Saturday, 14 December 2013

MRI Scan Part-4

MRI Scan At A Glance

  • Claustrophobic sensation can occur with MRI scanning.

Friday, 13 December 2013

MRI scan Part-3



How does a patient obtain the results of the MRI scan?

After the MRI scanning is completed, the computer generates visual images of the area of the body that was scanned. These images can be transferred to film (hard copy). A radiologist is a physician who is specially trained to interpret images of the body. The interpretation is transmitted in the form of a report to the practitioner who requested the MRI scan. The practitioner can then discuss the results with the patient and/or family.

Pictures of an MRI of the spine

Picture of herniated disc between L4 and L5
Picture of herniated disc between L4 and L5
Cross-section picture of herniated disc between L4 and L5
Cross-section picture of herniated disc between L4 and L5

Thursday, 12 December 2013

MRI scan Part-2

What are the risks of an MRI scan?

What are the risks of an MRI scan?


Wednesday, 11 December 2013

MRI scan Part-1

What is an MRI scan?


When are MRI scans used?

An MRI scan can be used as an extremely accurate method of disease detection throughout the body. In the head, trauma to the brain can be seen as bleeding or swelling. Other abnormalities often found include brain aneurysms, stroke, tumors of the brain, as well as tumors or inflammation of the spine.

Tuesday, 10 December 2013

Ascites Part-4

What is the outlook (prognosis) for ascites?

The outlook on ascites primarily depends on its underlying cause and severity.
Ascites due to cirrhosis usually is a sign of advanced liver disease and it usually has a fair prognosis with a 3-year survival rate of about 75%.
Ascites due to heart failure has a fair prognosis as the patient may live years with appropriate treatments.

Monday, 9 December 2013

Ascites part-3

What are the complications for ascites?

Some complications of ascites can be related to its size. The accumulation of fluid may cause breathing difficulties by compressing the diaphragm and formation of pleural effusion.
Infections are another serious complication of ascites. In patients with ascites related to portal hypertension, bacteria from the gut may spontaneously invade the peritoneal fluid (ascites) and cause an infection. This is called spontaneous bacterial peritonitis or SBP. Antibodies are rare in ascites and, therefore, the immune response in the ascitic fluid is very limited. The diagnosis of SBP is made by performing a paracentesis and analyzing the fluid for the number of white blood cells or evidence of bacterial growth.
Hepatorenal syndrome is a rare, but serious and potentially deadly (average survival rates range from 2 weeks to about 3 months) complication of ascites related to cirrhosis of the liver leading to progressive kidney failure. The exact mechanism of this syndrome is not well known, but it may result from shifts in fluids, impaired blood flow to the kidneys, overuse of diuretics, and administration of contrasts or drugs that may be harmful to the kidney.

Can ascites be prevented?

The prevention of ascites largely involves preventing the risk factors of the underlying conditions leading to ascites.
In patients with known advanced liver disease and cirrhosis of any cause, avoidance of alcohol intake can markedly reduce the risk of forming ascites. Nonsteroidal antiinflammatory drugs (ibuprofen [Advil, Motrin, etc.]) should also be limited in patients with cirrhosis as they may diminish the blood flow to the kidneys, thus, limiting the salt and water excretion. Complying with dietary salt restrictions is also another simple preventive measure to reduce ascites.

Sunday, 8 December 2013

Ascites Part-2

What is the treatment for ascites?

The treatment of ascites largely depends on the underlying cause. For example, peritoneal carcinomatosis or malignant ascites may be treated by surgical resection of the cancer and chemotherapy, while management of ascites related to heart failure is directed toward treating heart failure with medical management and dietary restrictions.
Because cirrhosis of the liver is the main cause of ascites, it will be the main focus of this section.


Managing ascites in patients with cirrhosis typically involves limiting dietary sodium intake and the use of diuretics (water pills). Restricting dietary sodium (salt) intake to less than 2 grams per day is very practical, successful, and widely recommended for patients with ascites. In majority of cases, this approach needs to be combined with the use of diuretics as salt restriction alone is generally not an effective way to treat ascites. Consultation with a nutrition expert in regards to daily salt restriction can be very helpful for patients with ascites.


