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Alternative names

• Hyperuricemia
• Asymptomatic Gout
• Acute Gout or Gouty Arthritis
• Interval and Intercritical Gout
• Chronic Tophaccous Gout

Symptoms

There are two different types of gout, primary gout and secondary gout. Primary gout is inherited, which consists of the over production of the uric acid in the blood, a decrease of uric acid in the urine, or both.

Secondary gout occurs when the medication causes the increase of uric acid in the blood. Diuretics can cause this. Kidney failure or the increased destruction of cells, such as cancer patients going through chemotherapy, are also attributed to secondary gout.

You will have redness of the joint accompanied by stiffness, inflammation, and extreme pain. Many will suffer from podagra, a condition where gout forms in the big toe, but you can also contract gout in other joints such as ankles, wrist, fingers, or elbows. 75 percent of first attacks start in the big toe.

Any type of pressure on the affected area hurts. Something as light as a bed sheet or your sock can cause extreme pain. Gout attacks can get better within a few days, even without treatment.

Four Stages With Different Symptoms:

• Asymptomatic (without symptoms) Hyperuricemia are elevated levels of uric acid in the blood with no symptoms.
• Acute Gout or Gouty Arthritis is when deposits of uric acid crystals form in the joint spaces. Sudden onsets of pain will follow, along with swelling, heat, and tenderness.
• Interval or Intercritical Gout is the period in between attacks where there are no symptoms.
• Chronic Tophaccous Gout is the most severe and disabling of all stages of gout. It develops over years, causing permanent damage to any of the joints that are affected, and in some cases, the kidneys.

Causes

If there an increased production in uric acid and your kidneys are doing what they need to do to eliminate the acid, it will build up in the blood, a condition called Hyperuricemia. The uric acid forms tiny crystals the size of the point on a needle in the joints or soft tissue. The crystals can also form into kidney stones.

Risk factors

• Genetics makes up about 20% of all people who suffer from gout.
• Gender and Age: Gout is more common in adult men between the ages of 40 and 50, with a peak age of 75,
  are more likely to contract gout than woman, children, and young adults.
• Weight: Being overweight increases the risk contracting gout. The more you weigh, the more frequent the attacks. Having the extra weight makes it harder for the body to do its job. Losing the weight gradually willbe a benefit to those who have high levels of uric acid, even though being on a diet can trigger an attack.
• Alcohol: People that drink too much alcohol can contract gout as well. The more alcohol you drink, the more the blood is not able to remove the uric acid, the rest crystallizes. Gout attacks happen because the major consumption of alcohol impairs the kidney function.
• Lead: Some studies have concluded that there’s a strong connection between gout and lead poisoning.
• Other risk factors that can cause gout are certain foods such as anchovies, asparagus, beef kidneys, dried bean or peas, game meats, gravy, liver. There are so many others, but these are definitely the foods that gout sufferers should watch out for.
• The kidneys that possess an inability to eliminate waste products.
• People that suffer from high blood pressure.
• People who have had organ transplants.
• Hypothyroidism, or under active thyroid.

Prevention tips

• Medications: Non steroid anti-inflammatory drugs, or NSAIDs, help with the pain and inflammation, oral
• Colchicine in small does to prevent future attacks. Zyloprim and Benemid are medications that are used for the treatment of Hyperuricemia.
• Zyloprim can help in the management of uric acid, but it won’t stop an acute attack of gout that is already present. It can, however, reduce your symptoms when taken over the course of several months.
• People that use medication for high blood pressure and high blood triglycerides find that these meds can be used for the treatment of gout. Cozaar, a high blood pressure medication, and Tricor, a triglyceride lowering medication, are the two that have been found to help aid in the treatment of this condition.
• Lifestyle Changes: Controlling your weight keeps the body from having to work harder break down the bodily waste.
• Drinking large amounts of water removes uric acid from the body.
• Avoid diets that have a low-carbohydrate intake. When you’re not taking in a substantial amount of carbohydrates, the body can’t burn fat completely.
• Eating foods that are purine free is key to reducing the frequency of gout attacks. Purine free means that foods that don’t have a nucleus such as an egg. The yolk is the nucleus. They can’t be avoided completely because purines are released when the body recycles dead cells. These foods are egg whites milk and milk products like cottage cheese mozzarell and whey protein, and pulp-free fruit juices.
• When you have an attack, it is important to avoid excessive exercise, don’t starve yourself, and don’t reduce you calorie intake. The body will continue to break down body tissue and not getting the proper intake of calories per day, the body will compensate by accelerating the breaking down process.

