Information on Carpal Tunnel Syndrome

What is carpal tunnel syndrome (CTS)?

Carpal tunnel syndrome (CTS) is the name for a group of problems that includes swelling, pain, tingling, and loss of strength in your wrist and hand. Your wrist is made of small bones that form a narrow groove or carpal tunnel. Tendons and a nerve called the median nerve must pass through this tunnel from your forearm into your hand. The median nerve controls the feelings and sensations in the palm side of your thumb and fingers. Sometimes swelling and irritation of the tendons can put pressure on the wrist nerve causing the symptoms of CTS. A person’s dominant hand is the one that is usually affected. However, nearly half of CTS sufferers have symptoms in both hands.

CTS has become more common in the U.S. and is quite costly in terms of time lost from work and expensive medical treatment. The U.S. Department of Labor reported that in 2003 the average number of missed days of work due to CTS was 23 days, costing over $2 billion a year. It is thought that about 3.7 percent of the general public in this country suffer from CTS.
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What are the symptoms of CTS?

Typically, CTS begins slowly with feelings of burning, tingling, and numbness in the wrist and hand. The areas most affected are the thumb, index and middle fingers. At first, symptoms may happen more often at night. Many CTS sufferers do not make the connection between a daytime activity that might be causing the CTS and the delayed symptoms. Also, many people sleep with their wrist bent, which may cause more pain and symptoms at night. As CTS gets worse, the tingling may be felt during the daytime too, along with pain moving from the wrist to your arm or down to your fingers. Pain is usually felt more on the palm side of the hand.

Another symptom of CTS is weakness of the hands that gets worse over time. Some people with CTS find it difficult to grasp an object, make a fist, or hold onto something small. The fingers may even feel like they are swollen even though they are not. Over time, this feeling will usually happen more often.

If left untreated, those with CTS can have a loss of feeling in some fingers and permanent weakness of the thumb. Thumb muscles can actually waste away over time. Eventually, CTS sufferers may have trouble telling the difference between hot and cold temperatures by touch.
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What causes CTS and who is more likely to develop it?

Women are three times more likely to have CTS than men. Although there is limited research on why this is the case, scientists have several ideas. It may be that the wrist bones are naturally smaller in most women, creating a tighter space through which the nerves and tendons must pass. Other researchers are looking at genetic links that make it more likely for women to have musculoskeletal injuries such as CTS. Women also deal with strong hormonal changes during pregnancy and menopause that make them more likely to suffer from CTS. Generally, women are at higher risk of CTS between the ages of 45 and 54. Then, the risk increases for both men and women as they age.

There are other factors that can cause CTS, including certain health problems and, in some cases, the cause is unknown.

These are some of the things that might raise your chances of developing CTS:

* Genetic predisposition. The carpal tunnel is smaller in some people than others.
* Repetitive Movements. People who do the same movements with their wrists and hands over and over may be more likely to develop CTS. People with certain types of jobs are more likely to have CTS, including manufacturing and assembly line workers, grocery store checkers, violinists, and carpenters. Some hobbies and sports that use repetitive hand movements can also cause CTS, such as golfing, knitting, and gardening. Whether or not long-term typing or computer use causes CTS is still being debated. Limited research points to a weak link, but more research is needed.
* Injury or Trauma. A sprain or a fracture of the wrist can cause swelling and pressure on the nerve, increasing the risk of CTS. Forceful and stressful movements of the hand and wrist can also cause trauma, such as strong vibrations caused by heavy machinery or power tools.
* Pregnancy. Hormonal changes during pregnancy and build up of fluid can put pregnant women at greater risk of getting CTS, especially during the last few months. Most doctors treat CTS in pregnant women with wrist splits or rest, rather than surgery, as CTS almost always goes away following childbirth.
* Menopause. Hormonal changes during menopause can put women at greater risk of getting CTS. Also, in some postmenopausal women, the wrist structures become enlarged and can press on the wrist nerve.
* Breast Cancer. Some women who have a mastectomy get lymphedema, the build-up of fluids that go beyond the lymph system's ability to drain it. In mastectomy patients, this causes pain and swelling of the arm. Although rare, some of these women will get CTS due to pressure on the nerve from this swelling.
* Medical Conditions. People who have diabetes, hypothyroidism, lupus, obesity, and rheumatoid arthritis are more likely to get CTS. In some of these patients, the normal structures in the wrist can become enlarged and lead to CTS.

Also, smokers with CTS usually have worse symptoms and recover more slowly than nonsmokers.
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How is CTS treated?

