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Thursday, October 31, 2019

In October, my Father's 85th Birthday and 7th Anniversary to my Blog.

First of all I wold like to greet my Father... 
Papa, Happy 85th Birthday. October 1934.  Time flies so fast for a man who went through a lot yet still stands tall and active while looking after my mother who is 90 years old.

During the Bataan Death March -Japanese Occupation in the Philippines, their family helped a lot of American and Filipino soldiers by feeding and treating them when sick and the soldiers just leave to continue their march when they get better. They also buried some American soldiers with his eldest brother while keeping their dog tags after being told by their father(my grandfather) to remember the deceased soldiers' name so that when the time comes that the relatives will look for their loved ones after the war they will just show the dog tags. If the relatives recognize the name they will show them where they had buried them so that the relatives can claim the body. Although the relatives tried to give them a reward after war, they declined because they did not expect ask anything in return. All the American soldiers that they buried came from rich families and were professionals such as doctors.

They were just happy they were able to be of service. I wish I can post of his picture but I chose not to. I am just so proud of him and my mother for all the sacrifices they did for me. Also, of course with the whole family that are no longer with us. 

I will post one of the most common illnesses of the soldiers during the war on November 1. The other one was already posted long time ago in my blog.

Last but not the least, Happy 7th Anniversary to my Nature's Eye : naomispenny. blogspot.com

Monday, October 7, 2019

Buerger’s Disease or Thromboangiitis Obliterans Causes and Treatment

Buerger’s Disease

First Description

This disease was first reported by Buerger in 1908, who described a disease in which the characteristic pathologic findings — acute inflammation and thrombosis (clotting) of arteries and veins — affected the hands and feet. Another name for Buerger’s Disease is thromboangiitis obliterans.

Who gets Buerger’s Disease (the “typical” patient)?

The classic Buerger’s Disease patient is a young male (e.g., 20–40 years old) who is a heavy cigarette smoker. More recently, however, a higher percentage of women and people over the age of 50 have been recognized to have this disease. Buerger’s disease is most common in the Orient, Southeast Asia, India and the Middle East, but appears to be rare among African–Americans.

Classic symptoms and signs of Buerger’s Disease

The initial symptoms of Buerger’s Disease often include claudication (pain induced by insufficient blood flow during exercise) in the feet and/or hands, or pain in these areas at rest. The pain typically begins in the extremities but may radiate to other (more central) parts of the body. Other signs and symptoms of this disease may include numbness and/or tingling in the limbs and Raynaud’s phenomenon (a condition in which the distal extremities — fingers, toes, hands, feet — turn white upon exposure to cold). Skin ulcerations and gangrene (pictured below) of the digits (fingers and toes) are common in Buerger’s disease. Pain may be very intense in the affected regions.
image: hopkinsvasculitis.org
An angiogram demonstrating lack of blood flow to vessels of the hand (figure below). This decreased blood flow (“ischemia”) led to ulcers of the fingers and severe pain.
image: hopkinsvasculitis.org
An abnormal result from an angiogram of the hand (figure below).
image: hopkinsvasculitis.org
Despite the severity of ischemia (lack of blood flow) to the distal extremities that occurs in Buerger’s, the disease does not involve other organs, unlike many other forms of vasculitis. Even as ulcers and gangrene develop in the digits, organs such as the lung, kidneys, brain, and gastrointestinal (GI) tract remain unaffected. The reasons for the confinement to the extremities and sparing of other organs are not known.

What Causes Buerger’s Disease?

The association of Buerger’s Disease with tobacco use, particularly cigarette smoking, cannot be overemphasized. Most patients with Buerger’s are heavy smokers, but some cases occur in patients who smoke “moderately”; others have been reported in users of smokeless tobacco. It has been postulated that Buerger’s Disease is an “autoimmune” reaction (one in which the body’s immune system attacks the body’s own tissues) triggered by some constituent of tobacco.
Pictured below, are a patient’s fingertips that have developed gangrene. This is a very painful condition which sometimes requires amputation of the affected area.
image: hopkinsvasculitis.org

How is Buerger’s diagnosed?

