Category: Ailmemts & Remedies

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Ailmemts & Remedies

Retinopathy of Prematurity (ROP)

Definition:
Retinopathy of prematurity (ROP) occurs in premature babies when abnormal blood vessels and scar tissue grow over the retina. The retina is the light detecting layer of cells at the back of the eye that allows us to see. Abnormal blood vessels and scar tissue can grow over the retina in premature babies with ROP. An ophthalmologist can detect ROP during an examination of your baby’s dilated eyes in the neonatal intensive care unit (NICU) or nursery.

….click to see the picture.>...(01).….....(1).……….(2)……..(3)

The causes of ROP are not completely understood. The retinal blood vessels in some very small, premature babies seem to develop abnormally during the therapy necessary for the infant’s survival. It was once thought that oxygen, given to almost all premature babies, was entirely responsible for all cases of ROP, but newer evidence indicates this is not true. How premature your baby is and their birthweight are factors which appear to influence ROP. For example, a baby who weighs 3 pounds at birth has about a 5% chance of developing ROP; an infant weighing less than 2 pounds has a 40% chance of developing ROP.

Not all babies who are premature will have ROP. Many of the babies who are born with ROP will improve spontaneously. However, since ROP is “responsible for more blindness among children in this country than all other causes combined” (Watson, 1997), it is important that premature babies are screened for ROP. This examination is done with an indirect ophthalmoscope which allows the doctor to get a wide-angle view of the retina. First a drop of topical anesthetic is applied to the eye to reduce the baby’s discomfort. Then the baby’s eyelids are held open with a device called a speculum and a special probe holds the eyeball still while the doctor examines it. Because this examination can be stressful to the baby, sometimes the exams are postponed until the baby’s medical condition is more stable. Usually only babies that are at high risk for ROP are screened. Those babies are usually the ones with a young gestational age and a low birth weight. Utah NICUs use 2000 grams or less as a weight guideline for screening. (Ophthalmology Associates Homepage, 1997)

Although there has been a correlation made between premies who receive high levels of oxygen and ROP, there appear to be a variety of factors that may account for development of ROP. These include, in addition to birth weight and gestational age: elevated blood carbon dioxide levels, anemia, blood transfusions, intraventricular hemorrhage, respiratory distress syndrome, chronic hypoxia in utero, multiple spells of apnea or bradycardia, mechanical ventilation, and seizures. (Ophthalmology Associates Homepage, 1997) There are some who feel that exposure to bright fluorescent lighting in hospitals contributes to the development of ROP (Prevent Blindness in Premature Babies, 1997), but to date this has not been proven and many ophthalmologists strongly disagree with this theory (Ophthalmology Associates Homepage, 1997). The current thinking is that probably it is a combination of factors, some occurring in utero and some occurring after the baby is born, that lead to this outcome.

Will ROP Affect Vision?
It is difficult to predict whether vision will be affected. In many infants, the abnormal blood vessels shrink or go away without affecting vision. In other infants with more extensive disease, bleeding and scar tissue may lead to distortion or detachment of the retina. This may result in moderate to severe loss of vision. Only a very small percentage of babies become blind. Nearsightedness (myopia) is common in children with ROP. Glasses may improve the vision of these children, unless the eye is badly damaged.

Can ROP be Prevented?
Unfortunately, clinical research has not yet found a way to prevent ROP in all babies. The sophisticated medical care provided in modern neonatal intensive care units has improved the survival chances of very small babies. Because more premature infants survive, ROP has become more common.

Causes :
The blood vessels of the retina begin to develop 3 months after conception and complete their development at the time of normal birth. If an infant is born very prematurely, eye development can be disrupted. The vessels may stop growing or grow abnormally from the retina into the normally clear gel that fills the back of the eye. The vessels are fragile and can leak, causing bleeding in the eye.

Scar tissue may develop and pull the retina loose from the inner surface of the eye. In severe cases, this can result in vision loss.

In the past, routine use of excess oxygen to treat premature babies stimulated abnormal vessel growth. Currently, oxygen can be easily and accurately monitored, so this problem is rare.

Today, the risk of developing ROP depends on the degree of prematurity. Generally, the smallest and sickest premature babies have the highest risk.

Typically all babies younger than 30 weeks gestation or weighing fewer than 3 pounds at birth are screened for the condition. Certain high-risk babies who weigh 3 – 4.5 pounds or who are born after 30 weeks should also be screened.

In addition to prematurity, other risks factors may include:

*Brief stop in breathing (apnea)
*Heart disease
*High carbon dioxide (CO2) in the blood
*Infection
*Low blood acidity (pH)
*Low blood oxygen
*Respiratory distress
*Slow heart rate (bradycardia)
*Transfusions

The rate of ROP in moderately premature infants has decreased dramatically with better care in the neonatal intensive care unit. Ironically, however, this has led to high rates of survival of very premature infants who would have had little chance of survival in the past.

Since these very premature infants are at the highest risk of developing ROP, the condition may actually be becoming more common again.


Symptoms:
Premature infants do not have symptoms. External signs develop only after disease has become severe or progressed to retianl detachmetns. Timely detection of ROP depends upon examination by an ophthalmologist experienced in the examination of premature infants.

Diagnosis:
Following pupillary dilation using eye drops, the retina is examined using a special lighted instrument (an indirect ophthalmoscope). The peripheral portions of the retina are pushed into view using scleral depression. Examination of the retina of a premature infant is performed to determine how far the retinal blood vessels have grown (the zone), and whether or not the vessels are growing flat along the wall of the eye (the stage). Retinal vascularization is judged to be complete when vessels extend to the ora serrata. The stage of ROP refers to the character of the leading edge of growing retinal blood vessels (at the vascular-avascular border). The stages of ROP disease have been defined by the International Classification of Retinopathy of Prematurity (ICROP).

Retinal examination with scleral depression is generally recommended for patients born before 30-32 weeks gestation, with birthweight 1500 grams or less, or at the discretion of the treating neonatologist. The initial examination is usually performed at 4–6 weeks of life, and then repeated every 1–3 weeks until vascularization is complete (or until disease progression mandates treatment).

In older patients the appearance of the disease is less well described but includes the residua of the ICROP stages as well as secondary retinal responses.


Treatment
Most babies’ eyes with ROP do well without any treatment. In more severe cases, cryotherapy (freezing) and/or laser surgery may be used. The pen-like tip of the cryotherapy instrument, a cryoprobe, can briefly freeze side areas of the retina through the outer wall of the eye. Laser photocoagulation surgery may also be used to treat the side areas of the retina. These treatments can slow down or reverse the abnormal growth of blood vessels and scar tissue in more severe ROP. It may be necessary for your ophthalmologist to examine a baby frequently while the infant is in the NICU or nursery before a treatment can be recommended. Important factors in the decision include where ROP is located in the eye, how severe it is, and how it is progressing.

Even with treatment, there is still a definite risk of serious vision loss. The long-term effects of cryotherapy and laser surgery for ROP are not known. If severe ROP disease pulls the retina out of place, more complex surgical procedures can sometimes restore limited vision. Other ROP complications such as glaucoma and misaligned eyes may also require surgery later in life. Periodic eye examinations will be necessary as your baby grows, to ensure that the child’s vision is developing as normally as possible.