Diuretics increase water and salt excretion from the kidneys. The recommended diuretic regimen in the setting of liver related ascites is a combination of spironolactone (Aldactone) and furosemide (Lasix). Single daily dose of 100 milligrams of spironolactone and 40 milligrams of furosemide is the usual recommended initial dosage. This can be gradually increased to obtain appropriate response to the maximum dosage of 400 milligrams of spironolactone and 160 milligrams of furosemide, as long as the patient can tolerate the dose increase without any side effects. Taking these medications together in the morning is typically advised to prevent frequent urination during the night.

Therapeutic paracentesis

For patients who do not respond well to or cannot tolerate the above regimen, frequent therapeutic paracentesis (a needle carefully is placed into the abdominal area, under sterile conditions) can be performed to remove large amounts of fluids. A few liters (up to 4 to 5 liters) of fluid can be removed safely by this procedure each time. For patients with malignant ascites, this procedure may also be more effective than diuretic use.


For more refractory cases, surgical procedures may be necessary to control the ascites. Transjugular intrahepatic portosystemic shunts (TIPS) is procedure done through the internal jugular vein (the main vein in the neck) under local anesthesia by an interventional radiologist. A shunt is placed between the portal venous system and the systemic venous system (veins returning blood back to the heart), thereby reducing the portal pressure. This procedure is reserved for patients who have minimal response to aggressive medical treatment. It has been shown to reduce ascites and either limit or eliminate the use of diuretics in a majority of cases performed. However, it is associated with significant complications such as hepatic encephalopathy (confusion) and even death.

Saturday, 7 December 2013

Ascites Part-1

Ascites Facts

  • Treatment of ascites depends on its underlying cause.

What is ascites?


What causes ascites?


Friday, 6 December 2013

Ascites Cont.

When should I call my doctor about ascites?


How is ascites diagnosed?

Diagnosis of underlying condition causing ascites is the most important part of understanding the reason for a person to develop ascites. The medical history may provide clues to the underlying cause and typically includes questions about previous diagnosis of liver disease, viral hepatitis infection and its risk factors, alcohol abuse, family history of liver disease, heart failure, cancer history, and medication history.
For di

Thursday, 5 December 2013


What are the types of ascites?

Traditionally, ascites is divided into 2 types; transudative or exudative. This classification is based on the amount of protein found in the fluid.
A more useful system has been developed based on the amount of albumin in the ascitic fluid compared to the serum albumin (albumin measured in the blood). This is called the Serum Ascites Albumin Gradient or SAAG.
  • Ascites caused by other reasons (malignant, pancreatitis) is lower than 1.1.

What are the risk factors for ascites?

The most common cause of ascites is cirrhosis of the liver. Many of the risk factors for developing ascites and cirrhosis are similar. The most common risk factors include hepatitis B, hepatitis C, and long standing alcohol abuse. Other potential risk factors are related to the other underlying conditions, such as congestive heart failure, malignancy, and kidney disease.

What are the symptoms of ascites?

There may be no symptoms associated with ascites especially if it is mild (usually less than about 100 – 400 ml in adults). As more fluid accumulates, increased abdominal girth and size are commonly seen. Abdominal pain, discomfort, and bloating are also frequently seen as ascites becomes larger. Shortness of breath can also happen with large ascites due to increased pressure on the diaphragm and the migration of the fluid across the diaphragm causing pleural effusions (fluid around the lungs). A cosmetically disfiguring large belly, due to ascites, is also a common concern of some patients.

Wednesday, 4 December 2013

Anemia Part-8

Take the Blood Disorders Quiz

What are the complications of anemia?

As mentioned earlier, hemoglobin has the important role of delivering oxygen to all parts of the body for consumption and carries back carbon dioxide back to the lung to exhale it out of the body. If the hemoglobin level is too low, this process may be impaired, resulting in low levels of oxygen in the body (hypoxia).

What is the outlook (prognosis) for anemia?

Anemia generally has a very good prognosis and it may be curable in many instances. The overall prognosis depends on the underlying cause of anemia, its severity, and the overall health of the patient.

Tuesday, 3 December 2013

Anemia Part-7

Anemia Part-7

Take the Blood Disorders Quiz

How is blood collected for a CBC?

