Hernia And Hernia Surgery

What is a hernia? 

A hernia means something coming through. It most frequently occurs when an organ or internal tissue pokes through a hole or weakness in your abdominal muscle wall.

In many cases, people have no or very few hernia symptoms. You may notice a swelling or lump in your stomach area or groin. Often you have no hernia pain.

If your hernia causes sudden pain and especially if it can’t be pushed back in, you should seek urgent medical care. It may mean that your hernia is trapped or tightly pinched where it pokes through the muscle wall (obstruction) and in extreme cases it may cut off the blood supply to your intestines and tissues in your abdomen (strangulation).

A hernia is not usually a serious condition but it will not go away without hernia treatment known as a hernia repair.

What does the hernia surgery involve?

Hernia repair surgery is the world’s most common surgical procedure. Hernia surgery can help to relieve pain, return the hernia abdominal organs to their correct place and, strengthen the weak muscle area. 

A hernia operation usually takes around an hour as a day case procedure. It can be performed by:

• Open surgery – under local or general anaesthetic, an incision usually around 2.5 to 3 inches is made to your skin near your hernia and your surgeon will push your hernia back into your abdomen. The incision is then either stitched closed or much more commonly a mesh is placed over the hole and fixed using fine stitches. The mesh acts like a scaffold and your own tissue will grow through the mesh to reinforce the weakened area without putting tension on the surrounding tissues.

• Keyhole (laparoscopic) surgery – under general anaesthetic, several smaller incisions are made to allow your surgeon to use a less invasive technique using various special instruments including a tiny telescopic camera to repair your hernia. A mesh may then be used to strengthen your abdominal wall. 

If hernia surgery is recommended, your surgeon will advise on the most appropriate type of surgery based on the location and severity of your hernia.

Are there different types of hernia?

Most hernias are found in the abdomen. Areas of weakness in the abdominal wall where hernias are commonly found include the groin, upper stomach, belly button and, where you have a surgical scar.

The most frequently seen types of hernia include:

• Inguinal hernias – the most common hernia, seen more in men, causes a bulge in your groin. The inguinal hernia appears through your inguinal canal, a narrow passage that blood vessels pass through in your abdominal wall and, may reach your scrotum.

• Femoral hernias – also a bulge in your groin, relatively uncommon and seen more in women. The femoral hernia happens at the hole in your abdominal wall where the femoral artery and vein pass from the abdomen into your leg.

• Hiatus hernias - occur in your upper chest area when part of your stomach pushes up into your chest by squeezing through a gap in your diaphragm called the hiatus.

• Umbilical/periumbilical hernias – occur at the umbilicus, a natural weakness in your abdominal wall, when fatty tissue or a part of your bowel pokes through your abdomen near your naval.

• Incisional hernia – occurs through a scar from past abdominal surgery as tissue pokes through the weak healed site in your abdominal wall.  

What complication can happen after the hernia surgery?

Hernia surgery is a routine procedure, but as with all surgeries there are risks of complications. These may vary depending upon the exact hernia operation you have and your health. Your surgeon will discuss these with you in detail.

Often the greatest complication risk is a reoccurrence of the hernia. Other hernia surgery side effects include: build-up of seroma or a fluid-filled sac under the surface of the skin, inability or difficulty urinating, organ or tissue damage, wound infection and, rejection of the mesh.

How soon will I recover after the hernia surgery?

Recovery time after hernia surgery is usually two to three weeks. Most patients will return to normal daily activities and go back to work within a week. You should not do any heavy lifting for at least six weeks. Your surgeon will talk to you about what you can and cannot do for your specific hernia operation.

And Also:

ABOUT YOUR HERNIA SURGERY

Hernia repair has been around for a long time. That means traditional techniques have been perfected while new options and materials have been developed. While not every technique is right for every hernia, they all have common goals: to provide the strongest repair and least chance of recurrence with the least possible discomfort and quickest recovery.

OPEN TENSION REPAIR

Until about 25 years ago, hernias were repaired one way, referred to as ‘open tension’ repair. Here’s what that means:

Open — An incision of 3" to 6" is made in the abdomen to give the surgeon access to the hernia.

Tension — The edges of healthy tissue around the hernia are pulled together and sewn with sutures.

The incision is then closed with dissolving sutures or abdominal adhesive.

This method has been tried and true for decades and may be the only way to repair a very large hernia. The incision tends to be painful and recovery can take as long as five to six weeks. The incision also leaves a scar, although it’s usually very low on the abdomen. Tension repair has a higher recurrence rate than non-tension, or mesh, repair.

THE BEST REASON TO FIX YOUR HERNIA EARLY!

Today’s hernia repair options include new techniques and materials that can make surgery less invasive, recovery faster, and recurrence less likely. And the smaller your hernia (meaning the earlier you fix it), the more options you’re likely to have.

NON-TENSION OR MESH REPAIR

Non-tension means just that. Instead of pulling the tissue around the hernia together, a piece of mesh is positioned to reinforce the area and fixed in place with sutures and/or staples.

The mesh is made of a flexible material that stays in the abdomen and encourages new tissue to grow into it.

Mesh repair has a lower incidence of recurrence than tension repair. There are also different kinds of mesh, including patches, plugs, three-dimensional, expanding, self-absorbing, and even self-gripping mesh that requires few to no sutures to keep it in place. A surgeon who specializes in hernia repair is most likely to have experience using the latest procedures. Ask which ones he or she uses, which may be best for you, and why. Sometimes the best procedure for you is the one with which your surgeon has the most experience and is most comfortable. Don’t hesitate to ask!

LAPAROSCOPIC OR CLOSED REPAIR

Many inguinal hernias can be repaired using a ‘closed’ or laparoscopic procedure — especially when they’re smaller. Laparoscopic repair entails inserting special instruments through tiny incisions in the abdomen through which the surgeon is able to visualize and perform the procedure. Laparoscopic repair uses mesh for reinforcement, so it has a lower recurrence rate. Plus, a smaller incision means less discomfort after surgery, little to no scarring, and a quicker return to normal activity. Many people return to work within a few days.

HOW IT WORKS

Your surgeon makes three or four ¼" to ½" incisions in your abdomen. One is near your navel and the others lower down.

A laparoscope, a fiber-optic tube with a tiny camera on the end, is inserted through one of the openings, allowing the surgeon to visualize the area on a TV monitor.

The surgeon performs the procedure using tiny surgical instruments inserted through the other openings while viewing it on the TV monitor. The mesh is positioned and fastened in place with sutures and/or staples.

The instruments are removed and the holes are closed with a stitch or two or with surgical tape.

ANESTHESIA

While open hernia repair may be done under general, regional (spinal), or even local anesthesia with sedation, laparoscopic hernia repair is always done under general anesthesia. If the idea of general anesthesia makes you nervous, it shouldn’t. General anesthesia is extraordinarily safe with today’s precise administration and monitoring. Your anesthesiologist is present throughout your surgery and monitors you continuously. When your procedure is finished and the anesthesia is stopped, you’ll wake up very quickly.

And if you’re concerned about side effects from general anesthesia, such as nausea and vomiting or headaches, you should know these are rare — the exception rather than the rule. Even if you’re having open repair, your surgeon may prefer to perform the surgery with general anesthesia. It may be easier and more comfortable for you, too. After all, what’s easier than going to sleep, waking up and…it’s done?

BEFORE YOUR SURGERY

A few days before surgery, your surgeon may order a pre-op exam consisting of blood tests, an EKG (electrocardiogram), and a chest X-ray to be sure your heart and lungs are in good condition. You may be instructed to stop taking some over-the-counter medications for a week to 10 days before surgery, such as aspirin or ibuprofen (Advil), which can increase bleeding. Make sure your surgeon knows all the prescription and over-the-counter medications you take, including natural or nutritional supplements. You may also be given a prescription for pain medication to take after surgery, in case you need it. Fill it before your surgery, so you don’t have to think about it after.

