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Vitiligo is a condition that occurs when white patches start to appear on the skin. These white patches can vary in their size and location of where they can be found. Melanocytes are pigment cells which produce the pigment melanin.

Melanin is responsible for determining the color of one’s skin, hair, and eyes. The white spots develop when the melanocytes are destroyed and no longer producing melanin. Areas in which pigment can be lost include the areas of the hands, face, and chest; around body openings such as eyes, nostrils, mouth, nipples, belly button, and genitalia; body folds such as arm pits and groin; injury sites of burns, scrapes, or cuts; hair, in which early graying occurs; and in the back of the eye.

An alternative name for vitiligo is leukoderma. It is a medical term which means white skin and vitiligo is one form of leukoderma. It is also known as ‘white spot disease’ or ‘achromia’, which means loss of color.

Symptoms

The main symptom of the vitiligo skin disorder is the occurrence of rapid pigment loss to the skin, resulting in white patches. This condition can occur in several areas throughout the body. Other signs may include premature whitening of the hair on the scalp, eyelashes, eyebrows, or beard; loss of color in the tissues lining the inside of the mouth; or loss in color of the retina.

The white patches which form on the skin can occur in three different patterns. The focal pattern shows the depigmentation being limited to only one or just a few areas of the body. Segmental patterns shows a loss of skin color only on one side of the body. The generalized pattern has pigment loss widespread over all parts of the body.

Vitiligo has been proven to be associated with other diseases and disorders. Associated skin disorders include ichthyosis, halo naevus, psoriasis, lichen planus, premature graying of hair, and alopecia areata (loss of hair). Systemic disorders which may be associated include thyroid disorders such as hypothyroidism and hyperthyroidism, System Lupus Erythematosus (SLE), pernicious anemia, Addison’s Disease, Collegen diseases, Grave’s disease, and diabetes mellitus. It has also been noted that many people who have vitiligo are deficient in folic acid, vitamin B12, vitamin C, copper, and zinc.

Causes

There is no real cause or reason as to why one experiences vitiligo. It can involve genetics or immunologic and environmental factors. If one is exposed to the right situation it may increase their chances of this condition. Some may experience vitiligo after sunburn and others may experience it after emotional trauma such as a death, accident, or divorce. Each individual has their own reasons and causes for their development of vitiligo and it is essential for their doctor, the dermatologist, to understand each individual situation in order to prescribe treatment.

The condition of vitiligo occurs when there is a loss of pigment in the skin. This happens when the melanocytes, or pigment-forming cells, are destroyed. This may be due to an auto-immune condition in which the body’s immune system destroys the pigment cells, otherwise known as melanocytes. Or, it could be due to the melanocytes being destroyed by internal biochemical reactions occurring while the melanocytes are making pigment.

Another cause could be that the nerves in the skin are producing signals that destroy the melanocytes. Vitiligo can be caused by one or more of these situations and there is medical treatment aimed at attempting to stop each of these occurrences. There are other treatment options available which try to stimulate the division of living melanocytes and move them to areas of depigmentation.

Risk factors

Two to five million Americans have this condition. Most develop it early in life between the ages of 10 and 30. It affects both men, women and all races equally, though it is more noticeable in people with darker skin.

This condition can be hereditary and families who are associated with it can experience premature graying of the hair.

Those with autoimmune diseases, such as thyroid disease, are at greater risk for this condition.

Patients with vitiligo suddenly have no natural protection from the sun for their skin. Melanin offers protection to the skin from damaged caused by sunlight. Without melanin, there is no protection. The white patches can easily burn, therefore, patients should wear sunscreen with a SPF of 30 on all white areas of skin. Because of this problem, patients with vitiligo are at greater risk for skin cancer and skin aging.

Test and Diagnosis Considerations

Usually a skin examination is all that is needed to diagnose vitiligo. A Wood’s light examination may be done to distinguish vitiligo from other conditions of lightened skin. Due to the fact that there may be other causes of pigment loss, a skin biopsy may be required. Blood tests can be performed to monitor the levels of thyroid or other hormones and vitamin B12 levels. Additionally, an ANA Test (Antinuclear Antibody) may be ordered to help determine if the patient has any autoimmune diseases.

Treatment Options

There is no cure for vitiligo but it can be treated. The goal of treating this skin condition is to stop or slow down the pigment loss. While vitiligo is difficult to treat, there are options available. A simple treatment is to use makeup or self-tanning lotion to camouflage the white spots. Medically, there are two treatment options to consider, repigmentation therapy and depigmentation therapy.

Re-pigmentation Therapy

Repigmentation therapy is the process of trying to restore the normal skin pigment. This is done by creating new pigment cells from already existing ones. These new cells can come from the base of hair follicles or from the white patch itself if depigmentation is not complete. Not all people are good candidates for this type of therapy.

Generally, children and young adults have been known to have a greater success rate. Patients should be healthy and be able to tolerate the long, tedious process involved. It is important to note that if a person has vitiligo over half the body, they are not a good candidate for re-pigmentation.

Hydrocortisone Creams

Hydrocortisone creams can be applied to the skin to slow down the process of depigmentation and to enhance repigmentation. Prescription strength cortisone ointments or creams are required as over-the-counter creams are too weak. Corticosteroids are often considered first in the attempt to treat vitiligo. They may be used topically (applied to the skin) or systemically (ingested/injected into the body). Topical use is considered for small lesions and systemic use is considered for numerous and widespread lesions.

Topical corticosteroids do have some side effects such as thinning of the skin, stretch marks, telangiectasia (dilation of small blood vessels), hypertrichosis (excessive growth of hair), and acneform papules (resembling acne). Systemic corticosteroids are effective in stopping the spread of vitiligo but they do have some serious side effects. They are usually used only for severe cases.

Another type of topical treatment involves a non-steroidal group of immunodulators, such as Pimecrolimus and tacrolimus. This treatment helps to regulate the activity of the immune system and stop the immune system from destroying melanocytes. Potential side effects include a stinging and burning sensation to the skin, but more seriously, these drugs may have some cancer risk associated with them.

Phototherapy

Phototherapy can induce repigmentation. This can be done alone or in combination with hydrocortisone treatment. Therapy of this sort involves narrow-band ultraviolet B light, excimer laser, and PUVA (psoralen plus UV-A). This treatment is considered when topical treatments are ineffective.

1. Narrow-band UVB treatment is a new option for vitiligo treatment and involves exposing the skin to a narrow-band UVB light. This process has minimal to no side effects and can be done in a doctor’s office. This procedure requires treatment 3 times a week for several months.
2. Home phototherapy units are also available. This treatment is usually considered the first choice for treatment options. Side effects include itching of the skin and redness. Long-term effects include skin cancer and premature aging of the skin.
3. Excimer laser treatment exposes the skin to a beam of laser light. This process can only be done in a doctor’s office. It is most often used for small areas of depigmentation and should be used as a complimentary treatment option.
4. PUVA therapy involves giving a patient a psoralen drug and then exposing him to UV-A light. Repigmentation is stimulated when this drug is activated by light. The pigment cells are stimulated to move into the vitiligo lesion. There are definite risks to pregnant women and they should not be treated with this procedure due to the harmful effects of the drug on the developing baby.

Depigmentation Therapy

Depigmentation therapy is considered when one wants to try destroying the remaining pigment cells. The process involves removing the normal skin color so it matches the patchy white areas. This is beneficial to patients who have vitiligo over half of the body or more. This treatment involves a topical agent called Benoquin (monobenzylether of hydroquinone). The process requires strict medical attention and does have serious side effects. It is important to note that depigmentation is generally irreversible but occasionally some patchy areas may return.