Blood is collected by venipuncture (using a needle to draw blood from a vein) in a lab, hospital, or physician's office. Typically, blood is collected in a special sterile tube from an arm vein. The tube has some preservatives to prevent clotting of the blood. Results may be available in an hour or longer depending on the setting.
In some instances, a quick in office test called hemoglobin rapid test may be performed using a few drops of blood from a finger prick. The advantage of this quick test is that results may be obtained in a few minutes and only a few drops of blood may be required.

What is the red blood cell (RBC) count?

The red blood cells (RBCs or erythrocytes) are the most common type of cells in the blood. We each have millions and millions of these little disc-shaped cells. The RBC count is done to determine if the number of red blood cells is low (anemia) or high (polycythemia).
In an RBC count, the number and size of the RBCs are determined. This is usually reported as number of RBCs per a specified volume, typically in millions of RBCs in microliters (one one-thousandth of an ml) of whole blood. The shape of the RBCs is also evaluated under a microscope. All of this information, the number, size and shape of the RBCs, is useful in the diagnosis of anemia. Further, the specific type of anemia may be determined by this information.

What is hemoglobin?

Hemoglobin is a red pigment that imparts the familiar red color to red blood cells and to blood. Functionally, hemoglobin is the key chemical compound that combines with oxygen from the lungs and carries the oxygen from the lungs to cells throughout the body. Oxygen is essential for all cells in the body to produce energy.
The blood also transports carbon dioxide, which is the waste product of this energy production process, back to the lungs from which it is exhaled into the air. The transport of the carbon dioxide back to the lung is also achieved by hemoglobin. The carbon dioxide bound to hemoglobin is unloaded in the lungs in exchange for oxygen to be transported to the tissues of the body.

Monday, 2 December 2013

Anemia Part-6

Take the Blood Disorders Quiz

What does a low hemoglobin level mean?

Low hemoglobin is called anemia. When there is a low hemoglobin level, there is often a low red blood cell count and a low hematocrit, too. Reference ranges are slightly different from one source to another, but typically hemoglobin of less than 13.5 gram/100 ml is abnormal in men and less than 12.0 gram/100 ml in women.

What is the hematocrit?


How is hematocrit determined?


How is anemia treated?

The treatment of the anemia varies greatly. First, the underlying cause of the anemia should be identified and corrected. For example, anemia as a result of blood loss from a stomach ulcer should begin with medications to heal the ulcer. Likewise, surgery is often necessary to remove a colon cancer that is causing chronic blood loss and anemia.
Sometimes iron supplements will also be needed to correct iron deficiency. In severe anemia, blood transfusions may be necessary. Vitamin B12 injections will be necessary for patients suffering from pernicious anemia or other causes of B12 deficiency.
In certain patients with bone marrow disease (or bone marrow damage from chemotherapy) or patients with kidney failure, epoetin alfa (Procrit, Epogen) may be used to stimulate bone marrow red blood cell production.
If a medication is thought to be the culprit, then it should be discontinued under the direction of the prescribing doctor.

Anemia Part-5

Take the Blood Disorders Quiz

How is anemia diagnosed?

Anemia is usually detected, or at least confirmed, by a complete blood cell (CBC) count. A CBC test may be ordered by a physician as a part of routine general checkup and screening or based on clinical signs and symptoms that may suggest anemia or other blood abnormalities.

What is a complete blood cell (CBC) count?

Traditionally, CBC analysis was performed by a physician or a laboratory technician by viewing a glass slide prepared from a blood sample under a microscope. Today, much of this work is often automated and done by machines. Six component measurements make up a CBC test:
  1. Red blood cell (RBC) count
  2. Hematocrit
  3. Hemoglobin
  4. White blood cell (WBC) count
  5. Differential blood count (the "diff")
  6. Platelet count
Only the first three of these tests -- the red blood cell (RBC) count, the hematocrit, and the hemoglobin -- are relevant to the diagnosis of anemia.
Additionally, mean corpuscular volume (MCV) is also often reported in a CBC, which basically measures the average volume of red blood cells in a blood sample. This is important in distinguishing the causes of anemia. Units of MCV are reported in femtoliters, a fraction of one millionth of a liter.
Other useful clues to causes of anemia that are reported in a CBC are the size, shape, and color of red blood cells.
Picture of Red Blood Cells

Sunday, 1 December 2013

Anemia Part-4

Take the Blood Disorders Quiz


What are the symptoms of anemia?