THE DAY OF SURGERY

You’ll arrive at the hospital the morning of your surgery; you’ll sign consent forms, change into a hospital cap and gown, have your blood pressure taken, and be started on an IV (intravenous line). The area of your hernia may need to be scrubbed and shaved to guard against infection.

The anesthesiologist will meet with you and review the type of anesthesia you and your surgeon have decided on. You’ll be given medication to relax you.

Next you’ll be taken to the operating room, your anesthesia will be administered and the next thing you know…

THAT’S IT — YOU’RE DONE.

You’ll be waking up in the recovery room with your surgery behind you. Sound easier than dealing with your hernia? It is. Now you can concentrate on your recovery and getting back to your life.

And Also:

ABDOMINAL HERNIA FACTS

Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area.

There are many different types of hernias.

Serious complications from a hernia result from the trapping of tissues in the hernia (incarceration), which can result in the damage or death of the tissue.

Hernia repair and the treatment of hernia complications require surgery.

Lumps and swelling in the abdominal area should be examined by a doctor.

WHAT IS AN ABDOMINAL HERNIA?

A hernia is a general term that refers to a bulge or protrusion of a body tissue or organ through the structure that normally contains it. For example, brain tissue can herniate as can discs in the spine. A common herniation in people is an abdominal herniation. 

An abdominal hernia is an opening or weakness in the muscular structure of the wall of the abdomen. The peritoneum (lining of the abdominal cavity) protrudes through the opening and this defect causes a bulging of the abdominal wall. This bulging is usually more noticeable when the abdominal muscles are tightened, thereby increasing the pressure in the abdomen. Any activities that increase intra-abdominal pressure can worsen a hernia; examples of such activities are lifting, coughing, or even straining to urinate or have a bowel movement. Imagine a barrel with a hole in its side and a balloon that is blown up inside the barrel. Part of the inflated balloon would bulge out through the hole. The balloon going through the hole is like the tissues of the abdomen bulging through a hernia.

When the lining protrudes it can contain intra-abdominal contents such as the intestines and omentum (the layer of fat that covers abdominal organs). Serious complications from a hernia can result from the trapping of tissues in the hernia -- a process called incarceration. Trapped or incarcerated tissues may have their blood supply cut off, leading to damage or death of the tissue. The treatment of an incarceration usually involves surgery.

About 10% of the population will have an abdominal hernia during their lifetime. The hernias may occur in infants, children, and adults -- both in males and females. However, the majority of abdominal hernias occur in males.

WHERE ARE ABDOMINAL HERNIAS LOCATED?

The most common location for hernias is the groin (or inguinal) area. There are several reasons for this tendency. First, there is a natural anatomical weakness in the groin region which results from incomplete muscle coverage. Second, the upright position of human posture results in a greater force that pushes toward the bottom of the abdomen, thereby increasing the stress on these weaker tissues. The combination of these factors over time breaks down the support tissues, enlarging any preexisting hole, or leads to a tear, resulting in a new hole.

Several different types of hernia may occur, and frequently coexist, in the groin area. These include indirect, direct, and femoral hernias, which are defined by the location of the opening of the hernia from the abdomen to the groin. Another type of hernia, called a ventral hernia, occurs in the midline of the abdomen, usually above the navel (umbilicus). Hernias can also occur within the navel (umbilical hernia).

WHAT ARE ABDOMINAL HERNIA SYMPTOMS AND SIGNS?

Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area. A hernia can also be painless and only appear as a bulging. The pain may be intermittent or constant and the swelling may decrease or be absent, depending on the amount of pressure in the abdomen. Constant, intense pain at a bulge site may indicate a medical emergency and should be evaluated immediately by a doctor.

WHAT ARE THE DIFFERENT TYPES OF ABDOMINAL HERNIAS?

Epigastric, umbilical, incisional, lumbar, internal, inguinal, hiatal, and Spigelian hernias all occur at different sites of the abdomen in areas that are prone to anatomical or structural weakness. With the exception of internal hernias (within the abdomen), these hernias are commonly recognized as a lump or swelling and are often associated with pain or discomfort at the site. Internal hernias can be extremely difficult to diagnose until the intestine (bowel) has become trapped and obstructed because there is usually no external evidence of a lump.

HOW IS AN ABDOMINAL HERNIA REPAIRED AND TREATED?

A hernia repair requires surgery. There are several different procedures that can be used for fixing any specific type of hernia. In the open surgical approach, following appropriate anesthesia and sterilization of the surgical site, an incision is made over the area of the hernia and carried down carefully through the sequential tissue layers. The goal is to separate away all the normal tissue and define the margins of the hole or weakness. Once this has been achieved, the hole is then closed, usually by some combination of suture and a plastic mesh. When a repair is done by suture alone, the edges of the defect are pulled together, much like sewing a hole together in a piece of cloth. One of the possible complications of this approach is that it can put excessive strain on the surrounding tissues through which the sutures are passed. Over time, with normal bodily exertion, this strain can lead to the tearing of these stressed tissues and the formation of another hernia. The frequency of such recurrent hernias, especially in the groin region, has led to the development of many different methods of suturing the deep tissue layers in an attempt to provide better results.

In order to provide a secure repair and avoid the stress on the adjacent tissue caused by pulling the hole closed, an alternative technique was developed which bridges the hole or weakness with a piece of plastic-like mesh or screen material. The mesh is a permanent material and, when sewn to the margins of the defect, it allows the body's normal healing process to incorporate it into the local structures. Hernia repair with mesh has proved to be a very effective means of repair.

After the hernia repair is completed, the overlying tissues and skin are surgically closed, usually with absorbable sutures. More and more of hernia repairs are now being done using laparoscopic techniques.

WHAT IS LAPAROSCOPIC ABDOMINAL HERNIA REPAIR SURGERY?

A number of factors have led to the development of a new method of repair called laparoscopic hernia repair. This technique is an extension of a traditional mesh repair method that was used in patients who may have already experienced several hernia recurrences at the same site. Previously, this mesh repair approach had required a separate incision somewhat removed from the target area. However, with the progressive development of the instruments and techniques for laparoscopic surgery, the same procedure can now be done with several relatively small incisions. This allows the surgeon to enter the space behind the hernia defect and place the mesh with minimal injury to the surface of the abdomen. The advantages of this method include coverage of all the potential sites of groin hernia, which reduces the risks of recurrence while also decreasing the amount of postsurgical pain.

WHAT ABOUT THE USE OF A LASER IN ABDOMINAL HERNIA REPAIR?

This is a relatively common question. It arises because, for a time, there were some surgeons marketing "laser hernia repair." While a laser may have been used to make the incision and to separate the tissues, the laser has no application in the repair of a hernia. It is impossible to perform the necessary structural repair with a laser, which functions essentially as a cutting tool. There has been no evidence that incisions by lasers will decrease pain or decrease healing time.

WHAT KIND OF ANESTHESIA IS USED FOR ABDOMINAL HERNIA SURGERY?

Most hernia repairs can be done with a variety of anesthetic methods. With modern general anesthetic techniques and monitoring, general anesthesia is very safe. However the surgery can also be performed under local anesthesia or regional anesthetics, often using sedation medications at the same time to help relax the patient. The specific type of anesthetic for an individual patient is selected after careful evaluation of the patient's general health and individual concerns.

CAN STRENGTHENING THE MUSCLES MAKE AN ABDOMINAL HERNIA GO AWAY?

Unfortunately, exercising to improve a hernia is likely to aggravate the condition. The hernia exists because of a localized absence of muscle and supporting structure. Exercise can strengthen the surrounding muscles, thereby worsening the localized weakness and increasing the pressures inside the abdomen. The result is that more tissue can be forced through the defect and enlarge the hernia.

WHAT CAN BE DONE TO PREVENT AN ABDOMINAL HERNIA?

Most of the factors that lead to the development of hernias are beyond the control of the individual. Some of those factors are inherited and develop as the individual grows. The arrangement of the local tissues and their thickness and strength may greatly affect the relative risk of developing a hernia over a lifetime. However, that risk can be increased by failure to use good body mechanics when lifting, poor abdominal support posture, smoking and weight-control problems.