It is important to be treated by a doctor for CTS in order to avoid permanent damage to the wrist nerve and muscles of the hand and thumb. Underlying causes such as diabetes or a thyroid problem should be addressed first. Left untreated, CTS can cause nerve damage that leads to loss of feeling and less hand strength. Over time, the muscles of the thumb can become weak and damaged. You can even lose the ability to feel hot and cold by touch. Permanent injury occurs in about 1 percent of those with CTS.

CTS is much easier to treat early on. Most CTS patients get better after first-step treatments and the following tips for protecting the wrist. Treatments for CTS include the following:

* Wrist Splint. A splint can be worn to support and brace your wrist in a neutral position so that the nerves and tendons can recover. A splint can be worn 24 hours a day or only at night. Sometimes, wearing a splint at night helps to reduce the pain. Splinting can work the best when done within three months of having any symptoms of CTS.
* Rest. For people with mild CTS, stopping or doing less of a repetitive movement may be all that is needed. Your doctor will likely talk to you about steps that you should take to prevent CTS from coming back.
* Medication. The short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful to control CTS pain. NSAIDs include aspirin, ibuprofen, and other non-prescription pain relievers. In severe cases, an injection of cortisone may help to reduce swelling. Your doctor may also give you corticosteroids in a pill form. But, these treatments only relieve symptoms temporarily. If CTS is caused by another health problem, your doctor will probably treat that problem first. If you have diabetes, it is important to know that long-term corticosteroid use can make it hard to control insulin levels.
* Physical Therapy. A physical therapist can help you do special exercises to make your wrist and hand stronger. There are also many different kinds of treatments that can make CTS better and help relieve symptoms. Massage, yoga, ultrasound, chiropractic manipulation, and acupuncture are just a few such options that have been found to be helpful. You should talk with your doctor before trying these alternative treatments.
* Surgery. CTS surgery is one of the most common surgeries done in the U.S. Generally, surgery is only an option for severe cases of CTS and/or after other treatments have failed for a period of at least six months. Open release surgery is a common approach to CTS surgery and involves making a small incision in the wrist or palm and cutting the ligament to enlarge the carpal tunnel. This surgery is done under a local anesthetic to numb the wrist and hand area and is an outpatient procedure.

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What is the best way to prevent CTS?

Current research is focused on figuring out what causes CTS and how to prevent it. The National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) support research on work-related factors that may cause CTS. Scientists are also researching better ways to detect and treat CTS, including alternative treatments such as acupuncture.

For more information on research, contact:

* NINDS at http://www.ninds.nih.gov or call 1-800-352-9424
* NIAMS at http://www.niams.nih.gov or call 1-301-496-8190 or 1-877-226-4267

The following steps can help to prevent CTS:

* Prevent workplace musculoskeletal injury. Make sure that your workspace and equipment are at the right height and distance for your hands and wrist to work with less strain. If you are working on a computer, the keyboard should be at a height that allows your wrist to rest comfortably without having to bend at an angle. Desk or table workspace should be about 27 to 29 inches above the floor for most people. It also helps to keep your elbows close to your sides as you type to reduce the strain on your forearm. Keeping good posture and wrist position can lower your risk of getting CTS.
* Take Breaks. Allowing your hand and wrist to rest and recover every so often will lower your risk of swelling. Experts believe that taking a 10 to 15 minute break every hour is a good way to prevent CTS.
* Vary Tasks. Avoid repetitive movements without changing up your routine. Try to do tasks that use different muscle movements during each hour. Break up tasks that require repetitive wrist and hand motion with those that do not.
* Relax Your Grip. Sometimes, people get into a habit of tensing muscles without needing to. Practice doing hand and wrist motion tasks more gently and less tightly. Stress and tension play a role in muscle strain and irritation.
* Do exercises. After doing repetitive movements for a while, you can sometimes cancel out the effects of those movements by flexing and bending your wrists and hands in the opposite direction. For example, after typing with your wrist and hand extended, it is helpful to make a tight fist and hold it for a second, then stretch out the fingers and hold for a few seconds. Try repeating this several times.
* Stay Warm. Muscles that are warm are less likely to get hurt and the risk of getting CTS is greater in a cold environment. It is important to keep your hands warm while you work, even if you must wear fingerless gloves.

Arthritis cannot be cured by diet, but some dietary changes may help

No special diet or ‘miracle food’ can cure arthritis, but some conditions may be helped by avoiding or including certain foods or supplements. Arthritis is a general term describing over 100 different conditions that cause pain, stiffness and (often) inflammation in one or more joints. Everyone with arthritis can benefit from eating a healthy, well-balanced diet.

