms that may occur include: - Abnormal vaginal bleeding between periods, after intercourse, or after menopause - Vaginal discharge that does not stop, and may be pale, watery, pink, brown, bloody, or foul-smelling - Periods that become heavier and last longer than usual Cervical cancer may spread to the bladder, intestines, lungs, and liver. Often, there are no problems until the cancer is advanced and has spread. Symptoms of advanced cervical cancer may include: - Back pain - Bone pain or fractures - Fatigue - Leaking of urine or feces from the vagina - Leg pain - Loss of appetite - Pelvic pain - Single swollen leg - Weight loss Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions: - A Pap smear screens for precancers and cancer, but does not make a final diagnosis. - The human papillomavirus (HPV) DNA test may be done along with a Pap test. Or it may be used after a woman has had an abnormal Pap test result. It may also be used as the first test. - If abnormal changes are found, the cervix is usually examined under magnification. This procedure is called colposcopy. Pieces of tissue are removed (biopsied) during this procedure. This tissue is then sent to a lab for examination. - A procedure called a\u00a0cone biopsy may also be done. If cervical cancer is diagnosed, the health care provider will order more tests. These help determine how far the cancer has spread. This is called staging. Tests may include: - Chest x-ray - CT scan of the pelvis - Cystoscopy - Intravenous pyelogram (IVP) - MRI of the pelvis Treatment of cervical cancer depends on: - The stage of the cancer - The size and shape of the tumor - The woman's age and general health - Her desire to have children in the future Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. This is why routine Pap smears are so important to prevent cervical cancer. There are surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future. Types of surgery for early cervical cancer include: - Loop electrosurgical excision procedure (LEEP): Uses electricity to remove abnormal tissue - Cryotherapy: Freezes abnormal cells - Laser therapy: Uses light to burn abnormal tissue A hysterectomy (surgery to remove the uterus but not the ovaries) is not often done for cervical cancer that has not spread. It may be done in women who have had repeated LEEP procedures. Treatment for more advanced cervical cancer may include: - Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina. - Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed. Radiation may be used to treat cancer that has spread beyond the cervix or cancer that has returned. Chemotherapy uses drugs to kill cancer. It may be given alone or with surgery or radiation. You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone. How well the person does depends on many things, including: - Type of cervical cancer - Stage of cancer (how far it has spread) - Age and general health - If the cancer comes back after treatment Precancerous conditions can be completely cured when followed up and treated properly. Most women are alive in 5 years (5-year survival rate) for cancer that has spread to the inside of the cervix walls but not outside the cervix area. The 5-year survival rate falls as the cancer spreads outside the walls of the cervix into other areas. Complications can include: - Risk of the cancer coming back in women who have treatment to save the uterus - Problems with sexual, bowel, and bladder function after surgery or radiation Call your provider if you: - Have not had regular Pap smears - Have abnormal vaginal bleeding or discharge Cervical cancer can be prevented by doing the following: - Get the HPV vaccine. The vaccine prevents most types of HPV infection that cause cervical cancer. Your provider can tell you if the vaccine is right for you. - Practice safer sex. Using condoms during sex reduces the risk for HPV and other sexually transmitted infections (STIs). - Limit the number of sexual partners you have. Avoid partners who are active in high-risk sexual behaviors. - Get Pap smears as often as your provider recommends. Pap smears can help detect early changes, which can be treated before they turn into cervical cancer. - Get the HPV test if recommended by your provider. It can be used along with the Pap test to screen for cervical cancer in women 30 years and older. - If you smoke, quit. Smoking increases your chance of getting cervical cancer. Updated by: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "Cervical cancer (Prevention): Cervical cancer can be prevented by doing the following: - Get the HPV vaccine. The vaccine prevents most types of HPV infection that cause cervical cancer. Your provider can tell you if the vaccine is right for you. - Practice safer sex. Using condoms during sex reduces the risk for HPV and other sexually transmitted infections (STIs). - Limit the number of sexual partners you have. Avoid partners who are active in high-risk sexual behaviors. - Get Pap smears as often as your provider recommends. Pap smears can help detect early changes, which can be treated before they turn into cervical cancer. - Get the HPV test if recommended by your provider. It can be used along with the Pap test to screen for cervical cancer in women 30 years and older. - If you smoke, quit. Smoking increases your chance of getting cervical cancer.",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "Cervical cancer (Treatment): Treatment of cervical cancer depends on: - The stage of the cancer - The size and shape of the tumor - The woman's age and general health - Her desire to have children in the future Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. This is why routine Pap smears are so important to prevent cervical cancer. There are surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future. Types of surgery for early cervical cancer include: - Loop electrosurgical excision procedure (LEEP): Uses electricity to remove abnormal tissue - Cryotherapy: Freezes abnormal cells - Laser therapy: Uses light to burn abnormal tissue A hysterectomy (surgery to remove the uterus but not the ovaries) is not often done for cervical cancer that has not spread. It may be done in women who have had repeated LEEP procedures. Treatment for more advanced cervical cancer may include: - Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina. - Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed. Radiation may be used to treat cancer that has spread beyond the cervix or cancer that has returned. Chemotherapy uses drugs to kill cancer. It may be given alone or with surgery or radiation.",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "Cervical cancer (Treatment): Treatment of cervical cancer depends on: - The stage of the cancer - The size and shape of the tumor - The woman's age and general health - Her desire to have children in the future Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. This is why routine Pap smears are so important to prevent cervical cancer. There are surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future. Types of surgery for early cervical cancer include: - Loop electrosurgical excision procedure (LEEP): Uses electricity to remove abnormal tissue - Cryotherapy: Freezes abnormal cells - Laser therapy: Uses light to burn abnormal tissue A hysterectomy (surgery to remove the uterus but not the ovaries) is not often done for cervical cancer that has not spread. It may be done in women who have had repeated LEEP procedures. Treatment for more advanced cervical cancer may include: - Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina. - Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed. Radiation may be used to treat cancer that has spread beyond the cervix or cancer that has returned. Chemotherapy uses drugs to kill cancer. It may be given alone or with surgery or radiation.",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "Cervical cancer (Treatment): Treatment for cervical cancer depends on several factors, such as the stage of the cancer, other health problems you may have and your preferences. Surgery, radiation, chemotherapy or a combination of the three may be used. Surgery Early-stage cervical cancer is typically treated with surgery to remove the uterus (hysterectomy). A hysterectomy can cure early-stage cervical cancer and prevent recurrence. But removing the uterus makes it impossible to become pregnant. Your doctor may recommend: - Simple hysterectomy. The cervix and uterus are removed along with the cancer. Simple hysterectomy is usually an option only in very early-stage cervical cancer. - Radical hysterectomy. The cervix, uterus, part of the vagina and lymph nodes in the area are removed with the cancer. Minimally invasive surgery may be an option for early-stage cervical cancer. Surgery that preserves the possibility of becoming pregnant also may be an option, if you have very early-stage cervical cancer without lymph node involvement. Radiation Radiation therapy uses high-powered energy beams, such as X-rays or protons, to kill cancer cells. Radiation therapy may be used alone or with chemotherapy before surgery to shrink a tumor or after surgery to kill any remaining cancer cells. Radiation therapy can be given: - Externally, by directing a radiation beam at the affected area of the body (external beam radiation therapy) - Internally, by placing a device filled with radioactive material inside your vagina, usually for only a few minutes (brachytherapy) - Both externally and internally Premenopausal women may stop menstruating and begin menopause as a result of radiation therapy. If you might want to get pregnant after radiation treatment, ask your doctor about ways to preserve your eggs before treatment starts. Chemotherapy Chemotherapy uses medications, usually injected into a vein, to kill cancer cells. Low doses of chemotherapy are often combined with radiation therapy, since chemotherapy may enhance the effects of the radiation. Higher doses of chemotherapy are used to control advanced cervical cancer that may not be curable. Follow-up care After you complete treatment, your doctor will recommend regular checkups. Ask your doctor how often you should have follow-up exams. Supportive (palliative) care Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer. Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.",
+    "https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501"
+  ],
+  [
+    "Cervical Cancer (Treatment Option Overview): - There are different types of treatment for patients with cervical cancer. - Four types of standard treatment are used: - Surgery - Radiation therapy - Chemotherapy - Targeted therapy - New types of treatment are being tested in clinical trials. - Treatment for cervical cancer may cause side effects. - Patients may want to think about taking part in a clinical trial. - Patients can enter clinical trials before, during, or after starting their cancer treatment. - Follow-up tests may be needed.",
+    "https://www.cancer.gov/types/cervical"
+  ],
+  [
+    "Cervical Cancer (Treatment Options by Stage): Carcinoma in Situ (Stage 0) Treatment of carcinoma in situ (stage 0) may include the following: - Conization, such as cold-knife conization, loop electrosurgical excision procedure (LEEP), or laser surgery. - Hysterectomy for women who cannot or no longer want to have children. This is done only if the tumor cannot be completely removed by conization. - Internal radiation therapy for women who cannot have surgery. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stage IA Cervical Cancer Stage IA cervical cancer is separated into stage IA1 and IA2. Treatment for stage IA1 may include the following: - Conization. - Total hysterectomy with or without bilateral salpingo-oophorectomy. Treatment for stage IA2 may include the following: - Modified radical hysterectomy and removal of lymph nodes. - Radical trachelectomy. - Internal radiation therapy for women who cannot have surgery. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stages IB and IIA Cervical Cancer Treatment of stage IB and stage IIA cervical cancer may include the following: - Radiation therapy with chemotherapy given at the same time. - Radical hysterectomy and removal of pelvic lymph nodes with or without radiation therapy to the pelvis, plus chemotherapy. - Radical trachelectomy. - Chemotherapy followed by surgery. - Radiation therapy alone. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stages IIB, III, and IVA Cervical Cancer Treatment of stage IIB, stage III, and stage IVA cervical cancer may include the following: - Radiation therapy with chemotherapy given at the same time. - Surgery to remove pelvic lymph nodes followed by radiation therapy with or without chemotherapy. - Internal radiation therapy. - A clinical trial of chemotherapy to shrink the tumor followed by surgery. - A clinical trial of chemotherapy and radiation therapy given at the same time, followed by chemotherapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stage IVB Cervical Cancer Treatment of stage IVB cervical cancer may include the following: - Radiation therapy as palliative therapy to relieve symptoms caused by the cancer and improve quality of life. - Chemotherapy and targeted therapy. - Chemotherapy as palliative therapy to relieve symptoms caused by the cancer and improve quality of life. - Clinical trials of new anticancer drugs or drug combinations. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.",
+    "https://www.cancer.gov/types/cervical"
+  ],
+  [
+    "Cervical cancer: Cervical cancer is cancer that starts in the cervix. The cervix is\u00a0the lower part of the uterus (womb) that opens at the top of the vagina. Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of the routine use of Pap smears. Cervical cancer starts in the cells on the surface of the cervix. There are 2 types of cells on the surface of the cervix, squamous and columnar. Most cervical cancers are from squamous cells. Cervical cancer\u00a0usually develops slowly. It starts as a precancerous condition called dysplasia. This condition can be detected by a Pap smear and is 100% treatable. It can take years for dysplasia to develop into cervical cancer. Most women who are diagnosed with cervical cancer today have not had regular Pap smears, or they have not followed up on abnormal Pap smear results. Almost all cervical cancers are caused by HPV (human papillomavirus). HPV is a common virus that is spread through sexual intercourse. There are many different types (strains) of HPV. Some strains lead to cervical cancer. Other strains can cause genital warts. Others do not cause any problems at all. A woman's sexual habits and patterns can increase her risk of developing cervical cancer. Risky sexual practices include: - Having sex at an early age - Having multiple sexual partners - Having a partner or many partners who take part in high-risk sexual activities Other risk factors for cervical cancer include: - Not getting the HPV vaccine - Being economically disadvantaged - Having a mother who took the drug diethylstilbestrol (DES) during pregnancy in the early 1960s to prevent miscarriage - Having a weakened immune system Most of the time, early cervical cancer has no symptoms. Symptoms that may occur include: - Abnormal vaginal bleeding between periods, after intercourse, or after menopause - Vaginal discharge that does not stop, and may be pale, watery, pink, brown, bloody, or foul-smelling - Periods that become heavier and last longer than usual Cervical cancer may spread to the bladder, intestines, lungs, and liver. Often, there are no problems until the cancer is advanced and has spread. Symptoms of advanced cervical cancer may include: - Back pain - Bone pain or fractures - Fatigue - Leaking of urine or feces from the vagina - Leg pain - Loss of appetite - Pelvic pain - Single swollen leg - Weight loss Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions: - A Pap smear screens for precancers and cancer, but does not make a final diagnosis. - The human papillomavirus (HPV) DNA test may be done along with a Pap test. Or it may be used after a woman has had an abnormal Pap test result. It may also be used as the first test. - If abnormal changes are found, the cervix is usually examined under magnification. This procedure is called colposcopy. Pieces of tissue are removed (biopsied) during this procedure. This tissue is then sent to a lab for examination. - A procedure called a\u00a0cone biopsy may also be done. If cervical cancer is diagnosed, the health care provider will order more tests. These help determine how far the cancer has spread. This is called staging. Tests may include: - Chest x-ray - CT scan of the pelvis - Cystoscopy - Intravenous pyelogram (IVP) - MRI of the pelvis Treatment of cervical cancer depends on: - The stage of the cancer - The size and shape of the tumor - The woman's age and general health - Her desire to have children in the future Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. This is why routine Pap smears are so important to prevent cervical cancer. There are surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future. Types of surgery for early cervical cancer include: - Loop electrosurgical excision procedure (LEEP): Uses electricity to remove abnormal tissue - Cryotherapy: Freezes abnormal cells - Laser therapy: Uses light to burn abnormal tissue A hysterectomy (surgery to remove the uterus but not the ovaries) is not often done for cervical cancer that has not spread. It may be done in women who have had repeated LEEP procedures. Treatment for more advanced cervical cancer may include: - Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina. - Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed. Radiation may be used to treat cancer that has spread beyond the cervix or cancer that has returned. Chemotherapy uses drugs to kill cancer. It may be given alone or with surgery or radiation. You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone. How well the person does depends on many things, including: - Type of cervical cancer - Stage of cancer (how far it has spread) - Age and general health - If the cancer comes back after treatment Precancerous conditions can be completely cured when followed up and treated properly. Most women are alive in 5 years (5-year survival rate) for cancer that has spread to the inside of the cervix walls but not outside the cervix area. The 5-year survival rate falls as the cancer spreads outside the walls of the cervix into other areas. Complications can include: - Risk of the cancer coming back in women who have treatment to save the uterus - Problems with sexual, bowel, and bladder function after surgery or radiation Call your provider if you: - Have not had regular Pap smears - Have abnormal vaginal bleeding or discharge Cervical cancer can be prevented by doing the following: - Get the HPV vaccine. The vaccine prevents most types of HPV infection that cause cervical cancer. Your provider can tell you if the vaccine is right for you. - Practice safer sex. Using condoms during sex reduces the risk for HPV and other sexually transmitted infections (STIs). - Limit the number of sexual partners you have. Avoid partners who are active in high-risk sexual behaviors. - Get Pap smears as often as your provider recommends. Pap smears can help detect early changes, which can be treated before they turn into cervical cancer. - Get the HPV test if recommended by your provider. It can be used along with the Pap test to screen for cervical cancer in women 30 years and older. - If you smoke, quit. Smoking increases your chance of getting cervical cancer. Updated by: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "Cervical cancer (Prevention): Cervical cancer can be prevented by doing the following: - Get the HPV vaccine. The vaccine prevents most types of HPV infection that cause cervical cancer. Your provider can tell you if the vaccine is right for you. - Practice safer sex. Using condoms during sex reduces the risk for HPV and other sexually transmitted infections (STIs). - Limit the number of sexual partners you have. Avoid partners who are active in high-risk sexual behaviors. - Get Pap smears as often as your provider recommends. Pap smears can help detect early changes, which can be treated before