Encephalitis

Encephalitis

Definition:

Encephalitis (en-sef-uh-LI-tis) is inflammation of the brain. Viral infections are the most common cause of the condition.

Encephalitis can cause flu-like symptoms, such as a fever or severe headache, as well as confused thinking, seizures, or problems with senses or movement. Many cases of encephalitis may go unnoticed because they result in only mild flu-like symptoms or even no symptoms. Severe cases of encephalitis, while relatively rare, can be life-threatening.

Because the course of any single case of encephalitis is relatively unpredictable, it's important to get a timely diagnosis and treatment.

Symptoms:

Most people with viral encephalitis have either no symptoms or mild flu-like symptoms, such as the following:

• Headache
• Fever
• Aches in muscles or joints
• Fatigue or weakness

More-serious cases require prompt medical care. Signs and symptoms may include the following:

• Severe headache
• Fever
• Altered consciousness
• Confusion or agitation
• Personality changes
• Seizures
• Loss of sensation or paralysis in certain areas of the body
• Muscle weakness
• Hallucinations
• Double vision
• Perception of foul smells
• Problems with speech or hearing
• Loss of consciousness

Signs and symptoms in infants and young children may also include:

• Bulging in the soft spots (fontanels) of the skull in infants
• Nausea and vomiting
• Body stiffness
• Constant, inconsolable crying
• Crying that worsens when the child is picked up
• Poor feeding

When to see a doctor
Get immediate care if you or someone you know is experiencing any of the symptoms associated with more-severe cases of encephalitis. Severe headache, fever and altered consciousness — almost always present with encephalitis in older children and adults — require urgent care.
Infants and young children with any signs or symptoms of encephalitis should receive urgent care.

Causes:

The cause of encephalitis is often unknown, but the most commonly diagnosed cause is a viral infection. Known causes of encephalitis may include:

• Viruses
• Bacteria
• Fungi
• Parasites

An infection may result in one of two conditions affecting the brain:

• Primary encephalitis occurs when a virus or other infectious agent directly infects the brain. The infection may be concentrated in one area or widespread. A primary infection may be a reactivation of a virus that had been inactive (latent) after a previous illness.
  
• Secondary (post-infectious) encephalitis is a faulty immune system reaction in response to an infection elsewhere in the body. This likely occurs when disease-fighting proteins enlisted to fight an infection mistakenly attack molecules in the brain. Secondary encephalitis often occurs two to three weeks after the initial infection. Rarely, secondary encephalitis occurs as a complication of vaccination against a viral infection.

Common viral causes
Common causes of encephalitis include:

• Herpes simplex virus. There are two types of herpes simplex virus (HSV). HSV type 1 (HSV-1) more commonly causes cold sores or fever blisters around your mouth, and HSV type 2 (HSV-2) more commonly causes genital herpes. While HSV-1 encephalitis is rare, it has the potential to cause significant brain damage or death.
  
• Other herpes viruses. Other herpes viruses that may cause encephalitis include the Epstein-Barr virus, which commonly causes infectious mononucleosis, and the varicella-zoster virus, which commonly causes chickenpox and shingles.
  
• Enteroviruses. These viruses include the poliovirus and the coxsackievirus, which usually causes an illness with flu-like symptoms, eye inflammation and abdominal pain.
  
• Mosquito-borne viruses. Arboviruses, or arthropod-borne viruses, are transmitted by mosquitoes or other blood-sucking insects. Mosquito-borne viruses can cause infections that include West Nile, La Crosse, St. Louis, western equine and eastern equine encephalitis. Mosquitoes transfer the virus from a nonhuman host — such as a bird, chipmunk or horse — to humans. Symptoms of an infection may appear within a few days to a couple of weeks after exposure to an arbovirus.
  
• Tick-borne viruses. In the United States, the only known tick-transmitted virus that causes encephalitis is Powassan virus. Symptoms usually appear about a week after exposure to the virus.
  
• Rabies virus. Infection with the rabies virus, which is usually transmitted by a bite from an infected animal, causes a rapid progression to encephalitis once symptoms begin. The disease causes death if the infection isn't treated before it reaches the spinal cord and brain.
  
• Childhood infections. Common childhood infections — such as measles (rubeola), mumps, and German measles (rubella) — used to be fairly common causes of secondary encephalitis. These causes are now rare because of the availability of vaccinations for these diseases

Complications:

The complications resulting from encephalitis depend on several factors, including age, the cause of the infection, the severity of the initial illness and the time from disease onset to treatment.
In most cases, people with relatively mild illness recover within a few weeks with no long-term complications.

Complications of severe illness
Injury to the brain from inflammation can result in a number of problems. The most severe cases can result in:

• Respiratory arrest
• Coma
• Death

Other complications — varying greatly in severity — may persist for many months or be permanent:

• Fatigue
• Weakness
• Mood disorders
• Personality changes
• Memory problems
• Intellectual disabilities
• Lack of muscle coordination
• Paralysis
• Hearing or vision defects
• Speech impairments

Treatments and drugs:

Treatment for mild cases mainly consists of:

• Bed rest
• Plenty of fluids
• Anti-inflammatory drugs — such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others) — to relieve headaches and fever.

Antiviral drugs
More-serious cases of encephalitis usually require aggressive antiviral treatments. Antiviral drugs commonly used to treat encephalitis include:

• Acyclovir (Zovirax)
• Ganciclovir (Cytovene)

Some viruses, such as insect-borne viruses, don't respond to these treatments. However, because the specific virus causing the infection may not be identified immediately or at all, treatment with acyclovir is often begun immediately. This drug can be effective against the herpes simplex virus, which can result in significant complications or death when not treated promptly.

Side effects of the antiviral drugs may include nausea, vomiting, diarrhea, loss of appetite, and muscle or joint soreness or pain. Rare serious problems may include abnormalities in kidney or liver function or suppression of bone marrow activity. Appropriate tests are used to monitor for serious adverse effects.

Supportive care
Additional supportive care also is needed in the hospital for people with severe encephalitis. The care may include:

• Breathing assistance, as well as careful monitoring of breathing and heart function
• Intravenous fluids to ensure proper hydration and appropriate levels of essential minerals
• Anti-inflammatory drugs, such as corticosteroids, to help reduce swelling and pressure within the skull
• Anticonvulsant medications, such as phenytoin (Dilantin), to stop or prevent seizures.