For example, osteoarthritis and rheumatoid arthritis seem to respond to an increased dietary intake of fish oils, while gout benefits from avoidance of alcohol and offal meats. The supplements glucosamine and chondroitin may help symptoms of osteoarthritis, but not other forms of arthritis.

Always seek the advice of your doctor or dietitian before changing your diet. You may be restricting your food intake unnecessarily or taking too much of products (such as mineral supplements) that may have no impact on your condition at all. Some supplements can also interact with other medications.

General recommendations
General dietary recommendations for a person with arthritis include:

* Eat a well-balanced diet.
* Avoid crash dieting or fasting.
* Increase dietary calcium to reduce the risk of osteoporosis in later life.
* Drink plenty of non-alcoholic fluids.
* Keep your weight within the normal range, by reducing the amount of dietary fats you consume.

Dietary modification for gout
Uric acid is a waste product that is normally excreted from the body in urine. Gout is a type of arthritis characterised by the build-up of uric acid in the joints (such as the big toe), which causes inflammation and pain.

Dietary changes that may help to ease the symptoms of gout include:

* Restrict or avoid alcohol.
* Restrict or avoid offal meats, such as liver, kidneys and brains.
* Restrict or avoid shellfish, such as prawns and scallops.
* Restrict or avoid some seafoods including sardines, herrings, mackerel and anchovies.
* Restrict or avoid products containing yeast, such as beer and Vegemite.
* Drink plenty of non-alcoholic fluids.
* Make sure you don’t overeat on a regular basis.
* Take your time when eating.

Rheumatoid arthritis and osteoarthritis
Fish oils that contain omega-3 fatty acids have been found to help reduce the inflammation associated with some forms of arthritis, such as rheumatoid arthritis.

The omega-3 fatty acids seem to work by reducing the number of inflammatory ‘messenger’ molecules made by the body’s immune system. There may be additional health benefits to eating foods rich in omega-3 fatty acids, including a lowered risk of asthma and prostate cancer.

Foods rich in omega-3 fatty acids include:

* Oily fish (such as salmon and sardines)
* Linseeds and linseed (flaxseed) oil
* Canola (rapeseed) oil
* Walnuts
* Some fish oil supplements.

Ask your doctor before taking any supplements, to ensure the correct dosage. Fish liver oils (such as cod liver oil) contain high levels of vitamin A and should not be taken in large doses.

Other supplements
The supplements glucosamine and chondroitin are popular. Yet evidence about their success in treating arthritis is limited.

Studies show that glucosamine and chondroitin, taken either separately or in combination, may relieve pain for people with osteoarthritis (OA), where there has been a breakdown of cartilage. There is no evidence that these supplements are effective for any other forms of arthritis.

Glucosamine and chondroitin may interact with other medications, including warfarin, and should only be taken after consultation with your doctor.

Obesity may worsen arthritis symptoms
If you are overweight or obese, the extra load on your joints may be exacerbating your arthritis symptoms, especially if your affected joints include those of the hip, knee or spine. There is also a clear link between being overweight and an increased risk of developing osteoarthritis.

To lose excess weight you must be active, but this can be difficult for people with arthritis due to pain or stiffness. See your doctor, dietitian or health professional for information and advice. Weight reduction strategies may include:

* Switch to a diet that is high in nutrition, while low in kilojoules.
* Experiment with different sorts of activities – for example, it may be possible to enjoy swimming or some kinds of low impact exercises.
* Limit your exercise activities to unaffected joints – for example, if your hands are affected, you may be able to comfortably ride on a stationary bicycle.

Current evidence for dietary cures is sparse
Gout can be helped by avoiding some foods. However, there is no substantial scientific evidence that other forms of arthritis can be helped by avoiding particular foods, unless that person has specifically shown intolerance to them.

There is no evidence that acidic foods (such as lemons), ‘nightshade’ foods (such as tomatoes, potatoes and eggplants) or dairy foods trigger arthritis symptoms. These foods all contain important nutrients and avoiding them may be a health risk.

As research reveals more connections between diet and health, it is possible that stronger connections between particular foods and arthritis may emerge.

Tips for managing arthritis and diet
If you think a particular food may aggravate your arthritis, it can help to keep a diary of your food intake and symptoms. After a month, you may have some idea about which food could be provoking symptoms. You could then try removing that food from your diet for two weeks.

Don’t cut out a whole food category – for example, all dairy products – and make sure you are getting the vitamins and minerals that this food provides from other sources. It is important to let your doctor know that you are doing this.