There are certain classifications of ROP that are used to describe the progression of the condition. What this classification relates to is the location and degree of retinal scarring that has occured. Chart 1 (below) shows the various stages of ROP (1-5) and what these notations mean. The zone number refers to the International Classification of Retinopahty of Prematurity (ICROP) diagram which designates three zones of the retina. Chart 2 shows the ICROP. For example, stage 3, zone 1 ROP describes ROP which is pretty severe while stage 1, zone 3 ROP describes a condition which is not as progressed. It is important to stress that not every child with ROP will progress to stage 5, and some babies with ROP may recover spontaneously from stage 1 or 2 ROP.

Chart 1 – Stages of retinopathy of prematurity (Vaughan, et al, 1995)

Stage  and Clinical Findings

Stage 1 Demarcation line (line where the normal and abnormal vessels meet)

Stage 2 Intraretinal ridge (ridge that rises up from the retina as a result of the growth of the abnormal vessels)

Stage 3 Ridge with extraretinal fibrovascular proliferation (the ridge grows from the spread of the abnormal vessels and extends into the vitreous)

Stage 4 Subtotal retinal detachment (the partial detachment of the retina)

Stage 5 Total retinal detachment

Chart 2 – ICROP diagram (Ophthalmology Homepage, 1997)

Zone and Area of Retina Affected

Zone I – Area centered on the optic disc and extending from the disc to twice the distance between the disc and the macula.

Zone II – A ring, concentric to Zone I, which extends to the edge of the retina on the side of the eye toward the nose.

Zone III – The remaining crescent area of the retina toward the side and away from the nose.

……. ICROP

Treatment for ROP depends on the stage of the condition. Stage 1 and 2 usually require nothing more than observation. (Vaughan, et al, 1995) There are a variety of ways that ROP is treated, but the most common is laser treatment. Laser photocoagulation is used to eliminate the abnormal vessels before they cause the retina to detach. Cryotherapy involves placing a very cold probe on the outside wall of the eye and freezing until an ice ball forms on the retinal surface. These treatment options are usually done with children in Stage 3 ROP. A scleral buckle involves placing a silicone band around the equator of the eye and tightening it to produce a slight indentation on the inside of the eye. This keeps the vitreous gel from pulling on the scar tissue and the retina and allows the retina to flatten back down onto the wall of the eye. Infants who have a sclera buckle done need to have the band removed months or years later since the eye continues to grow. Otherwise they will become nearsighted. Vitrectomy involves making several small incisions into the eye to remove the vitreous and replace it with a saline solution to maintain the shape and pressure of the eyeball. After the vitrous has been removed, the scar tissue on the retina can be peeled back or cut away, allowing the retina to relax and lay back down against the eye wall. Since it may take weeks for the retina to re-attach afterwards, holes or tears can occur which usually prevent the retina from re-attaching. If this happens the lens of the eye has to be removed to be able to remove the scar tissue. Sclera buckles are usually performed on children with Stage 4 and 5 ROP while vitrectomy is performed only at Stage 5. (Ophthalmology Associates Homepage, 1997)

Additionally there are some late complications from ROP which include strabismus (crossed eyes), amblyopia (lazy eye), myopia (near-sightedness), and glaucoma. (Ophthalmology Associates Homepage, 1997) Regular follow-up is needed to monitor and treat these conditions.

Depending on the stage of ROP, a child may have anywhere from near normal vision to light perception to total blindness. Many children will not progress to Stage 5. Usually children will benefit from early intervention and sensory stimulation. Adaptions such as high illumination, magnification for close work, telescopes for distance viewing, and closed-circuit television (CCTV) can be helpful to some students. (Levack, et al, 1991) Students may be braille readers.

Parents of children with ROP may wish to contact some of the following resources for information and support:

ROP Online Support Group – This support group is an attempt to provide a source of information and support for those struggling with these issues about how ROP will affect the future. You can post a message, ask a question, or answer someone else’s questions simply by sending e-mail to the group (rop@list.konnections.com). Any messages posted to the group will be forwarded to you as long as you are a member.

Ophthalmology Associates of Ogden, Utah – The purpose of this website is to provide information to the internet public concerning eye diseases and their medical and surgical treatment and has a variety of subjects, with real data in an understandable format. Go to <www.konnections.com/eyedoc/index.html>.

Prognosis:
Most premature infants with ROP recover with no lasting visual problems. Many premature infants with slight problems in retinal blood vessel growth have the vessels return to normal without treatment. Most infants with mild ROP can be expected to recover completely.

About 1 out of 10 infants with early changes will develop more severe retinal disease. Severe ROP may lead to significant vision problems or blindness. The most important factor in the outcome is early detection and treatment.

Prevention
In premature newborns who need oxygen, oxygen levels are monitored carefully so that the lowest amount of oxygen necessary can be used. Oxygen levels can be indirectly monitored using a pulse oximeter, an external sensor that measures the level of oxygen in the blood going through a finger or toe.

Retinopathy is usually mild and resolves spontaneously, but the eyes need to be monitored by an ophthalmologist until blood vessel growth is mature.

For very severe retinopathy of prematurity, laser treatment is done on the outermost portions of the retina. This treatment stops the abnormal growth of blood vessels and decreases the risk of retinal detachment and loss of vision.You may click to see:->Laser Cures Retinopathy in Infants

“Prevent Blindness in Premature Babies” – The major effort of the organization is to work to eliminate the use of bright fluorescent lighting in hospital premie units. Go to <www.brailleplanet.org/pbpb.html>. You may also contact them by phone or mail at P.O. Box 44792, Madison, Wisconsin 53744-4792, (608)845-6500.

Resources:
http://www.tsbvi.edu/Outreach/seehear/winter98/rop.htm
http://www.kellogg.umich.edu/patientcare/conditions/retinopathy.prematurity.html
http://www.merck.com/mmhe/sec23/ch264/ch264n.html
http://en.wikipedia.org/wiki/Retinopathy_of_prematurity
http://www.nlm.nih.gov/medlineplus/ency/article/001618.htm

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Attention Deficit Hyperactivity Disorder (ADHD)

Definition:
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood.. Children with ADHD have impaired functioning in multiple settings, including home, school, and in relationships with peers. If untreated, the disorder can have long-term adverse effects into adolescence and adulthood.

Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).

……….

ADHD has three subtypes:
1.Predominantly hyperactive-impulsive ……
*Most symptoms (six or more) are in the hyperactivity-impulsivity categories.
*Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.

2.Predominantly inattentive …………………
*The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.

*Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.

3.Combined hyperactive-impulsive and inattentive. .
*Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.
*Most children have the combined type of ADHD

Treatments can relieve many of the disorder’s symptoms, but there is no cure. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it.

Signs & Symptoms
Symptoms of ADHD will appear over the course of many months, and include:

Impulsiveness: a child who acts quickly without thinking first.
Hyperactivity: a child who can’t sit still, walks, runs, or climbs around when others are seated, talks when others are talking.

Inattention: a child who daydreams or seems to be in another world, is sidetracked by what is going on around him or her.

Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD, these behaviors are more severe and occur more often. To be diagnosed with the disorder, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age.