Follow-up therapy
After the initial illness, it may be necessary to receive additional therapy depending on the type and severity of complications. This therapy may include:

• Physical therapy to improve strength, flexibility, balance, motor coordination and mobility
• Occupational therapy to develop everyday skills and to use adaptive products that help with everyday activities
• Speech therapy to relearn muscle control and coordination to produce speech
• Psychotherapy to learn coping strategies and new behavioral skills to improve mood disorders or address personality changes — with medication management if necessary.

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Emphysema

Emphysema

Definition:

Emphysema occurs when the air sacs in your lungs are gradually destroyed, making you progressively more short of breath. Emphysema is one of several diseases known collectively as chronic obstructive pulmonary disease (COPD). Smoking is the leading cause of emphysema.

As it worsens, emphysema turns the spherical air sacs — clustered like bunches of grapes — into large, irregular pockets with gaping holes in their inner walls. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.

Emphysema also slowly destroys the elastic fibers that hold open the small airways leading to the air sacs. This allows these airways to collapse when you breathe out, so the air in your lungs can't escape. Treatment may slow the progression of emphysema, but it can't reverse the damage.

Symptoms:

You can have emphysema for many years without noticing any signs or symptoms. The main symptom of emphysema is shortness of breath, which usually begins gradually. You may start avoiding activities that cause you to be short of breath, so the symptom doesn't become a problem until it starts interfering with daily tasks. Emphysema eventually causes shortness of breath even while you're at rest.

When to see a doctor
See your doctor if you've had shortness of breath for several months, especially if it's getting worse or it's interfering with your daily activities. Don't try to attribute it to your deconditioning or age or weight. Seek immediate medical attention if:

• You're so short of breath, you can't talk
• Your lips or fingernails turn blue or gray
• You're not mentally alert
• Your heartbeat is very fast

Causes:

The main cause of emphysema is long-term exposure to airborne irritants, including:

• Tobacco smoke
• Marijuana smoke
• Air pollution
• Manufacturing fumes
• Coal and silica dust

Rarely, emphysema is caused by an inherited deficiency of a protein that protects the elastic structures in the lungs. It is called Alpha-1 antitrypsin deficiency emphysema.

 Complications:

People who have emphysema are also more likely to develop:

• Collapsed lung (pneumothorax). A collapsed lung can be life-threatening in people who have severe emphysema, because the function of their lungs is already so compromised.
  
• Heart problems. Emphysema can increase the pressure in the arteries that connect the heart and lungs. This can cause a condition called cor pulmonale, in which a section of the heart expands and weakens.
  
• Large holes in the lungs (giant bullae). Some people with emphysema develop empty spaces in the lungs called bullae. Giant bullae can be as large as half the lung. In addition to reducing the amount of space available for the lung to expand, giant bullae can become infected and are more prone to causing a collapsed lung (pneumothorax).

Treatments and drugs:

Emphysema can't be cured, but treatments can help relieve symptoms and slow the progression of the disease.
Medications

• Smoking cessation drugs. Prescription medications, such as bupropion hydrochloride (Zyban) and varenicline (Chantix), can help you quit smoking.
  
• Bronchodilators. These drugs can help relieve coughing, shortness of breath and trouble breathing by relaxing constricted airways, but they're not as effective in treating emphysema as they are in treating asthma or chronic bronchitis.
  
• Inhaled steroids. Corticosteroid drugs inhaled as aerosol sprays may help relieve shortness of breath. But prolonged use can weaken your bones and increase your risk of high blood pressure, cataracts and diabetes.
  
• Antibiotics. If you develop a bacterial infection, like acute bronchitis or pneumonia, antibiotics are appropriate.

Therapy

• Pulmonary rehabilitation. A pulmonary rehabilitation program can teach you breathing exercises and techniques that may help reduce your breathlessness and improve your ability to exercise. You'll also receive advice about proper nutrition. In the early stages of emphysema, many people need to lose weight, while people with late-stage emphysema often need to gain weight.
  
• Supplemental oxygen. If you have severe emphysema with low blood oxygen levels, using oxygen regularly at home and when you exercise may provide some relief. Many people use oxygen 24 hours a day. It's usually administered via narrow tubing that fits into your nostrils.

Surgery
Depending on the severity of your emphysema, your doctor may suggest one or more different types of surgery, including:

• Lung volume reduction. In this procedure, surgeons remove small wedges of damaged lung tissue. Removing the diseased tissue helps the remaining lung tissue work more efficiently and helps improve breathing.
  
• Lung transplant. Lung transplantation is an option if you have severe emphysema and other options have failed.

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Eisenmenger syndrome

Eisenmenger syndrome

Definition:

Eisenmenger (I-sun-meng-uhr) syndrome is a complication of a heart defect that you're born with (congenital). A heart defect that causes a hole (shunt) to develop between two chambers of your heart is the most common cause of Eisenmenger syndrome.

This hole causes blood to circulate abnormally in your heart and lungs. Increased blood flow returns to your lungs instead of going to the rest of your body. The blood vessels in your lung arteries become stiff and narrow, increasing the pressure in your lung's arteries. This permanently damages the blood vessels in your lungs.

Eisenmenger syndrome occurs when the increased pressure of the blood flow in the lung becomes so great that the direction of blood flow through the shunt reverses. Oxygen-poor (blue) blood from the right side of the heart flows into the left ventricle and is pumped to your body, making it so that you don't receive enough oxygen to all your organs and tissues. Eisenmenger syndrome is a life-threatening condition requiring careful medical monitoring. Medications can improve symptoms and prognosis.

Symptoms:

Eisenmenger syndrome signs and symptoms include:

• Bluish or grayish skin color (cyanosis)
• Large, rounded fingernails or toenails (clubbing)
• Easily tiring and shortness of breath with activity
• Shortness of breath while at rest
• Chest pain or tightness
• Skipped or racing heartbeats (palpitations)
• Fainting (syncope)
• Dizziness
• Numbness or tingling in the fingers or toes
• Headaches

When to see a doctor
If you have any signs or symptoms of Eisenmenger syndrome, make an appointment to see your doctor. Even if you haven't previously been diagnosed with a heart defect, symptoms such as cyanosis and shortness of breath are signals that you have a health problem that needs medical attention.


Causes:


Eisenmenger syndrome develops most often due to a hole between the chambers of your heart. To understand how Eisenmenger syndrome affects your heart and lungs, it's helpful to know how your heart works.

How the heart works
Your heart is divided into four chambers, two on the right and two on the left. In performing its basic job — pumping blood throughout your body — your heart uses its left and right sides for different tasks. The right side moves blood into vessels that lead to your lungs. In your lungs, oxygen enriches your blood, which circulates to your heart's left side.