Remember that remission may be coincidental
The symptoms of arthritis, particularly the inflammatory types, can change for no apparent reason. Don’t assume any improvement in your symptoms is due to what you eat or avoid. Be guided by your health professional.

Where to get help

* Your doctor
* An Accredited Practising Dietitian, Dietitians Association of Australia
* Arthritis Foundation of Victoria Tel. (03) 8531 8000 or 1800 011 041

Things to remember

* Arthritis is a general term describing over 100 different conditions that cause pain, stiffness and (often) inflammation in one or more joints.
* No special diet or ‘miracle food’ can cure arthritis, but some conditions may be helped by avoiding or including certain foods.
* Fish oil can ease the symptoms of inflammatory types of arthritis, such as rheumatoid arthritis.
* The symptoms of gout can be eased by avoiding alcohol and offal meats, and by drinking plenty of water.

Information on Asperger Syndrome

What is Asperger syndrome?
Asperger syndrome is an autism spectrum disorder, a group of conditions that include autism and other disorders with similar symptoms, such as problems with language and communication, and repetitive or restrictive patterns of thoughts and behavior.

People with Asperger syndrome have autism-like problems in areas of social interaction and communication, but have normal intelligence and verbal skills. Asperger syndrome is usually thought to be the mildest of the autism spectrum disorders.

What are the symptoms of Asperger syndrome?
One of the most distinct symptoms of Asperger syndrome is having an obsessive interest in a single object or topic—so much so that the person ignores other objects, topics, or thoughts.

Unlike some children with autism spectrum disorders, children with Asperger syndrome tend to have good vocabularies and grammar skills. But they usually have other language problems, such as being very literal and having trouble understanding non-verbal communications, such as body language.
Other symptoms of Asperger syndrome may include:

* Obsessive or repetitive routines and rituals
* Motor-skill problems, such as clumsy or uncoordinated movements and delays in motor skills
* Social-skill problems, especially related to communicating with others
* Sensitivity to sensory information, such as light, sound, texture, and taste

What is the treatment for Asperger syndrome?
There is no cure for Asperger syndrome, but people with Asperger syndrome can live full and happy lives, especially with early treatment intervention.

Treatment for Asperger syndrome can include educational and social skills training. It may also include behavioral therapy and medication for related conditions.

Get more information on Hay Fever

Hay fever is the common name for a condition called allergic rhinitis, which means an allergy that affects the nose. Most people associate hay fever with spring, when airborne pollens from grasses are at their peak. However, hay fever can occur at any time of the year. This is known as perennial allergic rhinitis, which is usually caused by a reaction to allergens around the home such as dust mites, moulds or animal hair or fur.

Symptoms
Some of the symptoms of hay fever include:

* Sneezing
* A runny or stuffy nose
* Itchy ears, nose and throat
* Red, itchy or watery eyes
* Headaches.

In some cases, the symptoms of hay fever can be so severe that a person can’t sleep or concentrate, and may feel tired or unwell.

Hay fever is an allergic reaction
Your nose acts as a filter. The tiny hairs and mucus that line the nasal passages trap dust, pollens and other microscopic particles. A person with hay fever is allergic to some of the particles that get trapped in the nose, such as pollen.

An allergic reaction means the immune system treats a harmless substance as if it were dangerous, and launches an ‘attack’. The nasal passages become inflamed and more mucus is produced.

Reducing hay fever symptoms
Suggestions to prevent or limit symptoms of hay fever include:

* Check the pollen count forecast on television or in the newspaper. Try to stay indoors if it’s a high count.
* Stay indoors as much as possible in spring, on windy days or after thunderstorms.
* In your garden, choose plants that are pollinated by birds or insects, rather than plants that release their seeds into the air.
* Replace your lawn with bricked or paved areas.
* Smear petroleum jelly (like Vaseline) inside your nose to stop the pollen from touching the lining of your nose.
* Splash your eyes often with cold water to flush out any pollen.
* Reduce your exposure to dust and dust mites, animals and animal hair or fur (dander).

Medication can help
If you have hay fever, your body produces a substance called histamine, which leads to inflammation (redness and swelling) in the nose.