Test and diagnosis considerations

To confirm a diagnosis, a doctor will inject a needle into the inflamed joint and pull a sample of the liquid that lubricates the joint called synovial fluid to analyze. If there are uric acid crystal found in the joint spaces, then you have gout. X-rays don’t work in the early stages of gout, only when the disease is in its later stage, will you see parts of the joint that have been worn away or eroded.

Patients will often seek medical attention thinking that finding the gout in its early stages will prevent it from getting worse later. Sometimes symptoms of gout can be confused with another form of arthritis. One form is called pseudogout. It resembles all the symptoms of gout, but instead of having uric acid crystals that form in the joint spaces, it calcium phosphate. In this case, pseudogout.

Treatment options

1. Home treatments

• Warming the joints with a foot bath and heating pad can help relieve joint pain.
• Increasing the amount of water that you drink will increase your urination, which decreases the amount of
  uric acid in your blood. According to the Institute of Medicine, men should drink approximately 13 cups of
  water per day, women should drink approximately nine cups, whether it’s in food or drink.
• NSAIDs, with the help of other prescribed drugs, are used to treat gout. Aspirin should not be taken
  because it can aggravate the condition.
• Corticosteroids can relieve pain and inflammation of gout in the joint by injecting it right into the joint if
  the pain medication that you have at home doesn’t work.
• Doctors have been advising patients who suffer from gout to take Vitamin E, B-complex, and folic acid to
  replenish the body’s supply.

This should be done under supervision of a physician, but a solution of half of a teaspoon of baking soda dissolved into a glass of water on an empty stomach. If the stomach is full, the combination of the stomach acid and the water/baking soda solution will turn the water into carbon dioxide gas.

The gas will increase stomach pressure, causing injury. Do not exceed more than seven 1/2 teaspoons or three 1/2 teaspoons if you’re over 60, in a 24 hour period. Don’t exceed the maximum dosage for more than two weeks.

Herbal Remedies

In folk medicine, eating or drinking cherries in various forms has shown to reduce the inflammation caused by gout. They have been promoted to the preventing or treating of the condition.

Other herbal remedies that people tend to use instead of conventional medicine are things like celery seed
oil, cherries or cherry extract, turmeric, artichoke extract, garlic, and various Chinese herbs.

Some people have found that swallowing a teaspoon of celery seed oil gives relief for people suffering from gout. It has been used as a herbal remedy to help with conditions where inflammation is a symptom and rheumatism. Turmeric is known in many countries for its health benefits. In Pakistan, it is used as an anti-inflammatory.

The herbal remedy Flamasil, which is turmeric based, it helps with the degeneration of cells, which is 70 percent of all uric acid production, enhances liver and kidney function, and blocks the enzyme that produces uric acid. With any home remedy or experimental drug, there will be opinions and criticisms about how well or if it works.

Side Effects

The side effects of oral colchicine is usually nausea, vomiting, abdominal cramps, or diarrhea. These side effects make it difficult for the patient to continue using the drug. Corticosteroids cannot be used for every attack you have. If used over time, it can cause deterioration of the joints. It can also decrease the ability for the body to fight off infection and may make these infections harder to treat. You might also notice an increase or decrease in appetite, nervousness, restlessness, problems sleeping, and indigestion.

If you’re using a corticosteroid, via inhalant, you’re more likely to suffer from dry throat as well as headaches, nausea, bruising and/or thinning of the skin, unpleasant sense of taste. Nasal sprays can also irritate the throat, and ointments or gels can cause skin irritation.