The left side of your heart pumps blood into a large vessel called the aorta, which circulates blood to the rest of your body. Valves control the flow of blood into and out of the chambers of your heart. These valves open to allow blood to move to the next chamber or to one of the arteries, and they close to keep blood from flowing backward.

How Eisenmenger syndrome develops
For most people who have Eisenmenger syndrome, the cause of their condition is due to a hole (shunt) between the main blood vessels or chambers of your heart. This shunt is a heart defect you're born with (congenital). Heart defects that can cause Eisenmenger syndrome include:

• Ventricular septal defect. This shunt in the wall of tissue that divides the right and left sides of your heart's main pumping chambers (ventricles) is the most common cause of Eisenmenger syndrome.
  
• Atrial septal defect. An atrial septal defect is a shunt in the wall of tissue that divides the right and left sides of the upper chambers of your heart (atria).
  
• Patent ductus arteriosus. This heart defect is an opening between the pulmonary artery that carries oxygen-poor blood to the lungs and the artery that carries oxygen-rich blood to the rest of your body (aorta).
  
• Atrioventricular canal defect. In this heart defect, there's a large hole in the center of the heart where the walls between the upper chambers (atria) and lower chambers (ventricles) meet. Some of the valves in your heart also may not function properly.

For each of these defects, the increased pressure of blood flowing through the shunt increases the pressure in your pulmonary artery. Over time, this increased pressure damages the smaller blood vessels in your lungs.

The damaged blood vessel walls make it difficult for the red blood cells to take up oxygen. Eisenmenger syndrome occurs when blood flows backward through the shunt, causing oxygen-rich and oxygen-poor blood to mix. This lowers the oxygen level in your blood (cyanosis), and your red blood cell count increases to try and make up for the lack of oxygen.

Complications:


Without proper treatment and monitoring, you can develop complications of Eisenmenger syndrome, including:

• Low oxygen levels in your blood (cyanosis). The reversed blood flow through your heart lowers the amount of oxygen your body's tissues and organs receive. This causes you to have a lower tolerance for physical activity and your skin to have a bluish or a grayish color. Cyanosis will worsen over time.
  
• High red blood cell count (erythrocytosis). Because you aren't getting enough oxygen-rich blood circulating throughout your body, your kidneys release a hormone that increases your number of red blood cells, the cells that carry oxygen throughout the body. Having too many red blood cells can reduce the blood flow to other organs and increase your risk of developing blood clots.
  
• Arrhythmias. Enlargement and thickening of the walls in the heart, along with low oxygen levels may cause an irregular heart rhythm (arrhythmia). Some types of arrhythmias can cause blood to pool in your heart's chambers where it can clot. If the clot travels out of your heart and blocks an artery, you can have a heart attack or stroke.
  
• Sudden cardiac arrest. If you develop an arrhythmia as a complication of Eisenmenger syndrome, it's possible the arrhythmia could suddenly stop your heartbeat. Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and consciousness. Without immediate medical attention, you can die of sudden cardiac arrest in minutes. You can also go into cardiac arrest during surgical procedures, usually related to changes in blood pressure caused by anesthesia.
  
• Heart failure. The increased pressure in your heart can cause your heart muscles to weaken, decreasing its pumping effectiveness. Eventually, this can lead to heart failure.
  
• Coughing up blood (hemoptysis). Increased pressure in the lungs and problems with your blood caused by Eisenmenger syndrome can cause life-threatening bleeding into your lungs and airways, causing you to cough up blood and further lowering your blood oxygen level. Bleeding can also occur in other parts of the body.
  
• Stroke. Stoke can occur when a blood clot travels from the right to left side of the heart without being filtered out by your lungs. This blood clot may then block a blood vessel in the brain, leading to a stroke. The high levels of red blood cells in Eisenmenger syndrome also increase your risk of blood clots and stroke.
  
• Kidney problems. Low oxygen levels in your blood may lead to problems with your kidneys. This can also increase your risk of developing gout.
  
• Pregnancy risks. Due to the demands pregnancy puts on a mother's heart and lungs, women who have Eisenmenger syndrome shouldn't become pregnant. Pregnancy for a woman who has Eisenmenger syndrome poses a high risk of death for both the mother and baby.

Eisenmenger syndrome is a life-threatening condition. The prognosis for people diagnosed with Eisenmenger syndrome depends on the type of congenital heart defect and other medical conditions. People who are diagnosed with Eisenmenger syndrome can survive as long as age 50 to 60 and sometimes longer.

Treatments and drugs:


Eisenmenger syndrome treatment is aimed at controlling your or your child's symptoms and managing the condition. Although there's no cure, medications may help you feel better, improve your quality of life and prevent serious complications. Doctors don't recommend surgery to repair the hole in your heart once Eisenmenger syndrome has developed, and any surgery may be life-threatening. It's important that you're treated by a doctor who has expertise in Eisenmenger syndrome.

Observation and monitoring
You'll be monitored through regular visits with a congenital heart disease cardiologist. You should have an appointment with your cardiologist at least once a year. A typical evaluation generally includes a thorough review of complaints and symptoms, a physical exam, and blood tests.

Medications
Medications are the primary treatment option for Eisenmenger syndrome. You'll need to be monitored closely by a doctor when taking medications for any changes in blood pressure, fluid volume or pulse rate.
Medications for Eisenmenger syndrome include:

• Medications to control arrhythmias. If you have an arrhythmia, you may receive medications to control your heart rhythms.
  
• Iron supplements. Your doctor may prescribe iron supplements if he or she finds your iron level is too low. Don't start taking iron supplements without talking to your doctor first.
  
• Aspirin or other blood-thinning medications. If you have had a stroke, blood clot or certain types of irregular heart rhythms, your doctor may recommend aspirin or other blood thinners such as warfarin (Coumadin, Jantoven). However, people who have Eisenmenger syndrome are also at increased risk of bleeding when taking these medications, so don't take any blood thinners unless your doctor tells you to do so. You shouldn't take over-the-counter pain medications, such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve), without talking to your doctor first.
  
• Endothelin receptor antagonists. These medications reverse the effect of endothelin, a substance in the walls of blood vessels that causes them to narrow. One of these medications, bosentan (Tracleer), may improve your energy level and symptoms by lowering the resistance in your lung arteries. If you take bosentan, you'll need monthly liver monitoring because the drug can damage your liver.
  
• Sildenafil and tadalafil. Sildenafil (Revatio, Viagra) and tadalafil (Cialis, Adcirca) are sometimes used to treat high blood pressure in your pulmonary arteries caused by Eisenmenger syndrome. These drugs work by opening the blood vessels in the lungs to allow blood to flow through more easily. Side effects include upset stomach, dizziness and vision problems.
  