they turn into cervical cancer. - Get the HPV test if recommended by your provider. It can be used along with the Pap test to screen for cervical cancer in women 30 years and older. - If you smoke, quit. Smoking increases your chance of getting cervical cancer.",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "Cervical cancer (Diagnosis): Screening Cervical cancer that is detected early is more likely to be treated successfully. Most guidelines suggest that women begin screening for cervical cancer and precancerous changes at age 21. Screening tests include: - Pap test. During a Pap test, your doctor scrapes and brushes cells from your cervix, which are then examined in a lab for abnormalities. A Pap test can detect abnormal cells in the cervix, including cancer cells and cells that show changes that increase the risk of cervical cancer. - HPV DNA test. The HPV DNA test involves testing cells collected from the cervix for infection with any of the types of HPV that are most likely to lead to cervical cancer. This test may be an option for women age 30 and older, or for younger women with an abnormal Pap test. Diagnosis If cervical cancer is suspected, your doctor is likely to start with a thorough examination of your cervix. A special magnifying instrument (colposcope) is used to check for abnormal cells. During the colposcopic examination, your doctor is likely to take a sample of cervical cells (biopsy) for laboratory testing. To obtain tissue, your doctor may use: - Punch biopsy, which involves using a sharp tool to pinch off small samples of cervical tissue. - Endocervical curettage, which uses a small, spoon-shaped instrument (curet) or a thin brush to scrape a tissue sample from the cervix. If the punch biopsy or endocervical curettage is worrisome, your doctor may perform one of the following tests: - Electrical wire loop, which uses a thin, low-voltage electrical wire to obtain a small tissue sample. Generally this is done under local anesthesia in the office. - Cone biopsy, which is a procedure that allows your doctor to obtain deeper layers of cervical cells for laboratory testing. A cone biopsy may be done in a hospital under general anesthesia. Staging If your doctor determines that you have cervical cancer, you'll have further tests to determine the extent (stage) of your cancer. Your cancer's stage is a key factor in deciding on your treatment. Staging exams include: - Imaging tests. Tests such as X-rays, CT scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) help your doctor determine whether your cancer has spread beyond your cervix. - Visual examination of your bladder and rectum. Your doctor may use special scopes to see inside your bladder and rectum. Stages of cervical cancer include: - Stage I. Cancer is confined to the cervix. - Stage II. Cancer is present in the cervix and upper portion of the vagina. - Stage III. Cancer has moved to the lower portion of the vagina or internally to the pelvic side wall. - Stage IV. Cancer has spread to nearby organs, such as the bladder or rectum, or it has spread to other areas of the body, such as the lungs, liver or bones.",
+    "https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501"
+  ],
+  [
+    "How to diagnose Cervical cancer?: Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions: - A Pap smear screens for precancers and cancer, but does not make a final diagnosis. - The human papillomavirus (HPV) DNA test may be done along with a Pap test. Or it may be used after a woman has had an abnormal Pap test result. It may also be used as a main test. - If abnormal changes are found, the cervix is usually examined under magnification. This procedure is called colposcopy. Pieces of tissue are removed (biopsied) during this procedure. This tissue is then sent to a lab for examination. - A procedure called cone biopsy may also be done. If cervical cancer is diagnosed, the health care provider will order more tests. These help determine how far the cancer has spread. This is called staging. Tests may include: - Chest x-ray - CT scan of the pelvis - Cystoscopy - Intravenous pyelogram (IVP) - MRI of the pelvis",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000893.htm"
+  ],
+  [
+    "Cervical Cancer (General Information About Cervical Cancer): - Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix. - Human papillomavirus (HPV) infection is the major risk factor for cervical cancer. - There are usually no signs or symptoms of early cervical cancer but it can be detected early with regular check-ups. - Signs and symptoms of cervical cancer include vaginal bleeding and pelvic pain. - Tests that examine the cervix are used to detect (find) and diagnose cervical cancer. - Certain factors affect prognosis (chance of recovery) and treatment options.",
+    "https://www.cancer.gov/types/cervical"
+  ],
+  [
+    "Cervical cancer: Cervical cancer is cancer that starts in the cervix. The cervix is\u00a0the lower part of the uterus (womb) that opens at the top of the vagina. Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of the routine use of Pap smears. Cervical cancer starts in the cells on the surface of the cervix. There are 2 types of cells on the surface of the cervix, squamous and columnar. Most cervical cancers are from squamous cells. Cervical cancer\u00a0usually develops slowly. It starts as a precancerous condition called dysplasia. This condition can be detected by a Pap smear and is 100% treatable. It can take years for dysplasia to develop into cervical cancer. Most women who are diagnosed with cervical cancer today have not had regular Pap smears, or they have not followed up on abnormal Pap smear results. Almost all cervical cancers are caused by HPV (human papillomavirus). HPV is a common virus that is spread through sexual intercourse. There are many different types (strains) of HPV. Some strains lead to cervical cancer. Other strains can cause genital warts. Others do not cause any problems at all. A woman's sexual habits and patterns can increase her risk of developing cervical cancer. Risky sexual practices include: - Having sex at an early age - Having multiple sexual partners - Having a partner or many partners who take part in high-risk sexual activities Other risk factors for cervical cancer include: - Not getting the HPV vaccine - Being economically disadvantaged - Having a mother who took the drug diethylstilbestrol (DES) during pregnancy in the early 1960s to prevent miscarriage - Having a weakened immune system Most of the time, early cervical cancer has no symptoms. Symptoms that may occur include: - Abnormal vaginal bleeding between periods, after intercourse, or after menopause - Vaginal discharge that does not stop, and may be pale, watery, pink, brown, bloody, or foul-smelling - Periods that become heavier and last longer than usual Cervical cancer may spread to the bladder, intestines, lungs, and liver. Often, there are no problems until the cancer is advanced and has spread. Symptoms of advanced cervical cancer may include: - Back pain - Bone pain or fractures - Fatigue - Leaking of urine or feces from the vagina - Leg pain - Loss of appetite - Pelvic pain - Single swollen leg - Weight loss Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions: - A Pap smear screens for precancers and cancer, but does not make a final diagnosis. - The human papillomavirus (HPV) DNA test may be done along with a Pap test. Or it may be used after a woman has had an abnormal Pap test result. It may also be used as the first test. - If abnormal changes are found, the cervix is usually examined under magnification. This procedure is called colposcopy. Pieces of tissue are removed (biopsied) during this procedure. This tissue is then sent to a lab for examination. - A procedure called a\u00a0cone biopsy may also be done. If cervical cancer is diagnosed, the health care provider will order more tests. These help determine how far the cancer has spread. This is called staging. Tests may include: - Chest x-ray - CT scan of the pelvis - Cystoscopy - Intravenous pyelogram (IVP) - MRI of the pelvis Treatment of cervical cancer depends on: - The stage of the cancer - The size and shape of the tumor - The woman's age and general health - Her desire to have children in the future Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. This is why routine Pap smears are so important to prevent cervical cancer. There are surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future. Types of surgery for early cervical cancer include: - Loop electrosurgical excision procedure (LEEP): Uses electricity to remove abnormal tissue - Cryotherapy: Freezes abnormal cells - Laser therapy: Uses light to burn abnormal tissue A hysterectomy (surgery to remove the uterus but not the ovaries) is not often done for cervical cancer that has not spread. It may be done in women who have had repeated LEEP procedures. Treatment for more advanced cervical cancer may include: - Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina. - Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed. Radiation may be used to treat cancer that has spread beyond the cervix or cancer that has returned. Chemotherapy uses drugs to kill cancer. It may be given alone or with surgery or radiation. You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone. How well the person does depends on many things, including: - Type of cervical cancer - Stage of cancer (how far it has spread) - Age and general health - If the cancer comes back after treatment Precancerous conditions can be completely cured when followed up and treated properly. Most women are alive in 5 years (5-year survival rate) for cancer that has spread to the inside of the cervix walls but not outside the cervix area. The 5-year survival rate falls as the cancer spreads outside the walls of the cervix into other areas. Complications can include: - Risk of the cancer coming back in women who have treatment to save the uterus - Problems with sexual, bowel, and bladder function after surgery or radiation Call your provider if you: - Have not had regular Pap smears - Have abnormal vaginal bleeding or discharge Cervical cancer can be prevented by doing the following: - Get the HPV vaccine. The vaccine prevents most types of HPV infection that cause cervical cancer. Your provider can tell you if the vaccine is right for you. - Practice safer sex. Using condoms during sex reduces the risk for HPV and other sexually transmitted infections (STIs). - Limit the number of sexual partners you have. Avoid partners who are active in high-risk sexual behaviors. - Get Pap smears as often as your provider recommends. Pap smears can help detect early changes, which can be treated before they turn into cervical cancer. - Get the HPV test if recommended by your provider. It can be used along with the Pap test to screen for cervical cancer in women 30 years and older. - If you smoke, quit. Smoking increases your chance of getting cervical cancer. Updated by: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "Cervical cancer (Prevention): Cervical cancer can be prevented by doing the following: - Get the HPV vaccine. The vaccine prevents most types of HPV infection that cause cervical cancer. Your provider can tell you if the vaccine is right for you. - Practice safer sex. Using condoms during sex reduces the risk for HPV and other sexually transmitted infections (STIs). - Limit the number of sexual partners you have. Avoid partners who are active in high-risk sexual behaviors. - Get Pap smears as often as your provider recommends. Pap smears can help detect early changes, which can be treated before they turn into cervical cancer. - Get the HPV test if recommended by your provider. It can be used along with the Pap test to screen for cervical cancer in women 30 years and older. - If you smoke, quit. Smoking increases your chance of getting cervical cancer.",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "Cervical cancer (Symptoms): Most of the time, early cervical cancer has no symptoms. Symptoms that may occur include: - Abnormal vaginal bleeding between periods, after intercourse, or after menopause - Vaginal discharge that does not stop, and may be pale, watery, pink, brown, bloody, or foul-smelling - Periods that become heavier and last longer than usual Cervical cancer may spread to the bladder, intestines, lungs, and liver. Often, there are no problems until the cancer is advanced and has spread. Symptoms of advanced cervical cancer may include: - Back pain - Bone pain or fractures - Fatigue - Leaking of urine or feces from the vagina - Leg pain - Loss of appetite - Pelvic pain - Single swollen leg - Weight loss",
+    "https://medlineplus.gov/ency/article/000893.htm"
+  ],
+  [
+    "Ovarian cancer: Ovarian cancer is cancer that begins in the ovaries. The ovaries make female hormones and produce a woman's eggs. Ovarian cancer is a serious cancer that is more common in older women. Treatment is most effective when the cancer is found early. Screening for ovarian cancer is not recommended for most women. Learn more about ovarian cancer at the National Cancer Institute. Ovarian cancer forms in tissues of the ovary. (An ovary is one of a pair of female reproductive glands in which the ova, or eggs, are formed.) Tumors in the ovaries can be benign, which means they are not cancer, or they can be malignant, which means they are cancer. Cancers that start in the ovaries can spread to other parts of the body. This is called metastasis. Cancer that starts in the ovaries and spreads to other parts of the body is still called ovarian cancer. Around one in every 60 women in the United States will develop ovarian cancer. Most ovarian cancers are diagnosed in women over 60, but this disease can also affect younger women. Among women in the United States, ovarian cancer is rare. Most ovarian cancers are diagnosed among women ages 55 to 64, but ovarian cancer can also affect younger women. Women with a high risk of ovarian cancer are those with a harmful mutation on the BRCA1 or BRCA2 genes. These mutations can be found with a blood test. Women with a family or personal history of breast or ovarian cancer also have a higher risk of ovarian cancer. If you have family members in multiple generations with breast cancer or ovarian cancer, see your doctor to learn more about your risk of ovarian cancer. Research shows that certain steps, such as surgery to remove the ovaries and the fallopian tubes, may help prevent ovarian cancer in women who are at high risk. The sooner ovarian cancer is found and treated, the better your chance for recovery. But ovarian cancer is hard to detect early, because its symptoms are also the symptoms of many other illnesses. The following may be symptoms of ovarian cancer if they continue or get worse over time: If you have any of these symptoms, talk to your doctor. He or she can determine if the cause is cancer or something else. Your doctor also may ask you to visit a gynecologic oncologist. This is a doctor who focuses on cancers of the female pelvis. The U.S. Preventive Services Task Force (USPSTF) recommends against screening women who are not at high risk for ovarian cancer. The USPSTF found that testing for ovarian cancer may do more harm than good. Current testing methods, like pelvic exams, ultrasound, and blood tests, can lead to \"false positives\" (results that say a woman has ovarian cancer when she really does not have ovarian cancer). These incorrect results can lead to surgeries that are not needed and that can be risky. Some women, like those who are at high risk, can talk to their doctor about their risk and what they can do to help prevent ovarian cancer. For more information about ovarian cancer, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "How to diagnose Ovarian cancer?: A physical exam is often normal. With advanced ovarian cancer, the doctor may find a swollen abdomen often due to accumulation of fluid (ascites). A pelvic examination may reveal an ovarian or abdominal mass. A CA-125 blood test is not considered a good screening test for ovarian cancer. But, it may be done if a woman has: - Symptoms of ovarian cancer - Already been diagnosed with ovarian cancer to determine how well treatment is working Other tests that may be done include: - Complete blood count and blood chemistry - Pregnancy test (serum HCG) - CT or MRI of the pelvis or abdomen - Ultrasound of the pelvis Surgery, such as a pelvic laparoscopy or exploratory laparotomy, is often done to find the cause of symptoms. A biopsy will be done to help make the diagnosis. No lab or imaging test has ever been shown to be able to successfully screen for or diagnose ovarian cancer in its early stages, so no standard screening tests are recommended at this time.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000889.htm"
+  ],
+  [
+    "Ovarian cancer: Ovarian cancer is a type of cancer that begins in the ovaries. The female reproductive system contains two ovaries, one on each side of the uterus. The ovaries - each about the size of an almond - produce eggs (ova) as well as the hormones estrogen and progesterone. Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat and is frequently fatal. Early-stage ovarian cancer, in which the disease is confined to the ovary, is more likely to be treated successfully. Surgery and chemotherapy are generally used to treat ovarian cancer. Early-stage ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer may cause few and nonspecific symptoms that are often mistaken for more common benign conditions. Signs and symptoms of ovarian cancer may include: - Abdominal bloating or swelling - Quickly feeling full when eating - Weight loss - Discomfort in the pelvis area - Changes in bowel habits, such as constipation - A frequent need to urinate When to see a doctor Make an appointment with your doctor if you have any signs or symptoms that worry you. If you have a family history of ovarian cancer or breast cancer, talk to your doctor about your risk of ovarian cancer. Your doctor may refer you to a genetic counselor to discuss testing for certain gene mutations that increase your risk of breast and ovarian cancers. It's not clear what causes ovarian cancer, though doctors have identified factors that can increase the risk of the disease. In general, cancer begins when a cell develops errors (mutations) in its DNA. The mutations tell the cell to grow and multiply quickly, creating a mass (tumor) of abnormal cells. The abnormal cells continue living when healthy cells would die. They can invade nearby tissues and break off from an initial tumor to spread elsewhere in the body (metastasize). Types of ovarian cancer The type of cell where the cancer begins determines the type of ovarian cancer you have. Ovarian cancer types include: - Epithelial tumors, which begin in the thin layer of tissue that covers the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors. - Stromal tumors, which begin in the ovarian tissue that contains hormone-producing cells. These tumors are usually diagnosed at an earlier stage than other ovarian tumors. About 7 percent of ovarian tumors are stromal. - Germ cell tumors, which begin in the egg-producing cells. These rare ovarian cancers tend to occur in younger women. Factors that can increase your risk of ovarian cancer include: - Older age. Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years. - Inherited gene mutations. A small percentage of ovarian cancers are caused by gene mutations you inherit from your parents. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes also increase the risk of breast cancer. Other gene mutations, including those associated with Lynch syndrome, are known to increase the risk of ovarian cancer. - Family history of ovarian cancer. People with two or more close relatives with ovarian cancer have an increased risk of the disease. - Estrogen hormone replacement therapy, especially with long-term use and in large doses. - Age when menstruation started and ended. Beginning menstruation at an early age or starting menopause at a later age, or both, may increase the risk of ovarian cancer. Tests and procedures used to diagnose ovarian cancer include: - Pelvic exam. During a pelvic exam, your doctor inserts gloved fingers into your vagina and simultaneously presses a hand on your abdomen in order to feel (palpate) your pelvic organs. The doctor also visually examines your external genitalia, vagina and cervix. - Imaging tests. Tests, such as ultrasound or CT scans of your abdomen and pelvis, may help determine the size, shape and structure of your ovaries. - Blood tests. Blood tests might include organ function tests that can help determine your overall health. Your doctor might also test your blood for tumor markers that indicate ovarian cancer. For example, a cancer antigen (CA) 125 test can detect a protein that's often found on the surface of ovarian cancer cells. These tests can't tell your doctor whether you have cancer, but may give clues about your diagnosis and prognosis. - Surgery. Sometimes your doctor can't be certain of your diagnosis until you undergo surgery to remove an ovary and have it tested for signs of cancer. Once it's confirmed that you have ovarian cancer, your doctor will use information from your tests and procedures to assign your cancer a stage. The stages of ovarian cancer are indicated using Roman numerals ranging from I to IV, with the lowest stage indicating that the cancer is confined to the ovaries. By stage IV, the cancer has spread to distant areas of the body. Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy. Surgery Operations to remove ovarian cancer include: - Surgery to remove one ovary. For very early stage cancer that hasn't spread beyond one ovary, surgery may involve removing the affected ovary and its fallopian tube. This procedure may preserve your ability to have children. - Surgery to remove both ovaries. If cancer is present in both your ovaries, but there are no signs of additional cancer, your surgeon may remove both ovaries and both fallopian tubes. This procedure leaves your uterus intact, so you may still be able to become pregnant using your own frozen embryos or eggs or with eggs from a donor. - Surgery to remove both ovaries and the uterus. If your cancer is more extensive or if you don't wish to preserve your ability to have children, your surgeon will remove the ovaries, the fallopian tubes, the uterus, nearby lymph nodes and a fold of fatty abdominal tissue (omentum). - Surgery for advanced cancer. If your cancer is advanced, your doctor may recommend chemotherapy followed by surgery to remove as much of the cancer as possible. Chemotherapy Chemotherapy is a drug treatment that uses chemicals to kill fast-growing cells in the body, including cancer cells. Chemotherapy drugs can be injected into a vein or taken by mouth. Sometimes the drugs are injected directly into the abdomen (intraperitoneal chemotherapy). Chemotherapy is often used after surgery to kill any cancer cells that might remain. It can also be used before surgery. Targeted therapy Targeted therapy uses medications that target the specific vulnerabilities present within your cancer cells. Targeted therapy drugs are usually reserved for treating ovarian cancer that returns after initial treatment or cancer that resists other treatments. Your doctor may test your cancer cells to determine which targeted therapy is most likely to have an effect on your cancer. Targeted therapy is an active area of cancer research. Many clinical trials are testing new targeted therapies. Supportive (palliative) care Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery and chemotherapy. When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer. Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.",
+    "https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941"
+  ],
+  [
+    "Ovarian cancer (Who gets ovarian cancer?): Around one in every 60 women in the United States will develop ovarian cancer. Most ovarian cancers are diagnosed in women over 60, but this disease can also affect younger women. Among women in the United States, ovarian cancer is rare. Most ovarian cancers are diagnosed among women ages 55 to 64, but ovarian cancer can also affect younger women.",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer (What is ovarian cancer?): Ovarian cancer forms in tissues of the ovary. (An ovary is one of a pair of female reproductive glands in which the ova, or eggs, are formed.) Tumors in the ovaries can be benign, which means they are not cancer, or they can be malignant, which means they are cancer. Cancers that start in the ovaries can spread to other parts of the body. This is called metastasis. Cancer that starts in the ovaries and spreads to other parts of the body is still called ovarian cancer.",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer (Should I be screened for ovarian cancer?): The U.S. Preventive Services Task Force (USPSTF) recommends against screening women who are not at high risk for ovarian cancer. The USPSTF found that testing for ovarian cancer may do more harm than good. Current testing methods, like pelvic exams, ultrasound, and blood tests, can lead to \"false positives\" (results that say a woman has ovarian cancer when she really does not have ovarian cancer). These incorrect results can lead to surgeries that are not needed and that can be risky. Some women, like those who are at high risk, can talk to their doctor about their risk and what they can do to help prevent ovarian cancer.",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer: Ovarian cancer is a form of cancer that occurs due to abnormal and uncontrolled cell growth in the ovaries. Many people with early ovarian cancer have no signs or symptoms of the condition. When present, symptoms are often nonspecific and blamed on other, more common conditions. Most cases of ovarian cancer occur sporadically in people with little to no family history of the condition; however, approximately 10-25% of ovarian cancers are thought to be \"hereditary.\" Although the underlying genetic cause of some\u00a0hereditary\u00a0cases is unknown, many are part of a hereditary cancer syndrome (such as BRCA1 or BRCA2 hereditary breast and ovarian cancer syndrome, Lynch syndrome and Peutz-Jeghers syndrome) and are inherited in an autosomal dominant manner. [1] [2] The best treatment options for ovarian cancer depend on many factors including the subtype and stage of the condition, but may include surgery, chemotherapy , radiation therapy , and/or targeted therapy (such as monoclonal antibody therapy). [3] [4] [5] Many people with early ovarian cancer have no signs or symptoms of the condition. When present, symptoms are often nonspecific and blamed on other, more common conditions. Some people with ovarian cancer may experience the following: [2] [6] Bloating Difficulty eating or early satiety Pelvic or lower abdominal pain Back pain Abnormal vaginal bleeding Digestive symptoms such as nausea and vomiting; constipation; indigestion; and/or acid reflux Weight loss or weight gain Increased urinary frequency or urgency Tiredness Shortness of breath The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Abnormality of metabolism/homeostasis - Autosomal dominant inheritance - Breast carcinoma - Dysgerminoma - Ovarian papillary adenocarcinoma - Most cases of ovarian cancer occur sporadically in people with little to no family history of the condition. They are due to random changes ( mutations ) that occur only in the cells of the ovary. These mutations (called somatic mutations ) accumulate during a person's lifetime and are not inherited or passed on to future generations. [1] However, approximately 10-25% of ovarian cancers are thought to be \"hereditary.\" These cases are caused by an inherited predisposition to ovarian cancer that is passed down through a family. In some of these families, the underlying genetic cause is not known. However, many of these cases are part of a hereditary cancer syndrome . For example, the following cancer syndromes are associated with an elevated risk of ovarian cancer and several other types of cancer: [1] Hereditary breast and ovarian cancer\u00a0syndrome\u00a0due to mutations in the BRCA1 or BRCA2 gene is the most common known cause of hereditary ovarian cancer. Lynch syndrome is caused by mutations in the MLH1, MSH2, MSH6, PMS2 or EPCAM gene Peutz-Jeghers syndrome is caused by mutations in the STK11 gene Of note, some research suggests that inherited mutations in several other genes (including BARD1 , BRIP1, MRE11A, NBN, RAD51, RAD50, CHEK2, and PALB2) may also be associated with an increased risk for ovarian cancer. However, the risk associated with many of these genes is not well understood. Most are termed \"moderate- or low-penetrant\" genes which means that, on their own, they would be expected to have a relatively small effect on ovarian cancer risk. However, in combination with other genes and/or environmental factors , these genes may lead to a significant risk of ovarian cancer. [7] Most cases of ovarian cancer occur sporadically in people with little to no family history of the condition. However, approximately 10-25% of ovarian cancer is thought to be inherited . In some of these families, the underlying genetic cause is not known. However, many of these cases are part of a hereditary cancer syndrome such as BRCA1 or BRCA2 hereditary breast and ovarian cancer syndrome, Lynch syndrome and Peutz-Jeghers syndrome, which are inherited in an autosomal dominant manner. [1] This means that a person only needs a change ( mutation ) in one copy of the responsible gene in each cell to have a hereditary predisposition\u00a0to ovarian cancer and other cancers associated with these syndromes. In some cases, an affected person inherits the mutation from an affected parent. Other cases may result from new ( de novo) mutations in the gene. A person with one of these syndromes has a 50% chance with each pregnancy of passing along the altered gene to his or her child. If ovarian cancer is suspected based on the presence of certain signs and symptoms, the following tests and procedures may be recommended: [2] [6] Physical evaluation and pelvic exam to check for signs of ovarian cancer (i.e. lumps or swelling) and to examine the size, shape and location of the ovaries Ultrasound and other imaging studies to look for abnormal growths Blood tests such as a CA-125 assay which may be elevated in people with ovarian cancer A biopsy of the tumor is the only way to confirm a diagnosis of ovarian cancer The National Cancer Institute offers more detailed information regarding the tests used to diagnose ovarian cancer. To access this resource, please click here. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. The best treatment options\u00a0for ovarian cancer depend on many factors including the subtype and\u00a0stage\u00a0of the condition. In general, treatment may include a combination of the following:[3][4][5] Surgery to remove the ovaries, the fallopian tubes, the uterus, and/or other structures in the belly (pelvis). Chemotherapy Radiation therapy Targeted therapy\u00a0(such as monoclonal antibody therapy) Unfortunately, research suggests that there are no benefits\u00a0of\u00a0ovarian cancer\u00a0 screening (using a CA-125\u00a0blood test\u00a0and transvaginal ultrasound), even\u00a0in women who are at an elevated risk due to their personal and/or family histories.[8] Women who are at a high-risk for ovarian cancer may, therefore, want to discuss other preventative measures, such as prophylactic surgery,\u00a0with their healthcare provider. In women with a known hereditary cancer syndrome , management should also\u00a0include screening for the other component cancers. Please click on the following links for more information regarding the treatment and management of each condition: Hereditary Breast and Ovarian Cancer Lynch syndrome Peutz-Jeghers syndrome \u00a0 FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information National Library of Medicine Drug Information Portal National Library of Medicine Drug Information Portal Medline Plus Health Information National Library of Medicine Drug Information Portal Medline Plus Health Information National Library of Medicine Drug Information Portal National Library of Medicine Drug Information Portal The long-term outlook ( prognosis ) for women with ovarian cancer depends on many factors including the subtype of cancer and the stage at which the cancer is diagnosed. In general, epithelial ovarian cancers (the most common subtype) are often associated with a worse prognosis than more rare subtypes such as germ cell and stromal ovarian tumors . [3] [4] [5] Because early stages of ovarian cancer are often not associated with any specific signs or symptoms, many cases are, unfortunately, diagnosed at a later and less treatable stage. Late stage ovarian cancers are generally associated with a poor prognosis. For example, 5-year survival rates for women diagnosed with stage I ovarian cancer range from 79-87%, while the 5-year survival rates for women diagnosed with stage IV ovarian cancer are approximately 11%. [2]",
+    "https://rarediseases.info.nih.gov/diseases/7295/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer (Are some women more at risk for ovarian cancer?): Women with a high risk of ovarian cancer are those with a harmful mutation on the BRCA1 or BRCA2 genes. These mutations can be found with a blood test. Women with a family or personal history of breast or ovarian cancer also have a higher risk of ovarian cancer. If you have family members in multiple generations with breast cancer or ovarian cancer, see your doctor to learn more about your risk of ovarian cancer. Research shows that certain steps, such as surgery to remove the ovaries and the fallopian tubes, may help prevent ovarian cancer in women who are at high risk. The sooner ovarian cancer is found and treated, the better your chance for recovery. But ovarian cancer is hard to detect early, because its symptoms are also the symptoms of many other illnesses.",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer (What are the symptoms of ovarian cancer?): The following may be symptoms of ovarian cancer if they continue or get worse over time: If you have any of these symptoms, talk to your doctor. He or she can determine if the cause is cancer or something else. Your doctor also may ask you to visit a gynecologic oncologist. This is a doctor who focuses on cancers of the female pelvis.",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer (Did we answer your question about ovarian cancer?): For more information about ovarian cancer, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer: Ovarian cancer is cancer that begins in the ovaries. The ovaries make female hormones and produce a woman's eggs. Ovarian cancer is a serious cancer that is more common in older women. Treatment is most effective when the cancer is found early. Screening for ovarian cancer is not recommended for most women. Learn more about ovarian cancer at the National Cancer Institute. Ovarian cancer forms in tissues of the ovary. (An ovary is one of a pair of female reproductive glands in which the ova, or eggs, are formed.) Tumors in the ovaries can be benign, which means they are not cancer, or they can be malignant, which means they are cancer. Cancers that start in the ovaries can spread to other parts of the body. This is called metastasis. Cancer that starts in the ovaries and spreads to other parts of the body is still called ovarian cancer. Around one in every 60 women in the United States will develop ovarian cancer. Most ovarian cancers are diagnosed in women over 60, but this disease can also affect younger women. Among women in the United States, ovarian cancer is rare. Most ovarian cancers are diagnosed among women ages 55 to 64, but ovarian cancer can also affect younger women. Women with a high risk of ovarian cancer are those with a harmful mutation on the BRCA1 or BRCA2 genes. These mutations can be found with a blood test. Women with a family or personal history of breast or ovarian cancer also have a higher risk of ovarian cancer. If you have family members in multiple generations with breast cancer or ovarian cancer, see your doctor to learn more about your risk of ovarian cancer. Research shows that certain steps, such as surgery to remove the ovaries and the fallopian tubes, may help prevent ovarian cancer in women who are at high risk. The sooner ovarian cancer is found and treated, the better your chance for recovery. But ovarian cancer is hard to detect early, because its symptoms are also the symptoms of many other illnesses. The following may be symptoms of ovarian cancer if they continue or get worse over time: If you have any of these symptoms, talk to your doctor. He or she can determine if the cause is cancer or something else. Your doctor also may ask you to visit a gynecologic oncologist. This is a doctor who focuses on cancers of the female pelvis. The U.S. Preventive Services Task Force (USPSTF) recommends against screening women who are not at high risk for ovarian cancer. The USPSTF found that testing for ovarian cancer may do more harm than good. Current testing methods, like pelvic exams, ultrasound, and blood tests, can lead to \"false positives\" (results that say a woman has ovarian cancer when she really does not have ovarian cancer). These incorrect results can lead to surgeries that are not needed and that can be risky. Some women, like those who are at high risk, can talk to their doctor about their risk and what they can do to help prevent ovarian cancer. For more information about ovarian cancer, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "How to diagnose Ovarian cancer?: A physical exam is often normal. With advanced ovarian cancer, the doctor may find a swollen abdomen often due to accumulation of fluid (ascites). A pelvic examination may reveal an ovarian or abdominal mass. A CA-125 blood test is not considered a good screening test for ovarian cancer. But, it may be done if a woman has: - Symptoms of ovarian cancer - Already been diagnosed with ovarian cancer to determine how well treatment is working Other tests that may be done include: - Complete blood count and blood chemistry - Pregnancy test (serum HCG) - CT or MRI of the pelvis or abdomen - Ultrasound of the pelvis Surgery, such as a pelvic laparoscopy or exploratory laparotomy, is often done to find the cause of symptoms. A biopsy will be done to help make the diagnosis. No lab or imaging test has ever been shown to be able to successfully screen for or diagnose ovarian cancer in its early stages, so no standard screening tests are recommended at this time.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000889.htm"
+  ],
+  [
+    "Ovarian cancer (Are some women more at risk for ovarian cancer?): Women with a high risk of ovarian cancer are those with a harmful mutation on the BRCA1 or BRCA2 genes. These mutations can be found with a blood test. Women with a family or personal history of breast or ovarian cancer also have a higher risk of ovarian cancer. If you have family members in multiple generations with breast cancer or ovarian cancer, see your doctor to learn more about your risk of ovarian cancer. Research shows that certain steps, such as surgery to remove the ovaries and the fallopian tubes, may help prevent ovarian cancer in women who are at high risk. The sooner ovarian cancer is found and treated, the better your chance for recovery. But ovarian cancer is hard to detect early, because its symptoms are also the symptoms of many other illnesses.",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer (Risk factors): Factors that can increase your risk of ovarian cancer include: - Older age. Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years. - Inherited gene mutations. A small percentage of ovarian cancers are caused by gene mutations you inherit from your parents. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes also increase the risk of breast cancer. Other gene mutations, including those associated with Lynch syndrome, are known to increase the risk of ovarian cancer. - Family history of ovarian cancer. People with two or more close relatives with ovarian cancer have an increased risk of the disease. - Estrogen hormone replacement therapy, especially with long-term use and in large doses. - Age when menstruation started and ended. Beginning menstruation at an early age or starting menopause at a later age, or both, may increase the risk of ovarian cancer.",