Some medications may help the symptoms of hay fever. Ask your doctor or pharmacist for advice. You may be advised to try:

* Corticosteroid nasal sprays – these help reduce the inflammation in the nose, which is the cause of nasal blockage and other symptoms. They need to be used regularly as directed to be effective.
* Anti-histamine medications (non-sedating) – these may be useful to control sneezing and itching, but are not as effective as sprays to control a severely blocked or runny nose. Ask your doctor or pharmacist for advice if you are breastfeeding, as some medications can cause breastfed babies to become irritable and restless.
* Eye drops – may relieve itchy, swollen or runny eyes. Ask your doctor or pharmacist for advice on choosing the correct eye drops.
* Immunotherapy – some people may benefit from immunotherapy, which exposes a person to increasing amounts of an allergen to improve tolerance and reduce symptoms. This therapy may help hay fever and some cases of asthma, but does not help food allergy. It should only be conducted under medical supervision as exposure to allergens can be dangerous and potentially life threatening. Seek advice from your doctor.

Where to get help

* Your doctor
* Your pharmacist.

Things to remember

* Hay fever is an allergic reaction to pollen and is common in spring.
* Perennial allergic rhinitis occurs all year round.
* Avoiding your triggers is the best way to reduce the frequency of hay fever attacks.

Insomnia

Insomnia is a common sleep disorder. If you have insomnia, you may:

* Lie awake for a long time and have trouble falling asleep
* Wake up a lot and have trouble returning to sleep
* Wake up too early in the morning
* Feel like you haven’t slept at all

Lack of or poor quality sleep causes other symptoms that can affect daytime function. You may feel very sleepy and have low energy throughout the day. You may have trouble thinking clearly or staying focused. Or, you might feel depressed or irritable.

Insomnia is defined as short and poor quality sleep that affects your functioning during the day. Although the amount of sleep a person needs varies, most people need between 7 and 8 hours of sleep a night to feel refreshed.

Insomnia can be mild to severe and varies in how often it occurs and how long it lasts. Acute insomnia is a short-term sleep problem that is generally related to a stressful or traumatic life event and lasts from a few days to a few weeks. Acute insomnia might happen from time to time. With chronic insomnia, sleep problems occur at least 3 nights a week for more than a month.

Insomnia tends to increase as women and men age.

Women are more likely to have insomnia than men. One reason is that hormonal changes during the menstrual cycle and menopause can affect sleep. During perimenopause, women may have trouble falling asleep and staying asleep. Hot flashes and night sweats often can disturb sleep.

During pregnancy, hormonal, physical, and emotional changes can disturb sleep. Pregnant women, especially in the third trimester, may wake up frequently due to discomfort, leg cramps, or needing to use the bathroom.

Some medical conditions that can cause secondary insomnia also are more common in women than men. These include depression, anxiety, fibromyalgia, and some sleep disorders, such as restless leg syndrome.

How is insomnia treated?

If insomnia is caused by a short-term change in the sleep/wake schedule, as with jet lag, your sleep schedule may return to normal on its own. Making lifestyle changes to help you sleep better can also help. If your insomnia makes it hard for you to function during the day, talk to your doctor.

Treatment for chronic insomnia begins by:

* Finding and treating any medical or mental health problems
* Stopping or reducing behaviors that may lead to the insomnia or make it worse, like drinking moderate to large amounts of alcohol at night

Other treatments are:

* Cognitive behavioral therapy (CBT)
* Medication

Cognitive behavioral therapy (CBT)

Research shows that CBT is an effective and lasting treatment of insomnia. CBT helps you change thoughts and actions that get in the way of sleep. This type of therapy is also used to treat conditions such as depression, anxiety, and eating disorders.

CBT consists of one or more approaches. These are:

* Cognitive control and psychotherapy — Controlling or stopping negative thoughts and worries that keep you awake.
* Sleep hygiene — Taking steps to make quality sleep more likely, such as going to bed and waking up at the same time each day, not smoking, avoiding drinking too much coffee or alcohol late in the day, and getting regular exercise.
* Sleep restriction — Matching the time spent in bed with the amount of sleep you need. This is achieved by limiting the amount of time spent in your bed not sleeping. You go to bed later and get up earlier then you would normally, and then slowly increase the time in bed until you are able to sleep all night.
* Stimulus control — Conditioning a positive response with getting into bed. For example, using the bed only for sleep and sex.
* Relaxation training — Reducing stress and body tension. This can include meditation, hypnosis, or muscle relaxation.
* Biofeedback — Measuring body actions, such as muscle tension and brain wave frequency, to help you control them.
* Remain passively awake — Trying not to fall asleep, thereby stopping any worries you might have about falling asleep easily.