• Antibiotics. Depending on your condition, you may need to take antibiotics before having certain dental and medical procedures. These procedures may allow bacteria to enter your bloodstream. Antibiotics taken before these procedures can help destroy or control the harmful bacteria that may lead to an infection of your heart's tissues (endocarditis). Antibiotics are recommended only before certain dental procedures (those that cut your gum tissue or part of the teeth) and procedures involving the respiratory tract, infected skin or tissue that connects muscle to bone.

Blood drawing (phlebotomy)
If your red blood cell count becomes too high, your doctor may recommend having blood drawn to help normalize your blood cell counts. You should also receive intravenous (IV) fluids when having blood drawn to help replace the lost fluids.

Heart-lung transplantation
Some people who have Eisenmenger syndrome may eventually need a heart and lung transplant or a lung transplant with repair of the hole in the heart if no other treatments prove effective.

Birth control and pregnancy
If you have Eisenmenger syndrome, becoming pregnant poses serious health risks — and can be fatal — for the mother and baby. It's critical that women who have Eisenmenger syndrome avoid becoming pregnant.

Your doctor may recommend nonreversible birth control, such as Essure. Essure is a metal coil inserted through the vagina to the fallopian tubes that causes scar tissue to develop. This blocks the fallopian tubes. Having your fallopian tubes tied (tubal ligation) is less often recommended due to the risks of having even minor surgery.

Birth control pills containing estrogen aren't recommended for women who have Eisenmenger syndrome. Estrogen increases your risk of developing blood clots that could potentially block an artery to your heart, brain or lungs. Using only barrier methods, such as condoms or diaphragms, isn't recommended due to the risk of those methods failing.

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Ehrlichiosis

Ehrlichiosis

Definition:

Ehrlichiosis is a bacterial illness transmitted by ticks that causes flu-like symptoms. The signs and symptoms of ehrlichiosis range from mild body aches to severe fever and usually appear within a week or two of a tick bite. If treated quickly with appropriate antibiotics, ehrlichiosis generally improves within a few days.

Another tick-borne infection — anaplasmosis — is closely related to ehrlichiosis. But the two have distinct differences and are caused by different microorganisms.
The best way to prevent these infections is to avoid tick bites. Tick repellents, thorough body checks after being outside and proper removal of ticks give you the best chance of avoiding ehrlichiosis.


Symptoms:

If a tick carrying the bacterium that causes ehrlichiosis has been feeding on you for at least 24 hours, the following flu-like signs and symptoms may appear within five to 14 days of the bite:

• Mild fever
• Headache
• Chills
• Muscle aches
• Nausea
• Vomiting
• Diarrhea
• Joint pain
• Confusion
• Rash
• Cough

Some people infected with ehrlichiosis may have symptoms so mild that they never seek medical attention, and the body fights off the illness on its own. But untreated ehrlichiosis with persistent symptoms can result in an illness serious enough to require hospitalization.

When to see a doctor
It may take 14 days after a tick bite for you to begin showing signs and symptoms of ehrlichiosis. If you get symptoms within two weeks of a tick bite, see your doctor. If you experience any of the above symptoms soon after you've been in an area known to have ticks, see your doctor. Be sure to tell your doctor that you recently received a tick bite or visited an area with a high population of ticks.


Causes:

Ehrlichiosis is caused by Ehrlichia chaffeensis bacteria and is transmitted primarily by the Lone Star tick.

Ticks feed on blood, latching onto a host and feeding until they're swollen to many times their normal size. During feeding, ticks that carry disease-producing bacteria can transmit the bacteria to a healthy host. Or they may pick up bacteria themselves if the host, such as a white-tailed deer or a coyote, is infected.

Usually, to get ehrlichiosis, you must be bitten by an infected tick. The bacteria enter your skin through the bite and eventually make their way into your bloodstream.

Before bacteria can be transmitted, a tick must be attached and feeding for at least 24 hours. An attached tick with a swollen appearance may indicate that the tick has been feeding long enough to have transmitted bacteria. Removing ticks as soon as possible may prevent infection.

It's also possible that ehrlichiosis may be transmitted through blood transfusions, from mother to fetus and through direct contact with an infected, slaughtered animal.


Complications:

Ehrlichiosis can have serious effects on an otherwise healthy adult or child if you don't seek prompt treatment.
People with weakened immune systems are at an even higher risk of more-serious and potentially life-threatening consequences. Serious complications of untreated infection include:

• Kidney failure
• Respiratory failure
• Heart failure
• Seizures
• Coma

Treatments and drugs:

If your doctor suspects that you have ehrlichiosis or another tick-borne illness, you'll likely receive a prescription for the antibiotic doxycycline (Doryx, Periostat, others). You'll generally take the antibiotic for seven to 10 days and should see signs and symptoms begin to subside within two days. Your doctor may have you take antibiotics for a longer period if you're severely ill.

If you're pregnant, your doctor may prescribe the antibiotic rifampin (Rifadin, Rimactane) instead, because doxycycline isn't recommended during pregnancy.

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Ehlers-Danlos syndrome

Ehlers-Danlos syndrome

Definition:

Ehlers-Danlos syndrome is a group of inherited disorders that affect your connective tissues — primarily your skin, joints and blood vessel walls. Connective tissue is a complex mixture of proteins and other substances that provides strength and elasticity to the underlying structures in your body.

People who have Ehlers-Danlos syndrome usually have overly flexible joints and stretchy, fragile skin. This can become a problem if you have a wound that requires stitches, because the skin often isn't strong enough to hold them.

A more severe form of the disorder, called vascular Ehlers-Danlos syndrome, can cause the walls of your blood vessels, intestines or uterus to rupture. If you have vascular Ehlers-Danlos syndrome, you may want to talk to a genetic counselor before starting a family.

Symptoms:

Signs and symptoms of the most common form of Ehlers-Danlos syndrome include:

• Overly flexible joints. Because the connective tissue that holds joints together is looser, your joints can move far past the normal range of motion. Small joints are affected more than large joints. You might also be able to touch the tip of your nose with your tongue.
  
• Stretchy skin. Weakened connective tissue allows your skin to stretch much more than usual. You may be able to pull a pinch of skin up away from your flesh, but it will snap right back into place when you let go. Your skin might also feel exceptionally soft and velvety.
  
• Fragile skin. Damaged skin often doesn't heal well. For example, the stitches used to close a wound often will tear out and leave a gaping scar. These scars may look thin and crinkly.
  