ARE ABDOMINAL HERNIAS INHERITED?

Since genetics dictate inherited features and structure, there is a significant risk of inheriting the anatomical features that may predispose to a hernia. There may also be inherited factors that result in tissue weakness, which ultimately allows the deterioration of the supporting structures and leads to the formation of a hernia. However, this does not necessarily imply that the offspring of an individual with a hernia will ultimately develop the problem. However, some infants are born with congenital defects that lead to hernia development.

DO ABDOMINAL HERNIAS USUALLY DEVELOP ON BOTH SIDES OF THE BODY?

Groin hernias are somewhat more likely to develop on both sides. This is probably because the structural elements develop symmetrically, and the stresses on the body that occur over time are similar on both sides. When a patient becomes aware of a groin swelling on one side, examination by a doctor will often identify a small hernia on the opposite side.

SHOULD ALL ABDOMINAL HERNIAS BE REPAIRED?

In general, hernias that are at risk for complications, that cause pain, or that limit activity should be repaired. If they are not repaired, there is a risk that an emergency surgical procedure may be required at a later date.

Sometimes, a hernia can be temporarily controlled by wearing a belt-like device that applies external compression, which pushes the tissues back into the abdomen and holds them there. This device is called a truss. The truss must be carefully applied on a daily basis. It should only be used for selected situations following careful evaluation by a doctor.

HOW CAN A PERSON DETERMINE IF A LUMP OR SWELLING IS AN ABDOMINAL HERNIA?

Not all lumps or swellings on the abdominal wall or in the groin are hernias. People should have such lumps or swellings examined by a doctor. Other possible causes include benign or malignant tumors or enlarged lymph nodes. These problems require entirely different types of evaluation and treatments; self-diagnosis may be incorrect and delay needed treatments.

The Heart And Heart Surgery

Heart Surgery Overview

Thousands of heart surgeries are performed every day in the United States.

Thousands of heart surgeries are performed every day in the United States. Even though there is a shortage of donor organs, more than 3,400 people have heart transplants each year.

Two major advances in medicine made heart surgery possible:

The heart-lung machine, which takes over the work of the heart.

Body cooling techniques, which allow more time for surgery without causing brain damage.

What is a heart-lung machine?

The heart-lung machine is also called a cardiopulmonary bypass machine. It takes over for the heart by replacing the heart’s pumping action and by adding oxygen to the blood. This means that the heart will be still for the operation, which is necessary when the heart has to be opened (open heart surgery).

When you are connected to the heart-lung machine, it does the same job that your heart and lungs would do. The heart-lung machine carries blood from the upper-right chamber of the heart (the right atrium) to a special reservoir called an oxygenator. Inside the oxygenator, oxygen bubbles up through the blood and enters the red blood cells. This causes the blood to turn from dark (oxygen-poor) to bright red (oxygen-rich). Then, a filter removes the air bubbles from the oxygen-rich blood, and the blood travels through a plastic tube to the body’s main blood conduit (the aorta). From the aorta, the blood moves throughout the rest of the body.

The heart-lung machine can take over the work of the heart and lungs for hours. Trained technicians called perfusion technologists (blood flow specialists, also called the “pump team”) operate the heart-lung machine.

What are cooling techniques?

Cooling techniques let surgeons stop the heart for long periods without damaging the heart tissue. Cool temperatures avoid damage to the heart tissue by reducing the heart’s need for oxygen.

The heart may be cooled in 2 ways:

Blood is cooled as it passes through the heart-lung machine. In turn, this cooled blood lowers body temperature when it reaches all of the body parts.

Cold salt-water (saline) is poured over the heart.

After cooling, the heart slows and stops. Injecting a special potassium solution into the heart can speed up this process and stop the heart completely. The heart is then safe from tissue injury for 2 to 4 hours.

Who is in the operating room during surgery?

During heart surgery, a highly trained group works as a team.

The cardiovascular surgeon heads up the surgery team and performs the key parts of the surgery.

The assisting surgeons follow the direction of the cardiovascular surgeon.

The cardiovascular anesthesiologist gives you the medicines that make you sleep during the surgery (called anesthesia) and monitors the ventilator, which breathes for you during surgery.

The perfusion technologists run the heart-lung machine.

The cardiovascular nurses are specially trained to assist in heart surgery.

What kinds of heart and blood vessel surgeries are there?

Coronary Artery Bypass

This is the most common kind of heart surgery, also called coronary artery bypass graft surgery (CABG), coronary artery bypass (CAB), coronary bypass, or bypass surgery.

The surgery involves using a healthy section of blood vessel from another part of the body to bypass a part of a diseased or blocked coronary artery. This creates a new route for blood to flow, so that the heart muscle will get the oxygen-rich blood it needs to work properly.

During bypass surgery, the breastbone (sternum) is divided, the heart is stopped, and blood is sent through a heart-lung machine. Unlike other kinds of heart surgery, the chambers of the heart are not opened during bypass surgery.

The terms single bypass, double bypass, triple bypass, or quadruple bypass refer to the number of arteries that are bypassed.

Valve repair or replacement

Blood is pumped through your heart in only one direction. Heart valves play key roles in this one-way blood flow, opening and closing with each heartbeat. Pressure changes behind and in front of the valves allow them to open their flap-like “doors” (called cusps or leaflets) at just the right time, then close them tightly to prevent a backflow of blood.

Two of the most common kinds of valve problems that require surgery are

Stenosis, which means the leaflets do not open wide enough and only a small amount of blood can flow through the valve. Stenosis (narrowing) occurs when the leaflets thicken, stiffen, or fuse together. Surgery is needed to either open the valve that is there or replace it with a new one.

Regurgitation, which is also called insufficiency or incompetence, means that the valve does not close properly and blood leaks backward instead of moving in the proper forward direction. 

Surgery is needed to either tighten or replace the valve.

Surgical repair of a valve involves the surgeon rebuilding the valve so that it will work properly. Valve replacement means that the valve is replaced with a biological valve (made of animal or human tissue) or a mechanical valve (made from materials such as plastic, carbon, or metal).

Arrhythmia Surgery

Any irregularity in your heart’s natural rhythm is called an arrhythmia. Arrhythmias are usually treated first with medicines. Other treatments may include

Electrical cardioversion, where the cardiologist or surgeon uses paddles to “shock” the heart back into a normal rhythm.

Catheter ablation, where the cardiologist uses a special tool to destroy (ablate) the cells that are causing the arrhythmia. This is done in the cardiac catheterization laboratory (the cath lab).

Pacing and rhythm-control devices, including pacemakers and implantable cardioverter defibrillators (ICDs). Patients can have these devices implanted while in the operating room or the cath lab.

When these treatments do not work, surgery may be needed. One type of surgery is called Maze surgery. In Maze surgery, surgeons create a “maze” of new electrical pathways to let electrical impulses travel easily through the heart. Maze surgery is used most often to treat a type of arrhythmia called atrial fibrillation. Atrial fibrillation is the most common type of arrhythmia.

Aneurysm Repair

An aneurysm is a balloon-like bulge in a blood vessel or in the wall of the heart. An aneurysm occurs when the wall of a blood vessel or the heart becomes weakened. Pressure from the blood forces it to bulge outward, forming what you might think of as a blister. An aneurysm can often be repaired before it bursts.

Surgery involves replacing the weakened section of blood vessel or heart with a patch or artificial tube (called a graft).

Aneurysms in the wall of the heart occur most often in the lower-left chamber (called the left ventricle). These aneurysms are called left ventricular aneurysms, and they may develop after a heart attack. (A heart attack can weaken the wall of the left ventricle.) If a left ventricular aneurysm leads to an irregular heartbeat or to heart failure, the surgeon may perform open heart surgery to remove the damaged part of the wall.

Transmyocardial Laser Revascularization (TMLR)

Angina is the pain you feel when a diseased vessel in your heart (called a coronary artery) can no longer deliver enough blood to a part of the heart to meet its need for oxygen. The heart’s lack of oxygen-rich blood is called ischemia. Angina usually occurs when your heart has an extra need for oxygen-rich blood, such as during exercise. Angina is nearly always caused by coronary artery disease (CAD).