Medication
In some cases, insomnia is treated with medicine:

* Prescription sleep medicines — Prescription sleep medicines can help some people get much-needed rest. Most sleep medicines are used for short-term treatment, though some people with severe chronic insomnia may benefit from longer treatment. It is important to understand the risks before using a sleep medicine. In some cases, sleep medicines may:
o Become habit-forming
o Mask medical problems that may be causing the insomnia, and delay treatment
o Interact with other medicines you use and cause serious health problems
o Cause grogginess or rebound insomnia, where the sleeping problems get worse

Uncommon side-effects of sleep medicines include:
o Severe allergic reactions or facial swelling
o High blood pressure, dizziness, weakness, nausea, confusion, or short-term memory loss
o Complex sleep-related behaviors, such as binge eating or driving while asleep

* Over-the-counter (OTC) sleep aids — OTC sleep aids may help on an occasional sleepless night, but they are not meant for regular or long-term use. Most OTC sleep aids contain antihistamines (ant-ih-HISS-tuh-meenz). Antihistamines are not safe for some people to use. OTC sleep aids also can have some unpleasant side-effects, such as dry mouth, dizziness, and prolonged grogginess.

Some dietary supplements claim to help people sleep. Some are “natural” products like melatonin (mel-uh-TOH-nuhn). Others are food supplements such as valerian (an herb) teas or extracts. The U.S. Food and Drug Administration does not regulate dietary supplements as it does medicine. It is unclear if these products are safe or if they actually work.

Talk to your doctor about sleep problems before using an OTC sleep aid. You may have a medical issue that needs to be treated. Also, the insomnia may be better treated in other ways.
If you decide to use a sleep medicine, experts advise you to:
o Read the Medication Guide first.
o Use the medicine at the time of day directed by your doctor.
o Do not drive or engage in activities that require you to be alert.
o Always take the dose prescribed by your doctor.
o Tell your doctor about other medicines you use.
o Call your doctor right away if you have any problems while using the medicine.
o Avoid drinking alcohol and using drugs.
o Talk to your doctor if you want to stop using the sleep medicine. Some medicines must be stopped gradually.

Hypoparathyroidism

What is hypoparathyroidism?

Hypoparathyroidism is a condition in which the body doesn’t make enough parathyroid hormone (PTH).

This hormone regulates the amount of calcium and phosphorus in your body’s bones and blood. Decreased levels of PTH lead to low levels of calcium and high levels of phosphorus in the blood. This imbalance can lead to problems with bones, muscles, skin, and nerve endings.
What causes hypoparathyroidism?

The most common cause of hypoparathyroidism is injury to the parathyroid glands, such as during head and neck surgery. Parathyroid glands are small endocrine glands that are located in the neck behind the thyroid gland.

It other cases, hypoparathyroidism is present at birth or may be associated with an autoimmune disease that affects the parathyroids along with other glands in the body, such as the thyroid, ovaries, or adrenal glands.

Hypoparathyroidism is very rare. It is different from hyperparathyroidism, a much more common condition in which the body makes too much PTH.
What are the symptoms of hypoparathyroidism?

Symptoms of hypoparathyroidism may include:

* Tingling in the lips, fingers, and toes
* Dry hair, brittle nails, and dry, coarse skin
* Muscle cramps and pain in the face, hands, legs, and feet
* Cataracts on the eyes
* Malformations of the teeth, including weakened tooth enamel and misshapen roots of the teeth
* Loss of memory
* Headaches
* Severe muscle spasms (also called tetany) and convulsions

How is hypoparathyroidism treated?

The goal of treatment for hypoparathyroidism is to restore the body’s calcium and phosphorus to normal levels. Calcium carbonate and vitamin D supplements are the only currently approved treatment. However, NIH studies have shown the investigational drug PTH to work well as an alternative therapy.

If hypoparathyroidism is diagnosed and treated early, outcomes are usual good and the body grows normally.

If hypoparathyroidism is left untreated, complications can include a blocked airway due to severe muscle spasms, stunted growth, malformed teeth, development of cataracts, and calcium deposits in the brain.

Will gestational diabetes affect the baby?

What is gestational diabetes?
Gestational diabetes, also known as gestational diabetes mellitus, GDM, or diabetes during pregnancy, is a type of diabetes that only pregnant women get. If a woman gets diabetes when she is pregnant, but never had it before, then she has gestational diabetes.

Normally, your stomach and intestines digest the carbohydrate in your food into a sugar called glucose. Glucose is your body’s main source of energy. After digestion, the glucose moves into your blood to give your body energy.

To get the glucose out of your blood and into the cells of your body, your pancreas makes a hormone called insulin. If you have diabetes, either your body doesn’t make enough insulin, or your cells can’t use it the way they should. Instead, the glucose builds up in your blood, causing diabetes, or high blood sugar.