Remedies and Treatments

Herbal & Home Remedies

The use of herbal remedies should be used with caution in treating vitiligo and they should be used only under a doctor’s supervision. Patients with autoimmune diseases need to be cautious with herbs such as Goldenseal, Astragalus, Echinacea, and Spirulina. These herbs are immune boosters and may boost the body’s destroying of melanocytes.

Pharmaceutical

There are many drugs available to help treat vitiligo. The reason for this abundance is because the condition affects each individual in its own way and, therefore, what works for one person may not work for another. Once an effective medication is found for treatment, it may only work for a little while and the patient will then have to search for other treatment options.

Transplant treatment

Skin transplant procedures seem to look promising for the future of vitiligo treatment. This involves a dermatologist removing a patch of normal pigmented skin and grafting it onto a depigmented area. There is also Melanocytes Transplant Therapy to consider. This involves the dermatologist taking pigment cells from a normal pigmented patch of skin, growing them in a culture, and placing them onto a white patch of skin.

Additional therapies

Therapy from a mental health professional is oftentimes very helpful for patients with vitiligo. Counseling and group sessions can be beneficial to patients when they can talk and discuss their situation with other individuals who are experiencing the same condition. Patients with this disorder often feel anger, embarrassment, anxiety, isolation, and depression. They need to receive positive support from their families and friends, doctors knowledgeable about the disorder and treatment, and they need to find a way to generate positive self-esteem.

Resources

EmedicineHealth.Com
WebMd.Com
MayoClinic.Com

Freckles are flat, circular tan spots of concentrated melanin often visible on individuals with fair skin. Also known as ephelides, the word freckle comes from the Middle English term freken which descends from the Old Norse term freknur meaning freckled.Those with freckles may have numerous spots on areas such as the cheeks, nose, forehead, chest, shoulders or arms, or may just have a few scattered in various places on the body.

Freckles can be of multiple colors including brown, light brown, reddish or even black. Not everyone is a fan of their freckles and therefore use home remedies, over the counter medications, prescription treatments or even professional chemical peels to reduce their appearance. Learning about effective cures and remedies for freckles can help to increase your skin care knowledge and benefit your skin.

Symptoms

There are two basic types of freckles, ephelides and lentigines. Ephelides are the most common type which results in flat, circular red or brown colored spots that typically occur darker in the summer and lighter in the winter. Lentigines are smaller in size and can appear brown, tan or black. These types of spots are usually darker than ephelides and stay dark through the summer and winter.

Lentigines, often called ˜liver spots are commonly found in older people after years of exposure to the sun. Freckles typically appear in areas that are exposed to sunlight. While most people are able to spot a freckle simply from sight, there are various other symptoms associated with the spots.

Symptoms of Freckles Include:

• Darkening or change of the affected area of the skin
• Freckles caused by sunlight can sometimes be accompanied by diarrhea
• Affected areas of the skin can be transformed into moles
• Abdominal pain that can vary in intensity
• Weight loss can accompany new freckles
• Passing off bloody stools or stools coated with mucus
• New or unusually shaped freckles can be a warning sign of cancer
• Brown, tan or red spots that become darker when exposed to the sun
• Spots that occur after a period of sun exposure
• Red hair and green eyes are most common traits for those with freckles
• The spots can appear as pin-size spots or be larger with smooth or ragged edges

Causes

Exposure to sunlight and genetics are the two leading factors in the creation of freckles. Depending on the type of freckles you have, they may fade or darken depending on the amount and intensity of sunlight on exposed areas of the skin.

Freckles can also be heredity and therefore be passed down by a mother, father, grandparent or other close relative. This is because some individuals carry special cells in the skin that produce excess amounts of melanin. Hormone abnormalities can also be accounted for as an over-stimulation of estrogen in the body can cause the pigment cells to generate excess color when exposed to sunlight.

Causes of freckles include:

• Over-exposure of bare skin to sunlight
• Accumulated melanin build-up in a certain area of the body
• Heredity and genetics can play a role in freckle production
• Hormonal imbalance or excess estrogen in the body
• Fair skinned individuals are most at risk as they absorb more ultraviolet rays
• Those who tan both outside or in a tanning bed can get freckles
• Skin cancer patients can develop freckles in colors such as black, pink or red with irregular shapes
• Caused by the dominant MC1R melanocortin receptor gene

Risk Factors

Many find freckles very attractive, especially when scattered across the cheek. Since freckles, pose no danger to our general health, those with freckles can enjoy their appearance and give a splash of color to their fair skin. The only threat detected by the appearance of freckles is when they mistaken for other skin conditions or diseases. If you have a new or unique freckle or freckles, its best to get them evaluated by a professional dermatologist to rule out potential harmful conditions.

Possible risk factors include:

• Excess exposure to sunlight in bare areas such as face, arms, back and shoulders
• Genetics plays as a factor so individuals with freckled family members or relatives
• Fair skinned individuals are more at risk, especially if they work or spend large amounts of time outdoors
• Those who tan on a regular basis outdoors or at a tanning salon are more at risk

Prevention Tips

When trying to prevent freckles from becoming darker or when trying to reduce the appearance of your freckles, you will need to engage in a few preventative measures.

The main goal is to stay protected while still being able to enjoy time in the sunlight. These preventative measures will also help reduce the risk of skin related conditions and diseases such as skin cancer. The younger you begin preventing the appearance of freckles; the chance of getting them in the future will be greatly reduced. Try the following prevention tips for sun safety and prevention of freckles.

How to prevent freckles:

• Avoid exposure to the sun whenever possible. Sit under a shaded tree or porch while outdoors.
• While outdoors, wear clothing that will help ward off the sunlight such as hats and t-shirts to cover your shoulder and back in warm weather.
• Keep your face and skin safe by wearing a thin layer of SPF make-up, face powder or simply sun screen alone.
• Products such as umbrellas, visors and sun hats can help keep the sun from direct contact with your skin.
• Increase your Vitamin C intake to prevent the occurrence of freckles
• Use a sun screen that blocks both UVB and UVA rays and contain at least one of the following active ingredients: titanium dioxide and zinc oxide
• Reapply sun screen after excess sweating or after swimming
• Avoid peak sun hours, typically between 10 AM and 4 PM when the sun is the highest and most intense
• Avoid using tanning beds as this gives direct UV radiation to the skin

Check any medications you take for skin sensitivity side effects

Test and Diagnosis Considerations

While freckles are not harmless to the individual who possesses them, some may still want a physician advice and proper diagnosis. Freckles can be diagnosed simply through appearance alone. Your dermatologist will know what to look for to distinguish a freckle from any other type of lesion based on the appearance of the skin.

Future testing may be needed if the freckles are abnormal in shape or color or if a separate skin condition or disease is suspected such as melanoma. If your doctors expect skin cancer after analyzing new or unusual freckles, a biopsy (skin sample) may be taken and assessed by a lab to properly diagnose and treat the skin disease. This procedure is typically done in your dermatologists office under local anesthesia.

Treatment Options

Freckles do not have to be removed for medical reasons but many prefer them lightened for cosmetic reasons. There are numerous treatments available for freckles including creams, oils, facial masks, lotions, topical prescriptions, as well as several in-office laser and chemical options. Here you will find various treatment options to fit your needs.

Herbal and Home Cures & Remedies Include

Natural remedies and cures used for freckles are extremely safe and present mild or no side effects in most cases. Irritation of the skin may occur with frequent use. Herbal and home cures may also take longer to see results as they gradually lighten skin over time. Cost of these home remedies are low as they can be found in your own home or purchased from a super market for just a few dollars.