Children who have symptoms of inattention may:
*Be easily distracted, miss details, forget things, and frequently switch from one activity to another
*Have difficulty focusing on one thing
*Become bored with a task after only a few minutes, unless they are doing something enjoyable
*Have difficulty focusing attention on organizing and completing a task or learning something new
*Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
*Not seem to listen when spoken to
*Daydream, become easily confused, and move slowly
*Have difficulty processing information as quickly and accurately as others
*Struggle to follow instructions.

Children who have symptoms of hyperactivity may:
*Fidget and squirm in their seats
*Talk nonstop
*Dash around, touching or playing with anything and everything in sight
*Have trouble sitting still during dinner, school, and story time
*Be constantly in motion
*Have difficulty doing quiet tasks or activities.

Children who have symptoms of impulsivity may:
*Be very impatient
*Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
*Have difficulty waiting for things they want or waiting their turns in games
*Often interrupt conversations or others’ activities.

ADHD Can Be Mistaken for Other Problems too.
Parents and teachers can miss the fact that children with symptoms of inattention have the disorder because they are often quiet and less likely to act out. They may sit quietly, seeming to work, but they are often not paying attention to what they are doing. They may get along well with other children, compared with those with the other subtypes, who tend to have social problems. But children with the inattentive kind of ADHD are not the only ones whose disorders can be missed. For example, adults may think that children with the hyperactive and impulsive subtypes just have emotional or disciplinary problems.

Diagnosis:
If ADHD is suspected, the diagnosis should be made by a professional with training in ADHD. This includes child psychiatrists, psychologists, developmental/behavioral pediatricians, behavioral neurologists, and clinical social workers. After ruling out other possible reasons for the child’s behavior, the specialist checks the child’s school and medical records and talks to teachers and parents who have filled out a behavior rating scale for the child. A diagnosis is made only after all this information has been considered.

Children mature at different rates and have different personalities, temperaments, and energy levels. Most children get distracted, act impulsively, and struggle to concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD. ADHD symptoms usually appear early in life, often between the ages of 3 and 6, and because symptoms vary from person to person, the disorder can be hard to diagnose. Parents may first notice that their child loses interest in things sooner than other children, or seems constantly “out of control.” Often, teachers notice the symptoms first, when a child has trouble following rules, or frequently “spaces out” in the classroom or on the playground.

No single test can diagnose a child as having ADHD. Instead, a licensed health professional needs to gather information about the child, and his or her behavior and environment. A family may want to first talk with the child’s pediatrician. Some pediatricians can assess the child themselves, but many will refer the family to a mental health specialist with experience in childhood mental disorders such as ADHD. The pediatrician or mental health specialist will first try to rule out other possibilities for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that seem like ADHD.

Between them, the referring pediatrician and specialist will determine if a child:

*Is experiencing undetected seizures that could be associated with other medical conditions
*Has a middle ear infection that is causing hearing problems
*Has any undetected hearing or vision problems
*Has any medical problems that affect thinking and behavior
*Has any learning disabilities
*Has anxiety or depression, or other psychiatric problems that might cause ADHD-like symptoms
*Has been affected by a significant and sudden change, such as the death of a family member, a divorce, or parent’s job loss.
A specialist will also check school and medical records for clues, to see if the child’s home or school settings appear unusually stressful or disrupted, and gather information from the child’s parents and teachers. Coaches, babysitters, and other adults who know the child well also may be consulted.

The specialist also will ask:
*Are the behaviors excessive and long-term, and do they affect all aspects of the child’s life?
*Do they happen more often in this child compared with the child’s peers?
*Are the behaviors a continuous problem or a response to a temporary situation?
*Do the behaviors occur in several settings or only in one place, such as the playground, classroom, or home?
The specialist pays close attention to the child’s behavior during different situations. Some situations are highly structured, some have less structure. Others would require the child to keep paying attention. Most children with ADHD are better able to control their behaviors in situations where they are getting individual attention and when they are free to focus on enjoyable activities. These types of situations are less important in the assessment. A child also may be evaluated to see how he or she acts in social situations, and may be given tests of intellectual ability and academic achievement to see if he or she has a learning disability.

Finally, if after gathering all this information the child meets the criteria for ADHD, he or she will be diagnosed with the disorder.

Treatment
Effective treatments for ADHD are available, and include behavioral therapy and medications.

Currently available treatments focus on reducing the symptoms of ADHD and improving functioning. Treatments include medication, various types of psychotherapy, education or training, or a combination of treatments.

Getting Help: Locate Services
Locate mental health services in your area, affordable healthcare, NIMH clinical trials, and listings of professionals and organizations.

Click to see for more locational services
You may also clic to see:->
*Child and Adolescent Mental Health:
*Treatment of Children with Mental Disorders
*Information about medications
*Attention Deficit Hyperactivity Disorder Information and Organizations from NLM’s MedlinePlus (en Español) :
*Listen to a NIH podcast about a study on ADHD medications by the National Institute on Environmental and Health Sciences:

*Chiropractic Care for ADD/ADHD

*ADD & Toxins

Resources:
http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtm

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Varicose Veins

Image by me. Larger version available on Flickr.
Image via Wikipedia

Definition:
Varicose veins are most often swollen, gnarled veins that most frequently occur in the legs, ankles and feet. They are produced by a condition known as venous insufficiency or venous reflux, in which blood circulating through the lower limbs does not properly return to the heart but instead pools up in the distended veins.
CLICK & SEE
More than 25 million Americans suffer from venous reflux disease. The symptoms can include pain and fatigue in the legs, swollen ankles and calves, burning or itching skin, skin discoloration and leg ulcers. In less severe cases, thin, discolored vessels – “spider veins” – may be the only symptom.

Gender and age are two primary risk factors in the development of venous reflux. An estimated 72% of American women and 42% of men will experience varicose veins symptoms by the time they reach their sixties. Women who have been pregnant more than once and people who are obese, have a family history of varicose veins or spend a great deal of time standing have an elevated risk for the condition, but it can occur in almost anyone at almost any age. Varicose veins never go away without treatment and frequently progress and worsen over time.

Severe varicose veins can have a significant impact on the lives of people who work on their feet – nurses, teachers, flight attendants et al. Research has shown that more than two million workdays are lost each year in the US, and annual expenditures for treatment total $1.4 billion.

Symptoms
Varicose veins are swollen vessels, blue or purple in color and generally bulging above the surface of the skin. They may appear twisted or “ropey” and can be accompanied by swelling in adjacent tissue. They can be found anywhere on the leg, from the ankle up to the groin, but most commonly appear on the inside of the thigh or on the back of the calf or knee.

Varicose veins are not always a serious or uncomfortable condition – for some people, small discolored vessels or minor swelling may be the only signs – but for millions of sufferers they can cause symptoms severe enough to significantly impact the quality of life. Throbbing pain, a deep ache or heavy feeling in the legs, muscle cramps, fatigue, “restless” legs, burning or itching skin, and severe swelling of the ankles can all be symptoms of venous reflux disease, the major underlying cause of varicose veins.

CLICK & SEE

If you have varicose veins, your legs may feel heavy, tired, restless, or achy. Standing or sitting for too long may worsen your symptoms. You may also experience night cramps.

