Dialysis

Alternative Names

Artificial kidneys; Hemodialysis; Peritoneal dialysis; Renal replacement therapy

Definition of Dialysis:

Dialysis is a method of removing toxic substances (impurities or wastes) from the blood when the kidneys are unable to do so.

How the test is performed:

Dialysis can be performed using several different methods.

PERITONEAL DIALYSIS

Peritoneal dialysis filters waste using the peritoneal membrane inside the abdomen. The abdomen is filled with special solutions that help remove toxins. The solutions remain in the abdomen for a time and then are drained out. This form of dialysis can be performed at home, but must be done every day.

Blood and Urine flow

HEMODIALYSIS

Hemodialysis works by circulating the blood through special filters outside the body. The blood flows across a filter, along with solutions that help remove toxins.

Dialysis uses special ways of accessing the blood in the blood vessels. The access can be temporary or permanent.

Temporary access takes the form of dialysis catheters -- hollow tubes placed in large veins that can support acceptable blood flows. Most catheters are used in emergency situations for short periods of time. However, catheters called tunneled catheters can be used for prolonged periods of time, often weeks to months.

Permanent access is created by surgically joining an artery to a vein. This allows the vein to receive blood at high pressure, leading to a thickening of the vein's wall. This vein can handle repeated puncture and also provides excellent blood flow rates.

The connection between an artery and a vein can be made using blood vessels (an arteriovenous fistula, or AVF) or a synthetic bridge (arteriovenous graft, or AVG). Your health care provider may suggest an AVF, because it has lower infection rates and better long-term function than an AVG.

Blood is diverted from the access point in the body to a dialysis machine. Here, the blood flows counter-current to a special solution called the dialysate. The chemical imbalances and impurities of the blood are corrected and the blood is then returned to the body. Typically, most patients undergo hemodialysis for three sessions every week. Each session lasts 3 - 4 hours.

How to prepare for the test:

When possible, patients should prepare for dialysis before dialysis is absolutely necessary.

It is important to stick to the diet and medicines prescribed by the dialysis staff and your kidney specialist (nephrologist).

The health care provider will make the following assessments before beginning the hemodialysis procedure:

• Blood pressure
• Breathing rate
• Chest assessment
• Examination of vein access
• Heart rate
• Temperature
• Weight

How the test will feel:

Because dialysis takes several hours, it may be tedious. With children, it is especially important to have games, something to read, or other distractions.

Why the test is performed:

The kidneys function as filters for the blood, removing waste products. They also:

• Regulate body water
• Maintain electrolyte balance
• Ensure that the blood pH remains between 7.35 and 7.45

Dialysis replaces some of the functions for kidneys that aren't working properly. It removes contaminants from the blood that could, and eventually would, lead to death if the kidney is not functioning.

Since dialysis is not a constant process, it cannot monitor body functions as do normal kidneys, but it can eliminate waste products and restore electrolyte and pH levels on an as-needed basis.

Dialysis is most often used for patients who have kidney failure, but it can also quickly remove drugs or poisons in acutesituations. This technique can be lifesaving in people with acute or chronic kidney failure.

Sore Throat

What causes a sore throat?

A sore throat can have many causes including:

1. Common viruses, and even the viruses that causemononucleosis (mono) and the flu, can cause a sore throat. Some viruses can also produce blisters in the mouth and throat ("aphthous stomatitis").
2. Breathing through the mouth can produce throat dryness and soreness.
3. Sinus drainage (post nasal drip) may cause a sore throat.
4. A sore throat can also be caused by bacteria. The two most common bacteria to cause a sore throat areStreptococcus (which causes strep throat) andArcanobacterium haemolyticum.Arcanobacterium causes sore throats mainly in young adults and is sometimes associated with a fine red rash.
5. Sore throat appearing after treatment with antibiotics,chemotherapy, or other immune-compromising medications may be due to Candida, commonly known as "thrush."
6. A sore throat lasting for more than two weeks can be a sign of a serious illness, such as throat cancer or AIDS.

What can I do at home for a sore throat?

Generally, sore throats must run their course (exception, strep throat will be addressed below.)

• Salt water gargles, hard candies, sprays for example, Chloraseptic) and lozenges can provide temporary pain relief. (Caution: Lozenges and hard candy are a choking hazard for children. Avoid their use in young children.)
  
• A humidifier may be helpful in relieving symptoms, especially in sore throats caused by mouth breathing and dry air.
  
• Acetaminophen or ibuprofen may help control the pain.
  