• Fatty lumps at pressure points. These small, harmless growths can occur around the knees or elbows and may show up on X-rays.

Symptom severity can vary from person to person. Some people with Ehlers-Danlos syndrome will have overly flexible joints but few or none of the skin symptoms.

Vascular Ehlers-Danlos syndrome
People who have the vascular subtype of Ehlers-Danlos syndrome often share distinctive facial features of a thin nose, thin upper lip, small earlobes and prominent eyes. They also have thin, translucent skin that bruises very easily. In fair-skinned people, the underlying blood vessels are very visible through the skin.

One of the most severe forms of the disorder, vascular Ehlers-Danlos syndrome can weaken your heart's largest artery (aorta), as well as the arteries to your kidneys and spleen. A rupture of any of these blood vessels can be fatal. The vascular subtype also can weaken the walls of the uterus or large intestines — which may also rupture.

Causes:

Different subtypes of Ehlers-Danlos syndrome are associated with a variety of genetic causes, some of which are inherited and passed on from parent to child.
If you have some subtypes of Ehlers-Danlos syndrome, such as the vascular variety, there's a 50 percent chance that you'll pass the gene on to each of your children.


Complications:

Complications depend on the types of signs and symptoms you have. For example, overly flexible joints can result in joint dislocations and early-onset arthritis. Fragile skin may develop prominent scarring.

People who have vascular Ehlers-Danlos syndrome are at risk of often fatal ruptures of major blood vessels. Some organs, such as the uterus and intestines, also may rupture. Pregnancy can increase these risks.


Treatments and drugs:

There is no cure for Ehlers-Danlos syndrome, but treatment can help you manage your symptoms and prevent further complications.
Medications
Your doctor may prescribe drugs to help you control:

• Pain. If over-the-counter pain relievers — such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve) — aren't enough, your doctor may prescribe stronger medications for your joint or muscle pain.
• Blood pressure. Because blood vessels are more fragile in some types of Ehlers-Danlos syndrome, your doctor may want to reduce the stress on the vessels by keeping your blood pressure low.

Physical therapy
Joints with weak connective tissue are more likely to dislocate. Exercises to strengthen the muscles around a joint can help stabilize the joint. Your physical therapist might also recommend specific braces to help prevent joint dislocations.
Surgical and other procedures
In rare cases, surgery is recommended to repair joints damaged by repeated dislocations. However, your skin and the connective tissue of the affected joint may not heal properly after the surgery.

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Egg allergy

Egg allergy

Definition:

Eggs are one of the most common allergy-causing foods in children. Egg allergy symptoms usually occur a few minutes to a few hours after eating eggs or foods containing eggs. Signs and symptoms range from mild to severe and can include skin rashes, hives, nasal inflammation, and vomiting or other digestive problems.

Rarely, egg allergy can cause anaphylaxis — a life-threatening reaction. Egg allergy can occur as early as infancy. Most children outgrow their egg allergy before adolescence. But in some cases, it continues into adulthood.

Symptoms:

Egg allergy reactions vary from person to person and usually occur soon after exposure to egg. Egg allergy symptoms can include:

• Skin inflammation or hives — the most common egg allergy reaction
• Allergic nasal inflammation (allergic rhinitis)
• Digestive (gastrointestinal) symptoms, such as cramps, nausea and vomiting
• Asthma signs and symptoms such as coughing, chest tightness or shortness of breath

Anaphylaxis
A severe allergic reaction can lead to anaphylaxis, a life-threatening emergency that requires an immediate epinephrine (adrenaline) shot and a trip to the emergency room. Anaphylaxis signs and symptoms include:

• Constriction of airways, including a swollen throat or a lump in your throat that makes it difficult to breathe
• Abdominal pain and cramping
• Rapid pulse
• Shock, with a severe drop in blood pressure felt as dizziness, lightheadedness or loss of consciousness

If you or your child has a reaction to eggs, discuss this with a doctor no matter how mild it may have been. The severity of egg allergy reactions can vary each time one occurs. This means that even if you or your child had a mild reaction in the past, the next reaction could be more serious.
If your doctor thinks you or your child may be at risk of a severe reaction, the doctor may prescribe an emergency epinephrine shot to be used if anaphylaxis occurs. The shot comes in a device that makes it easy to deliver, called an autoinjector.

When to see a doctor
See a doctor if you or your child has signs or symptoms of a food allergy shortly after eating eggs or a product that contains eggs. If possible, see the doctor when the allergic reaction is occurring. This may help in making a diagnosis.
If you or your child has signs and symptoms of anaphylaxis, seek immediate emergency treatment and use an autoinjector if one has been prescribed.

Causes:

All food allergies are caused by an immune system overreaction. The immune system mistakenly identifies certain egg proteins as harmful. When you or your child comes in contact with egg proteins, immune system cells (antibodies) recognize them and signal the immune system to release histamine and other chemicals that cause allergic signs and symptoms.
Both egg yolks and egg whites contain proteins that can cause allergies, but allergy to egg whites is most common. It's possible for breast-fed infants to have an allergic reaction to egg proteins in breast milk if the mother consumes eggs.

Complications:

The most significant complication of egg allergy is having a severe allergic reaction requiring an epinephrine injection and emergency treatment.
The same immune system reaction that causes egg allergy can also cause other conditions. If you or your child has an egg allergy, you or your child may be at increased risk of:

• Allergies to other foods, such as milk, soy or peanuts
• Hay fever — an allergic reaction to pet dander, dust mites or grass pollen
• Allergic skin reactions such as atopic dermatitis
• Asthma, which in turn increases the risk of having a severe allergic reaction to eggs or other foods

Treatments and drugs:

There's no medication or other treatment that can cure an egg allergy or prevent someone with a food allergy from having an allergic reaction. The only way to prevent egg allergy symptoms is to avoid eggs or egg products. This can be difficult, as eggs are a common food ingredient. However, you may find that you or your child can tolerate eggs that have been cooked into foods, such as when they are an ingredient in baked goods.

Antihistamines to ease symptoms
Despite your best efforts, you or your child may still come into contact with eggs. Medications, such as antihistamines, may reduce signs and symptoms of a mild egg allergy. These drugs can be taken after exposure to eggs. But, they aren't effective for preventing an allergic egg reaction or for treating a severe reaction.

Emergency epinephrine shots
If you or your child is at risk of a severe reaction, you may need to carry an emergency epinephrine injector (EpiPen, EpiPen Jr, Twinject) at all times. If you or your child develops anaphylaxis after egg exposure, you or your child will need an emergency epinephrine shot and a trip to the emergency room. Even if anaphylaxis symptoms improve, you or your child will need to remain under medical supervision for a period of time to be sure severe symptoms don't return.