  • Tired
  • Fatigue easily
  • Appear pale
  • Develop palpitations (feeling of heart racing)
  • Become short of breath
Additional symptoms may include:
  • Hair loss
  • Malaise (general sense of feeling unwell)
  • Worsening of heart problems

Saturday, 30 November 2013

Anemia Part-3

Take the Blood Disorders Quiz

What are other causes of anemia?

Some of the most common causes include:
    • Long-term alcoholics.
  • A wide assortment of bone marrow diseases can cause anemia.

Friday, 29 November 2013

Anemia Part-2

Take the Blood Disorders Quiz

Can inadequate iron cause anemia?

Another common reason for iron deficiency anemia can be due to recurring or small ongoing bleeding, for instance from colon cancer or from stomach ulcers. Stomach ulcer bleeding may be induced by medications, even very common over-the-counter drugs such as aspirin and ibuprofen (Advil, Motrin). Slow and chronic oozing from these ulcers can lead to loss of iron. Gradually, this could result in anemia. In infants and young children, iron deficiency anemia is most often due to a diet lacking iron.
Interpretation of CBC may lead to clues to suggest this type of anemia. For instance, iron deficiency anemia usually presents with low mean corpuscular volume (microcytic anemia) in addition to low hemoglobin.


Acute blood loss from internal bleeding (as from a bleeding ulcer) or external bleeding (as from trauma) can produce anemia in an amazingly short span of time. This type of anemia could result in severe symptoms and consequences if not addressed promptly. Dizziness, lightheadedness, fatigue, confusion, shortness of breath, and even loss of consciousness can occur with severe, sudden blood loss anemia.

Thursday, 28 November 2013

Heart Disease Part-7

Heart Disease Part-7

Heart Disease Part-7

View the Heart Disease Slideshow

Angioplasty and stenting

If the coronary angiogram (coronary=heart + angio=artery + gram=record) shows significant blockage in an artery, the cardiologist may attempt an angioplasty, in which a balloon is placed via a catheter (as with angiography) at the area of narrowing and when quickly inflated, compresses the offending plaque into the wall of the artery. Often a stent, or a metal cage, is placed at the site of angioplasty to keep the blood vessel from narrowing again. Should a stent be placed, patients are usually started on antiplatelet medication to prevent clot formation. Clopidogrel (Plavix) and prasugrel (Effient) are the two most common medications prescribed.


For those patients with multiple coronary artery blockages, coronary artery bypass grafting may be a consideration.

Tuesday, 26 November 2013

Heart Disease Part-5

Heart Disease Part-5

View the Heart Disease Slideshow


Heart Disease Part-5

Heart catheterization or coronary angiography

This test is the gold standard for the diagnosis of coronary artery disease. A cardiologist inserts and then threads a small tube through the groin or arm into the coronary arteries, where dye is injected to directly visualize the arteries on an x-ray. This test defines the anatomy of the coronary arteries. At the time of the catheterization, if blockages are found, they may be potentially treated with angioplasty in which a balloon is inflated to squash the plaque into the blood vessel wall and the insertion of a stent (wire cage that prevents the blood vessel from narrowing again).
CT coronary angiogram may be used test to diagnose coronary artery disease. During this procedure, intravenous dye containing iodine is injected into the patient and CT scanning is performed to image the coronary arteries.
Prior to the angiogram, a calcium score may be obtained. The calcium CT scan can measure the amount of calcium within heart blood vessels. If the score is 0, meaning that there is no calcium present, the risk of having heart disease is zero. The higher the score, the increased risk of narrowed coronary arteries.

What is the treatment for heart disease?

Coronary artery disease is usually treated in a multi-step approach depending upon a patient's symptoms. The patient and healthcare provider need to work together to return the patient to a normal lifestyle.

Prevention of heart disease

Comment on this
The key to the treatment is prevention. A healthy lifestyle includes exercise, proper nutrition, and smoking cessation. Moreover, controlling diabetes and high blood pressure to minimize contribution risk for heart disease is a major aspect of prevention.
An aspirin a day is recommended to decrease the risk for heart disease and should be started with the recommendation of a health care practitioner.
A little alcohol (one drink per day for women or two drinks per day for men) decreases the risk of heart disease compared to nondrinkers. However, it is not recommended that nondrinkers begin drinking.