Probenicid, or Benemid, is not a good medication to treat acute gout attacks. They can aggravate the inflammation if used in the beginning stages of the attack. It can also cause kidney issues such as renal colic and increased levels of uric acid that can turn into uric acid stones, or kidney stones. Zyloprim side effects are included, but not limited to, an acute attack of gout, nausea, diarrhea, and certain skin reactions such as a rash.

All gout medications have side effects that range from nausea to stomach cramps. Although, there are new medications being developed in clinical trials that will substantially increase the elimination of uric acid and the lowering of uric acid in the blood stream. Researchers are also working on medications that will stop chemical messages that are causing the gout inflammation.

Chinese Research

In China, researchers have invented a medicine that compliments, the Weicao Capsule, that helps relieve gout, therapeutically. This is still in its trial phase, but it has been shown in a study that the capsule has increased urination, which lowers high levels of uric acid and improves kidney function.

Gout can become extremely serious if not treated in it’s earliest stages. There are some people that will dismiss the condition, but gout is very serious and has the capability of interfering with the simplest of everyday things.

Resources

National Institute of Health
Cdc.Gov
MedicineNet.Com

Chicken pox, also referred to as Varicell disease, is classified as an infectious disease that particularly strikes children. However, chicken pox can affect persons of various ages and often does. Statistics indicate that over four million individuals in the United States alone are diagnosed with chicken pox annually and the incidence for chicken pox in many other countries remains much higher.

Symptoms

The hallmark symptoms of chicken pox include an itchy rash, fever, and headache. The rash tends to look like blisters and can most usually be found on the face, trunk, and sometimes the scalp. However, the rash can also spread to other areas of the body, including the eyes and mouth. Sore throat, chills, and profuse sweating may also accompany chicken pox. While many of these symptoms subside within ten days, serious complications resulting in hospitalization and even death can occur.

Complications

One of the most common complications of chicken pox is skin infection. The rash is extremely uncomfortable, causing itching and pain. Young children are especially prone to scratching, which can cause breaks in the skin. This allows a portal for microbes and other infectious disease. Once the chicken pox virus enters the body, it remains there and can also give rise to shingles later in life. One complication of chicken pox called Reye’s syndrome can easily be avoided by not administering aspirin to those with chicken pox.

Dehydration can also become a concern with chicken pox, especially if the child has blisters in his or her mouth. Ensuring adequate fluid intake can prevent dehydration.

Adults suffering from chicken pox are at an elevated risk for both pneumonia and encephalitis. In rare cases, permanent neurological impairments have been known to occur. Other than Rye Syndrome, liver damage is possible. However, the inflammation is usually short term and will gradually go away.

Transmission

Chicken pox or Varicella disease is transmitted from person to person. Vaccination, avoiding contact with respiratory secretions, and limiting exposure to those lacking sufficient immunity can reduce the transmission of chicken pox. Immunity to the disease is permanent once exposed via vaccination or infection.

Prognosis

As previously mentioned, chicken pox can cause a variety of complications. Scarring is likely with chicken pox and will depend on the severity of the virus. Refraining from scratching and allowing the scabs to fall off can help reduce scarring.

Children usually make a full recovery from the disease and the majority of complications are most prevalent in adults. Chicken pox remains dormant in the body and symptoms can resurface at anytime in life.

This most often occurs later in life and/or when the immune system is lacking. The most common recurring complication of chicken pox is shingles. Shingles is characterized by severe pain and a rash that eventually develops into small blisters filled with fluid. Unlike chicken pox, the symptoms can last a month or more. During an outbreak of shingles, the individual can transmit the virus to others.

Causes and Prevention

Chicken pox is caused by the Varicella Zoster virus of the Herpes family. While there is no cure for this disease, it can often be prevented with vaccination. The Centers for Disease Control and Prevention recommends that children between the ages of twelve months and twelve years should have the vaccination in two doses, three months apart.

Children over the age of twelve should have two vaccinations within a couple weeks apart. Adults of high risk, such as the elderly and the immune compromised are also candidates for the Varicella vaccination.

However, those that have previously contracted chicken pox or have had shingles do not need vaccinated. Chicken pox infections can still occur despite vaccination. However, those who contract the disease after vaccination will typically have a shorter, milder duration of chicken pox.