If you or your child does have an autoinjector, be sure it's always available. Learn how to use it properly. If your child has one, make sure caregivers have access to it and know how to use it. If your child is old enough, make sure he or she also understands how to use it. Replace the autoinjector before its expiration date. Otherwise, it may not work properly.

There's no cure for egg allergy, but most children will eventually outgrow it. Talk to your child's doctor about how often he or she should be tested to see whether eggs still cause symptoms. This may be yearly, or on another schedule depending on your child's symptoms and the doctor's recommendations. It may be unsafe for you to test your child's reaction to eggs at home, particularly if your child has had a severe reaction to eggs in the past.

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Edema

Edema

Definition:

Edema is swelling caused by excess fluid trapped in your body's tissues. Although edema can affect any part of your body, it's most commonly noticed in your hands, arms, feet, ankles and legs.
Edema can be the result of medication, pregnancy or an underlying disease — often heart failure, kidney disease or cirrhosis of the liver.

Taking medication to remove excess fluid and reducing the amount of salt in your food usually relieves edema. When edema is a sign of an underlying disease, the disease itself requires separate treatment.


Symptoms:

Signs and symptoms of edema include:

• Swelling or puffiness of the tissue directly under your skin
• Stretched or shiny skin
• Skin that retains a dimple after being pressed for several seconds
• Increased abdominal size

When to see a doctor
Make an appointment to see your doctor if you have swelling, stretched or shiny skin, or skin that retains a dimple after being pressed. Seek immediate medical attention if you experience:

• Shortness of breath
• Difficulty breathing
• Chest pain

Definition:

Edema is swelling caused by excess fluid trapped in your body's tissues. Although edema can affect any part of your body, it's most commonly noticed in your hands, arms, feet, ankles and legs.
Edema can be the result of medication, pregnancy or an underlying disease — often heart failure, kidney disease or cirrhosis of the liver.

Taking medication to remove excess fluid and reducing the amount of salt in your food usually relieves edema. When edema is a sign of an underlying disease, the disease itself requires separate treatment.


Complications:

If left untreated, edema can cause:

• Increasingly painful swelling
• Difficulty walking
• Stiffness
• Stretched skin, which can become itchy and uncomfortable
• Increased risk of infection in the swollen area
• Scarring between layers of tissue
• Decreased blood circulation
• Decreased elasticity of arteries, veins, joints and muscles
• Increased risk of skin ulcers

Treatments and drugs:

 Mild edema usually goes away on its own, particularly if you help things along by raising the affected limb higher than your heart. More severe edema may be treated with drugs that help your body expel excess fluid in the form of urine. One of the most common diuretics is furosemide (Lasix). Long-term management typically focuses on treating the underlying cause of the swelling.

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Ectropion

Ectropion

Definition:

Ectropion (ek-TROH-pee-on) is a condition in which your eyelid — typically the lower lid — turns out, leaving the inner eyelid surface exposed and prone to irritation. Ectropion occurs mainly in older adults. In severe ectropion, the entire length of the eyelid is turned out. When ectropion is less severe, only one segment of the eyelid sags away from the eye.

Artificial tears can help relieve the symptoms caused by ectropion until you can have surgery to correct the condition.


Symptoms:

Normally when you blink, your eyelids distribute tears evenly across your eyes, keeping them lubricated. These tears drain into the little openings on the inner part of your eyelids (puncta). When you have ectropion, your lower lid pulls away from your eye and tears don't drain into the puncta properly, causing a number of signs and symptoms:

• Irritation. Stagnant tears or dryness can irritate your eyes, causing a burning sensation and redness in your eyelids and the whites of your eyes.
• Excessive tearing. Without proper drainage, your tears may pool and constantly flow over your eyelids. Many people with ectropion complain of watery or weepy eyes.
• Excessive dryness. Ectropion can cause your eyes to feel dry, gritty and sandy.

When to see a doctor
If you begin noticing that your eyes are constantly watering or irritated, or your eyelid seems to be sagging or drooping, make an appointment to see your doctor for an evaluation.
If you know that you have ectropion, be alert for symptoms of cornea exposure or ulcers, including rapidly increasing redness, pain, light sensitivity or decreasing vision. If you experience any of these vision-threatening signs and symptoms, seek immediate care in an emergency room.


Causes:

Ectropion can have several different causes, including:

• Muscle weakness. As you age, the muscles under your eyes tend to get weaker as the tendons stretch out. These muscles and tendons are responsible for holding your eyelid taut against your eye, so when they relax, the eyelid can begin to droop and turn outward.
  
• Facial paralysis. When some of the facial nerves and muscles are paralyzed, as with Bell's palsy and some types of tumors, it can affect the eyelid muscles and cause ectropion.
  
• Scars or skin problems. Scarred skin from facial burns or trauma, such as a dog bite or lacerations, can affect the way that the eyelid rests against the eye.
  
• Eyelid growths. Benign or cancerous growths on your eyelid can cause the lid to turn outward.
  
• Previous surgery, radiation or cosmetic procedures. Previous eyelid surgery (blepharoplasty) can cause ectropion to develop later, particularly if too much skin from the eyelid was removed at the time of surgery. Radiation of your eyelid for a cancerous growth can trigger ectropion to develop. Even cosmetic laser skin resurfacing can shrink your eyelid too much, pulling it away from your eye and causing ectropion.
  
• Rapid weight loss. Sometimes, losing weight very quickly can cause ectropion.
• Congenital ectropion. Rarely, ectropion is present at birth (congenital), when it is usually associated with genetic disorders, such as Down syndrome.

Complications:

 The most serious complications associated with ectropion are irritation and damage of the cornea. Because ectropion leaves your cornea irritated and exposed, it's more susceptible to drying. This can lead to corneal abrasions and ulcers, which in turn can cause permanent loss of vision. Lubricating eyedrops and ointments can help to protect your cornea and prevent damage until your ectropion is corrected.

Treatments and drugs:

Eyedrops and ointments can be used to manage symptoms and protect your cornea until a permanent treatment is done. Most cases of ectropion require surgery.

Scar tissue stretching
This treatment can be considered if your ectropion is caused by a developing scar that's tightening or pulling on your skin. Massaging the scar tissue, injecting it with steroids or doing both may help to modify the scar and relieve the ectropion. However, this method may not be effective.