Buerger’s disease can be mimicked by a wide variety of other diseases that cause diminished blood flow to the extremities. These other disorders must be ruled out with an aggressive evaluation, because their treatments differ substantially from that of Buerger’s Disease (for Buerger’s, there is only one treatment known to be effective: complete smoking cessation — see below).
Diseases with which Buerger’s Disease may be confused include atherosclerosis (build–up of cholesterol plaques in the arteries), endocarditis (an infection of the lining of the heart), other types of vasculitis, severe Raynaud’s phenomenon associated with connective tissue disorders (e.g., lupus or scleroderma), clotting disorders of the blood, and others.
It should be noted that other substances, such as marijuana, have also been associated with a vasculitis similar to Buerger’s or polyarteritis nodosa that should be considered in the differential diagnosis.
Angiograms of the upper and lower extremities can be helpful in making the diagnosis of Buerger’s disease. In the proper clinical setting, certain angiographic findings are diagnostic of Buerger’s. These findings include a “corkscrew” appearance of arteries that result from vascular damage, particularly the arteries in the region of the wrists and ankles. Angiograms may also show occlusions (blockages) or stenoses (narrowings) in multiple areas of both the arms and legs.
Pictured below on the left is a normal angiogram. On the right, is an abnormal angiogram of an arm demonstrating the classic “corkscrew” appearance of arteries to the hand. The changes are particularly apparent in the blood vessels in the lower right hand portion of the picture (the ulnar artery distribution).
image: hopkinsvasculitis.org
In order to rule out other forms of vasculitis (by excluding involvement of vascular regions atypical for Buerger’s), it is sometimes necessary to perform angiograms of other body regions (e.g., a mesenteric angiogram).
Skin biopsies of affected extremities are rarely performed because of the frequent concern that a biopsy site near an area poorly perfused with blood will not heal well.

Treatment and Course of Buerger’s

It is essential that patients with Buerger’s disease stop smoking immediately and completely. This is the only treatment known to be effective in Buerger’s disease. Patients who continue to smoke are generally the ones who require amputation of fingers and toes.
Despite the clear presence of inflammation in this disorder, anti-inflammatory agents such as steroids have not been shown to be beneficial. Similarly, strategies of anticoagulation (thinning of the blood with aspirin or other agents to prevent clots) have not proven effective. The only way to prevent the progression of the disease is to abstain from all tobacco products.
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Myasthenia Gravis (MG) Symptoms,Causes,Test and Treatment

Myasthenia gravis (MG) is a neuromuscular disorder that causes weakness in the skeletal muscles, which are the muscles your body uses for movement. It occurs when communication between nerve cells and muscles becomes impaired. This impairment prevents crucial muscle contractions from occurring, resulting in muscle weakness.
According to the Myasthenia Gravis Foundation of America, MG is the most common primary disorder of neuromuscular transmission. It’s a relatively rare condition that affects between 14 and 20 out of every 100,000 people in the United States.

The main symptom of MG is weakness in the voluntary skeletal muscles, which are muscles under your control. The failure of muscles to contract normally occurs because they can’t respond to nerve impulses. Without proper transmission of the impulse, the communication between nerve and muscle is blocked and weakness results.
Weakness associated with MG typically gets worse with more activity and improves with rest. Symptoms of MG can include:
Not everyone will have every symptom, and the degree of muscle weakness can change from day to day. The severity of the symptoms typically increases over time if left untreated.