You may notice small clusters of veins in a winding pattern on your leg, or soft, slightly tender knots of veins. Sometimes, the skin on your legs may change color, become irritated, or even form sores.

If you have severe varicose veins, you have slightly increased chances of developing deep vein thrombosis (DVT). DVT may cause sudden, severe leg swelling. DVT is a serious condition that requires immediate medical attention

When symptoms like these are present, they frequently curtail the patient’s activities and can even force them to miss work. Sufferers complain of being unable to walk, stand or sit for very long without feeling pain or exhaustion.

In severe cases, varicose veins can be indicators of serious circulatory problems, producing blood clots or skin ulcers that require immediate medical attention.

Diagnosis:
To determine whether venous reflux disease is causing your varicose vein symptoms, your primary care physician may conduct an examination and some tests. In some cases, you may be referred to a vein specialist at this time.  After you describe your symptoms, the doctor will examine your legs in a standing position, looking for swelling, visible veins and signs of skin changes, like discoloration, irritation or early signs of ulcers.

The next step is a “hands-on” examination – the doctor will feel your leg with his fingertips to detect swollen veins that are too deep under the skin to be visible. The groin area and the back of the calf are particular targets for inspection, and the doctor will also pay special attention to any areas of significant pain or tenderness, because that can indicate a possible blood clot or deep vein thrombosis (DVT).

If the exam produces sufficient signs of venous reflux, your doctor will probably order an ultrasound examination, a non-invasive test that provides a clear and detailed image of the circulatory system in your leg. The most sophisticated ultrasound tests use  Doppler technology – the same technology used for weather radar – that illustrate the blood flow in various shades of red and blue to show the doctor the speed and direction of the blood flow through the vein.

If the ultrasound confirms the diagnosis of venous reflux, your physician will commonly prescribe conservative measures like compression stockings as a first step in your treatment. (If the ultrasound does not indicate venous reflux, a Magnetic Resonance Imaging test may be ordered to pinpoint the source of the symptoms.) Patients exhibiting the signs or symptoms of varicose veins may request a referral to a specialist performing the VNUS Closure procedure.

Causes :

Heredity, obesity, age, trauma and standing for long periods of time have all been thought to damage venous valves and therefore cause venous insufficiency and varicose veins. Women, especially if previously pregnant, are more likely to develop varicose veins.

If you have never suffered from varicose veins, you are quite fortunate or you are in the minority as– nearly three-quarters of American women and more than 40% of men will encounter the condition by the time they reach retirement age, and venous reflux disease occurs even in teenagers.

Possible causes are:-
High blood pressure inside your superficial leg veins causes varicose veins.

Factors that can increase your risk for varicose veins include having a family history of varicose veins, being overweight, not exercising enough, smoking, standing or sitting for long periods of time, or having DVT. Women are more likely than men to develop varicose veins. Varicose veins usually affect people between the ages of 30 and 70.

Pregnant women have an increased risk of developing varicose veins, but the veins often return to normal within 1 year after childbirth. Women who have multiple pregnancies may develop permanent varicose veins.

Risk Factors
By an almost 2-1 margin, women are more likely to develop varicose veins than men. pregnancy and childbirth are major contributing factors – women who have been pregnant more than once are highly susceptible – partly because the hormonal changes that occur during pre-menstruation and menopause are known to relax vein walls and increase the chances of venous reflux. Hormone replacement therapy and birth control pills can increase the risk as well.

Other significant contributing factors for varicose veins include obesity, a family history of varicose veins, and extended periods of standing – nurses, teachers, postal workers, flight attendants and other people with “vertical” careers or activities are vulnerable to developing varicose veins, as is anyone who does a lot of heavy lifting.
Finally, the longer you live, the more likely you are to develop varicose veins.  Half of all Americans over 50 have them, as do two-thirds of women over 60.

Prevention:
There are no medically proven ways to completely prevent varicose veins. Common sense, however, tells us that relieving pressure on the veins as well as promoting muscle strength helps to keep the blood flowing in the correct direction. Exercising, losing weight, elevating your legs when resting, and not crossing them when sitting all have potential benefits. Wearing loose clothing and avoiding long periods of sitting or standing also are thought to be helpful. Wearing high-heeled shoes is not advisable because they don’t allow the calf muscles to fully contract. Other than varicose vein treatment, medical compression hosiery is the most helpful method of decreasing the symptoms of varicose veins.

Advanced Vein Therapies uses the latest technology and offers several vein therapies & procedures to effectively treat varicose veins.

Treatments

* VNUS Closure® (Click  to 0pen the window to go toVNUS Closure Video)
* Endovenous Laser (EVL) (Click  to View RF Thermal Ablation Device Outperforms Endovenous Laser)
* Vein Stripping………CLICK & SEE
* Phlebectomy……….CLICK & SEE

Overview
For milder cases of varicose veins and spider veins, physicians generally recommend a variety of self-help, non-surgical measures to ease discomfort and prevent the condition from worsening. These measures include exercise, losing weight, wearing compression stockings, elevating the legs and avoiding long periods of standing or sitting.

Direct medical treatments for spider veins include sclerotherapy, in which the veins are sealed with injections of a chemical solution that closes the vein walls. Spider veins can also be treated with non-invasive lasers, which cause the veins to fade and disappear.

For more severe cases of varicose veins, in which the veins bulge beyond the skin or cause significant pain and swelling, relief usually requires a medical intervention. The traditional surgical approach has been vein stripping, a procedure commonly requiring general anesthesia in which incisions are made near the knee and groin and the diseased primary vein is literally pulled from the body using a device. While reasonably effective, vein stripping generally produces significant post-operative pain and bruising, and usually requires a lengthy and uncomfortable recovery period.

In the United States, however, vein stripping has been rendered virtually obsolete by new, minimally invasive catheter technology that enables even severe varicose veins to be successfully treated in a doctor’s office under a local anesthetic in just a few minutes. A device is inserted into the diseased vein, where a catheter or fiber delivers either radiofrequency (RF) or laser energy to heat and seal the vessel. The technique is extremely successful and far less painful and traumatic to the patient than vein stripping.

Endovenous laser (EVL) devices utilize an optical fiber to deliver extremely high heat – over 700 degrees centigrade – that boils the blood in the vein to create a clotting effect that seals the vein as the device is withdrawn. Radiofrequency devices operate at far lower temperatures to heat and shrink the vein walls, limiting the impact on surrounding tissues and, according to a clinical study, causing significantly less pain and bruising than laser.

Physicians using the VNUS® ClosureFAST™ catheter, the only radiofrequency device on the market today for the treatment of venous reflux,  report that most patients return to normal activity almost immediately following the procedure, with little or no post operative pain.

Compression Stockings.
For more severe varicose veins, your physician may prescribe compression stockings. Compression stockings are elastic stockings that squeeze your veins and stop excess blood from flowing backward. In this way, compression stockings also can help heal skin sores and prevent them from returning. You may be required to wear compression stockings daily for the rest of your life. For many patients, compression stockings effectively treat varicose veins and may be all that are needed to relieve pain and swelling and prevent future problems.

When these kinds of treatments alone do not relieve your varicose veins, you may require a surgical or minimally invasive treatment, depending upon the extent and severity of the varicose veins. These treatments include sclerotherapy, ablation, vein stripping, and laser treatment.