Surgery
There are several different surgical techniques for ectropion, depending on the cause and the condition of the tissue surrounding your eyelid. Before the surgery, you'll receive a local anesthetic to numb your eye and the area around it. You may be lightly sedated using oral or intravenous (IV) medication to make you more comfortable, depending on the type of procedure you're having and whether or not the surgery is performed in an outpatient surgical clinic.

If your ectropion is caused by muscle and ligament relaxation due to aging, your surgeon will likely remove a small part of your lower eyelid, which tightens the tendons and muscles of the lid. You'll have a few stitches on the outside corner of your eye or just below your lower eyelid. In general, this procedure is relatively simple and will be the only surgery you need.

If you have scar tissue from an injury or previous surgery, the surgeon may need to use a skin graft, taken from your upper eyelid or behind your ear, to help support the lower lid. If you have facial paralysis or significant scarring, the outcome of surgery is less predictable, and more than one procedure may be necessary before your ectropion is completely resolved.

Following your surgery, you may need to wear an eye patch for 24 hours, and then to use an antibiotic and steroid ointment on your eye several times a day for one week. You may also use cold compresses periodically to decrease bruising and swelling, as well as acetaminophen (Tylenol, others) for pain. Avoid drugs containing aspirin, because they can increase the risk of bleeding.

At first your eyelid might feel tight, but as you heal it will become more comfortable. Most people say that their ectropion symptoms are relieved immediately after surgery. You will get your stitches removed about a week after your surgery, and you can expect the swelling and bruising to fade in about two weeks.

Although uncommon, bleeding or infection are possible risks of surgery. You will likely experience temporary swelling, and your lid tissues may be somewhat bruised after surgery.

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Ectopic pregnancy

Ectopic pregnancy

Definition:

Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches itself to the lining of the uterus. With an ectopic pregnancy, the fertilized egg implants somewhere outside the uterus.

An ectopic pregnancy typically occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes). This type of ectopic pregnancy is known as a tubal pregnancy. In some cases, however, an ectopic pregnancy occurs in the abdominal cavity, ovary or neck of the uterus (cervix).

An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue might destroy various maternal structures. Left untreated, life-threatening blood loss is possible. Early treatment of an ectopic pregnancy can help preserve the chance for future healthy pregnancies.

Symptoms:

At first, an ectopic pregnancy might not cause any signs or symptoms. In other cases, early signs and symptoms of an ectopic pregnancy might be the same as those of any pregnancy — a missed period, breast tenderness and nausea. If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can't continue as normal.

Abdominal or pelvic pain and light vaginal bleeding are often the first warning signs of an ectopic pregnancy. If blood leaks from the fallopian tube, it's also possible to feel shoulder pain or an urge to have a bowel movement — depending on where the blood pools or which nerves are irritated. Heavy vaginal bleeding is unlikely, unless the ectopic pregnancy occurs in the cervix.
If the fallopian tube ruptures, heavy bleeding inside the abdomen is likely — followed by lightheadedness, fainting and shock.

When to see a doctor
Seek emergency medical help if you experience any signs or symptoms of an ectopic pregnancy, including:

• Severe abdominal or pelvic pain accompanied by vaginal bleeding
• Extreme lightheadedness or fainting

Causes:
 A tubal pregnancy — the most common type of ectopic pregnancy — happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is inflamed, damaged or misshapen. Hormonal imbalances or abnormal fetal development might also play a role. Sometimes, the specific cause of an ectopic pregnancy remains a mystery.


Complications:

 When you have an ectopic pregnancy, the stakes are high. Without treatment, a ruptured fallopian tube could lead to life-threatening bleeding

Treatments and drugs:

A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue must be removed.

If the ectopic pregnancy is detected early, an injection of the drug methotrexate is sometimes used to stop cell growth and dissolve existing cells. After the injection, your doctor will monitor your blood for the pregnancy hormone human chorionic gonadotropin (HCG). If the HCG level remains high, you might need another injection of methotrexate.

In other cases, ectopic pregnancy is treated with laparoscopic surgery. In this procedure, a small incision is made in the abdomen, near or in the navel. Then your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the area. Other instruments can be inserted into the tube or through other small incisions to remove the ectopic tissue and repair the fallopian tube. If the fallopian tube is significantly damaged, it might need to be removed.

If the ectopic pregnancy is causing heavy bleeding or the fallopian tube has ruptured, you might need emergency surgery through an abdominal incision (laparotomy). In some cases, the fallopian tube can be repaired. Typically, however, a ruptured tube must be removed.
In a few cases, an injection of methotrexate is needed after surgery.

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Eating disorders

Eating disorders

Definition:

Eating disorders are a group of serious conditions in which you're so preoccupied with food and weight that you can often focus on little else. The main types of eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder.

Eating disorders can cause serious physical problems and, at their most severe, can even be life-threatening. Most people with eating disorders are females, but males can also have eating disorders. An exception is binge-eating disorder, which appears to affect almost as many males as females.

Treatments for eating disorders usually involve psychotherapy, nutrition education, family counseling, medications and hospitalization.

Symptoms:

Eating disorders symptoms vary with the particular type of eating disorder.

Anorexia nervosa
When you have anorexia nervosa (an-o-REK-see-uh nur-VOH-suh), you're obsessed with food and being thin, sometimes to the point of deadly self-starvation.
Anorexia signs and symptoms may include:

• Refusal to eat and denial of hunger
• An intense fear of gaining weight
• A negative or distorted self-image
• Excessive exercise
• Flat mood or lack of emotion
• Irritability
• Fear of eating in public
• Preoccupation with food
• Social withdrawal
• Thin appearance
• Trouble sleeping
• Soft, downy hair present on the body (lanugo)
• Menstrual irregularities or loss of menstruation (amenorrhea)
• Constipation
• Abdominal pain
• Dry skin
• Frequently being cold
• Irregular heart rhythms
• Low blood pressure
• Dehydration

Bulimia nervosa
When you have bulimia, you have episodes of bingeing and purging. During these episodes, you typically eat a large amount of food in a short duration and then try to rid yourself of the extra calories through vomiting or excessive exercise. You may be at a normal weight or even a bit overweight.
Bulimia signs and symptoms may include:

• Eating until the point of discomfort or pain, often with high-fat or sweet foods
• Self-induced vomiting
• Laxative use
• Excessive exercise
• An unhealthy focus on body shape and weight
• A distorted, excessively negative body image
• Low self-esteem
• Going to the bathroom after eating or during meals
• A feeling that you can't control your eating behavior
• Abnormal bowel functioning
• Damaged teeth and gums
• Swollen salivary glands in the cheeks
• Sores in the throat and mouth
• Dehydration
• Irregular heartbeat
• Sores, scars or calluses on the knuckles or hands
• Menstrual irregularities or loss of menstruation (amenorrhea)
• Constant dieting or fasting
• Possibly, drug or alcohol abuse