Risks Associated with Vaccination

As with any other vaccination, there are some risks to the Varicella vaccination and it is not recommended for all persons. Pregnant women, patients undergoing chemotherapy and/or radiation therapy, those who may be allergic to the vaccine, seriously ill individuals, and anyone who has received a blood transfusion or blood products within the few previous months are not good candidates for vaccination. Persons suffering from mild illnesses can still have the vaccination though. Complications can easily be avoided by discussing the previous medical history with the physician.

Side Effects

Side effects of the Varicella vaccination are typically quite mild and may not occur in all individuals. The most common side effect noted is redness, swelling, and inflammation at the injection site. This is only temporary and typically goes away within a few days. Other side effects include fever, rash and/or bumps following the vaccination and occur in less than five percent of vaccination recipients. In some rare cases, chicken pox has been transmitted from the vaccinated individual to others.

Infection with the virus has occurred in only a small number of those that have been vaccinated. Serious side effects that are even less common include allergic reaction, encephalitis, seizures, and pneumonia. However, there is no evidence to indicate whether or not these reported incidents were actually caused by the chicken pox vaccination. The benefits of the vaccine outweigh the possible risks.

Risk Factors for Varicella Disease

Those most at risk for contracting chicken pox include those without sufficient immunity. This includes persons who have not been immunized and who have not had the disease. Infants, pregnant women, and those with weakened immune systems and/or certain medical conditions are also at high risk for the Varicella virus. Coming into contact with persons suffering from chicken pox significantly increases the chance for these individuals to contract the disease.

Certain geographical populations are also more prone to chicken pox outbreaks due to lack of herd immunity. For this reason, unvaccinated travelers are also considered high risk for contracting chicken pox. Another important risk factor is receiving an organ transplant. Transplant recipients are at high risk for developing not only chicken pox if not previously exposed, but developing shingles.

Diagnosis

Chicken pox can be diagnosed via a blood test. However, this is not usually necessary. Signs and symptoms alone are often sufficient enough to diagnose this disease. It is important that the child or afflicted individual be diagnosed by a licensed health care worker to rule out other conditions or illnesses.

Shingles may also be quite easy to diagnose clinically but a test known as the immunofluorescence assay test is a quick and convenient diagnostic tool most commonly used to detect Varicella when shingles is suspected.

Treatment

The treatment for Varicella disease is mainly symptomatic. Reducing pain, fever, and promoting comfort are all considerations. Over the counter pain reliever/fever reducers with the exception of aspirin and aspirin products are typically administered as needed. Acetaminophen, the main ingredient in Tylenol and other pain relievers is most commonly given. A physician may also prescribe topical ointments to relieve itching and/or antibiotic creams to prevent infection. Keeping the skin clean and intact is an important concern, especially in children.

Although there are anti viral drugs available, these are usually reserved for certain individuals. Antiviral drugs are mainly prescribed for adults and those at high risk for developing severe complications associated with chicken pox, those with weakened immune defenses and patients suffering from shingles.

Acyclovir, valacyclovir, and famcyclovir are generally the antiviral drug of choice for the Varicella virus.

Alternative Treatments

Some treatments for chicken pox are non pharmaceutical; these also are used to promote comfort and manage symptoms.

These treatments can consist of herbal supplements, plant extract, and vitamins. Since these products are not regulated by the Food and Drug Administration, it is recommended that a physician be consulted before attempting these alternative treatments for chicken pox.

Vitamins

Vitamins believed to be beneficial to those suffering from chicken pox include vitamin B-12, vitamin A with beta carotene, and vitamins D, E, and K. Advocates of this natural remedy for chicken pox note the properties of vitamin A and beta carotene to the skin and in fending off viral infections.

B-12 vitamins provide relief by helping the individual to feel better. Although many B-12 vitamins are available over the counter, injections of this vitamin can be provided by a physician. The remaining vitamins D, E, and K assist in the absorption of vitamin B-12 and A, as well as many other nutritional supplements.

Precautions should be taken, especially with children before providing vitamin supplements for treatment. Overdose of vitamins can have adverse health effects, leading to temporary or permanent disability and/or death.