• For adults, if your nose is plugged, nasal sprays such as Afrin may be used for two to three days to prevent mouth breathing. It is NOT a good idea to use these products for more than a couple of days; you may become dependent on them.
  
• Other decongestant products, such as Sudafed, may be helpful.
  

If you have health problems such as heart disease or high blood pressure, contact your health care professional before using these products. 

What is strep throat and why is it different?

Strep throat is caused by Streptococcusbacteria, which are the same bacteria that causes rheumatic fever. Only 5%-10% of adult sore throats are caused by strep, whereas about 15%-40% of sore throats in children are related to strep. For this reason, many health care professionals will recommend a "rapid Strep" test for a patient with a sore throat. The "rapid Strep" test can usually be done in the office and takes 15-20 minutes. If the result is negative, it is often followed with a strep culture. If either of these is positive, the sore throat is generally treated with penicillin or another antibiotic.

A major objective of treating strep throat is to prevent the development of rheumatic fever, a serious illness that can cause joint pain and heart valve damage. However, antibiotics do not necessarily speed the healing of the sore throat itself, and antibiotics are of no help for a sore throat unless it is caused by strep. Another strep- related illness, scarlet fever, can cause a rash, but will not cause heart injury or joint pain. For more, please read the Strep Throat article.

When should I seek medical care for a sore throat?

Seek medical care:

1. If you have been in contact with someone with strep throat and you have a sore throat, it is reasonable to have a strep test done.
2. If your sore throat is associated with a fever, swollen "glands" (lymph nodes), or white patches on the back of your throat.
3. If your sore throat is not associated with other cold symptoms (runny nose, watery eyes, sinus congestion).
4. Any sore throat that has a sudden onset and is associated with a fever.
5. If you are having trouble swallowing liquids (pain with swallowing is to be expected with a sore throat).
6. If your sore throat persists for more than a week.
7. If you have a sore throat and the front of your neck is sore and stiff.

What if I have multiple reccurent episodes of strep throat?

There are a number of situations in which a child or adult can have reccurent positive strep tests.

1. The first, and most common, is that the strep bacteria were never eradicated in the first place. The person did not get all of the doses of the medication prescribed. Unless you take a full 7-10 day course of penicillin orerythromycin, the strep throat will not clear. Even missing a dose or two can be a problem.
2. Individuals may be "carriers" of strep (people who have strep in their throats all the time as part of their normal bacteria.) A person may be an asymptomatic carrier (a carrier who does not have symptoms of a sore throat). You may be a carrier, someone in your immediate circle may be a carrier - even your pet dog may be a carrier! The whole family should be tested for strep if it is recurrent.
3. All strep throat bacteria will be killed by penicillin. If penicillin does not get rid of your strep throat, see your doctor. In rare cases, other bacteria in the throat can secrete an enzyme (penicillinase) that breaks down penicillin. This can be overcome by using a drug that is resistant to this enzyme.

Sore Throat At A Glance

• Most sore throats are caused by viruses or mechanical causes (such as mouth breathing) and can be treated successfully at home.
• Any sore throat that has a rapid onset and is associated with a fever or tenderness of the front of the neck may be serious and should be seen by a health care professional.
• Any sore throat that causes you to have difficulty swallowing (not just pain with swallowing) or breathing should be seen by a health care professional.
• Any sore throat that lasts for more than a week should be evaluated by a health care professional.

Meniere’s Disease

Definition

Meniere's disease is an inner ear disorder that affects balance and hearing.

See also: Vertigo

Alternative Names

Hydrops; Endolymphatic hydrops

Causes, incidence, and risk factors

The inner ear has fluid-filled tubes called semicircular canals, or labyrinths. The canals, along with a nerve in your skull, help interpret your body's position and maintain your balance.

Meniere's disease occurs when a part of the canal, called the endolymphatic sac, becomes swollen. This sac helps filter and remove fluid in the semicircular canals.

The exact cause of Meniere's disease is unknown. In some cases, it may be related to:

• Head injury
• Middle ear infection
• Syphilis

Other risk factors include:

• Allergies
• Alcohol use
• Fatigue
• Recent viral illness
• Respiratory infection
• Smoking
• Stress
• Use of certain medications, including aspirin

Genetics may also play a role.

About 100,000 people a year develop Meniere's disease.