Binge-eating disorder
When you have binge-eating disorder, you regularly eat excessive amounts of food (binge), but don't try to compensate for this behavior with exercise or purging as someone with bulimia or anorexia might. You may eat when you're not hungry and continue eating even long after you're uncomfortably full. After a binge, you may feel guilty or ashamed, which can trigger a new round of bingeing. You may be a normal weight, overweight or obese.
Symptoms of binge-eating disorder may include:

• Eating to the point of discomfort or pain
• Eating much more food during a binge episode than during a normal meal or snack
• Eating faster during binge episodes
• Feeling that your eating behavior is out of control
• Frequently eating alone
• Feeling depressed, disgusted or upset over the amount eaten

When to see a doctor
Because of its powerful pull, an eating disorder can be difficult to manage or overcome by yourself. Eating disorders can virtually take over your life. You may think about food all the time, spend hours agonizing over what to eat and exercise to exhaustion. You may feel ashamed, sad, hopeless, drained, irritable and anxious. You may also have a host of physical problems because of your eating disorder, such as irregular heartbeats, fatigue, and bowel or menstrual troubles. If you're experiencing any of these problems, or if you think you may have an eating disorder, seek medical help.

Urging a loved one to seek treatment
Unfortunately, many people with eating disorders resist treatment. If you have a loved one you're worried about, urge him or her to talk to a doctor. Even if your loved one isn't ready to acknowledge having an issue with food, you may be able to open the door by expressing concern and a desire to listen. If you're concerned your child may have an eating disorder, contact his or her doctor about your concerns. You can get a referral to qualified mental health providers for treatment.

Keep in mind, however, that in children it's sometimes hard to tell what's an eating disorder and what's simply a whim, a new fad, or experimentation with a vegetarian diet or other eating styles. In addition, many girls and sometimes boys go on diets to lose weight, but stop dieting after a short time. If you're a parent or guardian, be careful not to mistake occasional dieting with an eating disorder. On the other hand, be alert for eating patterns and beliefs that may signal unhealthy behavior, as well as peer pressure that may trigger eating disorders.

Red flags that may indicate an eating disorder include:

• Skipping meals
• Making excuses for not eating
• Eating only a few certain "safe" foods, usually those low in fat and calories
• Adopting rigid meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing
• Cooking elaborate meals for others, but refusing to eat them themselves
• Collecting recipes
• Withdrawing from normal social activities
• Persistent worry or complaining about being fat
• A distorted body image, such as complaining about being fat despite being underweight
• Not wanting to eat in public
• Frequent checking in the mirror for perceived flaws
• Wearing baggy or layered clothing
• Repeatedly eating large amounts of sweet or high-fat foods
• Use of syrup of ipecac, laxatives, the over-the-counter weight-loss drug orlistat (Alli), or over-the-counter drugs that can cause fluid loss, such as menstrual symptom relief medications
• Use of dietary supplements or herbal products for weight loss
• Food hoarding
• Leaving during meals to use the toilet
• Eating in secret

Causes:


The exact cause of eating disorders is unknown. As with other mental illnesses, there may be many causes. Possible causes of eating disorders include:

• Biology. There may be genes that make certain people more vulnerable to developing eating disorders. People with first-degree relatives — siblings or parents — with an eating disorder may be more likely to develop an eating disorder, too, suggesting a possible genetic link. In addition, there's some evidence that serotonin, a naturally occurring brain chemical, may influence eating behaviors.
  
• Psychological and emotional health. People with eating disorders may have psychological and emotional problems that contribute to the disorder. They may have low self-esteem, perfectionism, impulsive behavior and troubled relationships.
  
• Society. The modern Western cultural environment often cultivates and reinforces a desire for thinness. Success and worth are often equated with being thin in popular culture. Peer pressure and what people see in the media may fuel this desire to be thin, particularly among young girls.

Complications:

Eating disorders cause a wide variety of complications, some of them life-threatening. The more severe or long lasting the eating disorder, the more likely you are to experience serious complications. Complications may include:

• Death
• Heart problems
• Multiple organ failure
• Depression
• Suicidal thoughts or behavior
• Absence of menstruation (amenorrhea)
• Bone loss
• Stunted growth
• Digestive problems
• Kidney damage
• Severe tooth decay
• High or low blood pressure

Treatments and drugs:

Eating disorder treatment depends on your specific type of eating disorder. But in general, it typically includes psychotherapy, nutrition education and medication. If your life is at risk, you may need immediate hospitalization.

Psychotherapy
Individual psychotherapy can help you learn how to exchange unhealthy habits for healthy ones. You learn how to monitor your eating and your moods, develop problem-solving skills, and explore healthy ways to cope with stressful situations. Psychotherapy can also help improve your relationships and your mood. A type of psychotherapy called cognitive behavioral therapy is commonly used in eating disorder treatment, especially for bulimia nervosa and binge-eating disorder. Group therapy also may be helpful for some people.

Family-based therapy is the only effective treatment for children and adolescents with eating disorders. This type of therapy begins with the assumption that the person with the eating disorder is no longer capable of making sound decisions regarding his or her health and needs help from the family. An important part of family-based therapy is that your family is involved in making sure that your child or other family member is following healthy-eating patterns and is restoring weight. This type of therapy can help encourage support from concerned family members.


Weight restoration and nutrition education
If you're underweight due to an eating disorder, the first goal of treatment will be to start getting you back to a healthy weight. No matter what your weight, dietitians and other health care providers can give you information about a healthy diet and help design an eating plan that can help you achieve a healthy weight and instill normal-eating habits. If you have binge-eating disorder, you may benefit from medically supervised weight-loss programs.

Hospitalization
If you have serious health problems or if you have anorexia and refuse to eat or gain weight, your doctor may recommend hospitalization. Hospitalization may be on a medical or psychiatric ward. Some clinics specialize in treating people with eating disorders. Some may offer day programs, rather than full hospitalization. Specialized eating disorder programs may offer more intensive treatment over longer periods of time.

Medications
Medication can't cure an eating disorder. However, medications may help you control urges to binge or purge or to manage excessive preoccupations with food and diet. Medications such as antidepressants and anti-anxiety medications may also help with symptoms of depression or anxiety, which are frequently associated with eating disorders.

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