• Apply fresh lemon juice to the freckles twice a day
• Apply sour cream and leave on as a mask, do not rinse
• Use fruit or vegetable masks (includes: strawberries, cucumbers, apricots and red currant)
• Wash your face with sour milk to gently peel off top layers of skin
• Apply microwave heated honey to face and rinse with warm water
• Horseradish vinegar or juice applied to the face can lighten freckles
• Apply castor oil before going to bed
• Use parsley juice mixed with equal amounts of orange, lemon or red currant juice.
• Apply grinned yellow mustard mixed with milk and allow to sit overnight
• Wash your face with buttermilk
• Rub a slice of red onion on the freckles twice a day
• Mix sesame seeds with turmeric seeds, mix with water and apply
• Use grains of the inside of a watermelon to scrub face
• Mix unpasteurized honey with unripe currants and leave on face for half hour before rinsing

Pharmaceutical Cures & Remedies Include:

Pharmaceutical treatment options can vary from over the counter creams to prescription medications advised from your dermatologist. These types of freckle treatment options can present side effects such as reddening of the skin, irritation, headaches, acne, skin discoloration (temporary or permanent), rashes, chemical burns and oily or dry skin. Pharmaceutical methods for freckles do not work for everyone. Costs of these treatment methods can vary and in some cases, health insurance may cover the costs of prescription medications.

Bleaching creams containing kojic acid or high concentrations of hydroquinone. Beware of certain bleaching creams that can permanently discolor or damage skin.

Tretinoin can be used in conjunction with bleaching creams

• Alpha hydroxyl acids used on a regular basis
• Over the counter or prescription medications containing glycolic acid
• Prescription-strength retinoid applied daily over a period of time
• Prescription medications containing tazortene (Tazorac) or adapalene (Differin)
• Larger freckles may react to treatment methods made for the lightening of age spots

Surgery Cures & Remedies Include:

There are several ways to reduce or even hide the appearance of freckles almost instantly through treatments provided by a dermatologist. These options are very effective but may take numerous treatment appointments to fully lighten the freckles. The effectiveness, cost and time it takes to reduce the appearance of the freckles will depend on the type of freckles, how many you have, where on the body they located and how dark they are.

Laser resurfacing removes the top layers of skin with a laser and provides long-lasting results. Typically takes 1 to 2 weeks to complete and costs approximately $2,250.

Chemical peels are also effective in getting rid of freckles by using intense chemicals to peel away layers of skin. Only 1 treatment is usually need and the approximate cost is $800.

Liquid Nitrogen

Liquid nitrogen (cryotherapy) treatment is used to the freckle directly by forming a blister that lifts the freckle from the skin. Multiple sessions may be needed for this somewhat painful procedure and the approximate cost is $3,000.

Also known as angel kisses or beauty marks freckles can give a person a unique look. It’s not probable that everyone with freckles are going to like the way they look which is why there are thousands of freckle lightening and removal products on the market.

Many of these freckle treatment methods are permanent so it best to give the idea some thought and consideration before making a definite choice on whether or not you want to be freckle-free. Try wearing make-up to cover up your freckles for a few weeks to see what you look and feel will like without them.

Stick With It

It’s important to stay consistent when using any of the above cures and remedies for freckles as most take time to work. You will usually begin to see a gradual lightening of the freckles after two to three weeks of time. After six months, a visible change in the appearance of the skin should be noticed by yourself and others.

The removal of freckles from the skin can help one self confidence by providing freckle-free, healthy skin. If you interested in finding cures and remedies for freckles, use this guide to aid you in your quest to clear skin.

Hyperacidity occurs when the stomach releases a higher than normal amount of hydrochloric acid during the process of digestion. Hyperacidity also refers to the stomach simply containing an excess of acid.

The term heartburn refers to a sensation that can be described as feeling like burning and is felt in the chest area behind the breastbone. Though the pain will usually be felt in the chest, it may also radiate out towards the neck and throat area.

Stomach Acid

Heartburn may be experienced when there is a regurgitation of stomach acid (gastric acid). It also commonly occurs as a symptom of gastroesophageal reflux disease. The term acid reflux is often used interchangeably with heartburn. However, acid reflux is the action of the stomach acid leaking into the esophagus while heartburn is the associated sensation.

While most individuals experience infrequent and minor cases of heartburn, there is a severe condition known as GERD (gastroesophageal reflux disease) that affects some with symptoms far more often. This condition involves intense and frequent acid reflux and can lead to many potential health complications.

Alternative names

Hyperacidity is alternatively referred to as acid dyspepsia or Amalpitta.

Heartburn is alternatively referred to as acid indigestion or pyrosis.

Symptoms

The most common symptoms associated with hyperacidity and reflux are:

• The sensation of heartburn occurring after eating. Pain may last for a few minutes or up to several hours.
• A pain in the chest area that can get worse when lying down or bending over.
• A painful burning sensation occurring in the throat. Can be accompanied by an acidic taste in the mouth or the sensation of a sour or bitter liquid in the back of the throat.
• A sore throat or feeling of hoarseness.
• Feeling like something is caught in the esophagus or throat area.

In the more severe cases of GERD, symptoms may include:

• Belching
• Bloating
• Blood in stool or vomit
• Dysphagia the condition of having a narrowed esophagus, can lead to individuals feeling as though food has not gone down properly when eating or has become stuck in the throat
• Frequent and long lasting occurrences of hiccups
• Nausea
• Unexplained loss of weight
• Wheezing accompanied by a scratchy or sore throat

*Please contact your doctor should you experience symptoms of GERD or experience heartburn more than twice per week.

Causes

Hyperacidity occurs as a result of several different causes. The most common of these are ulcers in the lining of the stomach, GERD, cancer of the stomach, or a diet that is high in spicy foods.

Acid reflux, and the resulting heartburn, is typically caused by a condition of the lower esophageal sphincter (LES.) This sphincter is found in-between the esophagus and the stomach. The role of the LES is to prevent acid that is present in the stomach (due to normal digestive processes) from leaking into the esophagus.

The LES will regularly open during eating so that food can pass into the stomach area for digestion or to allow for belching as needed. When the LES becomes underactive or fails to provide the necessary seal due to poorly timed opening or improper closing, reflux can occur. Problems with the LES can occur due to overeating, which leads to an overfull stomach with too much food. Being overweight or pregnant also puts pressure on the stomach and can lead to the same problems.

Additionally, the LES can become relaxed, causing it to malfunction, as a result of diet or lifestyle.

Risk factors

Risk factors for acid reflux and heartburn are sometimes not a direct result of lifestyle and behavior, such as in the case of a medical condition. However, most of the time these risk factors can be controlled by making changes to ones habits or diet.

Some behaviors that are known to trigger occurrences of reflux and heartburn include:

• Being overweight. Body fat can put pressure on the stomach which may lead to a malfunctioning LES (lower esophageal sphincter.)
• Eating too much during meals, being overstuffed.
• Lying down flat or bending over within 2 hours after eating.
• Eating meals or snacks right before going to sleep.
• Smoke can act as a stimulant in the production of gastric acid. Also, smoking may weaken the LES which causes it to relax.
• Taking certain medications such as aspirin, ibuprofen, muscle relaxers or medication to treat blood pressure

Some of the foods and beverages that are known to increase the risks of having heartburn are:

• Tomatoes and tomato-based products
• Citrus fruit and juices (Examples: orange juice, lemons, lemonade, grapefruit juice, cranberry juice)
• Garlic and onions
• Chocolate
• Dairy products (Examples: milk, ice cream, sour cream, yogurt)
• Coffee (and other caffeinated products)
• Some carbonated beverages
• Alcohol (Examples: liquor, red wine, beer)
• Peppermint
• Dishes made with high levels of fats and oils or are fried
• Dishes prepared using spicy ingredients

Having occasional heartburn is not usually a cause for concern. 30% of the U.S. population will experience infrequent moderate episodes that do not require medical attention. Frequent heartburn occurring more than twice a week for an extended period may indicate a serious medical condition or can develop into one.