+    "https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941"
+  ],
+  [
+    "Ovarian cancer (Overview): Ovarian cancer is a type of cancer that begins in the ovaries. The female reproductive system contains two ovaries, one on each side of the uterus. The ovaries - each about the size of an almond - produce eggs (ova) as well as the hormones estrogen and progesterone. Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat and is frequently fatal. Early-stage ovarian cancer, in which the disease is confined to the ovary, is more likely to be treated successfully. Surgery and chemotherapy are generally used to treat ovarian cancer.",
+    "https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941"
+  ],
+  [
+    "Ovarian cancer (Should I be screened for ovarian cancer?): The U.S. Preventive Services Task Force (USPSTF) recommends against screening women who are not at high risk for ovarian cancer. The USPSTF found that testing for ovarian cancer may do more harm than good. Current testing methods, like pelvic exams, ultrasound, and blood tests, can lead to \"false positives\" (results that say a woman has ovarian cancer when she really does not have ovarian cancer). These incorrect results can lead to surgeries that are not needed and that can be risky. Some women, like those who are at high risk, can talk to their doctor about their risk and what they can do to help prevent ovarian cancer.",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer (Who gets ovarian cancer?): Around one in every 60 women in the United States will develop ovarian cancer. Most ovarian cancers are diagnosed in women over 60, but this disease can also affect younger women. Among women in the United States, ovarian cancer is rare. Most ovarian cancers are diagnosed among women ages 55 to 64, but ovarian cancer can also affect younger women.",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer (Causes): It's not clear what causes ovarian cancer, though doctors have identified factors that can increase the risk of the disease. In general, cancer begins when a cell develops errors (mutations) in its DNA. The mutations tell the cell to grow and multiply quickly, creating a mass (tumor) of abnormal cells. The abnormal cells continue living when healthy cells would die. They can invade nearby tissues and break off from an initial tumor to spread elsewhere in the body (metastasize). Types of ovarian cancer The type of cell where the cancer begins determines the type of ovarian cancer you have. Ovarian cancer types include: - Epithelial tumors, which begin in the thin layer of tissue that covers the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors. - Stromal tumors, which begin in the ovarian tissue that contains hormone-producing cells. These tumors are usually diagnosed at an earlier stage than other ovarian tumors. About 7 percent of ovarian tumors are stromal. - Germ cell tumors, which begin in the egg-producing cells. These rare ovarian cancers tend to occur in younger women.",
+    "https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941"
+  ],
+  [
+    "Ovarian cancer (Symptoms): Early-stage ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer may cause few and nonspecific symptoms that are often mistaken for more common benign conditions. Signs and symptoms of ovarian cancer may include: - Abdominal bloating or swelling - Quickly feeling full when eating - Weight loss - Discomfort in the pelvis area - Changes in bowel habits, such as constipation - A frequent need to urinate When to see a doctor Make an appointment with your doctor if you have any signs or symptoms that worry you. If you have a family history of ovarian cancer or breast cancer, talk to your doctor about your risk of ovarian cancer. Your doctor may refer you to a genetic counselor to discuss testing for certain gene mutations that increase your risk of breast and ovarian cancers.",
+    "https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941"
+  ],
+  [
+    "Ovarian cancer (What are the symptoms of ovarian cancer?): The following may be symptoms of ovarian cancer if they continue or get worse over time: If you have any of these symptoms, talk to your doctor. He or she can determine if the cause is cancer or something else. Your doctor also may ask you to visit a gynecologic oncologist. This is a doctor who focuses on cancers of the female pelvis.",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer (Symptoms): Many people with early ovarian cancer have no signs or symptoms of the condition. When present, symptoms are often nonspecific and blamed on other, more common conditions. Some people with ovarian cancer may experience the following: [2] [6] Bloating Difficulty eating or early satiety Pelvic or lower abdominal pain Back pain Abnormal vaginal bleeding Digestive symptoms such as nausea and vomiting; constipation; indigestion; and/or acid reflux Weight loss or weight gain Increased urinary frequency or urgency Tiredness Shortness of breath The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Abnormality of metabolism/homeostasis - Autosomal dominant inheritance - Breast carcinoma - Dysgerminoma - Ovarian papillary adenocarcinoma -",
+    "https://rarediseases.info.nih.gov/diseases/7295/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer (Diagnosis): If ovarian cancer is suspected based on the presence of certain signs and symptoms, the following tests and procedures may be recommended: [2] [6] Physical evaluation and pelvic exam to check for signs of ovarian cancer (i.e. lumps or swelling) and to examine the size, shape and location of the ovaries Ultrasound and other imaging studies to look for abnormal growths Blood tests such as a CA-125 assay which may be elevated in people with ovarian cancer A biopsy of the tumor is the only way to confirm a diagnosis of ovarian cancer The National Cancer Institute offers more detailed information regarding the tests used to diagnose ovarian cancer. To access this resource, please click here. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional.",
+    "https://rarediseases.info.nih.gov/diseases/7295/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer (Exams and Tests): A physical exam is often normal. With advanced ovarian cancer, the doctor may find a swollen abdomen often due to accumulation of fluid (ascites). A pelvic examination may reveal an ovarian or abdominal mass. A CA-125 blood test is not considered a good screening test for ovarian cancer. But, it may be done if a woman has: - Symptoms of ovarian cancer - Already been diagnosed with ovarian cancer to determine how well treatment is working Other tests that may be done include: - Complete blood count and blood chemistry - Pregnancy test (serum HCG) - CT or MRI of the pelvis or abdomen - Ultrasound of the pelvis Surgery, such as a pelvic laparoscopy or exploratory laparotomy, is often done to find the cause of symptoms. A biopsy will be done to help make the diagnosis. No lab or imaging test has ever been shown to be able to successfully screen for or diagnose ovarian cancer in its early stages, so no standard screening tests are recommended at this time.",
+    "https://medlineplus.gov/ency/article/000889.htm"
+  ],
+  [
+    "Ovarian epithelial cancer (Symptoms): The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Autosomal dominant inheritance - Breast carcinoma - Multifactorial inheritance -",
+    "https://rarediseases.info.nih.gov/diseases/9362/ovarian-epithelial-cancer"
+  ],
+  [
+    "Ovarian cancer: Ovarian cancer is cancer that begins in the ovaries. The ovaries make female hormones and produce a woman's eggs. Ovarian cancer is a serious cancer that is more common in older women. Treatment is most effective when the cancer is found early. Screening for ovarian cancer is not recommended for most women. Learn more about ovarian cancer at the National Cancer Institute. Ovarian cancer forms in tissues of the ovary. (An ovary is one of a pair of female reproductive glands in which the ova, or eggs, are formed.) Tumors in the ovaries can be benign, which means they are not cancer, or they can be malignant, which means they are cancer. Cancers that start in the ovaries can spread to other parts of the body. This is called metastasis. Cancer that starts in the ovaries and spreads to other parts of the body is still called ovarian cancer. Around one in every 60 women in the United States will develop ovarian cancer. Most ovarian cancers are diagnosed in women over 60, but this disease can also affect younger women. Among women in the United States, ovarian cancer is rare. Most ovarian cancers are diagnosed among women ages 55 to 64, but ovarian cancer can also affect younger women. Women with a high risk of ovarian cancer are those with a harmful mutation on the BRCA1 or BRCA2 genes. These mutations can be found with a blood test. Women with a family or personal history of breast or ovarian cancer also have a higher risk of ovarian cancer. If you have family members in multiple generations with breast cancer or ovarian cancer, see your doctor to learn more about your risk of ovarian cancer. Research shows that certain steps, such as surgery to remove the ovaries and the fallopian tubes, may help prevent ovarian cancer in women who are at high risk. The sooner ovarian cancer is found and treated, the better your chance for recovery. But ovarian cancer is hard to detect early, because its symptoms are also the symptoms of many other illnesses. The following may be symptoms of ovarian cancer if they continue or get worse over time: If you have any of these symptoms, talk to your doctor. He or she can determine if the cause is cancer or something else. Your doctor also may ask you to visit a gynecologic oncologist. This is a doctor who focuses on cancers of the female pelvis. The U.S. Preventive Services Task Force (USPSTF) recommends against screening women who are not at high risk for ovarian cancer. The USPSTF found that testing for ovarian cancer may do more harm than good. Current testing methods, like pelvic exams, ultrasound, and blood tests, can lead to \"false positives\" (results that say a woman has ovarian cancer when she really does not have ovarian cancer). These incorrect results can lead to surgeries that are not needed and that can be risky. Some women, like those who are at high risk, can talk to their doctor about their risk and what they can do to help prevent ovarian cancer. For more information about ovarian cancer, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer (Treatment): The best treatment options\u00a0for ovarian cancer depend on many factors including the subtype and\u00a0stage\u00a0of the condition. In general, treatment may include a combination of the following:[3][4][5] Surgery to remove the ovaries, the fallopian tubes, the uterus, and/or other structures in the belly (pelvis). Chemotherapy Radiation therapy Targeted therapy\u00a0(such as monoclonal antibody therapy) Unfortunately, research suggests that there are no benefits\u00a0of\u00a0ovarian cancer\u00a0 screening (using a CA-125\u00a0blood test\u00a0and transvaginal ultrasound), even\u00a0in women who are at an elevated risk due to their personal and/or family histories.[8] Women who are at a high-risk for ovarian cancer may, therefore, want to discuss other preventative measures, such as prophylactic surgery,\u00a0with their healthcare provider. In women with a known hereditary cancer syndrome , management should also\u00a0include screening for the other component cancers. Please click on the following links for more information regarding the treatment and management of each condition: Hereditary Breast and Ovarian Cancer Lynch syndrome Peutz-Jeghers syndrome \u00a0 FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information National Library of Medicine Drug Information Portal National Library of Medicine Drug Information Portal Medline Plus Health Information National Library of Medicine Drug Information Portal Medline Plus Health Information National Library of Medicine Drug Information Portal National Library of Medicine Drug Information Portal",
+    "https://rarediseases.info.nih.gov/diseases/7295/ovarian-cancer"
+  ],
+  [
+    "What are the treatments for ovarian cancer?: These resources address the diagnosis or management of ovarian cancer: - Dana-Farber Cancer Institute - Familial Ovarian Cancer Registry - Fred Hutchinson Cancer Research Center - Gene Review: Gene Review: BRCA1 and BRCA2 Hereditary Breast/Ovarian Cancer - Genetic Testing Registry: Hereditary breast and ovarian cancer syndrome - Genetic Testing Registry: Ovarian cancer - Genomics Education Programme (UK): Hereditary Breast and Ovarian Cancer - M.D. Anderson Cancer Center - MedlinePlus Encyclopedia: BRCA1 and BRCA2 Gene Testing - MedlinePlus Encyclopedia: CA-125 Blood Test - Memorial Sloan-Kettering Cancer Center These resources from MedlinePlus offer information about the diagnosis and management of various health conditions: - Diagnostic Tests - Drug Therapy - Surgery and Rehabilitation - Genetic Counseling - Palliative Care",
+    "https://ghr.nlm.nih.gov/condition/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer (Treatment): Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy. Surgery Operations to remove ovarian cancer include: - Surgery to remove one ovary. For very early stage cancer that hasn't spread beyond one ovary, surgery may involve removing the affected ovary and its fallopian tube. This procedure may preserve your ability to have children. - Surgery to remove both ovaries. If cancer is present in both your ovaries, but there are no signs of additional cancer, your surgeon may remove both ovaries and both fallopian tubes. This procedure leaves your uterus intact, so you may still be able to become pregnant using your own frozen embryos or eggs or with eggs from a donor. - Surgery to remove both ovaries and the uterus. If your cancer is more extensive or if you don't wish to preserve your ability to have children, your surgeon will remove the ovaries, the fallopian tubes, the uterus, nearby lymph nodes and a fold of fatty abdominal tissue (omentum). - Surgery for advanced cancer. If your cancer is advanced, your doctor may recommend chemotherapy followed by surgery to remove as much of the cancer as possible. Chemotherapy Chemotherapy is a drug treatment that uses chemicals to kill fast-growing cells in the body, including cancer cells. Chemotherapy drugs can be injected into a vein or taken by mouth. Sometimes the drugs are injected directly into the abdomen (intraperitoneal chemotherapy). Chemotherapy is often used after surgery to kill any cancer cells that might remain. It can also be used before surgery. Targeted therapy Targeted therapy uses medications that target the specific vulnerabilities present within your cancer cells. Targeted therapy drugs are usually reserved for treating ovarian cancer that returns after initial treatment or cancer that resists other treatments. Your doctor may test your cancer cells to determine which targeted therapy is most likely to have an effect on your cancer. Targeted therapy is an active area of cancer research. Many clinical trials are testing new targeted therapies. Supportive (palliative) care Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery and chemotherapy. When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer. Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.",
+    "https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941"
+  ],
+  [
+    "Ovarian cancer (Treatment): Surgery is used to treat all stages of ovarian cancer. For early stages, surgery may be the only treatment. Surgery may involve removing both ovaries and fallopian tubes, the uterus, or other structures in the belly or pelvis. Chemotherapy is used after surgery to treat any cancer that remains. Chemotherapy can also be used if the cancer comes back (relapses). Chemotherapy can be given intravenously (through an IV). Or it can be injected directly into the abdominal cavity (intraperitoneal, or IP). Radiation therapy is rarely used to treat ovarian cancer in the United States. After surgery and chemotherapy, follow instructions about how often you should see your doctor and the tests you should have.",
+    "https://medlineplus.gov/ency/article/000889.htm"
+  ],
+  [
+    "Ovarian epithelial cancer (Treatment): FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal Medline Plus Health Information National Library of Medicine Drug Information Portal Medline Plus Health Information National Library of Medicine Drug Information Portal",
+    "https://rarediseases.info.nih.gov/diseases/9362/ovarian-epithelial-cancer"
+  ],
+  [
+    "Cancer treatments (Summary): If you have cancer, your doctor will recommend one or more ways to treat the disease. The most common treatments are surgery, chemotherapy, and radiation. Newer options include targeted therapy, immunotherapy, laser hormonal therapy, and others. Here is an overview of the different treatments for cancer and how they work. Surgery Surgery is a common treatment for many types of cancer. During the operation, the surgeon takes out the mass of cancerous cells (tumor) and some of the nearby tissue. Sometimes, surgery is done to relieve side effects caused by a tumor. Chemotherapy Chemotherapy refers to drugs used to kill cancer cells. The drugs may be given by mouth, a shot, or into a blood vessel (IV). Different types of drugs may be given together at the same time or one after the other. Radiation Radiation therapy uses x-rays, particles, or radioactive seeds to kill cancer cells. Cancer cells grow and divide faster than normal cells in the body. Because radiation is most harmful to quickly growing cells, radiation therapy damages cancer cells more than normal cells. This prevents the cancer cells from growing and dividing, and leads to cell death. The two main types of radiation therapy are: - External beam. This is the most common form. It aims x-rays or particles at the tumor from outside the body. - Internal beam. This form delivers radiation inside your body. It may be given by radioactive seeds placed into or near the tumor; a liquid or pill that you swallow; or through a vein (intravenous, or IV). Targeted Therapies Targeted therapy uses drugs to stops cancer from growing and spreading. It does this with less harm to normal cells than other treatments. Standard chemotherapy works by killing cancer cells and some normal cells. Targeted treatment zeroes in on specific targets (molecules) in cancer cells. These targets play a role in how cancer cells grow and survive. Using these targets, the drug disables the cancer cells so they cannot spread. Targeted therapy drugs work in a few different ways. They may: - Turn off the process in cancer cells that causes them to grow and spread - Trigger cancer cells to die on their own - Kill cancer cells directly Targeted therapies are given as a pill or IV. Immunotherapy Immunotherapy is a type of cancer treatment that relies on the body\u2019s ability to fight infection (immune system). It uses substances made by the body or in a lab to help the immune system work harder or in a more targeted way to fight cancer. This helps your body get rid of cancer cells. Immunotherapy works by: - Stopping or slowing the growth of cancer cells - Preventing cancer from spreading to other parts of the body - Boosting the immune system's ability to get rid of cancer cells These drugs are designed to seek and attack certain parts of a cancer cell. Some\u00a0have toxins or radioactive substances attached to them. Immunotherapy is given by a shot or IV. Hormonal Therapy Hormone therapy is used to treat cancers that are fueled by hormones, such as breast, prostate, and ovarian cancers. It uses surgery, or drugs to stop or block the body's natural hormones. This helps slow the growth of cancer cells. The surgery involves removing organs that make hormones: the ovaries or testes. The drugs are given by IV or as pills. Hyperthermia Hyperthermia uses heat to damage and kill cancer cells without harming normal cells. It may be used for: - A small area of cells, such as a tumor - Parts of the body, such as an organ or limb - The whole body The heat is delivered from a machine outside the body or through a needle or probe placed in the tumor. Laser Therapy Laser therapy uses a very narrow, focused beam of light to destroy cancer cells. Laser therapy can be used to: - Destroy tumors and precancerous growths - Shrink tumors that are blocking the stomach, colon, or esophagus - Help treat cancer symptoms, such as bleeding - Seal nerve endings after surgery to reduce pain - Seal lymph vessels after surgery to reduce swelling and keep tumor cells from spreading Laser therapy is often given through a thin, lighted tube that is put inside the body. Thin fibers at the end of the tube direct the light at the cancer cells. Lasers are also used on the skin. Lasers are most often used with other types of cancer treatment such as radiation and chemotherapy. Photodynamic Therapy In photodynamic therapy, a person gets a shot of a drug that is sensitive to a special type of light. The drug stays in cancer cells longer than it stays in healthy cells. Then, the doctor directs light from a laser or other source at the cancer cells. The light changes the drug to a substance that kills the cancer cells. Cryotherapy Also called cryosurgery, this therapy uses very cold gas to freeze and kill cancer cells. It is sometimes used to treat cells that might turn into cancer (called pre-cancerous cells) on the skin or cervix, for example. Doctors can also used a special instrument to deliver cryotherapy to tumors inside the body, such as the liver or prostate.",