Herbal Remedies

Most herbal remedies for chicken pox are topical mixtures that are safe for most children and adults. One of the most common herbal remedies is to create a mixture of rosemary, comfrey, and chickweed to soothe the skin. The convection is slightly warmed and applied to the skin using a clean cloth. To avoid rupturing of the blisters during the application process, the mixture should be blotted onto the skin gently. The herbs are applied as needed to soothe the itching, pain, and burning caused by blisters.

Lotions and Gels

There are a variety of lotions and gels over the counter and by prescription that may be used to treat chicken pox. Aloe Vera, Calamine lotions, Oatmeal pastes, and similar concoctions are used topically to promote comfort. Some may even be used in bath water or directly from plants, especially extracts such as aloe. Products similar to the Calamine lotions typically have antimicrobial properties to help prevent infection and reduce itching and inflammation of the skin.

Treatment Costs

The cost of treatment for chicken pox will vary depending on the methods implemented. Lotions and gels can typically be purchased from major retailers for under $10, while others can be safely and effectively made at home. Some herbal products may have to be purchased at specialty stores and costs will vary.

Risks Associated with Alternative Treatments

Alternative treatments for chicken pox can provide relief of symptoms but is not recommended for everyone. Overdose, allergic reaction, and/or infection can result. Those with specific plant allergies, small children and infants, those with a compromised immune system should not undergo these treatments without first consulting their primary caregiver/physician.

Other Considerations

Chicken pox is caused by a virus, as with any other viral illness, it must run its course. There is no cure for chicken pox. Treatment should revolve around promoting comfort, and preventing complications such as dehydration and infection. Drinking fluids, getting plenty of rest, and avoiding skin abrasion are crucial to those with chicken pox.

If symptoms do not improve within ten days, a physician should be consulted. Immediate medical attention may be required for fever over 104 F, when dehydration is suspected, changes in mental status, or if the symptoms become progressively worse. To help prevent the spread of the disease, exposure to infected persons should be limited.

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.)

Frequent Urination Condition

Frequent urination simply means urinating more often than usual. Its a symptom rather than a condition. Most people empty their bladders between four and eight times a day; frequent urination is therefore defined as voiding urine more often than eight times a day with the implication that this increased rate is not strictly volitional.

Frequent urination does not always signify an underlying health problem.

You may be drinking too much fluid, or possibly you need to modify your food and beverage intake: alcohol, caffeinated beverages such as coffee and tea and even some foods such as celery, watermelon and parsley are natural diuretics increasing the amount of urine you would normally excrete.

Underlying Problems

But frequent urination is often a sign of an underlying medical pathology, most often a urinary tract infection or cystitis (an inflammation of the bladder) that can affect either sex although it most common in women.

Frequent urination can also be the first symptom of diabetes, both type 1 and type 2, as the body mobilizes the urinary system to rid itself of excess glucose.

Frequent urination is linked to prostate problems in men and to pregnancy and pelvic inflammatory disease in women. The symptom is also a common side effect of obesity and abdominal radiation treatments.

Even when frequent urination is not connected to an underlying pathology, it can be a disruptive and embarrassing condition. When you have to go, you have to go no matter what else is happening around you.

When frequent urination forces major changes in lifestyle habits or is accompanied by fever, pain, nausea and vomiting, increased or decreased appetite, genital discharge or changes in the appearance of the urine itself, it’s time to consult a physician about the condition.

Alternative Names

There are several different conditions which are closely associated with frequent urination:

Urgent Urination, Urinary Urgency

A sudden, compelling need to urinate linked to a burning sensation or pain, often a sign of an underlying urinary tract infection.

Urge Incontinence, Urinary Incontinence, Overactive Bladder Syndrome

A sudden, irresistible need to urinate due to bladder spasms. Symptoms include urinary frequency, urinary urgency, and sometimes leaking urine before you can get to a toilet.

Stress Incontinence

Involuntary urination that occurs during an activity such as coughing, sneezing or laughing, generally caused by an underlying anatomic weakness to the bladder.