Heartburn occurs daily for approximately 10% of the U.S. population. A doctor should be contacted if heartburn occurs over twice a week for a continuous two weeks or longer.

Prevention tips

1) Keep an eye on portion sizes. Eating until stuffed puts pressure on the stomach. A very large meal will stc6ay in the stomach fc6or longer and increc6ase the chances of reflux. Reduce the size of meal portions so that you are feeling satisfied after eating rather than full.

2) Take the time to eat slowly. Slowing down can keep you from overeating.

3) Don’t eat meals and snacks within two hours of going to sleep. Eating several hours before bedtime will allow your stomach to digest properly and empty prior to lying down. This will also give time for the acid produced during digestion to decrease again.

4) Know which foods trigger heartburn and avoid them. A food diary can help to track the foods that will cause heartburn. Staying away from these foods can reduce the occurrences of heartburn. Each person is different and some food items can be triggers for some people and not others.

5) Be careful when eating out. Stay away from foods with high fat content, a low fat option is always better. Also, restaurant portion sizes are typically very large. Decide in advance to take half the meal home to avoid overeating.

6) Lose weight. Symptoms of heartburn can be reduced by shedding some pounds, which reduces some of the pressure on the stomach.

7) Avoid tight fitting clothes. Clothing that is too tight around the stomach area may put pressure on the stomach and the LES (lower esophageal sphincter.)

8.) Quit smoking. Smoke can cause or worsen the symptoms of heartburn.

9) Don’t drink alcohol. Or just keep a watch on alcohol consumption. Some alcoholic beverages trigger heartburn more frequently (such as red wine.)

10) Do not exercise within two hours of eating a meal. A full stomach combined with the movement and strain of exercise can lead to acid reflux and heartburn.

11) Increase your water consumption. Keep the body hydrated and avoid carbonated and caffeinated beverages to assist the body with digestion.

Test and Diagnosis Considerations

Frequently occurring heartburn could indicate a medical problem and a doctor should be contacted. Doctors may run diagnostic tests to determine the nature of the heartburn or to see if it is a reflection of a more serious concern.

Upper Endoscopy Procedure where a thin and flexible tube called an endoscope is inserted into the throat. Doctor can then examine the upper lining of the gastrointestinal tract (includes the esophagus, stomach and part of the small intestine.)

This procedure can provide more accurate results than x-rays because it gets a much closer view of the lining. From an endoscopy, a doctor can diagnose inflammation in the gastrointestinal tract, ulcers, hernias, growths, obstructions, precancerous conditions or cancer.

Bernstein Test

Bernstein Test (or an acid perfusion test) Procedure where the doctor will attempt to reproduce symptoms related to heartburn in order to determine if acid from the stomach is the cause of the heart burn. A nasogastric (NG) tube will be inserted into the esophagus through the nose.

A solution similar to stomach acid will then be passed into the esophagus to determine if the heartburn sensation has been reproduced followed by a saline solution. From these tests, a doctor may be able to determine if the esophagus is irritated, if acid reflux is the cause of heartburn, or if additional testing will be necessary.

Esophageal Manometry Procedure

Esophageal Manometry Procedure performed to determine if the esophagus properly contracts. The doctor will pass a pressure-sensitive tube through the esophagus (through mouth or nose) and into the stomach. Pressure on the tube after swallowing can be measured to determine the effectiveness of the esophagus contractions. This is usually conducted prior to a surgery on the esophagus being considered.

PH Tests & Xrays

PH Test Procedure performed to measure the amount of the stomach acid present or backed up into the esophagus. A thin plastic tube will be inserted into the esophagus through the nose and is left in place for 24 hours. Regular activities should be continued for the day in order to get the most accurate acid measurements.

Barium X-Rays (or barium swallow) X-rays taken after ingestion of a liquid containing barium. The doctor can see the flow of the barium into the digestive tract to spot ulcers, hernias, or other abnormalities.

Treatment Options

There are many courses of action one may take to relieve the symptoms of hyperacidity and heartburn. Beyond simple prevent, there are home remedies, medicines, and surgeries that can help affected individuals.

Herbal & Home Remedies

Living enzymes in food are said to help with digestion and can help with or eliminate acid reflux. A diet high in organic, fresh, and raw fruits and vegetables will add living enzymes to the stomach and can lead to improvement of heartburn symptoms.

Some other remedies that may offer natural heartburn relief:

• Ginger root can be added to teas
• Anti-inflammatory herbs can help to repair tissue in esophagus that been damaged
• Anti-anxiety herbs such as slippery elm root bark powder

Stress and anxiety are known to aggravate acid reflux and heartburn symptoms. Finding methods to deal with normal anxiety and stress naturally can help to lessen symptoms. Some examples of natural ways to reduce anxiety and stress include aromatherapy, massage, meditative relaxing techniques or gentle exercise.

Pharmaceutical Remedies

For many individuals with lesser to moderate symptoms of heartburn, a combined strategy of avoiding triggers and using over-the-counter medicines can be an effective means for controlling heartburn and acid reflux.

There are many over-the-counter medicines on the market that can neutralize stomach acid or otherwise reduce heartburn. Some of these include:

• Foaming agents (such as Gaviscon) work to prevent reflux by coating the lining of the stomach
• Antacids (such as Alka-Seltzer, Maalox, Rolaids, Riopan Pepto-Bismol, and Mylanta) can rapidly bring relief of symptoms by neutralizing the acid in the stomach
• H2 Blockers (such as Tagamet HB, Zantac 75, Axid AR or Pepcid AC) will reduce the levels of acid being produced in the stomach

These medicines are easily accessible and affordable. However, there can be risks and side effects associated with long term use of these medications. Diarrhea, stomach cramping, headaches, nausea and constipation may occur with frequent use. Individuals taking antacids should ensure they are being taken according to instructions provided by their doctor or listed on the packaging.

Prescription Strength

When over-the-counter medicines are not providing relief, a doctor may prescribe medication for more severe cases. Those who experience very frequent occurrences of heartburn, experience hyperacidity, or individuals with gastroesophageal reflux disease (GERD) will benefit the most from the prescription medications that are taken once daily and work for 24 hours.

Proton pump inhibitors (such as Prilosec, Nexium, Protonix, and Prevacid) will reduce the amount of acid produced more effectively and for a more extended period of time than H2 blockers and also work to repair damage to the esophagus.

Prokinetics or Promotility agents (such as Reglan) can force the stomach to empty itself quicker, thus assisting the pressure on the LES and reducing acid reflux. They will stimulate stomach muscles to move food further along the gastrointestinal tract.

Side Effects

Side effects and risks associated with these types of prescription medications vary. Effects that should be reported to a doctor when taking proton pump inhibitors include confusion, tightness in the chest, fever, irregular heart beat and fatigue. High doses of prokinetics or promotility agents may reduce the absorption of other important medications and can cause effects such as drowsiness, diarrhea, restlessness, movement problems and issues with kidney functions in older adults.

Surgery

For some individuals, medications may not provide enough relief of symptoms. For these cases or where the symptoms seem to negatively interfere with ones life, individuals may undergo surgery that may assist in offering relief of GERD and heartburn symptoms. Doctors may also recommend surgery when the LES fails to work properly or when esophageal cancer has developed from chronic GERD. If not properly treated, long term cases of reflux can cause serious issues or complications.