+    "https://medlineplus.gov/ency/patientinstructions/000901.htm"
+  ],
+  [
+    "Ovarian, Fallopian Tube, and Primary Peritoneal Cancer (Treatment Options By Stage): Stage I Ovarian Germ Cell Tumors Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor. Treatment of dysgerminoma may include the following: - Unilateral salpingo-oophorectomy with or without lymphangiography or CT scan. - Unilateral salpingo-oophorectomy followed by observation. - Unilateral salpingo-oophorectomy followed by radiation therapy. - Unilateral salpingo-oophorectomy followed by chemotherapy. Treatment of other ovarian germ cell tumors may be either: - unilateral salpingo-oophorectomy followed by careful observation; or - unilateral salpingo-oophorectomy, sometimes followed by combination chemotherapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stage II Ovarian Germ Cell Tumors Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor. Treatment of dysgerminoma may be either: - total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by radiation therapy or combination chemotherapy; or - unilateral salpingo-oophorectomy followed by chemotherapy. Treatment of other ovarian germ cell tumors may include the following: - Unilateral salpingo-oophorectomy followed by combination chemotherapy. - Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain). - A clinical trial of a new treatment. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stage III Ovarian Germ Cell Tumors Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor. Treatment of dysgerminoma may include the following: - Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible. - Unilateral salpingo-oophorectomy followed by chemotherapy. Treatment of other ovarian germ cell tumors may include the following: - Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible. Chemotherapy will be given before and/or after surgery. - Unilateral salpingo-oophorectomy followed by chemotherapy. - Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain). - A clinical trial of a new treatment. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Stage IV Ovarian Germ Cell Tumors Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor. Treatment of dysgerminoma may include the following: - Total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by chemotherapy, with removal of as much of the cancer in the pelvis and abdomen as possible. - Unilateral salpingo-oophorectomy followed by chemotherapy. Treatment of other ovarian germ cell tumors may include the following: - Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible. Chemotherapy will be given before and/or after surgery. - Unilateral salpingo-oophorectomy followed by chemotherapy. - Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain). - A clinical trial of a new treatment. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.",
+    "https://www.cancer.gov/types/ovarian"
+  ],
+  [
+    "Ovarian, Fallopian Tube, and Primary Peritoneal Cancer (Treatment Options by Stage): Early Ovarian Epithelial and Fallopian Tube Cancer Treatment of early ovarian epithelial cancer or fallopian tube cancer may include the following: - Hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Lymph nodes and other tissues in the pelvis and abdomen are removed and checked under a microscope for cancer cells. Chemotherapy may be given after surgery. - Unilateral salpingo-oophorectomy may be done in certain women who wish to have children. Chemotherapy may be given after surgery. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available. Advanced Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment of advanced ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cancer may include the following: - Hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Lymph nodes and other tissues in the pelvis and abdomen are removed and checked under a microscope to look for cancer cells. Surgery is followed by one of the following: - Intravenous chemotherapy. - Intraperitoneal chemotherapy. - Chemotherapy and targeted therapy (bevacizumab, olaparib, or niraparib). - Chemotherapy followed by hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. - Chemotherapy alone for patients who cannot have surgery. - A clinical trial of intraperitoneal radiation therapy, immunotherapy (vaccine therapy), or targeted therapy. Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.",
+    "https://www.cancer.gov/types/ovarian"
+  ],
+  [
+    "Ovarian cancer (Diagnosis): Tests and procedures used to diagnose ovarian cancer include: - Pelvic exam. During a pelvic exam, your doctor inserts gloved fingers into your vagina and simultaneously presses a hand on your abdomen in order to feel (palpate) your pelvic organs. The doctor also visually examines your external genitalia, vagina and cervix. - Imaging tests. Tests, such as ultrasound or CT scans of your abdomen and pelvis, may help determine the size, shape and structure of your ovaries. - Blood tests. Blood tests might include organ function tests that can help determine your overall health. Your doctor might also test your blood for tumor markers that indicate ovarian cancer. For example, a cancer antigen (CA) 125 test can detect a protein that's often found on the surface of ovarian cancer cells. These tests can't tell your doctor whether you have cancer, but may give clues about your diagnosis and prognosis. - Surgery. Sometimes your doctor can't be certain of your diagnosis until you undergo surgery to remove an ovary and have it tested for signs of cancer. Once it's confirmed that you have ovarian cancer, your doctor will use information from your tests and procedures to assign your cancer a stage. The stages of ovarian cancer are indicated using Roman numerals ranging from I to IV, with the lowest stage indicating that the cancer is confined to the ovaries. By stage IV, the cancer has spread to distant areas of the body.",
+    "https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941"
+  ],
+  [
+    "How to diagnose Ovarian cancer?: A physical exam is often normal. With advanced ovarian cancer, the doctor may find a swollen abdomen often due to accumulation of fluid (ascites). A pelvic examination may reveal an ovarian or abdominal mass. A CA-125 blood test is not considered a good screening test for ovarian cancer. But, it may be done if a woman has: - Symptoms of ovarian cancer - Already been diagnosed with ovarian cancer to determine how well treatment is working Other tests that may be done include: - Complete blood count and blood chemistry - Pregnancy test (serum HCG) - CT or MRI of the pelvis or abdomen - Ultrasound of the pelvis Surgery, such as a pelvic laparoscopy or exploratory laparotomy, is often done to find the cause of symptoms. A biopsy will be done to help make the diagnosis. No lab or imaging test has ever been shown to be able to successfully screen for or diagnose ovarian cancer in its early stages, so no standard screening tests are recommended at this time.",
+    "https://www.nlm.nih.gov/medlineplus/ency/article/000889.htm"
+  ],
+  [
+    "Ovarian cancer (Diagnosis): If ovarian cancer is suspected based on the presence of certain signs and symptoms, the following tests and procedures may be recommended: [2] [6] Physical evaluation and pelvic exam to check for signs of ovarian cancer (i.e. lumps or swelling) and to examine the size, shape and location of the ovaries Ultrasound and other imaging studies to look for abnormal growths Blood tests such as a CA-125 assay which may be elevated in people with ovarian cancer A biopsy of the tumor is the only way to confirm a diagnosis of ovarian cancer The National Cancer Institute offers more detailed information regarding the tests used to diagnose ovarian cancer. To access this resource, please click here. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional.",
+    "https://rarediseases.info.nih.gov/diseases/7295/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer: Ovarian cancer is a type of cancer that begins in the ovaries. The female reproductive system contains two ovaries, one on each side of the uterus. The ovaries - each about the size of an almond - produce eggs (ova) as well as the hormones estrogen and progesterone. Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat and is frequently fatal. Early-stage ovarian cancer, in which the disease is confined to the ovary, is more likely to be treated successfully. Surgery and chemotherapy are generally used to treat ovarian cancer. Early-stage ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer may cause few and nonspecific symptoms that are often mistaken for more common benign conditions. Signs and symptoms of ovarian cancer may include: - Abdominal bloating or swelling - Quickly feeling full when eating - Weight loss - Discomfort in the pelvis area - Changes in bowel habits, such as constipation - A frequent need to urinate When to see a doctor Make an appointment with your doctor if you have any signs or symptoms that worry you. If you have a family history of ovarian cancer or breast cancer, talk to your doctor about your risk of ovarian cancer. Your doctor may refer you to a genetic counselor to discuss testing for certain gene mutations that increase your risk of breast and ovarian cancers. It's not clear what causes ovarian cancer, though doctors have identified factors that can increase the risk of the disease. In general, cancer begins when a cell develops errors (mutations) in its DNA. The mutations tell the cell to grow and multiply quickly, creating a mass (tumor) of abnormal cells. The abnormal cells continue living when healthy cells would die. They can invade nearby tissues and break off from an initial tumor to spread elsewhere in the body (metastasize). Types of ovarian cancer The type of cell where the cancer begins determines the type of ovarian cancer you have. Ovarian cancer types include: - Epithelial tumors, which begin in the thin layer of tissue that covers the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors. - Stromal tumors, which begin in the ovarian tissue that contains hormone-producing cells. These tumors are usually diagnosed at an earlier stage than other ovarian tumors. About 7 percent of ovarian tumors are stromal. - Germ cell tumors, which begin in the egg-producing cells. These rare ovarian cancers tend to occur in younger women. Factors that can increase your risk of ovarian cancer include: - Older age. Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years. - Inherited gene mutations. A small percentage of ovarian cancers are caused by gene mutations you inherit from your parents. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes also increase the risk of breast cancer. Other gene mutations, including those associated with Lynch syndrome, are known to increase the risk of ovarian cancer. - Family history of ovarian cancer. People with two or more close relatives with ovarian cancer have an increased risk of the disease. - Estrogen hormone replacement therapy, especially with long-term use and in large doses. - Age when menstruation started and ended. Beginning menstruation at an early age or starting menopause at a later age, or both, may increase the risk of ovarian cancer. Tests and procedures used to diagnose ovarian cancer include: - Pelvic exam. During a pelvic exam, your doctor inserts gloved fingers into your vagina and simultaneously presses a hand on your abdomen in order to feel (palpate) your pelvic organs. The doctor also visually examines your external genitalia, vagina and cervix. - Imaging tests. Tests, such as ultrasound or CT scans of your abdomen and pelvis, may help determine the size, shape and structure of your ovaries. - Blood tests. Blood tests might include organ function tests that can help determine your overall health. Your doctor might also test your blood for tumor markers that indicate ovarian cancer. For example, a cancer antigen (CA) 125 test can detect a protein that's often found on the surface of ovarian cancer cells. These tests can't tell your doctor whether you have cancer, but may give clues about your diagnosis and prognosis. - Surgery. Sometimes your doctor can't be certain of your diagnosis until you undergo surgery to remove an ovary and have it tested for signs of cancer. Once it's confirmed that you have ovarian cancer, your doctor will use information from your tests and procedures to assign your cancer a stage. The stages of ovarian cancer are indicated using Roman numerals ranging from I to IV, with the lowest stage indicating that the cancer is confined to the ovaries. By stage IV, the cancer has spread to distant areas of the body. Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy. Surgery Operations to remove ovarian cancer include: - Surgery to remove one ovary. For very early stage cancer that hasn't spread beyond one ovary, surgery may involve removing the affected ovary and its fallopian tube. This procedure may preserve your ability to have children. - Surgery to remove both ovaries. If cancer is present in both your ovaries, but there are no signs of additional cancer, your surgeon may remove both ovaries and both fallopian tubes. This procedure leaves your uterus intact, so you may still be able to become pregnant using your own frozen embryos or eggs or with eggs from a donor. - Surgery to remove both ovaries and the uterus. If your cancer is more extensive or if you don't wish to preserve your ability to have children, your surgeon will remove the ovaries, the fallopian tubes, the uterus, nearby lymph nodes and a fold of fatty abdominal tissue (omentum). - Surgery for advanced cancer. If your cancer is advanced, your doctor may recommend chemotherapy followed by surgery to remove as much of the cancer as possible. Chemotherapy Chemotherapy is a drug treatment that uses chemicals to kill fast-growing cells in the body, including cancer cells. Chemotherapy drugs can be injected into a vein or taken by mouth. Sometimes the drugs are injected directly into the abdomen (intraperitoneal chemotherapy). Chemotherapy is often used after surgery to kill any cancer cells that might remain. It can also be used before surgery. Targeted therapy Targeted therapy uses medications that target the specific vulnerabilities present within your cancer cells. Targeted therapy drugs are usually reserved for treating ovarian cancer that returns after initial treatment or cancer that resists other treatments. Your doctor may test your cancer cells to determine which targeted therapy is most likely to have an effect on your cancer. Targeted therapy is an active area of cancer research. Many clinical trials are testing new targeted therapies. Supportive (palliative) care Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery and chemotherapy. When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer. Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.",
+    "https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941"
+  ],
+  [
+    "Ovarian cancer: Ovarian cancer is cancer that begins in the ovaries. The ovaries make female hormones and produce a woman's eggs. Ovarian cancer is a serious cancer that is more common in older women. Treatment is most effective when the cancer is found early. Screening for ovarian cancer is not recommended for most women. Learn more about ovarian cancer at the National Cancer Institute. Ovarian cancer forms in tissues of the ovary. (An ovary is one of a pair of female reproductive glands in which the ova, or eggs, are formed.) Tumors in the ovaries can be benign, which means they are not cancer, or they can be malignant, which means they are cancer. Cancers that start in the ovaries can spread to other parts of the body. This is called metastasis. Cancer that starts in the ovaries and spreads to other parts of the body is still called ovarian cancer. Around one in every 60 women in the United States will develop ovarian cancer. Most ovarian cancers are diagnosed in women over 60, but this disease can also affect younger women. Among women in the United States, ovarian cancer is rare. Most ovarian cancers are diagnosed among women ages 55 to 64, but ovarian cancer can also affect younger women. Women with a high risk of ovarian cancer are those with a harmful mutation on the BRCA1 or BRCA2 genes. These mutations can be found with a blood test. Women with a family or personal history of breast or ovarian cancer also have a higher risk of ovarian cancer. If you have family members in multiple generations with breast cancer or ovarian cancer, see your doctor to learn more about your risk of ovarian cancer. Research shows that certain steps, such as surgery to remove the ovaries and the fallopian tubes, may help prevent ovarian cancer in women who are at high risk. The sooner ovarian cancer is found and treated, the better your chance for recovery. But ovarian cancer is hard to detect early, because its symptoms are also the symptoms of many other illnesses. The following may be symptoms of ovarian cancer if they continue or get worse over time: If you have any of these symptoms, talk to your doctor. He or she can determine if the cause is cancer or something else. Your doctor also may ask you to visit a gynecologic oncologist. This is a doctor who focuses on cancers of the female pelvis. The U.S. Preventive Services Task Force (USPSTF) recommends against screening women who are not at high risk for ovarian cancer. The USPSTF found that testing for ovarian cancer may do more harm than good. Current testing methods, like pelvic exams, ultrasound, and blood tests, can lead to \"false positives\" (results that say a woman has ovarian cancer when she really does not have ovarian cancer). These incorrect results can lead to surgeries that are not needed and that can be risky. Some women, like those who are at high risk, can talk to their doctor about their risk and what they can do to help prevent ovarian cancer. For more information about ovarian cancer, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer (Are some women more at risk for ovarian cancer?): Women with a high risk of ovarian cancer are those with a harmful mutation on the BRCA1 or BRCA2 genes. These mutations can be found with a blood test. Women with a family or personal history of breast or ovarian cancer also have a higher risk of ovarian cancer. If you have family members in multiple generations with breast cancer or ovarian cancer, see your doctor to learn more about your risk of ovarian cancer. Research shows that certain steps, such as surgery to remove the ovaries and the fallopian tubes, may help prevent ovarian cancer in women who are at high risk. The sooner ovarian cancer is found and treated, the better your chance for recovery. But ovarian cancer is hard to detect early, because its symptoms are also the symptoms of many other illnesses.",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "Ovarian cancer (Risk factors): Factors that can increase your risk of ovarian cancer include: - Older age. Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years. - Inherited gene mutations. A small percentage of ovarian cancers are caused by gene mutations you inherit from your parents. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes also increase the risk of breast cancer. Other gene mutations, including those associated with Lynch syndrome, are known to increase the risk of ovarian cancer. - Family history of ovarian cancer. People with two or more close relatives with ovarian cancer have an increased risk of the disease. - Estrogen hormone replacement therapy, especially with long-term use and in large doses. - Age when menstruation started and ended. Beginning menstruation at an early age or starting menopause at a later age, or both, may increase the risk of ovarian cancer.",