Sclerotherapy…
During sclerotherapy, your physician injects a chemical into your varicose veins. The chemical irritates and scars your veins from the inside out so your abnormal veins can then no longer fill with blood. Blood that would normally return to the heart through these veins returns to the heart through other veins. Your body will eventually absorb the veins that received the injection.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:

http://www.vnus.com/vascular-disease/varicose-veins/diagnosis-of-varicose-veins.aspx

http://www.vascularweb.org/patients/NorthPoint/Varicose_Veins.html

http://www.avtherapies.com/varicose-veins.php?gclid=CO7WodevxpsCFQ_xDAodqgvhAA

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Ailmemts & Remedies

Macular Degeneration (AMD OR ARMD)

Definition:
Macular degeneration is a medical condition usually of older adults which results in a loss of vision in the center of the visual field (the macula) because of damage to the retina. It occurs in “dry” and “wet” forms. It is a major cause of blindness in the elderly (>50 years). Macular degeneration can make it difficult or impossible to read or recognize faces, although enough peripheral vision remains to allow other activities of daily life.

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Human eye cross section view

Macular degeneration doesn’t cause total blindness, but it worsens your quality of life by blurring or causing a blind spot in your central vision. Clear central vision is necessary for reading, driving, recognizing faces and doing detail work.

The deterioration occurs in the macula (MAK-u-luh), which is in the center of the retina — the layer of tissue on the inside back wall of your eyeball.

The inner layer of the eye is the retina, which contains nerves that communicate sight, and behind the retina is the choroid, which contains the blood supply to the retina. In the dry (nonexudative) form, cellular debris called drusen accumulate between the retina and the choroid, and the retina can become detached. In the wet (exudative) form, which is more severe, blood vessels grow up from the choroid behind the retina, and the retina can also become detached. It can be treated with laser coagulation, and with medication that stops and sometimes reverses the growth of blood vessels.

Although some macular dystrophies affecting younger individuals are sometimes referred to as macular degeneration, the term generally refers to age-related macular degeneration (AMD or ARMD).

Signs:
Drusen
Pigmentary alterations
Exudative changes: hemorrhages in the eye, hard exudates, subretinal/sub-RPE/intraretinal fluid
Atrophy: incipient and geographic
Visual acuity drastically decreasing (two levels or more) ex: 20/20 to 20/80.

Symptoms:
Dry macular degeneration usually develops gradually and painlessly. You may notice these vision changes:

* The need for increasingly bright light when reading or doing close work
* Increasing difficulty adapting to low light levels, such as when entering a dimly lit restaurant
* Increasing blurriness of printed words
* A decrease in the intensity or brightness of colors
* Difficulty recognizing faces
* Gradual increase in the haziness of your overall vision
* Blurred or blind spot in the center of your visual field combined with a profound drop in the sharpness (acuity) of your central vision
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Normal Vision.……………………………...Vision with AMD

Your vision may falter in one eye while the other eye remains fine for years. You may not notice any or much change because your good eye compensates for the weak one. Your vision and lifestyle begin to be dramatically affected when this condition develops in both eyes.

Hallucinations
Additionally, some people with macular degeneration may experience visual hallucinations as their vision loss becomes more severe. These hallucinations may include unusual patterns, geometric figures, animals or even faces. You might be afraid to discuss these symptoms with your doctors or friends and family for fear you’ll be considered crazy. However, such hallucinations aren’t a sign of mental illness. In fact, they’re so common that there’s a name for this phenomenon — Charles Bonnet syndrome.

The Amsler Grid Test is one of the simplest and most effective methods for patients to monitor the health of the macula. The Amsler Grid is essentially a pattern of intersecting lines (identical to graph paper) with a black dot in the middle. The central black dot is used for fixation (a place for the eye to stare at). With normal vision, all lines surrounding the black dot will look straight and evenly spaced with no missing or odd looking areas when fixating on the grid’s central black dot. When there is disease affecting the macula, as in macular degeneration, the lines can look bent, distorted and/or missing. See a video on how to use an Amsler grid here:  and watch an animation showing the Amsler grid with macular degeneration here: .

Macular degeneration by itself will not lead to total blindness. For that matter, only a very small number of people with visual impairment are totally blind. In almost all cases, some vision remains. Other complicating conditions may possibly lead to such an acute condition (severe stroke or trauma, untreated glaucoma, etc.), but few macular degeneration patients experience total visual loss. The area of the macula comprises about 5% of the retina and is responsible for about 35% of the visual field. The remaining 65% (the peripheral field) remains unaffected by the disease

The loss of central vision profoundly affects visual functioning. It is not possible, for example, to read without central vision. Pictures which attempt to depict the central visual loss of macular degeneration with a black spot do not really do justice to the devastating nature of the visual loss. This can be demonstrated by printing letters 6 inches high on a piece of paper and attempting to identify them while looking straight ahead and holding the paper slightly to the side. Most people find this surprisingly difficult to do.

There is a loss off contrast sensitivity, so that contours, shadows and color vision are less vivid. The loss in contrast sensitivity can be quickly and easily measured by a contrast sensitivity test performed either at home or by an eye specialist.

Similar symptoms with a very different etiology and different treatment can be caused by Epiretinal membrane or macular pucker or leaking blood vessels in the eye..

When to see a doctor
See your eye doctor — particularly after age 50 — if:

* You notice changes in your central vision
* Your ability to see colors and fine detail becomes impaired

One way to monitor your eyes to determine if you may need to visit your eye doctor is to check your vision regularly using an Amsler grid. This simple test may help you detect changes in your sight that you otherwise may not notice.

Here’s how to perform the test:

* Hold the grid 14 inches (about 36 centimeters) in front of you in good light. Use your corrective glasses or reading glasses if you normally wear them.
* Cover one eye.
* Look directly at the center dot with your uncovered eye.
* While looking at this dot, determine whether all of the lines of the grid appear straight, uninterrupted and have the same contrast.
* Repeat the above steps with your other eye.
* If any part of the grid is missing or looks wavy, blurred or dark, contact your eye doctor immediately.

Causes:
The exact cause of dry macular degeneration is unknown, but the condition develops as the eye ages. The initial site of change is not in the light-sensitive cells of the macula, but in the retinal pigment epithelium (RPE), a single layer of cells located just behind the retina close to the back wall of your eye.

Your macula is an area about two-tenths of an inch (5 millimeters) in diameter at the center of your retina. This small part of your eye is responsible for clear vision, particularly in your direct line of sight.

The macula consists of millions of densely packed light-sensitive cells called cones and rods. Cones and rods have two segments: An inner segment controls cell functions and produces proteins responsive to light, and an outer segment stores and makes use of these proteins.

As they absorb light, outer segment proteins become degraded and eventually are shed as waste. Meanwhile, the inner segments continuously provide replacements for the outer segments. One function of the cells of the RPE is to remove the outer segments that are shed.

As the eye ages, cells in the RPE begin to deteriorate (atrophy) and lose their pigment. As a consequence, the RPE becomes less efficient in removing outer segment waste. When that happens, the normally uniform reddish color of the macula (as seen with an ophthalmoscope) takes on a mottled appearance. Drusen — yellow, fat-like deposits — begin to appear under the cones and rods. As the drusen and mottled pigmentation continue to develop, your vision gradually deteriorates.