Laparoscopic Surgery- A procedure which is minimally invasive and utilizes a thin instrument attached to a tiny video camera and light source. The video transmits images to a monitor and this helps to avoid the need for larger incisions. This procedure will create an artificial valve in the stomach. The top portions of the stomach will be wrapped around the LES through an incision in the abdomen or chest area using a lighted tube. The new valve can strengthen the LES and prevent future episodes of acid reflux.

Individuals who meet certain criteria would be considered the candidates most likely to benefit from this surgery.

• No previous abdominal surgery
• Most often experience symptoms when lying down
• No history of bleeding disorder and no other major medical issues
• Not pregnant

Benefits of Surgery

The benefits to this surgery include a short hospital stay and fast recovery/return to normal activities. There is less risk of infections and surgical complications due to the small incision that is used. This type of surgery is typically less expensive than more traditional and invasive surgeries. Surgery as treatment for GERD and heartburn symptoms would be considered a last resort.

Over 90% of those who undergo this surgery will be cured of their symptoms but there is no long term evidence to conclusively state that this cure will be permanent. Surgery as a method of treatment for reflux is debated in the medical world and many still believe medications are better long term solutions.

Those patients who are not a candidate for this type of laparoscopic surgery may require more invasive procedures to treat GERD. This may include laparotomy (which involves cutting open the abdomen) or thoracotomy (which involves cutting open the chest.)

One of the main reasons for deaths worldwide and the single leading cause of death (1 in 5) and illness in the US is coronary heart disease (CHD). Also referred to as coronary artery disease (CAD) and ischemic heart disease (IHD), approximately 14 million women and men are impacted by coronary heart disease in America. Costing about $156 billion annually, coronary heart disease is one of the most costly types of cardiovascular conditions in the US.

Causes

In general, coronary heart disease develops over time and occurs when the arteries or major blood vessels, which supply the heart with blood, become diseased or damaged. This is often the result of plaques or fatty deposits, which have built-up in the walls of the arteries.

The hardening of the arteries or atherosclerosis is the condition which causes coronary heart disease and this occurs when the arteries become narrow, restricting the flow of blood, resulting in chest pain or angina.

In addition, if the arteries are blocked because of plaque, it may cause a heart attack or sudden cardiac arrest.

Overall, if the heart does not received sufficient blood, which is rich in oxygen and nutrients, then you have a high chance of getting coronary heart disease.

Risk factors

There are several risk factors, which may contribute to coronary heart disease. However, some common ones may include:

• Diabetes and persistent kidney disease
• Hypertension or high blood pressure
• Diet high in fat
• Age, especially for men in their 40s and women who have reached menopause
• Family genes or hereditary, in that if someone in your family has had coronary heart disease before age 55, your chances of being affected by this disease increases
• High or abnormal cholesterol levels, which results if your bad cholesterol or low density lipoproteins (LDLs) are high and your good cholesterol, or high-density lipoproteins (HDLs) are low
• Smoking and excessive tobacco use, including smoking cigarettes, pipes and cigars as well as chewing tobacco
• Lack of exercise and physical activity
• Obesity and being overweight
• Excessive use of alcohol
• Emotional stress

Symptoms

Often called the silent killer, coronary heart disease symptoms may occur quickly, sharply, and unexpectedly and may be destructive, as in a cardiac arrest or a heart attack. Some symptoms include feelings of discomfort especially during exercise or increased activity when your heart has an increased demand for nutrients and oxygen in the blood. However, if the arteries are blocked, the flow is decreased and they may trigger a cardiac arrest or extreme discomfort.

Sometimes symptoms may not occur even though you have coronary heart disease and in many cases, apart from having an electrocardiogram (ECG) test done, it would not be discovered that you have a heart problem. This condition is called silent ischemia when half or more of your arteries are blocked without showing any symptoms.

Other common symptoms for coronary artery disease occur because the heart is unable to pump enough blood in order to meet the demands of your body. These may include

• Tightness in the chest and chest pains, which is one of the most common symptoms
• Heart palpitations
• Shortness of breath resulting from strenuous activity or exercise
• Pain in the neck, arm, back, stomach or jaw in particular on the left side of the body, which may occur during rest or strenuous exercise
• Feeling weak or fatigued during rest or exertion
• Heartbeat that is irregular
• Feeling dizzy, faint or lightheaded

While you may not have all of the symptoms, you may experience a few. However, paying close attention and seeking timely medical help if the symptoms are persistent is important since they may lead to serious complications.

Complications

Some complications include a heart attack, which usually damages your heart muscles due to little or no blood flowing to the heart. The damage is often irreversible; however, with quick treatment it may be reduced. Some persons who have a heart attack may show symptoms such as spells of blackout, sweating excessively without an explanation, frequent chest pains, shortness of breath and pain in the jaws with exertion or during rest.

If you have experienced a heart attack before, you may develop heart failure. With heart failure, the heart is too weak to pump the flow of blood required for your heart to function properly.

Another complication arising from the symptoms of coronary heart disease is angina or chest pains which is usually experienced during strenuous activity such as exercise. In addition, you may experience arrhythmia or abnormal heartbeats resulting from damage to the tissues of the heart due to limited blood flow. The possibility of unexpected or sudden death may also arise from coronary artery disease.

Prevention and Diagnosis Considerations

In general, people usually seek to have tests done and to get a diagnosis for coronary heart disease if they exhibit some of the symptoms or complications such as a heart attack, an unexpected cardiac arrest or angina.

However, many of the symptoms that lead to heart disease might be caused by other conditions that are not related to the heart. Therefore, the process of diagnosis begins with getting information on your medical history, including symptoms, general and specific health issues and any medications that you are taking currently.

In order to determine whether you are having a heart attack or any other type of condition that may be life threatening, the doctor may order a few tests, before making a diagnosis. These may include a physical examination, an ECG, a blood test and other imaging tests such as an x-ray or Computerized Tomography (CT) scan.

Testing

Some of the most common diagnostic tests, which are used include:

Blood Test to check your blood chemical makeup, the blood cells as well as if there are any leakages from heart muscles that may be damaged. This may indicate that there has been a heart attack.

Electrocardiogram (ECG) is used to measure the electrical signals in your heart and helps to detect heart problems, including a previous or current heart attack, ischemia, and strain on the heart because of high blood pressure and rhythm disorders. The ECG helps to give indications as to the significant causes of the coronary heart symptoms.

With the ECG, electrodes are attached to your chest, arms and legs as you lie down on a table. The test is easy and takes just a few minutes to be completed. In some cases, another test, called Holter monitoring, is used with the ECG. This requires you to wear a portable monitor for 24 hours to test any abnormalities that may exist in your heart.

Echocardiogram

Echocardiogram is a stress test, which uses sound waves on the heart walls and valves to produce images of the heart as it beats. It checks to see if all parts of your heart are helping with pumping the blood flow. This helps to identify any form of coronary disease or if some parts of the heart are weak or have been damaged by a heart attack. With echocardiography, the test may involve the patient exercising on a treadmill or a drug may be administered.

EBCT

CT scan and Electron Bean CT (EBCT) Scan use technology, which helps your doctor to see whether there are any plaques or calcium rich fatty deposits in your arteries. It also helps to detect blockages in your arteries up to 20%, which may be overlooked in other tests. The EBCT scans are most helpful in screening young people who may have many risk factors for heart disease and generally, minor blockages may be treated with medication and some lifestyle changes.

Coronary Angiogram or Coronary Catheterization

Coronary Angiogram or Coronary Catheterization is a surgery, which uses a catheter, a long, thin, flexible tube, filled with an iodine dye, which is injected intravenously into your arteries.

The catheter is often threaded through the opening of your arteries from a blood vessel usually in your leg or arm or groin. The arteries are made visible on an x-ray screen and images of the arteries are taken and recorded for further review. The images may show the size of the arteries and any blockages that may be occurring.