+    "https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941"
+  ],
+  [
+    "Ovarian Cancer (Summary): Summary The ovaries are part of the female reproductive system. They produce a woman's eggs and female hormones. Each ovary is about the size and shape of an almond. Cancer of the ovary is not common, but it causes more deaths than other female reproductive cancers. The sooner ovarian cancer is found and treated, the better your chance for recovery. But ovarian cancer is hard to detect early. Women with ovarian cancer may have no symptoms or just mild symptoms until the disease is in an advanced stage. Then it is hard to treat. Symptoms may include - A heavy feeling in the pelvis - Pain in the lower abdomen - Bleeding from the vagina - Weight gain or loss - Abnormal periods - Unexplained back pain that gets worse - Gas, nausea, vomiting, or loss of appetite To diagnose ovarian cancer, doctors do one or more tests. They include a physical exam, a pelvic exam, lab tests, ultrasound, or a biopsy. Treatment is usually surgery followed by chemotherapy. NIH: National Cancer Institute",
+    "#"
+  ],
+  [
+    "Ovarian cancer (Should I be screened for ovarian cancer?): The U.S. Preventive Services Task Force (USPSTF) recommends against screening women who are not at high risk for ovarian cancer. The USPSTF found that testing for ovarian cancer may do more harm than good. Current testing methods, like pelvic exams, ultrasound, and blood tests, can lead to \"false positives\" (results that say a woman has ovarian cancer when she really does not have ovarian cancer). These incorrect results can lead to surgeries that are not needed and that can be risky. Some women, like those who are at high risk, can talk to their doctor about their risk and what they can do to help prevent ovarian cancer.",
+    "https://www.womenshealth.gov/cancer/ovarian-cancer"
+  ],
+  [
+    "Familial prostate cancer: Familial prostate cancer is a cluster of prostate cancer within a family. Most cases of prostate cancer occur sporadically in people with no family history of the condition. However, approximately 5% to 10% of prostate cancer cases are believed to be primarily caused by a genetic predisposition to the condition. [1] In many families, the underlying genetic cause is unknown; however, some of these cases are caused by changes ( mutations ) in the BRCA1 , BRCA2, HOXB13, or several other genes . Other cases are likely due to a combination of gene(s) and other shared factors such as environment and lifestyle. [2] High-risk cancer screening at an earlier age is typically recommended in men who have an increased risk for prostate cancer based on personal and/or family histories. The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Autosomal dominant inheritance - Neoplasm - Prostate cancer - Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal",
+    "https://rarediseases.info.nih.gov/diseases/4520/familial-prostate-cancer"
+  ],
+  [
+    "How to diagnose Prostate Cancer?: Doctors use tests to detect prostate abnormalities, but tests cannot show whether abnormalities are cancer or another, less serious condition. The results from these tests will help the doctor decide whether to check the patient further for signs of cancer. The most common test is a blood test for prostate specific antigen or PSA -- a lab measures the levels of PSA in a blood sample. The level of PSA may rise in men who have prostate cancer, an enlarged prostate, or infection in the prostate.",
+    "http://nihseniorhealth.gov/prostatecancer/toc.html"
+  ],
+  [
+    "Cryotherapy for prostate cancer: Cryotherapy uses very cold temperatures to freeze and kill prostate cancer cells. The goal of cryosurgery is to destroy the entire prostate gland and possibly surrounding tissue. Cryosurgery is generally not used as a first treatment for prostate cancer. Before the procedure, you will be given medicine so that you do not feel pain. You may receive: - A sedative to make you drowsy and numbing medicine on your perineum. This is the area between the anus and scrotum. - Anesthesia. With spinal anesthesia, you will be drowsy but awake, and numb below the waist. With general anesthesia, you will be asleep and pain-free. First, you will get a catheter that will stay in place for about 3 weeks after the procedure. Then, the doctor makes small cuts to place several hollow needles into your perineum. - Ultrasound is used to guide the needles to the prostate gland. - Then, very cold gas passes through the needles, creating ice balls that destroy the prostate gland. - Warm salt water will flow through the catheter to keep your urethra (the tube from the bladder to outside the body) from freezing. Cryosurgery is most often a 2-hour outpatient procedure. Some people may need to stay in the hospital overnight. This therapy is not as commonly used and is not as well accepted as other treatments for prostate cancer. Doctors do not know for certain how well cryosurgery works over time. There is not enough data to compare it with standard prostatectomy, radiation treatment, or brachytherapy. It can only treat prostate cancer that has not spread beyond the prostate. Men who cannot have surgery because of their age or other health problems may have cryosurgery instead. It also may be used if cancer comes back after other treatments. It is generally not helpful for men with very large prostate glands. Possible short-term side effects of cryotherapy for prostate cancer include: - Blood in the urine - Trouble passing urine - Swelling of the penis or scrotum - Problems controlling your bladder (more likely if you have had radiation therapy also) Possible long-term problems include: - Erection problems in nearly all people - Damage to the rectum - A tube that forms between the rectum and the bladder, called a fistula (this is very rare) - Problems with passing or controlling urine. Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists and Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000907.htm"
+  ],
+  [
+    "How to diagnose Prostate Cancer?: The doctor may order other exams, including ultrasound, MRI, or CT scans, to learn more about the cause of the symptoms. But to confirm the presence of cancer, doctors must perform a biopsy. During a biopsy, the doctor uses needles to remove small tissue samples from the prostate and then looks at the samples under a microscope. If a biopsy shows that cancer is present, the doctor will report on the grade of the tumor. Doctors describe a tumor as low, medium, or high-grade cancer, based on the way it appears under the microscope.",
+    "http://nihseniorhealth.gov/prostatecancer/toc.html"
+  ],
+  [
+    "Prostate cancer: Prostate cancer is cancer that occurs in the prostate - a small walnut-shaped gland in men that produces the seminal fluid that nourishes and transports sperm. Prostate cancer is one of the most common types of cancer in men. Usually prostate cancer grows slowly and is initially confined to the prostate gland, where it may not cause serious harm. However, while some types of prostate cancer grow slowly and may need minimal or even no treatment, other types are aggressive and can spread quickly. Prostate cancer that's detected early - when it's still confined to the prostate gland- has a better chance of successful treatment. Prostate cancer care at Mayo Clinic Prostate cancer may cause no signs or symptoms in its early stages. Prostate cancer that's more advanced may cause signs and symptoms such as: - Trouble urinating - Decreased force in the stream of urine - Blood in semen - Discomfort in the pelvic area - Bone pain - Erectile dysfunction When to see a doctor Make an appointment with your doctor if you have any signs or symptoms that worry you. Debate continues regarding the risks and benefits of prostate cancer screening, and medical organizations differ on their recommendations. Discuss prostate cancer screening with your doctor. Together, you can decide what's best for you. It's not clear what causes prostate cancer. Doctors know that prostate cancer begins when some cells in your prostate become abnormal. Mutations in the abnormal cells' DNA cause the cells to grow and divide more rapidly than normal cells do. The abnormal cells continue living, when other cells would die. The accumulating abnormal cells form a tumor that can grow to invade nearby tissue. Some abnormal cells can also break off and spread (metastasize) to other parts of the body. Factors that can increase your risk of prostate cancer include: - Age. Your risk of prostate cancer increases as you age. - Race. For reasons not yet determined, black men carry a greater risk of prostate cancer than do men of other races. In black men, prostate cancer is also more likely to be aggressive or advanced. - Family history. If men in your family have had prostate cancer, your risk may be increased. Also, if you have a family history of genes that increase the risk of breast cancer (BRCA1 or BRCA2) or a very strong family history of breast cancer, your risk of prostate cancer may be higher. - Obesity. Obese men diagnosed with prostate cancer may be more likely to have advanced disease that's more difficult to treat. Complications of prostate cancer and its treatments include: - Cancer that spreads (metastasizes). Prostate cancer can spread to nearby organs, such as your bladder, or travel through your bloodstream or lymphatic system to your bones or other organs. Prostate cancer that spreads to the bones can cause pain and broken bones. Once prostate cancer has spread to other areas of the body, it may still respond to treatment and may be controlled, but it's unlikely to be cured. - Incontinence. Both prostate cancer and its treatment can cause urinary incontinence. Treatment for incontinence depends on the type you have, how severe it is and the likelihood it will improve over time. Treatment options may include medications, catheters and surgery. - Erectile dysfunction. Erectile dysfunction can result from prostate cancer or its treatment, including surgery, radiation or hormone treatments. Medications, vacuum devices that assist in achieving erection and surgery are available to treat erectile dysfunction. Screening for prostate cancer Whether to test healthy men with no symptoms for prostate cancer is controversial. Medical organizations don't agree on the issue of screening and whether it delivers benefits. Some medical organizations recommend men consider prostate cancer screening in their 50s, or sooner for men who have risk factors for prostate cancer. Discuss your particular situation and the benefits and risks of screening with your doctor. Together, you can decide whether prostate cancer screening is right for you. Prostate screening tests might include: - Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of the gland, you may need further tests. - Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that's naturally produced by your prostate gland. It's normal for a small amount of PSA to be in your bloodstream. However, if a higher than normal level is found, it may indicate prostate infection, inflammation, enlargement or cancer. PSA testing combined with DRE helps identify prostate cancers at their earliest stages. Hence, debate continues surrounding prostate cancer screening. Diagnosing prostate cancer If a DRE or PSA test detects an abnormality, your doctor may recommend further tests to determine whether you have prostate cancer, such as: - Ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to create a picture of your prostate gland. - Collecting a sample of prostate tissue. If initial test results suggest prostate cancer, your doctor may recommend a procedure to collect a sample of cells from your prostate (prostate biopsy). Prostate biopsy is often done using a thin needle that's inserted into the prostate to collect tissue. The tissue sample is analyzed in a lab to determine whether cancer cells are present. - MRI fusion. While still being developed worldwide, MRI fusion to assist in prostate biopsy and diagnosis is being used more and more. At Mayo Clinic, urologists and radiologists collaborate to leverage MRI fusion biopsy technology, yielding the best fusion imaging available for prostate cancer care. Mayo Clinic also leverages MRI-TRUS fusion technology, which blends (fuses) images from an MRI scan and transrectal ultrasound (TRUS) to create a more-precise 360-degree prostate map, which in turn can improve prostate biopsy accuracy. Mayo Clinic is also the first medical center in the United States approved by the Food and Drug Administration to prepare and administer C-11 choline PET scanning to help detect recurrent prostate cancer at its earliest stages - before it can be detected by other imaging tests - and enable more-precise targeting for follow-up treatment. Determining whether prostate cancer is aggressive When a biopsy confirms the presence of cancer, the next step is to determine the level of aggressiveness (grade) of the cancer cells. A laboratory pathologist examines a sample of your cancer to determine how much cancer cells differ from the healthy cells. A higher grade indicates a more aggressive cancer that is more likely to spread quickly. The most common scale used to evaluate the grade of prostate cancer cells is called a Gleason score. Gleason scoring combines two numbers and can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer). In addition, genomic testing in increasingly being used to more accurately assess risk and detect aggressive prostate cancer. Mayo Clinic physicians and researchers are leaders in the development of biomarkers for prostate cancer. Doctors in Mayo Clinic's Center for Individualized Medicine are advancing research on the use of biomarkers in blood and in prostate tissue to better individualize and optimize treatment for men with prostate cancer. The technology helps caregivers distinguish between insignificant and significant prostate cancer, as well as identify particularly aggressive prostate cancer in men undergoing surgery. Determining how far the cancer has spread Once a prostate cancer diagnosis has been made, your doctor works to determine the extent (stage) of the cancer. If your doctor suspects your cancer may have spread beyond your prostate, one or more of the following imaging tests may be recommended: - Bone scan - Ultrasound - Computerized tomography (CT) scan - Magnetic resonance imaging (MRI) - Positron emission tomography (PET) scan At Mayo Clinic, caregivers can also turn to prostate-specific membrane antigen (PSMA) studies to help detect the extent of newly diagnosed prostate cancer and whether the disease has spread to nearby lymph nodes. Mayo clinicians also use recent 7 Tesla (7T) magnet imaging technology advancements to differentiate between prostate cancer that does or doesn't require immediate intervention. Not every person should have every test. Your doctor will help determine which tests are best for your individual case. Your doctor uses the information from these tests to assign your cancer a stage. Prostate cancer stages are indicated by Roman numerals ranging from I to IV. The lowest stages indicate the cancer is confined to the prostate. By stage IV, the cancer has grown beyond the prostate and may have spread to other areas of the body. The cancer staging system continues to evolve and is becoming more complex as doctors improve cancer diagnosis and treatment. Your doctor uses your cancer stage to select the treatments that are right for you. Your prostate cancer treatment options depend on several factors, such as how fast your cancer is growing, how much it has spread and your overall health, as well as the potential benefits or side effects of the treatment. Immediate treatment may not be necessary For men diagnosed with low-risk prostate cancer, treatment may not be necessary right away. Some men may never need treatment. Instead, doctors sometimes recommend active surveillance. In active surveillance, regular follow-up blood tests, rectal exams and possibly biopsies may be performed to monitor progression of your cancer. If tests show your cancer is progressing, you may opt for a prostate cancer treatment such as surgery or radiation. Active surveillance may be an option for cancer that isn't causing symptoms, is expected to grow very slowly and is confined to a small area of the prostate. Active surveillance may also be considered for someone who has another serious health condition or who is of an advanced age that makes cancer treatment more difficult. Active surveillance carries a risk that the cancer may grow and spread between checkups, making the cancer less likely to be cured. Surgery to remove the prostate Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes. Radical prostatectomy can be performed in several ways: - Using a robot to assist with surgery. During robot-assisted surgery, the instruments are attached to a mechanical device (robot) and inserted into your abdomen through several small incisions. The surgeon sits at a console and uses hand controls to guide the robot to move the instruments. Robotic prostatectomy may allow the surgeon to make more-precise movements with surgical tools than is possible with traditional minimally invasive surgery. - Making an incision in your abdomen. During retropubic surgery, the prostate gland is taken out through an incision in your lower abdomen. Discuss with your doctor which type of surgery is best for your specific situation. Radical prostatectomy carries a risk of urinary incontinence and erectile dysfunction. Ask your doctor to explain the risks you may face based on your situation, the type of procedure you select, your age, your body type and your overall health. Radiation therapy Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy can be delivered in two ways: - Radiation that comes from outside of your body (external beam radiation). During external beam radiation therapy, you lie on a table while a machine moves around your body, directing high-powered energy beams, such as X-rays or protons, to your prostate cancer. You typically undergo external beam radiation treatments five days a week for several weeks. - Radiation placed inside your body (brachytherapy). Brachytherapy involves placing many rice-sized radioactive seeds in your prostate tissue. The radioactive seeds deliver a low dose of radiation over a long period of time. Your doctor implants the radioactive seeds in your prostate using a needle guided by ultrasound images. The implanted seeds eventually stop emitting radiation and don't need to be removed. Side effects of radiation therapy can include painful, frequent or urgent urination, as well as rectal symptoms such as loose stools or pain when passing stools. Erectile dysfunction can also occur. Hormone therapy Hormone therapy is treatment to stop your body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of testosterone may cause cancer cells to die or to grow more slowly. Hormone therapy options include: - Medications that stop your body from producing testosterone. Medications known as luteinizing hormone-releasing hormone (LH-RH) agonists prevent the testicles from receiving messages to make testosterone. Drugs typically used in this type of hormone therapy include leuprolide (Lupron, Eligard), goserelin (Zoladex), triptorelin (Trelstar) and histrelin (Vantas). Other drugs sometimes used include ketoconazole and abiraterone (Zytiga). - Medications that block testosterone from reaching cancer cells. Medications known as anti-androgens prevent testosterone from reaching your cancer cells. Examples include bicalutamide (Casodex), nilutamide (Nilandron) and flutamide. The drug enzalutamide (Xtandi) may be an option when other hormone therapies are no longer effective. - Surgery to remove the testicles (orchiectomy). Removing your testicles reduces testosterone levels in your body. Hormone therapy is used in men with advanced prostate cancer to shrink the cancer and slow the growth of tumors. In men with early-stage prostate cancer, hormone therapy may be used to shrink tumors before radiation therapy, which can increase the likelihood that radiation therapy will be successful. Side effects of hormone therapy may include erectile dysfunction, hot flashes, loss of bone mass, reduced sex drive and weight gain. Freezing prostate tissue Cryosurgery or cryoablation involves freezing tissue to kill cancer cells. During cryosurgery for prostate cancer, small needles are inserted in the prostate using ultrasound images as guidance. A very cold gas is placed in the needles, which causes the surrounding tissue to freeze. A second gas is then placed in the needles to reheat the tissue. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue. Initial attempts to use cryosurgery for prostate cancer resulted in high complication rates and unacceptable side effects. However, newer technologies have lowered complication rates, improved cancer control and made the procedure easier to tolerate. Cryosurgery is more frequently used as a salvage therapy for men who haven't been helped by radiation therapy. Chemotherapy Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both. Chemotherapy may be a treatment option for men with prostate cancer that has spread to remote body locations. Chemotherapy may also be an option for cancers that don't respond to hormone therapy. Biological therapy Biological therapy (immunotherapy) uses your body's immune system to fight cancer cells. One type of biological therapy called sipuleucel-T (Provenge) has been developed to treat advanced, recurrent prostate cancer. This treatment takes some of your own immune cells, genetically engineers them in a laboratory to fight prostate cancer, then injects the cells back into your body through a vein. Some men do respond to this therapy with some improvement in their cancer, but the treatment is very expensive and requires multiple treatments. No complementary or alternative treatments will cure prostate cancer. However, complementary and alternative prostate cancer treatments may help you cope with the side effects of cancer and its treatment. Nearly everyone diagnosed with cancer experiences some distress at some point. If you're distressed, you may feel sad, angry or anxious. You may experience difficulty sleeping or find yourself constantly thinking about your cancer. Several complementary medicine techniques may help you cope with your distress, including: - Art therapy - Dance or movement therapy - Exercise - Meditation - Music therapy - Relaxation techniques - Spirituality Discuss your feelings and concerns with your doctor. In some cases, treatment for distress may require medications.",
+    "https://www.mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087"
+  ],
+  [
+    "Prostate cancer - resources: The following organizations are good resources for information on prostate cancer: - American Cancer Society -- www.cancer.org/cancer/prostatecancer/index - National Cancer Institute -- www.cancer.gov/cancertopics/types/prostate - Prostate Cancer Foundation -- www.pcf.org - U.S. Centers for Disease Control and Prevention -- www.cdc.gov/cancer/prostate - U.S. National Library of Medicine Genetics Home Reference -- ghr.nlm.nih.gov/condition/prostate-cancer Updated by: Jennifer K. Mannheim, ARNP, Medical Staff, Department of Psychiatry and Behavioral Health, Seattle Children's Hospital, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/article/003979.htm"
+  ],
+  [
+    "Cryotherapy for prostate cancer (When Cryosurgery is Used to Treat Prostate Cancer): This therapy is not as commonly used and is not as well accepted as other treatments for prostate cancer. Doctors do not know for certain how well cryosurgery works over time. There is not enough data to compare it with standard prostatectomy, radiation treatment, or brachytherapy. It can only treat prostate cancer that has not spread beyond the prostate. Men who cannot have surgery because of their age or other health problems may have cryosurgery instead. It also may be used if cancer comes back after other treatments. It is generally not helpful for men with very large prostate glands.",
+    "https://medlineplus.gov/ency/patientinstructions/000907.htm"
+  ],
+  [
+    "Prostate cancer screening: Cancer screenings can help find signs of cancer early, before you notice any symptoms. In many cases, finding cancer early makes it easier to treat or cure. However, at present it is not clear if screening for prostate cancer is helpful for most men. For this reason, you should speak with your health care provider before having a prostate cancer screening. Prostate-specific antigen (PSA) test is a blood test that checks the level of PSA in your blood. - In some cases, a high level of PSA could mean you have prostate cancer. - But other conditions can also cause a high level, such as infection in the prostate or an enlarged prostate. You may need another test to find out if you have cancer. - Other blood tests or a prostate biopsy can help diagnose a cancer if the PSA test is high. Digital rectal exam\u00a0(DRE) is a test where your provider inserts a lubricated, gloved finger into your rectum. This allows the provider to check the prostate for lumps or unusual areas. Unfortunately, most cancers cannot be felt with this type of exam, at least in the early stages. In most cases, the PSA and DRE are done together. Imaging tests such as an ultrasound or an MRI do not do an accurate job of screening for prostate cancer. The benefit of any cancer screening test is to find cancer early, when it easier to treat. But the value of PSA screening for prostate cancer is debated. No single answer fits all men. Prostate cancer often grows very slowly. PSA levels can begin to rise years before a cancer causes any symptoms or problems. It is also very common as men age. In many cases, the cancer will not cause any problems or shorten a man's life span. For these reasons, it is not clear if the benefits of routine screenings outweigh the risks or side effects of being treated for prostate cancer once it is found. There are other factors to think about before having a PSA test: - Anxiety. Elevated PSA levels do not always mean you have cancer. These results and the need for further testing can cause a lot of fear and anxiety, even if you do not have prostate cancer. - Side effects from further testing. If your PSA test is higher than normal, you may need to have a one or more biopsies to find out for sure. A biopsy is safe but can cause problems such as an infection, pain, fever, or blood in the semen or urine. - Overtreatment. Many prostate cancers will not affect your normal life span. But since it is impossible to know for sure, most people want to get treatment. Cancer treatment can have serious side effects, including problems with erections and urinating. These side effects can cause more problems than the untreated cancer. Measuring the PSA level can increase the chance of finding prostate cancer when it is very early. But there is debate over the value of the PSA test for detecting prostate cancer. No single answer fits all men. Before having the test, talk to your provider about the pros and cons of having a PSA test. Ask about: - Whether screening decreases your chance of dying from prostate cancer. - Whether there is any harm from prostate cancer screening, such as side effects from testing or overtreatment of cancer when discovered. If you choose to be tested, the PSA is most often done every year to screen men: - From ages 55 to 69, if no risk factors are present. - Starting around age 40 to 45 if they have a higher chance of developing prostate cancer. A family history of prostate cancer (especially a brother or father) and being African American are more common risk factors. Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists and Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000846.htm"
+  ],
+  [
+    "Prostate Cancer (Stages of Prostate Cancer): - After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body. - There are three ways that cancer spreads in the body. - Cancer may spread from where it began to other parts of the body. - The following stages are used for prostate cancer: - Stage I - Stage II - Stage III - Stage IV",
+    "https://www.cancer.gov/types/prostate"
+  ],
+  [
+    "Prostate cancer staging: Cancer staging is a way to describe how much cancer is in your body and where it is located in your body. Prostate cancer staging helps determine how big your tumor is, whether it has spread, and where it has spread. Knowing the stage of your cancer helps your cancer team: - Decide the best way to treat the cancer - Determine your chance of recovery - Find clinical trials you may be able to join Initial staging is based on the results of PSA blood tests, biopsies, and imaging tests. This is also called clinical staging. PSArefers to a protein made by the prostate measured by a lab test. - A higher level of PSA can indicate a more advanced cancer. - The doctors will also look at how fast the PSA levels have been increasing from test to test. A faster increase could show a more aggressive tumor. A prostate biopsy is done in your doctor's office. The results can indicate: - How much of the prostate is involved. - The Gleason score. A number from 2 to 10 that shows how closely the cancer cells look like normal cells when viewed under a microscope. Scores less than 6 suggest the cancer is slow growing and not aggressive. Higher numbers indicate a faster growing cancer that is more likely to spread. Imaging tests such as a CT scan, MRI, or Bone scan also may be done. Using the results from these tests, your doctor can tell you your clinical stage. At times, this is enough information to make decisions about your treatment. Surgical staging (pathological staging) is based on what your doctor finds if you have surgery to remove the prostate and perhaps some of the lymph nodes. Lab tests are done on the tissue that's removed. This staging helps determine what other treatment you may need might. It also helps predict what to expect after treatment ends. The higher the stage, the more advanced the cancer. Stage I cancer. The cancer is found only in only one part of the prostate. Stage I is called localized prostate cancer. It cannot be felt during a digital rectal exam or seen with imaging tests. If the PSA is less than 10 and the Gleason score is 6 or less, Stage I cancer is likely to grow slowly. Stage II cancer. The cancer is more advanced than stage I. It has not spread beyond the prostate and is still called localized. The cells are less normal than cells in stage I, and may grow more rapidly. There are two types of stage II prostate cancer: - Stage IIA is most likely found in only one side of the prostate. - Stage IIB may be found in both sides of the prostate. Stage III cancer. The cancer has spread outside the prostate into local tissue. It may have spread into the seminal vesicles. These are the glands that make semen. Stage III is called locally advanced prostate cancer. Stage IV cancer. The cancer has spread to distant parts of the body. It could be in nearby lymph nodes or bones, most often of the pelvis or spine. Other organs such as bladder, liver, or lungs can be involved. Staging along with the PSA value and Gleason score help you and your doctor decide on the best treatment, taking into account: - Your age - Your overall health - Your symptoms (if you have any) - Your feelings about side effects of treatment - The chance that treatment can cure your cancer or help you in other ways With stage I, II, or III prostate cancer, the main goal is to cure the cancer by treating it and keeping it from coming back. With stage IV, the goal is to improve symptoms and prolong life. In most cases, stage IV prostate cancer cannot be cured. Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists and Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000397.htm"
+  ],
+  [
+    "Familial prostate cancer (Summary): Familial prostate cancer is a cluster of prostate cancer within a family. Most cases of prostate cancer occur sporadically in people with no family history of the condition. However, approximately 5% to 10% of prostate cancer cases are believed to be primarily caused by a genetic predisposition to the condition. [1] In many families, the underlying genetic cause is unknown; however, some of these cases are caused by changes ( mutations ) in the BRCA1 , BRCA2, HOXB13, or several other genes . Other cases are likely due to a combination of gene(s) and other shared factors such as environment and lifestyle. [2] High-risk cancer screening at an earlier age is typically recommended in men who have an increased risk for prostate cancer based on personal and/or family histories.",
+    "https://rarediseases.info.nih.gov/diseases/4520/familial-prostate-cancer"
+  ],
+  [
+    "How to diagnose Prostate Cancer?: Doctors use tests to detect prostate abnormalities, but tests cannot show whether abnormalities are cancer or another, less serious condition. The results from these tests will help the doctor decide whether to check the patient further for signs of cancer. The most common test is a blood test for prostate specific antigen or PSA -- a lab measures the levels of PSA in a blood sample. The level of PSA may rise in men who have prostate cancer, an enlarged prostate, or infection in the prostate.",
+    "http://nihseniorhealth.gov/prostatecancer/toc.html"
+  ],
+  [
+    "How to diagnose Prostate Cancer?: The doctor may order other exams, including ultrasound, MRI, or CT scans, to learn more about the cause of the symptoms. But to confirm the presence of cancer, doctors must perform a biopsy. During a biopsy, the doctor uses needles to remove small tissue samples from the prostate and then looks at the samples under a microscope. If a biopsy shows that cancer is present, the doctor will report on the grade of the tumor. Doctors describe a tumor as low, medium, or high-grade cancer, based on the way it appears under the microscope.",
+    "http://nihseniorhealth.gov/prostatecancer/toc.html"
+  ],
+  [
+    "Cryotherapy for prostate cancer (Summary): Cryotherapy uses very cold temperatures to freeze and kill prostate cancer cells. The goal of cryosurgery is to destroy the entire prostate gland and possibly surrounding tissue. Cryosurgery is generally not used as a first treatment for prostate cancer.",
+    "https://medlineplus.gov/ency/patientinstructions/000907.htm"
+  ],
+  [
+    "Cryotherapy for prostate cancer (When Cryosurgery is Used to Treat Prostate Cancer): This therapy is not as commonly used and is not as well accepted as other treatments for prostate cancer. Doctors do not know for certain how well cryosurgery works over time. There is not enough data to compare it with standard prostatectomy, radiation treatment, or brachytherapy. It can only treat prostate cancer that has not spread beyond the prostate. Men who cannot have surgery because of their age or other health problems may have cryosurgery instead. It also may be used if cancer comes back after other treatments. It is generally not helpful for men with very large prostate glands.",
+    "https://medlineplus.gov/ency/patientinstructions/000907.htm"
+  ],
+  [
+    "Prostate cancer - resources (Summary): The following organizations are good resources for information on prostate cancer: - American Cancer Society -- www.cancer.org/cancer/prostatecancer/index - National Cancer Institute -- www.cancer.gov/cancertopics/types/prostate - Prostate Cancer Foundation -- www.pcf.org - U.S. Centers for Disease Control and Prevention -- www.cdc.gov/cancer/prostate - U.S. National Library of Medicine Genetics Home Reference -- ghr.nlm.nih.gov/condition/prostate-cancer",
+    "https://medlineplus.gov/ency/article/003979.htm"
+  ],
+  [
+    "Familial prostate cancer (Symptoms): The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Autosomal dominant inheritance - Neoplasm - Prostate cancer -",
+    "https://rarediseases.info.nih.gov/diseases/4520/familial-prostate-cancer"
+  ],
+  [
+    "Prostate cancer screening (Who Needs Screenings): Measuring the PSA level can increase the chance of finding prostate cancer when it is very early. But there is debate over the value of the PSA test for detecting prostate cancer. No single answer fits all men. Before having the test, talk to your provider about the pros and cons of having a PSA test. Ask about: - Whether screening decreases your chance of dying from prostate cancer. - Whether there is any harm from prostate cancer screening, such as side effects from testing or overtreatment of cancer when discovered. If you choose to be tested, the PSA is most often done every year to screen men: - From ages 55 to 69, if no risk factors are present. - Starting around age 40 to 45 if they have a higher chance of developing prostate cancer. A family history of prostate cancer (especially a brother or father) and being African American are more common risk factors.",
+    "https://medlineplus.gov/ency/patientinstructions/000846.htm"
+  ],
+  [
+    "Prostate cancer screening: Cancer screenings can help find signs of cancer early, before you notice any symptoms. In many cases, finding cancer early makes it easier to treat or cure. However, at present it is not clear if screening for prostate cancer is helpful for most men. For this reason, you should speak with your health care provider before having a prostate cancer screening. Prostate-specific antigen (PSA) test is a blood test that checks the level of PSA in your blood. - In some cases, a high level of PSA could mean you have prostate cancer. - But other conditions can also cause a high level, such as infection in the prostate or an enlarged prostate. You may need another test to find out if you have cancer. - Other blood tests or a prostate biopsy can help diagnose a cancer if the PSA test is high. Digital rectal exam\u00a0(DRE) is a test where your provider inserts a lubricated, gloved finger into your rectum. This allows the provider to check the prostate for lumps or unusual areas. Unfortunately, most cancers cannot be felt with this type of exam, at least in the early stages. In most cases, the PSA and DRE are done together. Imaging tests such as an ultrasound or an MRI do not do an accurate job of screening for prostate cancer. The benefit of any cancer screening test is to find cancer early, when it easier to treat. But the value of PSA screening for prostate cancer is debated. No single answer fits all men. Prostate cancer often grows very slowly. PSA levels can begin to rise years before a cancer causes any symptoms or problems. It is also very common as men age. In many cases, the cancer will not cause any problems or shorten a man's life span. For these reasons, it is not clear if the benefits of routine screenings outweigh the risks or side effects of being treated for prostate cancer once it is found. There are other factors to think about before having a PSA test: - Anxiety. Elevated PSA levels do not always mean you have cancer. These results and the need for further testing can cause a lot of fear and anxiety, even if you do not have prostate cancer. - Side effects from further testing. If your PSA test is higher than normal, you may need to have a one or more biopsies to find out for sure. A biopsy is safe but can cause problems such as an infection, pain, fever, or blood in the semen or urine. - Overtreatment. Many prostate cancers will not affect your normal life span. But since it is impossible to know for sure, most people want to get treatment. Cancer treatment can have serious side effects, including problems with erections and urinating. These side effects can cause more problems than the untreated cancer. Measuring the PSA level can increase the chance of finding prostate cancer when it is very early. But there is debate over the value of the PSA test for detecting prostate cancer. No single answer fits all men. Before having the test, talk to your provider about the pros and cons of having a PSA test. Ask about: - Whether screening decreases your chance of dying from prostate cancer. - Whether there is any harm from prostate cancer screening, such as side effects from testing or overtreatment of cancer when discovered. If you choose to be tested, the PSA is most often done every year to screen men: - From ages 55 to 69, if no risk factors are present. - Starting around age 40 to 45 if they have a higher chance of developing prostate cancer. A family history of prostate cancer (especially a brother or father) and being African American are more common risk factors. Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists and Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000846.htm"