Based on this progression, dry macular degeneration is categorized in three stages:

* Early stage. Several small drusen or a few medium-sized drusen are detected on the macula in one or both eyes. Generally, there’s no vision loss in the earliest stage.
* Intermediate stage. Many medium-sized drusen or one or more large drusen are detected in one or both eyes. At this stage, your central vision may start to blur and you may need extra light for reading or doing detail work.
* Advanced stage. Several large drusen, as well as extensive breakdown of light-sensitive cells in the macula, are detected. These features cause a well-defined spot of blurring in your central vision. The blurred area may become larger and more opaque over time.

Macular degeneration almost always starts out as the dry form. Dry macular degeneration may initially affect only one eye but, in most cases, both eyes eventually become involved.

Risk factors:
Contributing factors for development of macular degeneration include:

 * Age. In the United States, macular degeneration is the leading cause of severe vision loss in people age 60 and older.
* Family history of macular degeneration. If someone in your family had macular degeneration, your odds of developing macular degeneration are higher. In recent years, researchers have identified some of the genes associated with macular degeneration. In the future, genetic screening tests may be helpful for assessing early risk of the disease.
* Race. Macular degeneration is more common in whites than it is in other groups, especially after age 75.
* Sex. Women are more likely than men to develop macular degeneration, and because they tend to live longer, women are more likely to experience the effects of severe vision loss from the disease.
* Cigarette smoking. Exposure to cigarette smoke doubles your risk of macular degeneration. Cigarette smoking is the single most preventable cause of macular degeneration.
*Stargardt’s disease (STGD, also known as Juvenile Macular Degeneration) is an autosomal recessive retinal disorder characterized by a juvenile-onset macular dystrophy, alterations of the peripheral retina, and subretinal deposition of lipofuscin-like material. A gene encoding an ATP-binding cassette (ABC) transporter was mapped to the 2-cM (centiMorgan) interval at 1p13-p21 previously shown by linkage analysis to harbor the STGD gene. This gene, ABCR, is expressed exclusively and at high levels in the retina, in rod but not cone photoreceptors, as detected by in situ hybridization. Mutational analysis of ABCR in STGD families revealed a total of 19 different mutations including homozygous mutations in two families with consanguineous parentage. These data indicate that ABCR is the causal gene of STGD/FFM.
*Drusen CMSD studies indicate that drusen are similar in molecular composition to plaques and deposits in other age-related diseases such as Alzheimer’s disease and atherosclerosis.
While there is a tendency for drusen to be blamed for the progressive loss of vision, drusen deposits can, however, be present in the retina without vision loss. Some patients with large deposits of drusen have normal visual acuity. If normal retinal reception and image transmission are sometimes possible in a retina when high concentrations of drusen are present, then even if drusen can be implicated in the loss of visual function, there must be at least one other factor that accounts for the loss of vision. Retinitis Pigmentosa (RP) is a genetically linked dysfunction of the retina and is related to mutation of the ATP Synthase Gene 63.
* Obesity. Being severely overweight increases the chance that early or intermediate macular degeneration will progress to the more severe form of the disease.
* Light-colored eyes. People with light-colored eyes appear to be at greater risk than do those with darker eyes.
* Exposure to sunlight. Although the retina is more sensitive to shorter wavelengths of light, including ultraviolet (UV) light, only a small percentage of ultraviolet light actually reaches the retina. Most ultraviolet light is filtered by the transparent outer surface of your eye (cornea) and the natural crystalline lens in your eye. Some experts believe that long-term exposure to ultraviolet light may increase your risk of developing macular degeneration, but this risk has not been proved and remains controversial.
* Low levels of nutrients. This includes low blood levels of minerals, such as zinc, and of antioxidant vitamins, such as A, C and E. Antioxidants may protect your cells from oxygen damage (oxidation), which may partially be responsible for the effects of aging and for the development of certain diseases such as macular degeneration.
* Cardiovascular diseases. These include high blood pressure, stroke, heart attack and coronary artery disease with chest pain (angina).
*High fat intake is associated with an increased risk of macular degeneration in both women and men. Fat provides about 42% of the food energy in the average American diet. A diet that derives closer to 20-25% of total food energy from fat is probably healthier. Reducing fat intake to this level means cutting down greatly on consumption of red meats and high-fat dairy products such as whole milk, cheese, and butter. Eating more cold-water fish (at least twice weekly), rather than red meats, and eating any type of nuts may help macular degeneration patients.
*Oxidative stress: It has been proposed that age related accumulation of low molecular weight, phototoxic, pro-oxidant melanin oligomers within lysosomes in the retinal pigment epithelium may be partly responsible for decreasing the digestive rate of photoreceptor outer rod segments (POS) by the RPE. A decrease in the digestive rate of POS has been shown to be associated with lipofuscin formation – a classic sign associated with macular degeneration.
*Fibulin-5 mutation Rare forms of the disease are caused by geneic defects in fibulin-5, in an autosomal dominant manner. In 2004 Stone et al. performed a screen on 402 AMD patients and revealed a statistically significant correlation between mutations in Fibulin-5 and incidence of the disease. Furthermore the point mutants were found in the Calcium binding sites of the cbEGF domains of the protein. there is no structural basis for the effects of the mutations.

Diagnosis:
Diagnostic tests for macular degeneration may include:

*An eye examination. One of the things your eye doctor looks for while examining the inside of your eye is the presence of drusen and mottled pigmentation in the macula. The eye examination includes a simple test of your central vision and may include testing with an Amsler grid. If you have macular degeneration, when you look at the grid some of the straight lines may seem faded, broken or distorted. By noting where the break or distortion occurs — usually on or near the center of the grid — your eye doctor can better determine the location and extent of your macular damage.

Regular screening examinations can detect early signs of macular degeneration before the disease leads to vision loss.
*Angiography. To evaluate the extent of the damage from macular degeneration, your eye doctor may use fluorescein angiography. In this procedure, fluorescein dye is injected into a vein in your arm and photographs are taken of the back of the eye as the dye passes through blood vessels in your retina and choroid. Your doctor then uses these photographs to detect changes in macular pigmentation or to identify small macular blood vessels.

Your doctor may also suggest a similar procedure called indocyanine green angiography. Instead of fluorescein, a dye called indocyanine green is used. This test provides information that complements the findings obtained through fluorescein angiography.
* Optical coherence tomography. This noninvasive imaging test helps identify and display areas of retinal thickening or thinning. Such changes are associated with macular degeneration. This test can also reveal the presence of abnormal fluid in and under the retina or the RPE. It’s often used to help monitor the response of the retina to macular degeneration treatments.

Treatment:
There’s no treatment available to reverse dry macular degeneration. But this doesn’t mean you’ll eventually lose all of your sight. Dry macular degeneration usually progresses slowly, and many people with the condition are able to live relatively normal, productive lives, especially if only one eye is affected. Dry macular degeneration can, however, develop into the more rapidly progressive wet type of macular degeneration at any time.