The coronary angiogram is one of the most accurate tests, which are used to determine the type of treatment you will require for your heart condition.

Possible treatments may include a heart bypass surgery, an angioplasty, stent placement or medications.

The diagnosis test using the coronary angiogram is usually a one-day invasive surgery at a hospital or a special catheterization lab and the complication risks are extremely limited especially with an experienced doctor.

CT Angiography and MRA’s

CT angiography is another method used to perform the coronary angiogram, which is non-invasive.

Magnetic Resonance Angiogram (MRA) is combined with an injected dye, which is used to detect if the arteries are narrow or blocked. However, the results are not as effective as with the coronary angiogram.

Nuclear Scan

Nuclear Scan is often used as a stress test and involves the injection of a small dose of radioactive tracer such as thallium into a vein. With the help of a special camera, the amount of blood flow reaching the areas of the heart muscles is identified.

You will be required to do two tests, one with stress or exercise on a treadmill and the other when you are at rest. If you are unable to exercise, you will be given a drug, such as Adenocard, Persantine or Dobutrex to help stress your heart on a temporary basis. The nuclear scan is a non-invasive and very accurate test, and is often very expensive.

Stress Tests

Stress Tests are used to determine when coronary heart disease symptoms occur, whether during exertion or at rest. It may involve walking on a treadmill or riding a stationary bike during an ECG. In cases where you are unable to exercise, a drug may be used to stimulate your heart.

Treatment options

The treatment for coronary heart disease involves home, pharmaceutical and medical applications. Following your doctor directions is very important to reducing or preventing this disease as well as other related ones such as hypertension and diabetes.

Home remedies or treatments

Most of the control for treatment lies in the hands of the individual with heart problems. With changes to your lifestyle, you are able to help prevent or slow the progression of the disease. These changes include

Eating a diet that is heart-healthy, which should include fruits, vegetables, whole grains and fish and reduce your fat intake.

• Maintaining a healthy weight by exercising on a regular basis or 30 to 60 minutes for 3 to 5 days weekly.
• Controlling high blood pressure and diabetes by taking measurements and getting the appropriate treatment.
• Quitting smoking so that you may reduce your risk for heart disease after 3 years of quitting.
• Keeping your cholesterol in check with acceptable levels of LDL.
• Managing your stress or reducing it by using muscle relaxation and deep breathing techniques.

Pharmaceutical treatment

There are many drugs, which are used for treating coronary heart disease. Aspirin is a popular medication and taking a low-dose type daily may help to reduce your risk of a heart attack and the possibility of a clot forming. However, always consult your doctor before taking this medication as some people may experience side effects such as bleeding problems or ulcers. You doctor may also recommend a blood thinner.

Beta Blockers help to slow your heart rate and your blood pressure by decreasing your heart demand for oxygen. However, asthma patients should avoid this treatment as it may trigger an asthma attack. Statins are drugs, which are used to reduce the amounts of lipids such as cholesterol and fats in your blood.

They also help to slow or prevent the succession of heart disease and the repeat of heart attacks. Other medications may include calcium channel blockers, nitroglycerin, cholesterol-modifying drugs and angiotensin-converting enzyme inhibitors. Some side effects from the calcium blockers may include constipation and leg swelling.

Medical Treatment

The medical treatment for coronary heart disease may involve some invasive procedures and more complicated measures such as surgery, which may have some risks such as a stroke, heart attack or even death.

Some invasive procedures include coronary angioplasty, which provides both therapeutic and diagnostic treatment and involves a tube, which is inserted in your artery. Another method is using a stent to keep the blocked arteries open so that the blood can flow freely.

It is a small coil-like tube, which is placed over an inflated balloon at the blocked area. Other invasive treatments include brachytherapy, which uses radiation to clear the blocked arteries, and atherectomy helps to cut away the plaque build-up in small areas or self-contained parts of an artery.

Other Options

However, when medication and invasive procedures fail to help the person with coronary heart disease or if the disease is severe, then surgery is often recommended. If several coronary arteries are blocked or if the major left artery is significantly blocked, a coronary artery bypass operation is usually performed. With this operation, you are connected to a bypass pump machine while the heart is stopped briefly. In rare cases, the operation is done without using a bypass pump.

Other surgical treatments include minimally invasive coronary bypass, usually for your front or right coronary arteries. Some patients who are unable to have either a bypass surgery or angioplasty, the transmyocardial laser revascularization (TMR) procedure is offered. This surgery, which may be done by itself or with a bypass surgery, uses a laser catheter to make several holes in your heart™s muscle so that new vessels will grow into the diseased heart muscles.

Stem Cells

A relatively new treatment option uses stem cell; however, this is not approved by the US FDA and is done on a limited basis in a few countries. It involves screening by stem cell cardiologists and the cells are taken, isolated, multiplied and injected into one or more of coronary arteries. This procedure is similar to the standard angioplasty or minimal invasive heart surgery.

Angina, also known as Angina Pectoris which means squeezing of the chest in Latin, is a symptom of ischemic heart disease. The chest discomfort, pressure and pain are caused by the coronary arteries delivering an inadequate amount of oxygen-rich blood to the heart. The two main causes of angina are artherosclerotic plaque buildup and coronary artery spasm. If left untreated, angina can result in total blockage of the arteries and cause a heart attack.

The risk of heart disease and heart attack increases with the number of risk factors you have and their severity. Some heart disease risk factors can develop within the first ten years of life. Risk factors include hypertension, coronary artery disease, high blood fats or cholesterol, family history of premature ischemic heart disease, smoking, high blood pressure, obesity and diabetes. Angina occurs more frequently in men than in women. The most frequent cause of angina is coronary artery disease. The risk factors you cannot control are family history, age and gender.

Four Different Types of Angina.

Stable Angina

Stable angina is chest pain or discomfort that usually occurs with stress or physical activity. It begins slowly and intensifies before going away but reoccurs with additional activity or stress. The pain usually lasts from one to 15 minutes and is relieved with medication or rest. The frequency and severity of the pain does not change much.

Symptoms of Stable Angina include pain that occurs behind or slightly to the left of the breastbone and a feeling of tightness, pressure, squeezing or crushing pain in the chest. Stable Angina can be treated with medication, angioplasty or stenting. Medications require no recovery time and are much less expensive than angioplasty and stenting.

People who take only medications to relieve their angina may not have quick chest pain relief, but if you choose to take medications to treat your angina, it’s important that you take them exactly as your doctor instructs you so that you get the maximum benefit from your medications.

Angioplasty and stenting may have earlier and better symptom relief, such as reduced chest pain but research has shown the chest pain relief was about the same between those who have angioplasty and stenting and those who only take medication after five years.

Unstable Angina

Unstable angina is chest pain that occurs suddenly and gets increasingly worse. It is the most serious form of angina and requires immediate medical attention. The chest pain lasts longer than 15 – 20 minutes, may occur along with a drop in blood pressure or significant shortness of breath, occurs without cause and responds poorly to nitroglycerin.

Calcium channel blockers are extremely effective in preventing the coronary spasms of variant angina. These drugs, along with nitrates, are the most common treatment. If you have unstable angina, you most likely will be admitted to the hospital and given medicines, including heparin, aspirin and other antiplatelet medicines.

Unstable angina requires close monitoring and testing. If you are at high risk for heart attack and chest pain continues after the above treatment, your doctor may decide to perform coronary catheterization and plan for possible angioplasty and stent placement to prevent a heart attack.

Variant Angina

Prinzmetal’s or variant angina is caused by spasm of one of the coronary arteries. It is usually the result of severe coronary atherosclerosis in at least one major vessel. The spasm normally occurs very close to the blockage. It mostly occurs spontaneously and unlike typical angina, it nearly always occurs when a person is at rest. It doesn’t occur with physical exertion or emotional stress.