Symptoms

Symptoms include:

• Abnormal sensations of movement (vertigo)
  • Gets worse with sudden movement
  • Lasts for a few minuts to several hours
  • May come and go
• Dizziness
• Hearing loss in one or both ears
  • Low frequency noises lost first
  • Extent of hearing loss may change
• Noises or ringing in the ear (tinnitus)
• Sudden episodes of complete disorientation that causes the person to fall down
• Sweating (may be heavy)
• Uncontrollable eye movements
• Vomiting and nausea

The feeling of dizziness and being off balance generally come in attacks that last from minutes to hours. Other symptoms can last for longer.

Signs and tests

A neurological examination may show problems with hearing, balance, or eye movement.

A procedure called caloric stimulation tests eye reflexes by warming and cooling the inner ear with water. Abnormal results on this test can be a sign of Meniere's disease.

Additional tests done to distinguish Meniere's disease from other causes of vertigo may include:

• Evoked potential studies
• Electronystagmography
• Head CT scan or head MRI scan
• Hearing tests (audiology/audiometry)

Treatment

There is no known cure for Meniere's disease. The goal of treatment is to reduce pressure in the inner ear and relieve symptoms.

Medications such as antihistamines, anticholinergics, are used but are rarely effective.

Water pills (diuretics) may help relieve fluid pressure in the inner ear. A low-salt diet to reduce fluid retention may also help (See: Sodium in diet)

Medicines called antiemetics may be prescribed for nausea and vomiting. Symptoms such as dizziness, and vertigo may respond to sedative/hypnotics and benzodiazepines such as diazepam.

Ear surgery may be required if symptoms are severe and do not respond to other treatment.

Hearing aids may be needed for severe hearing loss.

Avoid sudden movements that may aggravate symptoms. You may need help walking due to loss of balance during attacks.

Avoid bright lights, TV, and reading during attacks, which may make symptoms worse. Rest during severe episodes, and gradually increase activity.

Avoid hazardous activities such as driving, operating heavy machinery, climbing, and similar activities until 1 week after symptoms disappear.

Expectations (prognosis)

The outcome varies. Meniere's disease can often be controlled with treatment. Recovery may occur spontaneously. However, the disorder may be chronic or disabling.

Complications

• Inability to walk or function due to uncontrollable vertigo
• Hearing loss on the affected side

Calling your health care provider

Call for an appointment with your health care provider if symptoms of Meniere's disease, such as hearing loss, ringing in the ears, or dizziness, occur or worsen.

Prevention

There is no known prevention for Meniere's disease, but prompt treatment of ear infection and other related disorders may be helpful.

Tachycardia

Definition

Tachycardia is a fast or irregular heart rhythm, usually more than 100 beats per minute and as many as 400 beats per minute. At these elevated rates, the heart is not able to efficiently pump oxygen-rich blood to your body.

Tachycardia can occur in either the upper heart chambers (atrial tachycardia) or lower heart chambers (ventricular tachycardia).

Causes

Causes of tachycardia include:

• Heart-related conditions such as high blood pressure (hypertension)
• Poor blood supply to the heart muscle due to coronary artery disease (atherosclerosis), heart valve disease, heart failure, heart muscle disease (cardiomyopathy), tumors, or infections
• Other medical conditions such as thyroid disease, certain lung diseases, electrolyte imbalance, and alcohol or drug abuse
• Emotional stress or drinking large amounts of alcoholic or caffeinated beverages

Symptoms

Symptoms of tachycardia include:

• Shortness of breath
• Dizziness
• Sudden weakness
• Fluttering in the chest
• Lightheadedness
• Fainting

Risk Factors

Certain conditions can increase your risk of developing tachycardia:

• Coronary artery disease (atherosclerosis)
• Heart failure (poor pumping heart)
• Heart attack (myocardial infarction)
• Congenital heart defects (condition you are born with)
• Inflammatory or degenerative heart conditions
• Chronic lung disease

Treatments

There are several treatment options available for people who experience tachycardia. Tachycardia can be ventricular (in the lower chambers of the heart) or atrial (in the upper chambers of the heart). Your heart doctor will determine the treatment that's best for your condition.

Ventricular Tachycardia Treatments

• Medications
• Implantable cardioverter defibrillator (ICD)

Ventricular Fibrillation Treatments

• External defibrillation
• Implantable cardioverter defibrillator (ICD)
• Medications

Atrial Flutter Treatments

• Medications

Atrial Fibrillation Treatments

• Medications
• Cardiac catheter ablation
• Cardioversion
• Implantable cardioverter defibrillator (ICD)
• Surgery

Your doctor may also discuss lifestyle changes with you.