Transmyocardial laser revascularization (TMLR) is a procedure that uses lasers to make channels in the heart muscle, in an attempt to allow blood to flow from a heart chamber directly into the heart muscle. If the blood flow is increased, more oxygen can reach the heart. This procedure is only done as a last resort. For example, TMLR may be done in patients who have had many coronary artery bypass operations and cannot have another bypass operation.

Carotid Endarterectomy

Carotid artery disease affects the vessels leading to the head and brain. Like the heart, the brain’s cells need a constant supply of oxygen-rich blood. This blood supply is delivered to the brain by the 2 large carotid arteries in the front of your neck and by 2 smaller vertebral arteries at the back of your neck. The right and left vertebral arteries come together at the base of the brain to form what is called the basilar artery. A stroke most often occurs when fatty plaque blocks the carotid arteries and the brain does not get enough oxygen.

Carotid endarterectomy is the most common surgical treatment for carotid artery disease. Surgeons make an incision at the location of the blockage in the neck and a tube is inserted above and below the blockage to reroute blood flow. Surgeons can then remove the fatty plaque.

A carotid endarterectomy can also be done by a technique that does not require blood flow to be rerouted. In this procedure, the surgeon stops the blood flow just long enough to peel the blockage away from the artery.

Heart Transplantation

The first heart transplants were performed in the late 1960s. But it was not until the use of anti-rejection medicines in the 1980s that the procedure became an accepted operation. Today, heart transplantation gives hope to a select group of patients who would otherwise die of heart failure.

The need for a heart transplant can be traced to one of many heart problems, each of which causes damage to the heart muscle. The two most common heart problems are idiopathic cardiomyopathy (disease of the heart muscle without a known cause) and coronary artery disease (the buildup of plaque in the arteries of the heart).

As the heart problem gets worse, the heart grows weaker and is less able to pump oxygen-rich blood to the rest of the body. 

Because the heart must work harder to pump blood through the body, it tries to make up for this extra work by becoming enlarged (hypertrophied). In time, the heart works so hard to pump blood that it may simply wear out, overcome by disease and unable to meet even the smallest pumping demands. 

Medicines, mechanical devices to assist the heart, and other therapies (including stem cell therapy) can sometimes help and even improve a patient’s condition. But when those treatments fail, transplantation becomes the only option.

And Also:

Cardiac Procedures and Surgeries

If you've had a heart attack, you may have already had certain procedures to help you survive your heart attack and diagnose your condition. For example, many heart attack patients have undergone thrombolysis, a procedure that involves injecting a clot-dissolving agent to restore blood flow in a coronary artery. 

This procedure is administered within a few (usually three) hours of a heart attack. If this treatment isn't done immediately after a heart attack, many patients will need to undergo coronary angioplasty or coronary artery bypass graft surgery (CABG) later to improve blood supply to the heart muscle. 

Cardiac Procedures and Surgeries

Angioplasty

Also known as Percutaneous Coronary Interventions [PCI], Balloon Angioplasty and Coronary Artery Balloon Dilation. View an animation of angioplasty.

What the Procedure Does

Special tubing with an attached deflated balloon is threaded up to the coronary arteries. The balloon is inflated to widen blocked areas where blood flow to the heart muscle has been reduced or cutoff. Often combined with implantation of a stent to help prop the artery open and decrease the chance of another blockage. Considered less invasive because the body is not cut open. Lasts from 30 minutes to several hours. May require an overnight hospital stay.

Reason for the Procedure

Greatly increases blood flow through the blocked artery.

Decreases chest pain (angina).

Increases ability for physical activity that has been limited by angina or ischemia.

Can also be used to open neck and brain arteries to help prevent stroke.

Angioplasty, Laser

What the Procedure Does

Similar to angioplasty except that the catheter has a laser tip that opens the blocked artery. Pulsating beams of light vaporize the plaque buildup.

Reason for the Procedure

Increases blood flow through blocked arteries.

Artificial Heart Valve Surgery

(Also known as Heart Valve Replacement Surgery)

What the Procedure Does

Replaces an abnormal or diseased heart valve with a healthy one.

Reason for the Procedure

Restores function of the heart valves.

Atherectomy

What the Procedure Does

Similar to angioplasty except that the catheter has a rotating shaver on its tip to cut away plaque from the artery.

Reason for the Procedure

Increases blood flow through the blocked artery by removing plaque buildup.

May also be used in carotid arteries (major arteries of the neck leading to the brain) to remove plaque and reduce risk for stroke.

Bypass Surgery

(Also known as CABG, pronounced "cabbage," Coronary Artery Bypass Graft done via Open-Heart Surgery) 

What the Procedure Does

Treats blocked heart arteries by taking arteries or veins from other parts of your body — called grafts — and using them to reroute the blood around the clogged artery to supply blood flow to your heart muscle. View an animation of blood flow(link opens in new window).  A patient may undergo one, two, three or more bypass grafts, depending on how many coronary arteries are narrowed. Requires several days in the hospital.

Reason for the Procedure

One of the most common and effective procedures to manage blockage of blood to the heart muscle.

Improves the supply of blood and oxygen to the heart.

Relieves chest pain (angina).

Reduces risk of heart attack.

Improves ability for physical activity that has been limited by angina or ischemia.

Cardiomyoplasty

What the Procedure Does

An experimental procedure in which skeletal muscles are taken from a patient's back or abdomen. Then they're wrapped around an ailing heart. This added muscle, aided by ongoing stimulation from a device similar to a pacemaker, may boost the heart's pumping motion.

Reason for the Procedure

Increases the pumping motion of the heart.

Heart Transplant

What the Procedure Does

Removes a diseased heart and replaces it with a healthy human heart when a heart is irreversibly damaged. Uses hearts from organ donation.

Reason for the Procedure

Recognized as a proven procedure to restore heart health in appropriately selected patients.

Minimally Invasive Heart Surgery

(Also known as Limited Access Coronary Artery Surgery and includes Port-Access Coronary Artery Bypass (PACAB or PortCAB) and Minimally Invasive Coronary Artery Bypass Graft (MIDCAB or minimally invasive CABG)

What the Procedure Does

An alternative to standard bypass surgery (CABG). Small incisions ("ports") are made in the chest. Chest arteries or veins from your leg are attached to the heart to "bypass" the clogged coronary artery or arteries. The instruments are passed through the ports to perform the bypasses. The surgeon views these operations on video monitors rather than directly. In PACAB, the heart is stopped and blood is pumped through an oxygenator or "heart-lung" machine. MIDCAB is used to avoid the heart-lung machine. It's done while the heart is still beating. Requires several days in the hospital.

Reason for the Procedure

Manages blockage of blood flow to the heart and improves the supply of blood and oxygen to the heart.

Relieves chest pain (angina).

Reduces risk of heart attack.

Improves ability for physical activity.

Radiofrequency Ablation

(Also known as Catheter Ablation)

What the Procedure Does

A catheter with an electrode at its tip is guided through the veins to the heart muscle with real-time, moving X-rays (fluoroscopy) displayed on a video screen. The catheter is placed at the exact site inside the heart where cells give off the electrical signals that stimulate the abnormal heart rhythm. Then a mild, painless radiofrequency energy (similar to microwave heat) is transmitted to the pathway. This destroys carefully selected heart muscle cells in a very small area (about 1/5 of an inch).

Reason for the Procedure

Preferred treatment for many types of rapid heartbeats (arrhythmias) especially supraventricular tachyarrhythmias.

Stent Placement

What the Procedure Does

A stent is a wire mesh tube used to prop open an artery during angioplasty. The stent stays in the artery permanently. View an animation of a stent(link opens in new window). 

Coronary narrowings can form again within stents and are referred to as “restenosis.”

Reason for the Procedure

Holds the artery open.

Improves blood flow to the heart muscle.

Relieves chest pain (angina).