Attacks can be very painful and usually occur between midnight and eight a.m. Treatment helps to control chest pain and prevent a heart attack. Nitroglycerin is frequently used to relieve an episode of pain. Nitrates, beta -blockers or calcium channel blockers may also be prescribed.

The medication dosage can be gradually reduced after six to 12 months of treatment. In some cases surgery is used when blockages exist along with spasm.

Microvascular Angina

Microvascular angina is caused by inadequate blood flow through the tiny cardiac blood vessels. Microvascular angina symptoms include chest pain or discomfort, a crushing or burning sensation in the chest, and pain or numbness in the arms, shoulders or jaw.

Microvascular angina usually occurs during routine daily activities and times of mental stress. It may be more severe or last longer than other types of angina pain. Symptoms include shortness of breath, sleep problems, fatigue, and lack of energy.

Treatment for microvascular angina includes nitroglycerin, calcium channel blockers or beta blockers and lifestyle changes. Since microvascular angina is not caused by significant arterial blockages, it is harder to recognize and diagnose.

Diagnosis

Laboratory tests can help the physician identify angina and conditions that may contribute to its development.

Urinalysis may reveal underlying conditions such as diabetes mellitus or renal disease, both of which are associated with atherosclerosis.

A chest x-ray may show an enlarged heart or other signs of possible heart failure.

Blood tests may show elevated CPK (creatine phosphokinase) level. When heart tissue dies it causes the enzyme CPK to be released into the blood. Blood tests to check for inflammation, high cholesterol and glucose levels are also used to diagnose angina. Stress tests are commonly used to evaluate coronary artery disease.

EKG

During a stress test an electrocardiogram (ECG or EKG) is taken before, during and after exercise on a treadmill or stationary bicycle. Patients who are at risk for a coronary event with exercise are given a drug to increase the heart rate instead of exercising on the treadmill. A normal ECG could indicate a patient’s chest pain is caused by something other than a blocked coronary artery.

A coronary angiogram consists of injecting contrast material into the bloodstream and taking x-rays of the coronary arteries. This enables the physician to see malformations, blockages, and stenosis in the vessels. In variant angina, spasm of an artery may be induced during angiography and would help confirm a diagnosis of that form of angina.

Echocardiography is a procedure used to evaluate the valves, function, and size of the heart. This diagnostic test uses soundwaves to take a detailed picture of the heart. A nuclear heart scan shows the level of blood flow to the heart by providing moving pictures of the blood flowing through the heart and arteries.

Medication Side Effects

All medications used to treat angina have similar side effects which should be reported to your physician immediately if they worsen or persist. They include headache, dizziness, flushing and restlessness. Blurred vision, dry mouth, nausea, pale skin or rapid heartbeat are serious side effects that should be reported immediately.

If the medication is working you will experience headaches which can be treated with aspirin or non aspirin pain relieve unless they become severe. Rash, itching, swelling, severe dizziness or trouble breathing are signs of an allergic reaction to the medication and require immediate attention.

Natural Herbs can help control angina symptoms. The following herbs are the most commonly used to relieve the symptoms of angina.

Garlic

Garlic contains substances that discourage platelets from sticking together and helps prevent blood clots. It also lowers total cholesterol and triglycerides while increasing HDL, the good cholesterol. Include one clove of garlic in your daily diet or take 10 milligrams per day.

Ginkgo

Ginkgo’s antioxidant properties neutralize harmful molecules called free radicals. It increases blood supply to the extremities and makes heart cells more efficient. It keeps platelets from sticking together and has a tonic effect on blood vessels. Take 40 to 80 milligrams of capsules three times per day.

Hawthorne

This traditional European herb used in treating heart disease dilates coronary arteries, which increases blood supply to the heart. Hawthorne improves oxygenation and energy metabolism and helps decrease lactic acid which is the waste product of exertion that causes heart muscle pain.

Hawthorne contains antioxidant and anti-inflammatory properties that help strengthen artery walls and reduce cholesterol. Take 100 to 250 milligrams three times per day or drink one cup of tea three times per day. The tea can be made by simmering one teaspoon of dried berries or steeping one teaspoon of leaves and flowers in a cup of hot water for ten to 15 minutes.

Coleus

Coleus keeps platelets from sticking together, relaxes arterial muscles, and improves heart function. Take 50 milligrams two or three time per day. Use coleus carefully if you take blood pressure medication or if your blood pressure is already low. Coleus may also increase the effects of antihistamine drugs.

Khella

This herb improves exercise tolerance and normalizes heart rhythms in patients with angina. It also help to dilate coronary arteries. Take 250 to 300 milligrams per day. Reduce the dosage if you experience nausea, dizziness or decreased appetite.

Ginger

This aromatic herb works best if eaten fresh and on an empty stomach. It lowers cholesterol and keeps platelets from sticking together. Take 250 milligrams per day. At higher doses, ginger may cause upset stomach.

Lifestyle changes can also help to relieve and control the symptoms of angina. If heavy meals trigger angina then avoid large meals and rich foods that leave you feeling stuffed. Try to avoid situations that make you upset or stressed if that is what triggers your angina. Eating a healthy diet is also important and can help to prevent or reduce high blood pressure and cholesterol. Quitting smoking along with avoiding alcoholic beverages will also help to control angina and reduce the frequency of symptoms.

Heart Attack

Angina does increase your risk of a heart attack. It’s very important that you know how and when to seek medical attention. An emergency action plan is important and will improve the chances of surviving cardiac arrest.

The plan should include making sure you as well as your family members know the location of the nearest hospital that offers 24-hour emergency heart care. Make sure you know the signs and symptoms of a heart attack, how to reach emergency medical services in your community and how to use aspirin and nitroglycerin when needed.

If your chest pain becomes severe, lasts longer than a few minutes, or is not relieved by rest or medicine seek immediate medical care. It can be difficult to tell the difference between unstable angina and a heart attack. Both are emergency situations, so you should call for an ambulance right away.

Prognosis

A diagnosis of angina at least gives you some warning that you have coronary artery disease. Undiagnosed angina can lead to a heart attack or sudden cardiac death. If you are at high risk for a heart attack, you need to find out early so that you can get the best treatment right away. Getting the appropriate treatment combined with lifestyle changes can result in living a normal, full and healthy life.

What is a Throat Obstruction?

There are many medical conditions or traumas which may cause throat obstruction. The results of having a throat obstruction can range from mild irritation to life threatening medical events. Internal throat obstructions are quite different from throat obstructions caused by a foreign, or swallowed, object.

Each type of throat obstruction requires a different level of care, ranging from easily administered home remedies to an emergency visit to the hospital. Internal throat obstructions can be caused by swollen tissue in the esophagus which is often a result of illness, disease or injury. Foreign object throat obstructions can be much more hazardous to a patient’s health and normally need to be treated by medical personnel.

Causes of Throat Obstruction

Internally occurring throat obstructions are usually caused by a swelling of the soft tissue surrounding the esophagus. Swelling can be caused by fever, infection or disease such as cancer.

Some internal throat obstructions are not noticeable unless the patient is lying down in a sleeping position. These types of throat obstructions occur when the uvula or soft palate is in a relaxed position and causes a partial blockage of the patient’s airway; the tongue may also slide backwards and cause a partial throat obstruction if the patient is lying on their back.

The effects of these types of internal throat obstructions can be generally be heard while the patient is sleeping and can range from a soft snoring all the way to a loud and rather unpleasant buzzing sound. Snoring is rarely fatal but can become a serious health issue if the patient stops breathing in their sleep, experiences sleep apnea, and is awakened several times per night.