Gestational diabetes happens in about 5 percent of all pregnancies, or about 200,000 cases a year in the United States.
How do I know if I have gestational diabetes?
Health care providers will test most women who have average risk for gestational diabetes when they are between 24-28 weeks pregnant.

If your risk is higher-than-average, your health care provider may test you earlier, possibly as soon as you know you are pregnant.

There are two approaches to testing for gestational diabetes:

* In the one-step approach, a woman will fast for 4 to 8 hours. Then a health care provider will measure her blood sugar and will do so again 2 hours after she drinks a sugar drink. This type of test is called an oral glucose tolerance test.
* In the two-step approach, a health care provider measures a woman’s blood sugar 1 hour after drinking a sugar drink. Women whose blood sugar is normal after 1 hour probably don’t have gestational diabetes. Women whose blood sugar is high after 1 hour will then have an oral glucose tolerance test to see if they have gestational diabetes.

Will gestational diabetes affect the baby?
Most women who have gestational diabetes give birth to healthy babies, especially when they control their blood sugar, eat a healthy diet, exercise, and keep a healthy weight.

In some cases, though, gestational diabetes can affect the pregnancy and baby. Some potential risks include:

* The baby’s body is larger than normal—called macrosomia. A large baby may need to be delivered by a surgical procedure called cesarean section, instead of naturally through the vagina.
* The baby’s blood sugar is too low—called hypoglycemia. Starting to breastfeed right away can help get more glucose to the baby. The baby may also need to get glucose through a tube into his or her blood.
* The baby’s skin turns yellowish and the whites of the eyes may change color—called jaundice. This condition is easily treated and is not serious if treated.
* The baby may have trouble breathing and need oxygen or other help—called Respiratory Distress Syndrome.
* The baby may have low mineral levels in the blood. This problem can causes muscle twitching or cramping, but can be treated by giving the baby extra minerals

How is gestational diabetes treated?
Many women with gestational diabetes have healthy pregnancies and healthy babies because they follow a treatment plan from their health care provider.

Each woman should have a specific plan designed just for her needs, but there are some general ways to stay healthy with gestational diabetes:

* Know your blood sugar and keep it under control – By testing how much sugar is in your blood, it is easier to keep it in a healthy range. Women usually need to test a drop of their blood several times a day to find out their blood sugar level.
* Eat a healthy diet – Your health care provider can make a plan with the best diet for you. Usually controlling carbohydrates is an important part of a healthy diet for women with gestational diabetes because carbohydrates affect blood sugar.
* Get regular, moderate physical activity – Exercise can help control blood sugar levels. Your health care provider can tell you the best activities and right amount for you.
* Keep a healthy weight – The amount of weight gain that is healthy for you will depend on how much you weighed before pregnancy. It is important to track your both your overall weight gain and weekly rate of gain.
* Keep daily records of your diet, physical activity, and glucose level – Women with gestational diabetes should write down their blood sugar numbers, physical activity, and everything they eat and drink in a daily record book. This can help track how well the treatment is working and what, if anything, needs to be changed.

Some women with gestational diabetes will also need to take insulin to help manage their diabetes. The extra insulin can help lower their blood sugar level. Some women might also have to test their urine to see if they are getting enough glucose.
What happens after the baby is born?
For most women, blood sugar levels go back to normal quickly after the baby is born. Six weeks after the baby is born, you should have a blood test to check your blood sugar levels. The test also checks for your risk of getting diabetes in the future.

If you know you want to get pregnant again, have a blood sugar test up to three months before becoming pregnant to make sure your blood sugar level is normal.

Children whose mothers had gestational diabetes are at higher risk for obesity, abnormal glucose tolerance, and diabetes.

Women who have had gestational diabetes and children whose mothers had gestational diabetes are at higher lifetime risk for obesity and type 2 diabetes. It may be possible to prevent type 2 diabetes through lifestyle changes. Talk to your health care provider about diabetes and increased risk from gestational diabetes.

Contraception

What is contraception?
Contraception, also known as birth control, is designed to prevent pregnancy.