Nocturia

Frequent urination at night involving waking up several times to use the toilet.

Polyuria

The production of excessive volumes of urine for an adult, over 2.5 liters in 24 hours.

Depending on the underlying cause of your urinary frequency, you may experience some of these symptoms as well.

Physiology

Urination is the process by which urine is eliminated from the body, a function which in healthy humans is partly under voluntary control.

Cellular metabolism generates nitrogenous waste products that must be eliminated from the bloodstream. These wastes are filtered out of the bloodstream by the kidneys. There are two kidneys in the body, each made up of microscopic structures called nephrons that act as filtering units removing most of the water, salt and waste from the blood that passes through them.

The resulting liquid waste product called urine is transported through anatomic structures called ureters to the bladder where it is stored. The anatomical structure of the ureters and bladder do not allow urine to back up towards the kidneys under most circumstances.

Bladder Muscles

The bladder has two sets of muscles controlling its opening. Only the external sphincter is under voluntary control. Both the internal sphincter and the smooth muscle in the wall of the bladder are under the control of the parasympathetic nervous system. As your bladder fills with urine, the smooth muscle stretches by means of small contractile waves to accommodate the extra volume of urine. When urination occurs, the bladder’s outer layer of muscle (called the detrusor) contracts to help push out urine.

Urine is excreted from the bladder through the urethra, a process called urination. The average adult bladder can hold between 300 and 500 cc of urine. Urine is sterile when it is excreted from the body: it contains fluid, salts and waste products, but it is free of bacteria, viruses and other pathogenic organisms.

Causes of Frequent Urination

Overactive Bladder

Overactive bladder is a condition associated with a sudden, irresistible urge to urinate, resulting from involuntary contractions of the musculature of the bladder wall.

Overactive bladder is particularly common among middle-aged and older adults, and some medical experts estimate that one out of ever 11 adults in the United States suffers from some form of it. Untreated overactive bladder can lead to an increased incidence of urinary tract infections and skin infections from the corrosive effects of urine on the delicate skin of the urogenital area. But treatment success rates are high: with behavioral modification techniques and medication, 80% of people are able to bring their symptoms under control.

Overactive bladder can be brought on by abnormalities of the nervous system such as spinal cord injuries, multiple sclerosis, strokes, Parkinson’s disease and diabetic neuropathy; by urinary tract infections; and by blockages to the urinary system such as those caused by kidney stones or an enlarged prostate. But in many cases, there is no underlying pathogenic cause to overactive bladder.

Medical History

Medical history plays an important role in diagnosis: urinary frequency, urinary urgency, stress incontinence and urinating more than three times a night are all suggestive of overactive bladder. A pelvic exam for women (to rule out pelvic inflammatory disease) and a prostate exam for men (to check for enlargement) are generally indicated. Ultrasonic measurement of the post-void residual (the amount of urine left in the bladder after urination) can further help determine whether symptoms are due to muscle spasms or some other cause.

If underlying pathology is ruled out then treatment for overactive bladder focuses on:

Improving the Tone of the Surrounding Pelvic Muscles

Doing Kegel exercises (also called pelvic floor exercises) for five minutes, two to three times a day, can markedly decrease incontinence in both women and men. Occasionally Kegel exercises are used in conjunction with biofeedback and electrical stimulation of the floor of the pelvis.

Behavioral Modification

Behavioral techniques called bladder training can teach you to resist the urge to urinate, gradually increasing the interval between trips to the toilet.

Medications

Several medications that block the effects of the neurotransmitter acetylcholine have proven successful in the treatment of overactive bladder. They share common side effects including dry mouth, constipation, blurred vision, and in the elderly, confusion.

• Oxybutynin (Ditropan): Oxybutynin suppresses spasms in the smooth muscles of the bladder wall. Additionally it relaxes the detrusor.
• Tolterodine (Detrol, Detrol LA): Tolterodine suppresses spasms in the smooth muscles of the bladder wall. It does not cause the mouth to dry out as much as Oxybutynin.
• Solifenacin (VESIcare). Similar to Tolterodine, but with a longer half-life.
• Tricyclic antidepressants such as imipramine (Tofranil) and doxepin (Sinequan, Adapin) have also been used to treat overactive bladder with some success. Their mechanism of action is not clear.