Taking a high-dose formulation of antioxidants and zinc may reduce progression of dry macular degeneration to advanced macular degeneration. The National Eye Institute-sponsored Age-Related Eye Disease Study (AREDS) showed that a daily supplement of 500 milligrams (mg) of vitamin C, 400 international units (IU) of vitamin E, 15 mg of beta carotene (often as vitamin A — up to 25,000 IU), 80 mg of zinc (as zinc oxide) and 2 mg of copper (as cupric oxide) reduced the risk of progressing to moderate or severe vision loss by up to 25 percent.

Life Style & Home Remedies:
Macular degeneration doesn’t affect your side (peripheral) vision and usually doesn’t cause total blindness. But it can rob you of your central vision — which is important for driving, reading and recognizing people’s faces. A low-vision center may be able to assess your visual capabilities and suggest certain optical and household devices that can be helpful for some near-vision tasks. Ask your eye doctor if there are any low-vision centers in your area.

There are ways to cope with impaired vision. Below are a few suggestions:

* Use caution when driving. First, check with your doctor to see if driving is still safe based on your current visual acuity. When you do drive, there are certain situations to avoid. For example, don’t drive at night, in heavy traffic or in bad weather.
* Seek help traveling. Use public transportation or ask family members to help, especially with night driving.
* Travel with others. Contact your local area agency on aging for a list of vans and shuttles, volunteer driving networks or ride shares.
* Get good glasses. Optimize the vision you have with the right glasses, and keep an extra pair in the car.
* Use magnifiers. Large-print books and magazines can help you read more easily.
* View with large type on the Internet. Look for Web sites that use large-sized type fonts, or change the font size on your display.
* Obtain specialized appliances. Some clocks, radios, telephones and other appliances have extra-large numbers.
* Have proper light in your home. This will help with reading and other activities.
* Remove home hazards. Eliminate throw rugs and other possible tripping hazards in your home.
* Ask friends and family members for help. Tell them about your vision problems so that they can help you perform certain tasks and help you recognize people.
* Don’t become socially isolated. A common frustration of people with macular degeneration is the inability to recognize other people and greet them by name. If this happens to you, try asking people you know to say hi and tell you their names when you meet them on the street or in other situations so that you can greet them back.
* Take advantage of online networks. The Internet is a good source for support groups and resources for people with macular degeneration.

Alternative Medicine:
Some people have turned to complementary or alternative therapies, such as bilberry, ginkgo and shark cartilage, in the belief that they can help prevent the progression of macular degeneration.

However, there’s no conclusive evidence that any of these products are effective for macular degeneration, and some may interact with other medications you’re taking. Check with your doctor before taking any dietary or herbal supplement.

Prevention
The Age-Related Eye Disease Study showed that a combination of high-dose beta-carotene, vitamin C, vitamin E, and zinc can reduce the risk of progressing from early to advanced AMD by about 25 percent.  Studies are underway with the goal of reducing lipofuscin accumulation.

Studies have found that Lutein and zeaxanthin (Carotenoid nutrients found in green vegetables such as Kale, Spinach, Collards, spices such as Saffron, and egg yolk) protect against and possibly reverse macular degeneration and Retinitis pigmentosa.  Studies found that antioxidants disrupt the link of two processes that cause macular degeneration and extend the lifetime of irreplaceable photoreceptors and other retinal cells (Lutein is known to have antioxidant properties).

Eating spinach or collard greens five times a week decreases the risk of AMD by 43%

Studies reported in the British Journal of Ophthalmology suggest that while beneficial for those in advanced stages, antioxidant supplements can be counterproductive for people with early stages of AMD as antioxidants can potentially negate the beneficial effects of Omega-3 fats. It has been found that Omega-3 fatty acids can prevent or even halt the progress of degeneration. However, moderation of oily fishes in patients’ diets is suggested as they can lead to a build up of pollutants such fishes may contain.

The following measures may help you avoid macular degeneration:
*Eat foods containing antioxidants.
*Take antioxidant and zinc supplements.
* Eat fish.
*Stop smoking.
*Manage your other diseases.
*Get regular eye exams.
*Screen your vision regularly.

If you have some vision loss because of macular degeneration, your eye doctor can prescribe optical devices called low-vision aids that will help you see better for close-up work. Or your doctor may refer you to a low-vision specialist. In addition, a wide variety of support services and rehabilitation programs are available that may help you adjust your lifestyle.
Impact:
Macular degeneration can advance to legal blindness and inability to drive. It can also result in difficulty or inability to read or see faces.

Adaptive devices can help people read. These include magnifying glasses, special eyeglass lenses, desktop and portable electronic devices, and computer screen readers such as JAWS for Windows.

Composer Josef Tal checks a manuscript (2006)Accessible publishing also aims to provide a variety of fonts and formats for published books to make reading easier. This includes much larger fonts for printed books, patterns to make tracking easier, audiobooks and DAISY books with both text and audio.

Because the peripheral vision is not affected, people with macular degeneration can learn to use their remaining vision to continue most activities. Assistance and resources are available in every country and every state in the U.S. Classes for “independent living” are given and some technology can be obtained from a state department of rehabilitation. You can also search for macular degeneration on the internet and contact one of the non-profit organizations for assistance.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
http://www.mayoclinic.com/health/macular-degeneration/DS00284
http://en.wikipedia.org/wiki/Macular_degeneration

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Ailmemts & Remedies

Spinal Stenosis

Vertebral column.
Image via Wikipedia

Definition
Spinal stenosis is a narrowing of the lumbar (back) or cervical (neck) spinal canal, which causes compression of the nerve roots.This can cause weakness in your extremities as narrowing often results in pressure on the spinal cord and/or nerves. Spinal stenosis can occur in a variety of ways in the spine. Most cases of spinal stenosis occur in the lower back (lumbar spine) and will affect the sciatic nerve, which runs along the back of the leg.

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The most commonly referred to types of this condition are: lumbar spinal stenosis, occurring in the lower back, and cervical spinal stenosis which occurs in the neck. As mentioned previously, the condition more commonly occurs in the lower back.

Causes
Spinal stenosis mainly affects middle-aged or elderly people. It may be caused by osteoarthritis or Paget’s disease or by an injury that causes pressure on the nerve roots or the spinal cord itself.

The three major causes of spinal stenosis are:

Aging – With age, the body’s ligaments (tough connective tissues between the bones in the spine) can thicken. Spurs (small growths) may develop on the bones and into the spinal canal. The cushioning discs between the vertebrae may begin to deteriorate. The facet joints (flat surfaces on each vertebra that form the spinal column) also may begin to thicken. Aging, coupled with secondary changes, is the most common cause of spinal stenosis. Heredity – if the spinal canal is too small at birth, symptoms of spinal stenosis may show in a relatively young person. Structural deformities of the involved vertebrae can cause narrowing of the spinal canal.

Tumors of the spine – Abnormal growths of soft tissue that may affect the spinal canal directly by inflammation or by growth of tissue into the canal. Tissue growth may lead to bone resorption (bone loss due to over activity of certain bone cells) or displacement of bone and the eventual collapse of the supporting framework of the spinal column.

Trauma – accidents and injuries may either dislocate the spine and the spinal canal or cause burst fractures that produce fragments of bone that penetrate the canal.