MG is a neuromuscular disorder that’s usually caused by an autoimmune problem. Autoimmune disorders occur when your immune system mistakenly attacks healthy tissue. In this condition, antibodies, which are proteins that normally attack foreign, harmful substances in the body, attack the neuromuscular junction. Damage to the neuromuscular membrane reduces the effect of the neurotransmitter substance acetylcholine, which is a crucial substance for communication between nerve cells and muscles. This results in muscle weakness.
The exact cause of this autoimmune reaction is unclear to scientists. According to the Muscular Dystrophy Association, one theory is that certain viral or bacterial proteins may prompt the body to attack acetylcholine.
According to the National Institutes of Health, MG typically occurs in people over the age of 40. Women are more likely to be diagnosed as younger adults, whereas men are more likely to be diagnosed at 60 or older.

Your doctor will perform a complete physical exam, as well as take a detailed history of your symptoms. They’ll also do a neurological exam. This may consist of:
  • checking your reflexes
  • looking for muscle weakness
  • checking for muscle tone
  • making certain your eyes move properly
  • testing sensation in different areas of your body
  • testing motor functions, like touching your finger to your nose
Other tests that can help your doctor diagnose the condition include:
  • repetitive nerve stimulation test
  • blood testing for antibodies associated with MG
  • edrophonium (Tensilon) test: a drug called Tensilon (or a placebo) is administered intravenously, and you’re asked to perform muscle movements under doctor observation
  • imaging of the chest using CT scans or MRI to rule out a tumor

There is no cure for MG. The goal of treatment is to manage symptoms and control the activity of your immune system.

Medication

Corticosteroids and immunosuppressants can be used to suppress the immune system. These medications help minimize the abnormal immune response that occurs in MG.
Additionally, cholinesterase inhibitors, such as pyridostigmine (Mestinon), can be used to increase communication between nerves and muscles.

Thymus gland removal

Removal of the thymus gland, which is part of the immune system, may be appropriate for many patients with MG. Once the thymus is removed, patients typically show less muscle weakness.
According to the Myasthenia Gravis Foundation of America, between 10 and 15 percent of people with MG will have a tumor in their thymus. Tumors, even those that are benign, are always removed because they may become cancerous.

Plasma exchange

Plasmapheresis is also known as a plasma exchange. This process removes harmful antibodies from the blood, which may result in an improvement in muscle strength.
Plasmapheresis is a short-term treatment. The body continues to produce the harmful antibodies and weakness may recur. Plasma exchange is helpful before surgery or during times of extreme MG weakness.

Intravenous immune globulin

Intravenous immune globulin (IVIG) is blood product that comes from donors. It’s used to treat autoimmune MG. Although it’s not entirely known how IVIG works, it affects the creation and function of antibodies.

Lifestyle changes

There are some things you can do at home to help alleviate symptoms of MG:
  • Get plenty of rest to help minimize muscle weakness.
  • If you’re bothered by double vision, talk to your doctor about whether you should wear an eye patch.
  • Avoid stress and heat exposure, as both can worsen symptoms.
These treatments cannot cure MG. However, you’ll typically see improvements in your symptoms. Some individuals may go into remission, during which treatment is not necessary.
Tell your doctor about any medications or supplements you take. Some drugs can make MG symptoms worse. Before taking any new medication, check with your doctor to ensure it’s safe.
One of the most dangerous potential complications of MG is myasthenic crisis. This consists of life-threatening muscle weakness that can include breathing problems. Talk with your doctor about your risks. If you start to have trouble breathing or swallowing, call 911 or go to your local emergency room immediately.
Individuals with MG are at a higher risk of developing other autoimmune disorders such as lupus and rheumatoid arthritis.

The long-term outlook for MG depends on a lot of factors. Some people will only have mild symptoms. Others may eventually become confined to a wheelchair. Talk to your doctor about what you can do to minimize the severity of your MG. Early and proper treatment can limit disease progression in many people.
Note: All information and image/s are credited to the original writer's source/s and reference/s.
Please click the link/s for complete information.
The information contained on this site is for educational purposes only and 
should not be taken as expert advice.

Suggestion other Information about this Topic:

Myasthenia Gravis Fact Sheet