Natural Treatments

If you are suffering from the symptoms of overactive bladder, there are a number of remedies you can try at home without seeking medical attention. Regulate your fluid intake. If you smoke, stop. Consider eliminating coffee, tea and other caffeinated beverages and foods: caffeine is a known diuretic.

Foods such as chocolate, spicy cuisines, alcohol and carbonated drinks can also irritate the bladder. If you are even a few pounds overweight, consider going on a diet: middle-aged people tend to put on weight in their abdomen, and all that extra avoirdupois exerts extra pressure on your bladder.

Constipation, similarly, also exerts extra pressure on your bladder so consider increasing the amount of fiber in your diet if you suffer from it.

Some naturopathic doctors believe that overactive bladder is linked to food sensitivities, particularly to wheat and dairy products.

These foods, it’s speculated, cause a systemic inflammation that manifests, among other things, as an inflamed bladder. By cutting out one food group for a period of time and observing how your symptoms respond, you can pinpoint the dietary culprit.

Mineral Supplements

A number of botanicals and mineral supplements have also been used to treat overactive bladder with some success.

Pumpkin

Native Americans have used pumpkin seeds for centuries to improve bladder and prostate health. Pumpkin is also one of the few natural remedies to be tested in clinical trials: in one six-week study of postmenopausal women suffering from overactive bladder, almost 60% of participants showed marked improvement.

Magnesium

Clinical trials have also proven the efficacy of magnesium, particularly among patients suffering from Parkinson’s disease. It thought to control smooth muscle spasms.

Saw Palmetto

Palmetto is commonly used throughout Europe to treat the symptoms of benign enlarged prostate. Its precise mechanism of action is unclear but it has anti-inflammatory properties and is known to reduce the activity of enzymes linked to prostate problems. Clinical studies have proved that it reduces urinary frequency. But palmetto has some mild estrogenic effects; for that reason, women who are pregnant, breastfeeding, taking birth control pills or undergoing hormone therapy should avoid it.

Stress Incontinence

Stress incontinence is the involuntary loss of urine due to a sudden pressure on the abdominal muscles secondary to physical activities like coughing, sneezing or laughing.

While its symptoms and many non-invasive treatments are similar to those for overactive bladder, its underlying cause is quite different: it due to a weakening of the pelvic musculature which in men can occur following a prostatectomy and among women is a common aftermath to childbirth among women (exacerbated when estrogen levels decrease in the week before menstruation or following menopause.)

In addition to the treatments described under overactive bladder above, one non-surgical treatment that sometimes used for women suffering from stress incontinence is the insertion of a small ring-shaped medical device called a pessary into the vagina. The pessary reduces stress incontinence by compressing the urethra against the symphysis pubis bone. If a woman uses this treatment option, she must be carefully monitored by her physician to reduce the chance of contracting a vaginal or urinary tract infection.

Surgical treatment is only considered if other non-invasive treatments have failed and the exact anatomical site of the pelvic muscle weakness is known.

Nocturia

Nocturia is the medical term for frequent urination at night. It can be a symptomatic of a systemic disease process such as a kidney or bladder infection, diabetes or sleep apnea; in men, it is often the first sign of prostate enlargement. But even when its causes are relatively benign, nocturia can still be a difficult condition to live with because it interferes with sleep.

Interventions to try at home include minimizing all fluid intake but particularly caffeine and alcohol for at least three hours before bedtime, taking medications that have a diuretic effect earlier in the day, and avoiding strenuous exercise and potentially stressful interactions before sleep. You should see your physician if nighttime urination is accompanied by fever, pain or discomfort, or if your urinary frequency is not affected at all when you cut down on fluids before bedtime.

Medical History and Testing

Since nocturia is frequently a symptom of an underlying systemic pathology, when you visit your physician, he or she will try to rule these out by taking a thorough patient history, performing a physical exam, and ordering diagnostic tests such as urinalysis, urine culture, blood sugar and BUN/creatinine clearance.