What are some methods of contraception?
There are several general methods of birth control, including (but not limited to):

* Barrier methods, such as condoms, the diaphragm, and the cervical cap, designed to prevent the sperm from entering the uterus.
* Intrauterine device, or IUD, is a small device that is inserted into the uterus by a health care provider. The IUD is more than 99 percent effective at preventing pregnancy. An IUD can stay in the uterus for up to 10 years until it is removed by a health care provider.
* Hormonal birth control, such as birth control pills, injections, skin patches, vaginal rings, and implants release hormones into a woman’s body that interfere with fertility by preventing ovulation.
* Sterilization is a method that permanently prevents a woman from getting pregnant or a man from being able to get a woman pregnant. Sterilization involves surgical procedures that must be done by a health care provider and usually cannot be reversed.

The choice of birth control depends on factors such as a person's overall health, age, frequency of sexual activity, number of sexual partners, desire to have children in the future, and family history of certain diseases. A woman should talk to her health care provider about her choice of birth control method.

Congenital Adrenal Hyperplasia

What is congenital adrenal hyperplasia?
Congenital adrenal hyperplasia, also known as CAH or 21-Hydroxylase Deficiency, is a genetic disorder of the adrenal glands.

Normally, the adrenal glands help keep the body in balance by making the right amounts of hormones, such as cortisol, aldosterone, and androgens.

In people with congenital adrenal hyperplasia, the body doesn’t make enough of the hormone cortisol. Their bodies may also not make aldosterone. Instead, their adrenal glands make too much androgen.

(View a picture of the adrenal glands and a patient education page about the adrenal glands)

Congenital adrenal hyperplasia is caused by an error on a single gene. It is inherited, meaning it is passed down from parents to their children. Congenital adrenal hyperplasia is the most common autosomal recessive genetic disorder in humans.
What are the symptoms of congenital adrenal hyperplasia?
Symptoms of congenital adrenal hyperplasia range from mild to serious. Some people with mild congenital adrenal hyperplasia might never be diagnosed because their symptoms do not cause them any problems.

Symptoms of the mild form of CAH may include:

* Shorter height than their parents
* Early signs of puberty (in children)
* Acne
* Irregular periods and possible trouble getting pregnant (in women)
* Excess facial hair (in women)

Symptoms of the severe form of CAH may include:

* Dehydration
* Low blood pressure
* Low blood sugar level
* Trouble keeping enough salt in their bodies
* Altered development of the external genitalia in girls which is noted at birth and may require surgery to correct
* Shorter height than their parents
* Early signs of puberty (in children)
* Irregular periods and possible trouble getting pregnant (in women)
* Excess facial hair (in women)
* Benign testicular tumors and infertility (in men)

Testing for the severe form of congenital adrenal hyperplasia is now part of routine newborn screening done in most states.
What are the treatments for congenital adrenal hyperplasia?
Congenital adrenal hyperplasia can’t be cured, but it can be treated. People with congenital adrenal hyperplasia can take medication to help replace the hormones their bodies are not making. Some people with congenital adrenal hyperplasia (those with the mild form) only need these medications when they are sick, while others (those with the severe form) need to take them every day for their entire life. The severe form of CAH can be life threatening without medication.

Preeclampsia and Eclampsia

What are preeclampsia and eclampsia?
Preeclampsia is a syndrome marked by a sudden increase in the blood pressure of a pregnant woman after the 20th week of pregnancy. It can affect the mother’s kidney, liver, and brain. If left untreated, the condition can be fatal for the mother and/or the baby and can lead to long-term health problems.

Eclampsia is a more severe form of preeclampsia that can cause seizures and coma in the mother.
What are the symptoms of preeclampsia?
Possible signs of preeclampsia include:

* High blood pressure
* Too much protein in the urine
* Swelling in a woman’s face and hands (a woman’s feet might swell too, but swollen feet are common during pregnancy and may not signal a problem)
* Systemic problems, such as headache, blurred vision, and abdominal pain

What is the treatment for preeclampsia?
The only cure for preeclampsia is delivering the fetus.

If preeclampsia develops, the health care provider may develop a plan to try to prolong the pregnancy to give the fetus more time to grow and mature. At the same time, the health care provider will closely watch the health of the mother for signs that the fetus needs to be delivered right away, even prematurely, if necessary. If the preeclampsia is severe enough and the fetus is not delivered, the mother could die. Health care providers will take steps to prevent the condition from being fatal for mother and baby.

If you have questions about preeclampsia and delivery, talk to your health care provider.
What are the risk factors for preeclampsia?
There is no proven way to prevent preeclampsia. But some women are more likely to develop it, including:

* Women who have high blood pressure before becoming pregnant
* Women who had high blood pressure or preeclampsia in previous pregnancies
* Women who are obese
* Women younger than age 20 or older than age 40
* Women who are pregnant with more than one baby
* Women with certain health conditions, such as diabetes or kidney disease