Transmyocardial Revascularization (TMR)

What the Procedure Does

An incision is made on the left breast to expose the heart. Then, a laser is used to drill a series of holes from the outside of the heart into the heart's pumping chamber. In some patients TMR is combined with bypass surgery. In those cases an incision through the breastbone is used for the bypass. Usually requires a hospital stay.

Reason for the Procedure

Used to relieve severe chest pain (angina) in very ill patients who aren't candidates for bypass surgery or angioplasty.

New Medical Discoveries

Close up shot of doctor wearing virtual reality glasses

Artificial organs and a possible cancer cure aren't the future—they're the now

3D-Printed Devices and Organs

Scientists gathering around 3-D printer and watching process of model production in laboratory

The 3D printer was invented in 1983 by Chuck Hull. In 2019, however, the medical industry began to perfect 3D printers to design and create artificial organs. Implants, joints, and prosthetics can be measured and designed precisely, so they fit perfectly in your body. The printing has improved the ability to accurately design and create artificial organs, so they're more likely to be comfortable and mobile for the recipient.

Research published in the British Medical Journal studied 350 cases of 3D-printed artificial implants, the majority of which were used in oral and maxillofacial surgery (affecting the mouth, teeth, jaws and face) and 23.7% of which were used in musculoskeletal system (which provides form, support, stability, and movement to the body). These implants were found to be "clinically effective," and it was concluded that these 3D printed devices "outperformed their conventional comparators." 

In one case, published in the New England Journal of Medicine, Dr. Glenn Green treated an infant with localized bronchial malacia, a breathing issue, with a three-dimensional splint created by a 3D printer. The splint immediately improved the infant's breathing. Said Dr. Green: "Beyond anything that I even dreamt about during my early training, 3D printing offers the ability to create medical devices to improve the lives of our patients."

Genetic Testing to Decrease the Opioid Epidemic

Opioid addiction is an overwhelming and dangerous problem in the U.S. According to the National Institute on Drug Abuse, more than 130 people die in the U.S. every day from opioid overdoses and 21% to 29% of patients who were prescribed opiates by their doctors abuse them. Since chronic pain is the reason for opioid prescriptions, the medical industry is focused on alternative therapies for pain relief. In 2019, the process of pharmacogenomic testing was analyzed and may be one of the strongest methods of alternative therapy to opioid prescriptions.

According to the Cleveland Clinic, "Pharmacogenomics is the study of how genetic factors relate to interindividual variability of drug response." A patient's genetics are studied and tested so the medical provider can better predict how he or she will metabolize a drug. With this information, more accurate and effective drug therapy can be prescribed for pain management. With unique and custom-tailored drug therapies for pain sufferers, the need for opioid prescriptions can decrease.

Routine pharmacogenomic testing is not endorsed by the Food and Drug Administration (FDA) and isn't widely accepted by medical providers or health insurance companies yet. However, research, additional testing, and clinical trials conducted by the National Heart, Lung, and Blood Institute this year may bring this method to the forefront to fight against the opioid crisis.

A Possible Cure for Cervical Cancer

Medical Research Scientists Examines Laboratory Mice kept in a Glass Cage. She Works in a Light Laboratory

One of the most exciting medical discoveries of 2019 was when Australian scientists used gene-editing technology to eliminate cancer from experimental mice. Over five years, these scientists injected specialized nanoparticles into mice that had tumors caused by the gene E7. This is the gene usually found in cancers caused by the human papillomavirus (HPV), which is the culprit for cervical cancer. 

The scientists edited this gene by introducing additional DNA, a technique called Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR). Nigel McMillan, the lead researcher in the study, said, "This is like adding a few extra letters into a word, so the spell checker doesn't recognize it anymore."

All mice survived this treatment, and the tumors were 100% eliminated. The scientists may move on to conducting this experiment in humans next. While this treatment has a ways to go before it can be approved and proven effective, it's an exciting small step to the potential cure for cancer.

Virtual Reality for Medical Training

Today's virtual reality is so realistic, medical students and professionals can use these programs to practice performing medical procedures and surgeries or to learn more about real-life situations they may encounter in a healthcare setting.

A study published in Cyberpsychology and Behavior states that virtual reality technology is being used in the healthcare industry for:

Medical crisis training.

Temporal bone dissection.

Orthopedic surgery.

Virtual endoscopy simulator.

Arthroscopic knee surgery.

Interventional neuroradiology procedures.

Esophageal intubation training.

Laparoscopic skill practice.

Not only can virtual reality training help future medical professionals practice dealing with real-world situations, but they can also build confidence in currently practicing doctors. By sharpening their skills through virtual reality programs, medical providers can put their knowledge to the test to ensure they feel comfortable performing complicated or grueling medical procedures and surgeries.

A Visor That Detects Strokes

The volumetric impedance phase shift spectroscopy (VIPS) device

About 800,000 strokes occur each year, according to research published in Neurotherapeutics. Approximately 87% of these strokes are ischemic strokes, which are caused by blood clots blocking blood flow to the brain. About 10% of these strokes are primary hemorrhage strokes, which usually occurs when blood vessels in the brain rupture. While hemorrhage strokes aren't as common, they're more deadly. According to Harvard Medical School, 30% to 60% of people with an intracerebral hemorrhage die. 

Since hemorrhage strokes cause internal bleeding inside the brain, fast diagnosis and treatment is crucial to prevent permanent brain damage or death. Medical professionals focusing on how to quickly diagnose this type of stroke created the hemorrhage scanning visor. This visor scans the brain to detect bleeding. By simply placing the hemorrhage scanning visor on a patient's head, a medical professional can easily identify if the brain is hemorrhaging and begin treatment immediately. Science Daily claims this visor has 92% accuracy and provides results within seconds, making this a promising medical discovery of 2019.

Discovery of a New HIV Strand

Focused life science professional pipetting human serum media containing HIV infected cells from petri dish to microtiter plate

The discovery of a new Human Immunodeficiency Virus (HIV) strand in 2019 sounds like a bad thing. But, to develop effective treatments for this disease, researchers must be able to identify each different strand and learn how it behaves. This is the first new strand of HIV that's been identified in 19 years, so it's
a breakthrough that can help researchers in their quest for effective treatment.

According to the Journal of Acquired Immune Deficiency Syndrome, specimen CG-0018a-01 is a rare form of HIV. Researchers are still studying how it affects the body and if it responds to the HIV treatments that are already developed. Co-author of the study, Dr. Carole McArthur, states, "This discovery reminds us that to end the HIV pandemic, we must continue to out-think this continuously changing virus and use the latest advancements in technology and resources to monitor its evolution."

RNA-Based Therapies

Laboratory research of cancer diseases, rack with RNA samples

Genetic diseases, including certain forms of cancer and neurological diseases, are currently incurable, but researchers are dedicated to finding treatments. RNA therapies work similarly to DNA based therapies and have shown promise for treating gene mutation disorders in 2019. RNA therapy interferes with genetic data at the ribonucleic acid (RNA) level to try and "fix" the gene mutation that's causing the disease. 

By tweaking the nucleobase code, or the fundamental units of genetic code, scientists can adjust what the therapy affects. According to Professor Paula Hammond from MIT: "You simply change the sequence, and you're hitting another indication. If the platform works once, it multiplies."

According to UMass Medical School's RNA Therapeutics Institute, this treatment is still undergoing clinical trials but has been showing favorable outcomes. Once tested appropriately, researchers are hopeful RNA-based therapies can help to treat:

Neurodegenerative diseases.

Diabetes.

Atherosclerosis.

Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig's Disease).

Preeclampsia.

Hypercholesterolemia.

Viral infections.

Alpha-1 antitrypsin.

Huntington's disease.

Frontotemporal Lobar Degeneration (FTLD).