Monday, 25 November 2013

Heart Disease Part-4

Heart Disease Part-4

View the Heart Disease Slideshow


Heart Disease Part-4


Used with or without exercise, echocardiography can assess how the heart works. Using sound waves to generate an image, a cardiologist can evaluate many aspects of the heart. Echocardiograms can examine the structure of the heart including the heart valves, the thickness of the heart muscle, the septum (the tissues that separate the four heart chambers from each other) and the pericardial sac (the outside lining of the heart).
The test can indirectly assess blood flow to parts of the heart muscle. If there is decreased blood flow, then segments of the heart wall may not beat as strongly as adjacent heart muscle. These wall motion abnormalities signal the potential for coronary artery disease.
The echocardiogram can also assess the efficiency of the heart by measuring ejection fraction. Normally when the heart beats, it pushes more than 60% of the blood in the ventricle out to the body. Many diseases of the heart, including coronary artery disease, can decrease this percentage (the ejection fraction).

Perfusion studies

Radioactive chemicals like thallium or technetium can be injected into a vein and their uptake measured in heart muscle cells. Abnormally decreased uptake can signify decreased blood flow to parts of the heart because of coronary artery narrowing. This test may be used when the patient's baseline EKG is not normal and is less reliable when used to monitor a stress test.

Computerized tomography

The latest generation of CT scanners can take detailed images of blood vessels and may be used as an adjunct to determine whether coronary artery disease is present. In some institutions, the heart CT is used as a negative predictor. That means that the test is done to prove that the coronary arteries are normal rather than to prove that the disease is present.

Saturday, 23 November 2013

Cholesterol Drugs May Boost Your Gums' Health, Too

Cholesterol Drugs May Boost Your Gums' Health, Too


News Picture: Cholesterol Drugs May Boost Your Gums' Health, TooIn the United States, more than 30 million people take statins, and as many as 200 million people worldwide take these cholesterol-lowering medications, according to a journal editorial accompanying the study. Periodontal disease (or gum disease) affects nearly half of U.S. adults.

Daily Walk May Cut Your Breast Cancer Risk

Daily Walk May Cut Your Breast Cancer Risk

This is welcome news for women who aren't very athletic.

The message is encouraging, Patel said.
"This is not running a marathon," she said.

Wednesday, 20 November 2013

Heart Disease Part-3

Heart Disease Part-3

View the Heart Disease Slideshow

 Heart Disease Part-3

How is heart disease diagnosed?

Heart disease tests

Electrocardiogram (ECG or EKG)


Stress testing


Wednesday, 13 November 2013

Heart Disease- Part-2

Heart Disease- Part-2

View the Heart Disease Slideshow

Heart Disease- Part-2

What are the symptoms of heart disease?

The typical symptoms of coronary artery disease are chest pain associated with shortness of breath. Classically, the pain of angina is described as a pressure or heaviness behind the breast bone with radiation to the jaw and down the arm accompanied by shortness of breath and sweating. Unfortunately, angina has a variety of signs and symptoms, and there may not even be specific chest pain. Other locations of pain and other symptoms may include shoulder or back ache, upper abdominal pain, nausea, and indigestion.
Women, the elderly, and people with diabetes may have different perceptions of pain or have no discomfort at all. Instead, they may complain of malaise or fatigue and generalized weakness and the inability to complete routine physical tasks such as walking or climbing stairs.
Health care practitioners and patients may have difficulty understanding each other when symptoms of angina are described. Patients may experience pressure or tightness but may deny any complaints of pain. Health care practitioners may misinterpret these symptoms when patient answers "no" to the question whether "pain is present," even though the patient is experiencing other types of discomfort.
People with coronary artery disease usually have gradual progression of their symptoms. As an artery narrows over time, the symptoms of decreased blood flow to part of the heart muscle may increase in frequency and/or severity. Health care practitioners may inquire about changes in exercise tolerance (How far can you walk before getting symptoms? Is it to the mailbox? Up a flight of stairs?), and whether there has been an acute change in the symptoms.
Once again, patients may be asymptomatic until a heart attack occurs. Of course, some patients also may be in denial as to their symptoms and procrastinate in seeking care.
Picture of the Heart and Heart Attack

Thursday, 31 October 2013

Heart Disease- Part-1

Heart Disease- Part-1

View the Heart Disease Slideshow

Heart Disease- Part-1

Heart disease facts

  • Prevention is the key to treatment of heart disease.