Nocturia can be a symptom of benign prostate enlargement, urinary tract infection, kidney failure, congestive heart failure, obstructive sleep apnea or diabetes.

Urinary Tract Infections (UTI)

Urinary tract infections are the second most common type of infection, resulting in 8.3 million visits to doctors offices every year. UTIs are named differently according to the primary site of infection:

• Urethritis is an infection of the urethra
• Cystitis is an infection of the bladder
• Pyelonephritis is a kidney infection

In addition to urinary symptoms like urinary frequency and urinary urgency, UTI symptoms can include low-grade fever, abdominal or back pain, and urine that appears cloudy and has an unusual or foul odor. With more serious infections that spread to the kidneys, symptoms may include a fever over 101 degrees Fahrenheit with chills and night sweats, nausea and vomiting and more severe pain in the abdomen or lower back or referred to the flank.

In a significant number of cases, UTIs are asymptomatic. Indeed among the elderly for whom UTIs are a huge concern, the only symptoms may be confusion, combativeness or other changes in mentation.

UTIs occur when bacteria contaminate the urethra opening and begin to multiply. The most common contaminant is Escherichia coli (E. coli), a bacteria which typically lives in the intestines and the most common source of infection in active individuals is fecal contamination following bowel movements. But any abnormality in the urinary tract that obstructs the free flow of urine a kidney stone, for example, or an external catheter can set the stage for infection.

Higher Risk Categories

Women are more prone to UTIs than men, possibly because their urethras are shorter and closer to the anus. Medical experts estimate that half of all women will experience a UTI at least once in their lifetime, and most of them more than once. Factors that increase a woman™s susceptibility to UTIs include sexual activity (because intercourse can irritate the urethra,) use of the diaphragm as a birth control device, and aging since the decrease in estrogen following menopause leads to more fragile urogenital tissues.

If the UTI involves mild discomfort but no fever, you can try to manage it at home. Your goal will be to flush the offending microorganisms by drinking lots and lots of water. Avoid drinking caffeinated beverages such as coffee and tea, alcohol and carbonated beverages as these will irritate your bladder. Since an ounce of prevention is worth a pound of cure, for the future remember to wipe from front to back after a bowel movement (rather than the other way around), to urinate as soon as possible after sexual intercourse and (for women) to avoid potentially irritating feminine hygiene products.

Cranberry Juice

For more than a century, cranberry juice has been used as a natural remedy for UTIs. Cranberries contain substances called proanthocyanins which seem to prevent bacteria from sticking to the walls of the urinary tract. Don’t use the highly sweetened cranberry juice you find in supermarkets for this purpose. Instead use unsweetened cranberry juice or cranberry extract tablets available from health food stores.

If you are running even a low-grade fever or your UTI is causing you significant discomfort, then you should opt to see a physician for treatment.

Definitive diagnosis will be made on the basis of a urinalysis done on a clean, mid-stream catch specimen of urine. Blood, pus and/or bacteria will be present in a urinalysis that’s positive for a UTI. Occasionally a urine culture may also be ordered to test for specific strains of bacterial infection. Other tests your physician may order if he or she thinks your infection may be more serious include blood cultures and a CBC.

Treatment Options

The first line of treatment for a simple UTI is antibiotics. Commonly used antibiotics include Amoxicillin (Amoxil, Trimox), Ciprofloxacin (Cipro), and Sulfamethoxazole-trimethoprim (Bactrim). Symptoms often respond to treatment within 24 hours, but it is important to complete the antibiotic regimen even if symptoms have disappeared otherwise the implicated bacteria may develop a resistance to that antibiotic.

Your doctor may also prescribe medication called Phenazopyridine hydrochloride (Pyridium) to control the burning sensation you experience upon urination. One side effect of Pyridium is that it turns your urine bright blue!

If your UTI has made you extremely sick or you are incapacitated in some way that makes your doctor think you will be unable to adhere to the antibiotic protocol (as sometimes happens with elderly patients), your doctor may recommend hospitalization so that antibiotics and fluids can be administered intravenously

References:

• MayoClinic.Com
• National Health Institute