Telemedicine

Videoconferencing With Happy Female Doctor On Laptop

We stare at our phones to check work emails or look for the latest shopping deals. Why not use this little piece of addictive technology to improve our health? Telemedicine, also referred to as telehealth, has taken off in 2019. With the latest telemedicine services, you can see a doctor right through an app on your smartphone instead of waiting for a face-to-face appointment. In some cases, a simple email providing information on your symptoms will suffice, while some specialists may want to video chat with you before offering a diagnosis or treatment. Telemedicine is a great way for patients with chronic conditions to check in with doctors without going through the rigamarole of making an appointment and heading to the doctor's office.

According to the American Hospital Association, telemedicine will continue to grow. About 76% of U.S. hospitals offer telehealth services to their patients. Medicare provides some form of reimbursement for telemedicine sessions, and 35 states and the District of Columbia have enacted "parity" laws that require private health insurance companies to cover telehealth services. The telemedicine industry has proven its effectiveness and convenience in 2019, and growth and improvement should continue over the coming years.

An Injection to Prevent Paralysis

Radiologist analysing X-ray image with human spine in consulting room

According to the National Spinal Cord Injury Statistical Center, there are about 17,700 new spinal cord injury cases each year in the United States. Some of these cases can cause paralysis or even death. When your body experiences a trauma, it goes into overdrive, attempting to clear out damaged tissue and provide defense against infection. But sometimes your body's reaction to the injury can do more harm than good.

With a spinal cord injury, the body's reaction can cause nerve damage, numbness, or paralysis. That's why researchers from the University of Michigan focused their studies on eliminating this sometimes debilitating and permanently damaging over-reactive immune response. These scientists discovered that an injection of non-pharmaceutical nanoparticles helped to suppress the harmful immune activity that occurs after a spinal injury. 

Not only is the effectiveness of this spinal injury "Epi-pen" good news for those who experience spinal cord injuries, but this treatment also shows promise for other conditions. According to Jonghyuck Park from the University of Michigan, a research fellow on this study, "Hopefully, this technology could lead to new therapeutic strategies not only for patients with spinal cord injury but for those with various inflammatory diseases."

Bluetooth-Enabled Inhalers

The Asthma and Allergy Foundation of America claims that more than 25 million Americans have asthma. This condition is easily manageable by using an asthma inhaler. But one product making waves this year can prove to be helpful for these people living with asthma. A Bluetooth-enabled smart inhaler has a small device attached to it that records the date and time of the last dose administered. This data is sent to the patient's smartphone, allowing the patient to track the frequency of inhaler use and stay on a strict treatment plan as needed. By keeping track of the frequency of use, doctors can identify if a patient is overusing an inhaler and further investigate the reasons for overuse.

According to Jon-Paul Sherlock, director of AstraZeneca's Intelligent Pharmaceutical Respiratory division, "This new technology introduces the potential to support patients, ensuring they get the best from the medicine they have been prescribed." Adding this cutting-edge technology to inhalers can change the way asthma sufferers manage their condition and can make it easier for them to stay healthy. 

Arthritis, Its Causes And Treatment

What are the causes and types of arthritis?

Treatment,  Causes,  Types,  Natural remedies,  Early signs

Arthritis means joint inflammation, but the term is used to describe around 200 conditions that affect joints, the tissues that surround the joint, and other connective tissue. It is a rheumatic condition.

The most common form of arthritis is osteoarthritis. Other common rheumatic conditions related to arthritis include gout, fibromyalgia, and rheumatoid arthritis (RA).

Rheumatic conditions tend to involve pain, aching, stiffness, and swelling in and around one or more joints. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of the body.

Some forms of arthritis, such as rheumatoid arthritis and lupus (SLE), can affect multiple organs and cause widespread symptoms.

According to the Centers for Disease Control and Prevention (CDC), 54.4 million adults in the United States have received a diagnosis of some form of arthritis. Of these, 23.7 million people have their activity curtailed in some way by their condition.

Arthritis is more common among adults aged 65 years or older, but it can affect people of all ages, including children.

Facts on arthritis

Arthritis refers to around 200 rheumatic diseases and conditions that affect joints, including lupus and rheumatoid arthritis.

It can cause a range of symptoms and impair a person’s ability to perform everyday tasks.

Physical activity has a positive effect on arthritis and can improve pain, function, and mental health.

Factors in the development of arthritis include injury, abnormal metabolism, genetic makeup, infections, and immune system dysfunction.

Treatment aims to control pain, minimize joint damage, and improve or maintain quality of life. It involves medications, physical therapies, and patient education and support.

Treatment

The doctor will likely recommend a course of physical therapies to help you manage some of the symptoms of arthritis.

Treatment for arthritis aims to control pain, minimize joint damage, and improve or maintain function and quality of life.

A range of medications and lifestyle strategies can help achieve this and protect joints from further damage.

Treatment might involve:

medications

non-pharmacologic therapies

physical or occupational therapy

splints or joint assistive aids

patient education and support

weight loss

surgery, including joint replacement

Medication

Non-inflammatory types of arthritis, such as osteoarthritis, are often treated with pain-reducing medications, physical activity, weight loss if the person is overweight, and self-management education.

These treatments are also applied to inflammatory types of arthritis, such as RA, along with anti-inflammatory medications such as corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), and a relatively new class of drugs known as biologics.

Medications will depend on the type of arthritis. Commonly used drugs include:

Analgesics: these reduce pain, but have no effect on inflammation. Examples include acetaminophen (Tylenol), tramadol (Ultram) and narcotics containing oxycodone (Percocet, Oxycontin) or hydrocodone (Vicodin, Lortab). Tylenol is available to purchase online.

Non-steroidal anti-inflammatory drugs (NSAIDs): these reduce both pain and inflammation. NSAIDs include available to purchase over-the-counter or online, including ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Some NSAIDs are available as creams, gels or patches which can be applied to specific joints.

Counterirritants: some creams and ointments contain menthol or capsaicin, the ingredient that makes hot peppers spicy. Rubbing these on the skin over a painful joint can modulate pain signals from the joint and lessen pain. Various creams are available to purchase online.

Disease-modifying antirheumatic drugs (DMARDs): used to treat RA, DMARDs slow or stop the immune system from attacking the joints. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil).

Biologics: used with DMARDs, biologic response modifiers are genetically engineered drugs that target various protein molecules involved in the immune response. Examples include etanercept (Enbrel) and infliximab (Remicade).

Corticosteroids: prednisone and cortisone reduce inflammation and suppress the immune system.

Natural remedies

A healthful, balanced diet with appropriate exercise, avoiding smoking, and not drinking excess alcohol can help people with arthritis maintain their overall health.

Diet

There is no specific diet that treats arthritis, but some types of food may help reduce inflammation.

The following foods, found in a Mediterranean diet, can provide many nutrients that are good for joint health:

fish

nuts and seeds

fruits and vegetables

beans

olive oil

whole grains

Foods to avoid

There are some foods that people with arthritis may want to avoid.

Nightshade vegetables, such as tomatoes, contain a chemical called solanine that some studies have linked with arthritis pain. Research findings are mixed when it comes to these vegetables, but some people have reported a reduction in arthritis symptoms when avoiding nightshade vegetables.

Self-management

Self-management of arthritis symptoms is also important.

Key strategies include:

staying physically active

achieving and maintaining a healthy weight

getting regular check-ups with the doctor

protecting joints from unnecessary stress

Seven habits that can help a person with arthritis to manage their condition are:

Being organized: keep track of symptoms, pain levels, medications, and possible side effects for consultations with your doctor.

Managing pain and fatigue: a medication regimen can be combined with non-medical pain management. Learning to manage fatigue is key to living comfortably with arthritis.

Staying active: exercise is beneficial for managing arthritis and overall health.

Balancing activity with rest: in addition to remaining active, rest is equally important when your disease is active.

Eating a healthful diet: a balanced diet can help you achieve a healthy weight and control inflammation. Avoid refined, processed foods and pro-inflammatory animal-derived foods and choose whole plant foods that are high in antioxidants and that have anti-inflammatory properties.

Improving sleep: poor sleep can aggravate arthritis pain and fatigue. Take steps to improve sleep hygiene so you find it easier to fall asleep and stay asleep. Avoid caffeine and strenuous exercise in the evenings and restrict screen-time just before sleeping.