Paget’s disease of bone – This chronic (long-term) disorder usually results in enlarged and deformed bones. The disease can affect any bone of the body, but is often found in the spine.
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Blood supply – The blood supply that feeds healthy nerve tissue may be diverted to the area of involved bone.

Fluorosis – An excessive level of fluoride in the body. It may result from chronic inhalation of industrial dusts or gases contaminated with fluorides, prolonged ingestion of water containing large amounts of fluorides, or accidental ingestion of fluoride-containing insecticides. The condition may lead to calcified spinal ligaments or softened bones and to degenerative conditions like spinal stenosis.

Symptoms

* Back pain that spreads to the legs
* Difficulty or imbalance when walking
* Leg pain
* Neck pain
* Numbness in the buttocks, thighs, or calves that is worse with standing, walking, or exercise
* Pain in the buttocks, thighs, or calves that is worse with walking or exercise
* Weakness of the legs

Spinal narrowing doesn’t always cause problems. But if the narrowed areas compress the spinal cord or spinal nerves, you’re likely to develop signs and symptoms. These often start gradually and grow worse over time. The most common spinal stenosis symptoms include:

*Pain or cramping in your legs. Compressed nerves in your lower (lumbar) spine can lead to a condition called pseudoclaudication, false claudication or neurogenic intermittent claudication, which causes pain or cramping in your legs when you stand for long periods of time or when you walk. The discomfort usually eases when you bend forward or sit down, but it persists if you continue to stand upright.

Another type of intermittent claudication (vascular claudication) occurs when there’s a narrowing or blockage in the arteries in your legs.

Although both types of claudication cause similar symptoms, they differ in two important ways: Vascular claudication becomes worse when you walk uphill and improves when you stand still. Pseudoclaudication is usually worse when going downhill and gets better when you lean forward or sit down.

*Radiating back and hip pain. A herniated disk can narrow your spinal canal and compress nerves in your lumbar spine, leading to pain that starts in your hip or buttocks and extends down the back of your leg. The pain is worse when you’re sitting and generally affects only one side.

You may also experience numbness, weakness or tingling in your leg or foot. For some people, the radiating pain is a minor annoyance, but for others, it can be debilitating.

* Pain in your neck and shoulders. This is likely to occur when the nerves in your neck (cervical spine) are compressed. The pain may occur only occasionally or it may be chronic, and it sometimes can extend into your arm or hand. In addition, the spinal cord is sometimes compressed, which can result in lower extremity weakness and difficulty walking. You also may experience headaches, a loss of sensation or muscle weakness.

* Loss of balance. Pressure on the cervical spinal cord can affect the nerves that control your balance, resulting in clumsiness or a tendency to fall.

* Loss of bowel or bladder function (cauda equina syndrome). In severe cases, nerves to your bladder or bowel may be affected, leading to partial or complete urinary or fecal incontinence. If you experience either of these problems, seek medical care right away.

Risk factors

Age is the main known risk factor for spinal stenosis. Your risk of this condition increases after age 50.

Also at risk are people with skeletal fluorosis, a sometimes crippling bone disease caused by high levels of fluoride in the body. Although the disease is rare in the United States, several million people worldwide have severe skeletal fluorosis.

Diagnosis
Spinal stenosis can be difficult to diagnose because its signs and symptoms are often intermittent and because they resemble those of many age-related conditions. To help diagnose spinal stenosis and rule out other disorders, your doctor will ask about your medical history and perform a physical exam that may include checking your peripheral pulses, range of motion and leg reflexes.

You’re also likely to have one or more of the following tests:

* Spinal X-ray. Although an X-ray isn’t likely to confirm that you have spinal stenosis, it can help rule out problems that cause similar symptoms, including a fracture, bone tumor or inherited defect.
* Magnetic resonance imaging (MRI). In many cases, this is the imaging test of choice for diagnosing spinal stenosis. Instead of X-rays, an MRI uses a powerful magnet and radio waves to produce cross-sectional images of your back. The test can detect damage to your disks and ligaments, as well as the presence of tumors.
* Computerized tomography (CT) scan. This test uses a narrow beam of radiation to produce detailed, cross-sectional images of your body, including the shape and size of your spinal canal. Because you receive more radiation from a CT scan than from a regular X-ray, you should avoid this test if you’re pregnant.
* CT myelogram. This may be the most sensitive test for detecting spinal stenosis, but because it poses more risks than either MRI or CT, it may not be your doctor’s first choice. If you’re contemplating surgery, however, your doctor may recommend a CT myelogram to assess the severity of the stenosis. In a myelogram, a contrast dye is injected in your spinal column. The dye then circulates around your spinal cord and spinal nerves. A myelogram can show herniated disks, bone spurs and tumors.
* Bone scan. In this test, a small amount of a radioactive material that attaches to bone is injected into a vein in your arm. The material emits waves of radiation that are detected by a gamma camera. The camera then produces images of your bones. In a sense, a bone scan is the opposite of a standard X-ray, in which radiation passes through your body to create an image on film. A bone scan can detect a number of bone disorders, but often can’t distinguish among them. For that reason, it’s usually performed with other tests.
* Other diagnostic procedures. Sometimes your doctor may inject you with a spinal nerve block or epidural steroids. If your symptoms improve after the injection, spinal stenosis is likely the cause of your discomfort. The problem with this approach is that a negative finding doesn’t mean you don’t have spinal stenosis.

Treatment
Generally, conservative management is encouraged. This involves the use of anti-inflammatory medications, other pain relievers, and possibly steroid injections. If the pain is persistent and does not respond to these measures, surgery is considered to relieve the pressure on the nerves.

Surgery is performed on the neck or lower back, depending on the site of the nerve compression.

The recommended treatment for spinal stenosis is generally open back surgery with high risks, hospital stays and lengthy recuperation time. Laser-assisted surgical procedures can correct the causes of spinal stenosis and relieve painful symptoms. These procedures are called a Foraminotomy or a Laminotomy. These laser spine procedures will remove the portion of the disc or bone spur that is pressing against a nerve causing the symptoms of spinal stenosis. By removing or shrinking the disc with the laser and removing any bone spurs, we can decompress the spinal cord or nerve root that is being impinged. At this point, excess disc material is removed and the symptoms of spinal stenosis typically disappear

Complications of spinal stenosis may include:

* Loss of feeling. Depending on which nerves are compressed, spinal stenosis may cause a loss of feeling in your arms, hands, feet or legs. As a result, cuts or wounds may become seriously infected because you’re not aware of them.
* Loss of bladder or bowel control. In addition, spinal stenosis sometimes interferes with bowel or bladder function — a problem that can affect your quality of life.
* Degenerative changes. Although treatment can relieve symptoms of spinal stenosis, it doesn’t stop degenerative changes. Some of these changes, such as muscle atrophy, may be permanent, even after the pressure is relieved.

Other Complications:Injury can occur to the legs or feet due to lack of sensation. Infections may get worse because pain related to them may not be felt. Changes caused by nerve compression may be permanent, even if the pressure is relieved.

When to Contact a Medical Professional

Call your health care provider if you have symptoms of spinal stenosis.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000441.htm#Definition
http://www.laserspineinstitute.com/back_problems/spinal_stenosis/
http://www.mayoclinic.com/health/spinal-stenosis/

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