Snoring

Severe snoring, such as the type which causes sleep apnea has been known to cause severe sleep deprivation in patients and has been reported as the cause of discord in many marriages. The daytime effects of internal throat obstructions can be characterized by drowsiness, lack of focus and irritability. Each time the patient descends into deep sleep at night, the muscles of the throat relax and partially block the airway. This repeats the cycle of snoring and, in severe cases, sleep apnea. Sleep deprivation can also lead to other health problems, including heart disease and stroke.

External Causes

Externally caused throat obstructions are much more severe and the effects can be immediately life threatening. Blunt force trauma injury, applied externally, can cause the muscles and soft tissue in the throat to swell to the point of complete airway blockage. Throat obstructions due to a swallowed object can also be immediately life threatening.

These types of throat obstructions can be partial or complete and are more commonly called choking. Choking prevents the adequate normal flow of air into the lungs and can be caused by a partial blockage or a full blockage. Partial throat obstructions do allow some air to flow into the lungs, though in a seriously decreased quantity. Complete throat obstructions can lead, if not treated immediately, to asphyxia and death.

Children and Throat Obstructions

Children are often the most susceptible to throat obstructions caused by a swallowed object. In their explorations of the world, they are more likely to place an inedible object in their mouths than a knowledgeable adult.

When a foreign, inedible, object encounters the soft tissue in the airway, it can become lodged where the patient cannot remove or expel the object by coughing. Throat obstructions in adults are most commonly encountered while eating food. Either the patient attempts to swallow a bite of food which is too large and becomes lodged in the esophagus. Another hazard adults encounter while eating is bones from meat, such as chicken or fish.

Treatments for Throat Obstructions

The most common internal throat obstructions cause snoring and require one or more of many treatment options. The most common low or no cost treatments for snoring require a change in diet, behavior and sleeping habits in order to effectively work. The first step to treating snoring is to analyze the patient’s behaviors and eliminate activities, food or drink that may make the throat obstruction worse.

Medications, foods or drinks which have drowsiness as a side effect tend to make snoring worse. Sleeping pills, depressants and decongestants relax the muscles beyond normal sleeping relaxation. The excessive relaxation of muscles can cause the soft palate, uvula or tongue to slide further back in the throat than normal sleeping and makes snoring worse for the patient and louder for those near the sleeper.

For Snorers

Those snoring patients who tend to sleep on their back often experience more severe snoring. There are two common methods for patients to ease snoring when they usually sleep on their back. The first is to modify the patient’s sleeping position so they sleep on their side. While the patient may find it uncomfortable at first to sleep in this position, using pillows may assist the patients in maintaining a side-sleeping posture.

Body pillows are especially good for this method of position modification and are relatively inexpensive. Another treatment is for the patient, if they find it impossible to sleep on their side, is to elevate either their head or the head of their bed. Phone books or spare wood placed under the frame of the bed can elevate the head position enough to allow the patient to sleep without throat obstructions. Adding pillows of varying firmness direct under the patient’s head can also serve to free any airway restrictions during sleeping.

Severe Snoring

For patients with severe snoring, which causes sleep apnea and sleep deprivation, surgery is often the only effective option. Physicians who specialize in treating snoring will usually conduct a sleep study on the patient to determine the extent of the apnea. Sometimes surgery is not necessary; however, a constant positive airway pressure, or CPAP, device may be prescribed to maintain air pressure in the airway and keep it open while the patient sleeps.

CPAP devices can be uncomfortable at first and do require an adjustment period. In cases where CPAP devices are ineffective, or the patient is not experiencing any significant relief from prescription appliances, surgery may be an option. Surgery for throat obstructions which cause snoring generally includes the removal of any offensive soft tissue which blocks the patient’s airway while sleeping. The extent of the surgery depends on the patient’s weight, specific soft tissue obstruction and overall physical health.

Serious Emergencies

Throat obstructions caused by an external source, either swallowing of an inedible object to swallowing food that is too large for the throat, are serious emergencies and can be immediately life threatening. Partial or complete airway blockage can cause asphyxia or death and needs to be attended to immediately.

Partial throat obstructions can sometimes be dislodged by the patient’s coughing. If the patient is coughing and drawing in any amount of air, one should not interfere with the Heimlich maneuver, but should keep a close eye in case the object causing the throat obstruction becomes further lodged in the airway. Previously, slapping a choking person on the back was thought to be a dangerous way to dislodge an airway obstruction.

This has been found to sometimes make the situation worse by possibly lodging the object further down the throat and completely obstructing the throat. Back slapping to clear an obstruction should be done with some amount of force, but should be discontinued if the patient’s choking symptoms worsen.

Emergency Procedures

If someone is choking or has another throat obstruction that is mostly to completely blocking their airway, call 911 immediately. Some obstructions can be cleared via the Heimlich maneuver, which should be done with care. There are different methods of delivering the Heimlich maneuver, depending on the patient’s age and weight.

Direct abdominal thrusts should never be used on women who are pregnant, obese patients and small children. Delivering sharp abdominal thrusts to an average size adult who is choking is intended to compress the lungs and forcefully expel air and dislodge whatever object is lodged in the throat. Even in the best of circumstances, the Heimlich maneuver can sometimes cause rib injuries, especially to the xyphoid process. The xyphoid process is the bone protrusion directly in the center of the front of the rib cage.

Abdominal Thrusts

Abdominal thrusts should never be used if the choking patient is conscious and is still drawing air into their lungs. If the patient is coughing, and continues to cough, this is a good indication they are still able to draw air into their lungs. Not all throat obstructions that cause choking are due to solid or food objects. Sometimes swallowing liquid and having it travel down the airway instead of the throat can cause coughing.

The patient should be allowed to cough to try to clear the airway as long as they are conscious and still able to cough. If a choking person falls unconscious, the rescuer should switch from abdominal thrusts directly to CPR, or Cardio Pulmonary Resuscitation. CPR with chest compressions and assistance breathing is often enough to dislodge a foreign object from the airway and allow air to enter the lungs again.

Throat Obstruction Prevention

Taking the time and care to chew food completely before swallowing is one of the best ways to prevent food from becoming a choking hazard. In order to better prevent foreign objects from becoming a choking hazard for children, parents and caregivers should invest in a small plastic cylinder that is available in the baby care section of most major stores.

The plastic cylinder is sized very closely to the size of a toddler’s airway. For safety, parents and caregivers can take an object and insert it into the plastic cylinder. If the object fits into the cylinder it will generally fit into a child’s mouth and pose a choking hazard. Keeping small game pieces and toys away from small children is one of the only ways to prevent objects from becoming a life threatening choking hazard.

Internal throat obstructions are much more difficult to prevent and can sometimes pose as serious a health hazard as foreign object throat obstructions. Patients who candidly speak with their physicians regarding any type of difficulty they are having in swallowing or breathing often have a better chance at preventing serious internal throat obstructions.

If the obstruction is being caused by a sinus or throat infection, physicians can prescribe anti-inflammatory or antibiotic medications to prevent the infection from becoming worse. Gargling with peppermint mouthwash or salt water can often ease the discomfort and pain of an infection caused throat obstruction.

Effectiveness of Treatment

While some internal throat obstructions can easily be treated, at little or no cost, in the home, some require expensive machinery, appliances or surgery. The type, cause and severity of a throat obstruction will dictate the expense of the treatment. In cases of externally caused throat obstructions, prevention is the simplest cure.

In any case of foreign object throat obstruction, rescuers should not hesitate at all to call medical professionals or emergency services for assistance. Sometimes even the best trained rescuers cannot dislodge the object causing an obstruction and the patient must be treated in a hospital with emergency surgery. Above all else, staying calm for the patient is of utmost importance.