Caring for joints: tips for protecting joints include using the stronger, larger joints as levers when opening doors, using several joints to spread the weight of an object such as using a backpack and gripping as loosely as possible by using padded handles.

Do not sit in the same position for long periods. Take regular breaks to keep mobile.

Physical therapies

Doctors will often recommend a course of physical therapy to help patients with arthritis overcome some of the challenges and to reduce limitations on mobility.

Forms of physical therapy that may be recommended include:

Warm water therapy: exercises in a warm-water pool. The water supports weight and puts less pressure on the muscles and joints

Physical therapy: specific exercises tailored to the condition and individual needs, sometimes combined with pain-relieving treatments such as ice or hot packs and massage

Occupational therapy: practical advice on managing everyday tasks, choosing specialized aids and equipment, protecting the joints from further damage and managing fatigue

Physical activity

Research suggests that although individuals with arthritis may experience short-term increases in pain when first beginning exercise, continued physical activity can be an effective way to reduce symptoms long-term.

People with arthritis can participate in joint-friendly physical activity on their own or with friends. As many people with arthritis have another condition, such as heart disease, it is important to choose appropriate activities.

Joint-friendly physical activities that are appropriate for adults with arthritis and heart disease include:

walking

swimming

cycling

A health care professional can help you find ways to live a healthful lifestyle and have a better quality of life.

Natural therapies

A number of natural remedies have been suggested for different types of arthritis.

According to the organization Versus Arthritis, based in the United Kingdom (U.K.), some research has supported the use of devil’s claw, rosehip, and Boswellia, from the frankincense tree. Devil’s claw and Boswellia supplements can be purchased online.

There is some evidence that turmeric may help, but more studies are needed to confirm their effectiveness.

Various other herbs and spices have been recommended for RA, but again, more research is needed. They include turmeric, garlic, ginger, black pepper, and green tea.

Many of these herbs and spices are available to purchase online in supplement form, including turmeric, ginger, and garlic.

Anyone who is considering using natural remedies for any type of arthritis should speak to a doctor first.

Causes

There is no single cause of all types of arthritis. The cause or causes vary according to the type or form of arthritis.

Possible causes may include:

injury, leading to degenerative arthritis

abnormal metabolism, leading to gout and pseudogout

inheritance, such as in osteoarthritis

infections, such as in the arthritis of Lyme disease

immune system dysfunction, such as in RA and SLE

Most types of arthritis are linked to a combination of factors, but some have no obvious cause and appear to be unpredictable in their emergence.

Some people may be genetically more likely to develop certain arthritic conditions. Additional factors, such as previous injury, infection, smoking and physically demanding occupations, can interact with genes to further increase the risk of arthritis.

Diet and nutrition can play a role in managing arthritis and the risk of arthritis, although specific foods, food sensitivities or intolerances are not known to cause arthritis.

Foods that increase inflammation, particularly animal-derived foods and diets high in refined sugar, can make symptoms worse, as can eating foods that provoke an immune system response.

Gout is one type of arthritis that is closely linked to diet, as it is caused by elevated levels of uric acid which can be a result of a diet high in purines.

Diets that contain high-purine foods, such as seafood, red wine, and meats, can trigger a gout flare-up. Vegetables and other plant foods that contain high levels of purines do not appear to exacerbate gout symptoms, however.

Risk factors for arthritis

Certain risk factors have been associated with arthritis. Some of these are modifiable while others are not.

Non-modifiable arthritis risk factors:

Age: the risk of developing most types of arthritis increases with age.

Sex: most types of arthritis are more common in females, and 60 percent of all people with arthritis are female. Gout is more common in males than females.

Genetic factors: specific genes are associated with a higher risk of certain types of arthritis, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and ankylosing spondylitis.

Modifiable arthritis risk factors:

Overweight and obesity: excess weight can contribute to both the onset and progression of knee osteoarthritis.

Joint injuries: damage to a joint can contribute to the development of osteoarthritis in that joint.

Infection: many microbial agents can infect joints and trigger the development of various forms of arthritis.

Occupation: certain occupations that involve repetitive knee bending and squatting are associated with osteoarthritis of the knee.

Comorbidities

More than half of adults in the U.S. with arthritis report high blood pressure. High blood pressure is associated with heart disease, the most common comorbidity among adults with arthritis.

Around 1 in 5 of adults in the U.S. who have arthritis are smokers. Smoking is associated with chronic respiratory conditions, the second most common comorbidity among adults with arthritis.

Types

There are around 200 types of arthritis, or musculoskeletal conditions. These are split into seven main groups:

Inflammatory arthritis

Degenerative or mechanical arthritis

Soft tissue musculoskeletal pain

Back pain

Connective tissue disease

Infectious arthritis

Metabolic arthritis

Inflammatory arthritis

Inflammation is a normal part of the body’s healing process. The inflammation tends to occur as a defense against viruses and bacteria or as a response to injuries such as burns. However, with inflammatory arthritis, inflammation occurs in people for no apparent reason.

Inflammatory arthritis can affect several joints, damaging the surface of the joints and the underlying bone.

Inflammatory arthritis is characterized by damaging inflammation that does not occur as a normal reaction to injury or infection. This type of inflammation is unhelpful and instead causes damage in the affected joints, resulting in pain, stiffness and swelling.

Inflammatory arthritis can affect several joints, and the inflammation can damage the surface of the joints and also the underlying bone.

Examples of inflammatory arthritis include:

Rheumatoid arthritis (RA)

Reactive arthritis

Ankylosing spondylitis

Arthritis associated with colitis or psoriasis

The word “arthritis” means “joint inflammation,” but inflammation may also affect the tendons and ligaments surrounding the joint.

Degenerative or mechanical arthritis

Degenerative or mechanical arthritis refers to a group of conditions that mainly involve damage to the cartilage that covers the ends of the bones.

The main job of the smooth, slippery cartilage is to help the joints glide and move smoothly. This type of arthritis causes the cartilage to become thinner and rougher.

To compensate for the loss of cartilage and changes in joint function, the body begins to remodel the bone in an attempt to restore stability. This can cause undesirable bony growths to develop, called osteophytes. The joint can become misshapen. This condition is commonly called osteoarthritis.

Osteoarthritis can also result from previous damage to the joint such as a fracture or previous inflammation in the joint.

Soft tissue musculoskeletal pain

Soft tissue musculoskeletal pain is felt in tissues other than the joints and bones. The pain often affects a part of the body following injury or overuse, such as tennis elbow, and originates from the muscles or soft tissues supporting the joints.

Pain that is more widespread and associated with other symptoms may indicate fibromyalgia.

Back pain

Back pain can arise from the muscles, discs, nerves, ligaments, bones, or joints. Back pain may stem from problems with organs inside the body. It can also be a result of referred pain, for example, when a problem elsewhere in the body leads to pain in the back.

There may be a specific cause, such as osteoarthritis. This is often called spondylosis when it occurs in the spine. Imaging tests or a physical examination may detect this.

A “slipped” disc is another cause of back pain, as is osteoporosis, or thinning of the bones.

If a doctor cannot identify the exact cause of back pain, it is often described as “non-specific” pain.

Connective tissue disease (CTD)

Connective tissues support, bind together, or separate other body tissues and organs. They include tendons, ligaments, and cartilage.

CTD involves joint pain and inflammation. The inflammation may also occur in other tissues, including the skin, muscles, lungs, and kidneys. This can result in various symptoms besides painful joints, and it may require consultation with a number of different specialists.

Examples of CTD include:

SLE, or lupus

scleroderma, or systemic sclerosis

dermatomyositis

Infectious arthritis

A bacterium, virus, or fungus that enters a joint can sometimes cause inflammation.

Organisms that can infect joints include:

Salmonella and Shigella, spread through food poisoning or contamination

chlamydia and gonorrhea, which are sexually transmitted diseases (STDs)

hepatitis C, a blood-to-blood infection that may be spread through shared needles or transfusions

A joint infection can often be cleared with antibiotics or other antimicrobial medication. However, the arthritis can sometimes become chronic, and joint damage may be irreversible if the infection has persisted for some time.