+  ],
+  [
+    "Prostate cancer (Symptoms): With early prostate cancer, there are often no symptoms. The PSA blood test may done to screen men for prostate cancer. Often, PSA level rises before there are any symptoms. The symptoms listed below can occur with prostate cancer as it grows larger in the prostate. These symptoms can also be caused by other prostate problems: - Delayed or slowed start of urinary stream - Dribbling or leakage of urine, most often after urinating - Slow urinary stream - Straining when urinating, or not being able to empty all of the urine - Blood in the urine or semen When the cancer has spread, there may be bone pain or tenderness, most often in the lower back and pelvic bones.",
+    "https://medlineplus.gov/ency/article/000380.htm"
+  ],
+  [
+    "Familial prostate cancer (Symptoms): The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Autosomal dominant inheritance - Neoplasm - Prostate cancer -",
+    "https://rarediseases.info.nih.gov/diseases/4520/familial-prostate-cancer"
+  ],
+  [
+    "What are the symptoms of Prostate Cancer?: - a need to urinate frequently, especially at night - difficulty starting urination or holding back urine - inability to urinate - weak or interrupted flow of urine a need to urinate frequently, especially at night difficulty starting urination or holding back urine inability to urinate weak or interrupted flow of urine If prostate cancer develops and is not treated, it can cause these symptoms: - painful or burning urination - difficulty in having an erection - painful ejaculation - blood in urine or semen - pain or stiffness in the lower back, hips, or upper thighs painful or burning urination difficulty in having an erection painful ejaculation blood in urine or semen pain or stiffness in the lower back, hips, or upper thighs",
+    "http://nihseniorhealth.gov/prostatecancer/toc.html"
+  ],
+  [
+    "What are the symptoms of Prostate Cancer?: Yes. Any of the symptoms caused by prostate cancer may also be due to enlargement of the prostate, which is not cancer. If you have any of the symptoms mentioned in question #10, see your doctor or a urologist to find out if you need treatment. A urologist is a doctor who specializes in treating diseases of the genitourinary system.",
+    "http://nihseniorhealth.gov/prostatecancer/toc.html"
+  ],
+  [
+    "Stage 4 prostate cancer (Symptoms): Signs and symptoms of stage 4 prostate cancer may include: - Painful urination - Decreased force in the stream of urine - Blood in the semen - Erectile dysfunction - Bone pain - Swelling in the legs - Fatigue - Frequent infections When to see a doctor Make an appointment with your doctor if you have any persistent signs or symptoms that worry you.",
+    "https://www.mayoclinic.org/diseases-conditions/stage-4-prostate-cancer/symptoms-causes/syc-20377966"
+  ],
+  [
+    "Prostate Cancer (Overview): The prostate gland makes fluid that forms part of semen. The prostate lies just below the bladder in front of the rectum. It surrounds the urethra (the tube that carries urine and semen through the penis and out of the body). Prostate cancer is the most common cancer in men in the United States, after skin cancer. It is the second leading cause of death from cancer in men. Prostate cancer occurs more often in African-American men than in white men. African-American men with prostate cancer are more likely to die from the disease than white men with prostate cancer. Almost all prostate cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids). Prostate cancer often has no early symptoms. Advanced prostate cancer can cause men to urinate more often or have a weaker flow of urine, but these symptoms can also be caused by benign prostate conditions. Prostate cancer usually grows very slowly. Most men with prostate cancer are older than 65 years and do not die from the disease. Finding and treating prostate cancer before symptoms occur may not improve health or help you live longer. Talk to your doctor about your risk of prostate cancer and whether you need screening tests.",
+    "https://www.cancer.gov/types/prostate"
+  ],
+  [
+    "Familial prostate cancer: Familial prostate cancer is a cluster of prostate cancer within a family. Most cases of prostate cancer occur sporadically in people with no family history of the condition. However, approximately 5% to 10% of prostate cancer cases are believed to be primarily caused by a genetic predisposition to the condition. [1] In many families, the underlying genetic cause is unknown; however, some of these cases are caused by changes ( mutations ) in the BRCA1 , BRCA2, HOXB13, or several other genes . Other cases are likely due to a combination of gene(s) and other shared factors such as environment and lifestyle. [2] High-risk cancer screening at an earlier age is typically recommended in men who have an increased risk for prostate cancer based on personal and/or family histories. The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Autosomal dominant inheritance - Neoplasm - Prostate cancer - Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal",
+    "https://rarediseases.info.nih.gov/diseases/4520/familial-prostate-cancer"
+  ],
+  [
+    "Cryotherapy for prostate cancer (When Cryosurgery is Used to Treat Prostate Cancer): This therapy is not as commonly used and is not as well accepted as other treatments for prostate cancer. Doctors do not know for certain how well cryosurgery works over time. There is not enough data to compare it with standard prostatectomy, radiation treatment, or brachytherapy. It can only treat prostate cancer that has not spread beyond the prostate. Men who cannot have surgery because of their age or other health problems may have cryosurgery instead. It also may be used if cancer comes back after other treatments. It is generally not helpful for men with very large prostate glands.",
+    "https://medlineplus.gov/ency/patientinstructions/000907.htm"
+  ],
+  [
+    "What are the treatments for prostate cancer?: These resources address the diagnosis or management of prostate cancer: - American College of Radiology: Prostate Cancer Radiation Treatment - Genetic Testing Registry: Familial prostate cancer - Genetic Testing Registry: Prostate cancer, hereditary, 2 - MedlinePlus Encyclopedia: Prostate Brachytherapy - MedlinePlus Encyclopedia: Prostate Cancer Staging - MedlinePlus Encyclopedia: Prostate Cancer Treatment - MedlinePlus Encyclopedia: Prostate-Specific Antigen (PSA) Blood Test - MedlinePlus Encyclopedia: Radical Prostatectomy - MedlinePlus Health Topic: Prostate Cancer Screening - National Cancer Institute: Prostate-Specific Antigen (PSA) Test - U.S. Preventive Services Task Force These resources from MedlinePlus offer information about the diagnosis and management of various health conditions: - Diagnostic Tests - Drug Therapy - Surgery and Rehabilitation - Genetic Counseling - Palliative Care",
+    "https://ghr.nlm.nih.gov/condition/prostate-cancer"
+  ],
+  [
+    "Prostate cancer (Treatment): Your prostate cancer treatment options depend on several factors, such as how fast your cancer is growing, how much it has spread and your overall health, as well as the potential benefits or side effects of the treatment. Immediate treatment may not be necessary For men diagnosed with low-risk prostate cancer, treatment may not be necessary right away. Some men may never need treatment. Instead, doctors sometimes recommend active surveillance. In active surveillance, regular follow-up blood tests, rectal exams and possibly biopsies may be performed to monitor progression of your cancer. If tests show your cancer is progressing, you may opt for a prostate cancer treatment such as surgery or radiation. Active surveillance may be an option for cancer that isn't causing symptoms, is expected to grow very slowly and is confined to a small area of the prostate. Active surveillance may also be considered for someone who has another serious health condition or who is of an advanced age that makes cancer treatment more difficult. Active surveillance carries a risk that the cancer may grow and spread between checkups, making the cancer less likely to be cured. Surgery to remove the prostate Surgery for prostate cancer involves removing the prostate gland (radical prostatectomy), some surrounding tissue and a few lymph nodes. Radical prostatectomy can be performed in several ways: - Using a robot to assist with surgery. During robot-assisted surgery, the instruments are attached to a mechanical device (robot) and inserted into your abdomen through several small incisions. The surgeon sits at a console and uses hand controls to guide the robot to move the instruments. Robotic prostatectomy may allow the surgeon to make more-precise movements with surgical tools than is possible with traditional minimally invasive surgery. - Making an incision in your abdomen. During retropubic surgery, the prostate gland is taken out through an incision in your lower abdomen. Discuss with your doctor which type of surgery is best for your specific situation. Radical prostatectomy carries a risk of urinary incontinence and erectile dysfunction. Ask your doctor to explain the risks you may face based on your situation, the type of procedure you select, your age, your body type and your overall health. Radiation therapy Radiation therapy uses high-powered energy to kill cancer cells. Prostate cancer radiation therapy can be delivered in two ways: - Radiation that comes from outside of your body (external beam radiation). During external beam radiation therapy, you lie on a table while a machine moves around your body, directing high-powered energy beams, such as X-rays or protons, to your prostate cancer. You typically undergo external beam radiation treatments five days a week for several weeks. - Radiation placed inside your body (brachytherapy). Brachytherapy involves placing many rice-sized radioactive seeds in your prostate tissue. The radioactive seeds deliver a low dose of radiation over a long period of time. Your doctor implants the radioactive seeds in your prostate using a needle guided by ultrasound images. The implanted seeds eventually stop emitting radiation and don't need to be removed. Side effects of radiation therapy can include painful, frequent or urgent urination, as well as rectal symptoms such as loose stools or pain when passing stools. Erectile dysfunction can also occur. Hormone therapy Hormone therapy is treatment to stop your body from producing the male hormone testosterone. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of testosterone may cause cancer cells to die or to grow more slowly. Hormone therapy options include: - Medications that stop your body from producing testosterone. Medications known as luteinizing hormone-releasing hormone (LH-RH) agonists prevent the testicles from receiving messages to make testosterone. Drugs typically used in this type of hormone therapy include leuprolide (Lupron, Eligard), goserelin (Zoladex), triptorelin (Trelstar) and histrelin (Vantas). Other drugs sometimes used include ketoconazole and abiraterone (Zytiga). - Medications that block testosterone from reaching cancer cells. Medications known as anti-androgens prevent testosterone from reaching your cancer cells. Examples include bicalutamide (Casodex), nilutamide (Nilandron) and flutamide. The drug enzalutamide (Xtandi) may be an option when other hormone therapies are no longer effective. - Surgery to remove the testicles (orchiectomy). Removing your testicles reduces testosterone levels in your body. Hormone therapy is used in men with advanced prostate cancer to shrink the cancer and slow the growth of tumors. In men with early-stage prostate cancer, hormone therapy may be used to shrink tumors before radiation therapy, which can increase the likelihood that radiation therapy will be successful. Side effects of hormone therapy may include erectile dysfunction, hot flashes, loss of bone mass, reduced sex drive and weight gain. Freezing prostate tissue Cryosurgery or cryoablation involves freezing tissue to kill cancer cells. During cryosurgery for prostate cancer, small needles are inserted in the prostate using ultrasound images as guidance. A very cold gas is placed in the needles, which causes the surrounding tissue to freeze. A second gas is then placed in the needles to reheat the tissue. The cycles of freezing and thawing kill the cancer cells and some surrounding healthy tissue. Initial attempts to use cryosurgery for prostate cancer resulted in high complication rates and unacceptable side effects. However, newer technologies have lowered complication rates, improved cancer control and made the procedure easier to tolerate. Cryosurgery is more frequently used as a salvage therapy for men who haven't been helped by radiation therapy. Chemotherapy Chemotherapy uses drugs to kill rapidly growing cells, including cancer cells. Chemotherapy can be administered through a vein in your arm, in pill form or both. Chemotherapy may be a treatment option for men with prostate cancer that has spread to remote body locations. Chemotherapy may also be an option for cancers that don't respond to hormone therapy. Biological therapy Biological therapy (immunotherapy) uses your body's immune system to fight cancer cells. One type of biological therapy called sipuleucel-T (Provenge) has been developed to treat advanced, recurrent prostate cancer. This treatment takes some of your own immune cells, genetically engineers them in a laboratory to fight prostate cancer, then injects the cells back into your body through a vein. Some men do respond to this therapy with some improvement in their cancer, but the treatment is very expensive and requires multiple treatments.",
+    "https://www.mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087"
+  ],
+  [
+    "Prostate Cancer (Treatment Option Overview): - There are different types of treatment for patients with prostate cancer. - Seven types of standard treatment are used: - Watchful waiting or active surveillance - Surgery - Radiation therapy and radiopharmaceutical therapy - Hormone therapy - Chemotherapy - Biologic therapy - Bisphosphonate therapy - There are treatments for bone pain caused by bone metastases or hormone therapy. - New types of treatment are being tested in clinical trials. - Cryosurgery - High-intensity-focused ultrasound therapy - Proton beam radiation therapy - Patients may want to think about taking part in a clinical trial. - Patients can enter clinical trials before, during, or after starting their cancer treatment. - Follow-up tests may be needed.",
+    "https://www.cancer.gov/types/prostate"
+  ],
+  [
+    "Familial prostate cancer (Treatment): FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal",
+    "https://rarediseases.info.nih.gov/diseases/4520/familial-prostate-cancer"
+  ],
+  [
+    "Familial prostate cancer: Familial prostate cancer is a cluster of prostate cancer within a family. Most cases of prostate cancer occur sporadically in people with no family history of the condition. However, approximately 5% to 10% of prostate cancer cases are believed to be primarily caused by a genetic predisposition to the condition. [1] In many families, the underlying genetic cause is unknown; however, some of these cases are caused by changes ( mutations ) in the BRCA1 , BRCA2, HOXB13, or several other genes . Other cases are likely due to a combination of gene(s) and other shared factors such as environment and lifestyle. [2] High-risk cancer screening at an earlier age is typically recommended in men who have an increased risk for prostate cancer based on personal and/or family histories. The Human Phenotype Ontology (HPO) provides the following list of features that have been reported in people with this condition. Much of the information in the HPO comes from Orphanet, a European rare disease database. If available, the list includes a rough estimate of how common a feature is (its frequency). Frequencies are based on a specific study and may not be representative of all studies. You can use the MedlinePlus Medical Dictionary for definitions of the terms below. Signs and Symptoms Approximate number of patients (when available) Autosomal dominant inheritance - Neoplasm - Prostate cancer - Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person\u2019s medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. FDA-Approved Treatments The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products. National Library of Medicine Drug Information Portal",
+    "https://rarediseases.info.nih.gov/diseases/4520/familial-prostate-cancer"
+  ],
+  [
+    "Cryotherapy for prostate cancer: Cryotherapy uses very cold temperatures to freeze and kill prostate cancer cells. The goal of cryosurgery is to destroy the entire prostate gland and possibly surrounding tissue. Cryosurgery is generally not used as a first treatment for prostate cancer. Before the procedure, you will be given medicine so that you do not feel pain. You may receive: - A sedative to make you drowsy and numbing medicine on your perineum. This is the area between the anus and scrotum. - Anesthesia. With spinal anesthesia, you will be drowsy but awake, and numb below the waist. With general anesthesia, you will be asleep and pain-free. First, you will get a catheter that will stay in place for about 3 weeks after the procedure. Then, the doctor makes small cuts to place several hollow needles into your perineum. - Ultrasound is used to guide the needles to the prostate gland. - Then, very cold gas passes through the needles, creating ice balls that destroy the prostate gland. - Warm salt water will flow through the catheter to keep your urethra (the tube from the bladder to outside the body) from freezing. Cryosurgery is most often a 2-hour outpatient procedure. Some people may need to stay in the hospital overnight. This therapy is not as commonly used and is not as well accepted as other treatments for prostate cancer. Doctors do not know for certain how well cryosurgery works over time. There is not enough data to compare it with standard prostatectomy, radiation treatment, or brachytherapy. It can only treat prostate cancer that has not spread beyond the prostate. Men who cannot have surgery because of their age or other health problems may have cryosurgery instead. It also may be used if cancer comes back after other treatments. It is generally not helpful for men with very large prostate glands. Possible short-term side effects of cryotherapy for prostate cancer include: - Blood in the urine - Trouble passing urine - Swelling of the penis or scrotum - Problems controlling your bladder (more likely if you have had radiation therapy also) Possible long-term problems include: - Erection problems in nearly all people - Damage to the rectum - A tube that forms between the rectum and the bladder, called a fistula (this is very rare) - Problems with passing or controlling urine. Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists and Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.",
+    "https://medlineplus.gov/ency/patientinstructions/000907.htm"
+  ]
+]
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