Introduction to heart disease


Can Eating Peanut Butter Cut Breast Cancer Risk in Later Life?

Can Eating Peanut Butter Cut Breast Cancer Risk in Later Life?


News Picture: Can Eating Peanut Butter Cut Breast Cancer Risk in Later Life?The study participants were part of a long-term, ongoing study on the health effects of diet and exercise in young people. They filled out questionnaires about their diet annually from 1996 until 2001, then four more times until 2010. They also reported if they had been diagnosed with benign breast disease. In all, 112 women said they had.

Wednesday, 30 October 2013

apixaban, Eliquis

apixaban, Eliquis

View the Atrial Fibrillation Slideshow Pictures

GENERIC NAME: apixaban


DRUG CLASS AND MECHANISM: Eliquis is an oral drug used for preventing blood clots in patients with atrial fibrillation. It is an anticoagulant that works by blocking the action of factor Xa. Factor Xa is an important protein in the coagulation cascade that causes blood to clot. Reducing the action of factor Xa reduces the ability of blood to clot. In patients with atrial fibrillation there is increased risk of blood clots which can travel to the brain where it causes strokes as well as to other organs. Eliquis reduces this risk. The FDA approved Eliquis in December 2012.
PREPARATIONS: Tablets: 2.5 and 5 mg
STORAGE: Apixaban should be stored at room temperature between 15 C to 30 C (59 F to 86 F).
PRESCRIBED FOR: Eliquis is used for reducing the risk of strokes and blood clots in patients with atrial fibrillation who have no problems with their heart valve (nonvalvular atrial fibrillation).
DOSING: The usually recommended dose is 5 mg by mouth twice daily. The dose for individuals 80 years or older, weighing less than or equal to 60 kg, or with reduced kidney function is 2.5 mg twice daily.
DRUG INTERACTIONS: Blood levels of apixaban are increased by drugs that reduce the activity of the liver enzymes that break down apixaban. The dose of apixaban should be reduced to 2.5 mg twice daily if combined with drugs that reduce the activity of these enzymes. Examples include ketoconazole (Nizoral, Extina, Xolegel, Kuric), itraconazole (Sporanox), ritonavir (Norvir), and clarithromycin (Biaxin, Biaxin XL).
Drugs that increase the breakdown of apixaban reduce its blood levels and its effectiveness. Examples include carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol), rifampin, St. John's Wort, and phenytoin (Diantin, Dilantin-125. They should not be combined with apixaban.
Administration of other drugs that also can prevent clotting will increase the risk of bleeding during treatment with apixaban. Examples include aspirin, heparin, chronic use of NSAIDs, and drugs that breakdown blood clots (fibrinolytics).
PREGNANCY: There are no adequate studies in pregnant women. Use during pregnancy may increase the risk of bleeding during pregnancy and delivery.
NURSING MOTHERS: It is not known if apixaban is excreted in human milk. Nursing mothers should discontinue apixaban or discontinue nursing.
SIDE EFFECTS: The most common side effects of apixaban involve bleeding. These include bleeding in the stomach, intestines, brain, and eyes; the bleeding may be fatal. Major bleeding events were fewer in patients who received apixaban when compared to a similar group that received warfarin (Coumadin), another widely used drug for preventing blood clots. Rash and serious allergic reactions also may occur.

Tuesday, 29 October 2013

WebMD Resources for Affordable Care Act Enrollment

WebMD Resources for Affordable Care Act Enrollment


Monday, 28 October 2013

More Evidence That Exercise Can Help Prevent High Blood Pressure

More Evidence That Exercise Can Help Prevent High Blood Pressure


News Picture: More Evidence That Exercise Can Help Prevent High Blood PressureHowever, the researchers did not find a solid link between physical activity at work and high blood pressure risk. Physical activity on the job, such as farm or industrial work, can involve heavy lifting, prolonged standing and repetitive tasks.

Anemia Part-1

Anemia facts*


What is anemia?


What causes anemia?

Picture of Red Blood Cells
Picture of Red Blood Cells