Metabolic arthritis

Uric acid is a chemical created when the body breaks down substances called purines. Purines are found in human cells and several foods.

Most uric acid dissolves in blood and travels to the kidneys. From there, it passes out in urine. Some people have high levels of uric, acid because they either naturally produce more than they need or their body cannot clear the uric acid quickly enough.

Uric acid builds up and accumulates in some people and forms needle-like crystals in the joint, resulting in sudden spikes of extreme joint pain or a gout attack.

Gout can either come and go in episodes or become chronic if uric acid levels are not reduced.

It commonly affects a single joint or a small number of joints, such as the big toe and hands. It usually affects the extremities. One theory is that uric acid crystals form in cooler joints, away from the main warmth of the body.

Some of the more common types of arthritis are discussed below.

Rheumatoid arthritis

Rheumatoid arthritis and osteoarthritis share some characteristics, but they are different conditions.

Rheumatoid arthritis (RA) occurs when the body’s immune system attacks the tissues of the body, specifically connective tissue, leading to joint inflammation, pain, and degeneration of the joint tissue.

Cartilage is a flexible, connective tissue in joints that absorb the pressure and shock created by movement like running and walking. It also protects the joints and allows for smooth movement.

Persistent inflammation in the synovia leads to the degeneration of cartilage and bone. This can then lead to joint deformity, pain, swelling, and redness.

RA can appear at any age and is associated with fatigue and prolonged stiffness after rest.

RA causes premature mortality and disability and it can compromise quality of life. Conditions it is linked to include cardiovascular diseases, such as ischemic heart disease and stroke.

Diagnosing RA early gives a better chance of learning how to manage symptoms successfully. This can reduce the impact of the disease on quality of life.

Osteoarthritis

Osteoarthritis is caused by a reduction in the normal amount of cartilage tissue through wear and tear throughout life.

Osteoarthritis is a common degenerative joint disease that affects the cartilage, joint lining and ligaments, and underlying bone of a joint.

The breakdown of these tissues eventually leads to pain and joint stiffness.

The joints most often affected by osteoarthritis are those that get heavy use, such as hips, knees, hands, the spine, the base of the thumb, and the big toe joint.

And Also:

Arthritis,  Symptoms,  Causes,  Diagnosis,  Treatments,  Diet and exercise,  Outlook

What is arthritis?

Arthritis is an inflammation of the joints. It can affect one joint or multiple joints. There are more than 100 different types of arthritis, with different causes and treatment methods. Two of the most common types are osteoarthritis (OA) and rheumatoid arthritis (RA).

The symptoms of arthritis usually develop over time, but they may also appear suddenly. Arthritis is most commonly seen in adults over the age of 65, but it can also develop in children, teens, and younger adults. Arthritis is more common in women than men and in people who are overweight.

What are the symptoms of arthritis?

Joint pain, stiffness, and swelling are the most common symptoms of arthritis. Your range of motion may also decrease, and you may experience redness of the skin around the joint. Many people with arthritis notice their symptoms are worse in the morning.

In the case of RA, you may feel tired or experience a loss of appetite due to the inflammation the immune system’s activity causes. You may also become anemic — meaning your red blood cell count decreases — or have a slight fever. Severe RA can cause joint deformity if left untreated.

What causes arthritis?

Cartilage is a firm but flexible connective tissue in your joints. It protects the joints by absorbing the pressure and shock created when you move and put stress on them. A reduction in the normal amount of this cartilage tissue cause some forms of arthritis.

Normal wear and tear causes OA, one of the most common forms of arthritis. An infection or injury to the joints can exacerbate this natural breakdown of cartilage tissue. Your risk of developing OA may be higher if you have a family history of the disease.

Another common form of arthritis, RA, is an autoimmune disorder. It occurs when your body’s immune system attacks the tissues of the body. These attacks affect the synovium, a soft tissue in your joints that produces a fluid that nourishes the cartilage and lubricates the joints.

RA is a disease of the synovium that will invade and destroy a joint. It can eventually lead to the destruction of both bone and cartilage inside the joint.

The exact cause of the immune system’s attacks is unknown. But scientists have discovered genetic markers that increase your risk of developing RA fivefold.

How is arthritis diagnosed?

Seeing your primary care physician is a good first step if you’re unsure who to see for an arthritis diagnosis. They will perform a physical exam to check for fluid around the joints, warm or red joints, and limited range of motion in the joints. Your doctor can refer you to a specialist if needed.

If you’re experiencing severe symptoms, you may choose to schedule an appointment with a rheumatologist first. This may lead to a faster diagnosis and treatment.

Extracting and analyzing inflammation levels in your blood and joint fluids can help your doctor determine what kind of arthritis you have. Blood tests that check for specific types of antibodies like anti-CCP (anti-cyclic citrullinated peptide), RF (rheumatoid factor), and ANA (antinuclear antibody) are also common diagnostic tests.

Doctors commonly use imaging scans such as X-ray, MRI, and CT scans to produce an image of your bones and cartilage. This is so they can rule out other causes of your symptoms, such as bone spurs.

How is arthritis treated?

The main goal of treatment is to reduce the amount of pain you’re experiencing and prevent additional damage to the joints. You’ll learn what works best for you in terms of controlling pain. Some people find heating pads and ice packs to be soothing. Others use mobility assistance devices, like canes or walkers, to help take pressure off sore joints.

Improving your joint function is also important. Your doctor may prescribe you a combination of treatment methods to achieve the best results.

Shop heating pads for pain relief.

Medication

A number of different types of medication treat arthritis:

Analgesics, such as hydrocodone (Vicodin) or acetaminophen (Tylenol), are effective for pain management, but don’t help decrease inflammation.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and salicylates, help control pain and inflammation. Salicylates can thin the blood, so they should be used very cautiously with additional blood thinning medications.

Menthol or capsaicin creams block the transmission of pain signals from your joints.

Immunosuppressants like prednisone or cortisone help reduce inflammation.

If you have RA, your doctor may put you on corticosteroids or disease-modifying antirheumatic drugs (DMARDs), which suppress your immune system. There are also many medications to treat OA available over the counter or by prescription.

Shop capsaicin creams for pain relief.

Surgery

Surgery to replace your joint with an artificial one may be an option. This form of surgery is most commonly performed to replace hips and knees.

If your arthritis is most severe in your fingers or wrists, your doctor may perform a joint fusion. In this procedure, the ends of your bones are locked together until they heal and become one.

Physical therapy

Physical therapy involving exercises that help strengthen the muscles around the affected joint is a core component of arthritis treatment.

What lifestyle changes can help people with arthritis?

Weight loss and maintaining a healthy weight reduce the risk of developing OA and can reduce symptoms if you already have it.

Eating a healthy diet is important for weight loss. Choosing a diet with lots of antioxidants, such as fresh fruits, vegetables, and herbs, can help reduce inflammation. Other inflammation-reducing foods include fish and nuts.

Foods to minimize or avoid if you have arthritis include fried foods, processed foods, dairy products, and high intakes of meat.

Some research also suggests that gluten antibodies may be present in people with RA. A gluten-free diet may improve symptoms and disease progression. A 2015 study also recommends a gluten-free diet for all people who receive a diagnosis of undifferentiated connective tissue disease.

Regular exercise will keep your joints flexible. Swimming is often a good form of exercise for people with arthritis because it doesn’t put pressure on your joints the way running and walking do. Staying active is important, but you should also be sure to rest when you need to and avoid overexerting yourself.

At-home exercises you can try include:

the head tilt, neck rotation, and other exercises to relieve pain in your neck

finger bends and thumb bends to ease pain in your hands

leg raises, hamstring stretches, and other easy exercises for knee arthritis

What is the long-term outlook for people with arthritis?

While there’s no cure for arthritis, the right treatment can greatly reduce your symptoms.

In addition to the treatments your doctor recommends, you can make a number of lifestyle changes that may help you manage your arthritis.