Coma

 What do you think about when you hear the word coma (say: ko-muh)? Does it make you think of someone in a deep sleep, or the way you feel after eating too much Thanksgiving turkey? Does the word remind you of a TV soap opera, where it seems that at least one character is always in a coma?

A coma can be difficult to understand, especially because people sometimes jokingly use the words coma and comatose (say: ko-muh-tose, which means in a coma or coma-like state) to describe people who aren't paying attention or who are drowsy or sleeping. But a coma is a serious condition that has nothing to do with sleep.

What Happens When Someone Is in a Coma?

Someone who is in a coma is unconscious and will not respond to voices, other sounds, or any sort of activity going on nearby. The person is still alive, but the brain is functioning at its lowest stage of alertness. You can't shake and wake up someone who is in a coma like you can someone who has just fallen asleep.

What Can Cause a Coma?

Comas can be caused by different things, including:

• a severe injury to the head that hurts the brain
• seizures
• infections involving the brain
• brain damage caused by a lack of oxygen for too long
• an overdose (taking too much) of medicine or other drugs
• a stroke
• Swelling
• Poisons

When one of these things happens, it can mess up how the brain's cells work. This can hurt the parts of the brain that make someone conscious, and if those parts stop working, the person will stay unconscious.

How is coma assessed?

• When a patient presents in coma, diagnosis and treatment begin simultaneously. Initial treatment is aimed at addressing immediate life-threatening issues:

• Are the ABCs intact? Is the patient's airway open? Are they breathing? Do they have good circulation (a heart beat and blood pressure)?
• Is the patient hypoglycemic? The blood sugar is checked by a quick fingerstick bedside test and if it is low, glucose is administered.
  
• Did the patient ingest a narcotic?Naloxone (Narcan) may be given intravenously to reverse an overdose situation.

History remains the important key to the diagnosis. Since the patient cannot be the source of information, questions are asked of family, friends, bystanders, and rescue personnel. For example, a person sitting at a bar fell down, hit his head and is in coma. While it might be easy to jump to the conclusion that he was intoxicated, fell, and bled in his brain, other scenarios need to be considered. Did he have a heart attack, did he suffer a stroke, or was this a diabetic medication reaction and the blood sugar is low.

Once the patient has been stabilized with acceptable vital signs, physical examination will include a complete neurologic assessment. From head to toe, this may include examination of the eyes, pupils, face movements to assess cranial nerves including facial movement and gag reflex, extremity movement and reaction to stimulation, tendon reflexes and other testing of spinal cord function. There is special attention paid to symmetry in the neurology exam, since lack of movement or response on one side of the body may be caused by bleeding inside the skull or by stroke. General examination surveys the skin for cuts, scrapes, wounds, etc.

The GCS score will be documented; the deeper the coma, the lower the score. Please appreciate that a person with a "normal" GCS of 15 still can be in coma. Once the initial screening physical examination complete, a more detailed exam will likely occur to include the lungs, the heart, and the abdomen. Repeated neurologic assessment is key to monitoring the status of the patient and decide if the coma is lightening or getting worse.

What tests are there for coma?

The strategy to decide which tests will help provide a diagnosis will depend upon the suspected cause. Many times, the cause involves many factors and the sequence of events will require serious detective work. Blood tests, electrocardiogram and CT scan of the head are most often obtained.

What is the outcome and prognosis for a patient in a coma?

Depending upon the diagnosis, the evaluation may be no more than assessing blood sugar, treating hypoglycemia, and having complete resolution of the situation. On the other hand, the cause of coma may be a catastrophic brain hemorrhage without hope for significant recovery. The outlook very much depends on the cause of the coma and the ability to correct the particular situation.

How Do People Take Care of Someone in a Coma?

Someone in a coma usually needs to be cared for in the intensive care unit (ICU) of the hospital. There, the person can get extra care and attention from doctors, nurses, and other hospital staff. They make sure the person gets fluids, nutrients, and any medicines needed to keep the body as healthy as possible. These are sometimes given through a tiny plastic tube inserted in a vein or through a feeding tube that brings fluids and nutrients directly to the stomach.

Some comatose people are unable to breathe on their own and need the help of a ventilator (say: ven-tih-lay-ter), a machine that pumps air into the lungs through a tube placed in the windpipe. The hospital staff also tries to prevent bedsores in someone who is comatose. Bedsores are open sores on the body that come from lying in one place for too long without moving at all.

It can be very upsetting and frustrating for a person's family to see someone they love in a coma, and they may feel scared and helpless. But they can help take care of the person. Taking time to visit the hospital and read to, talk to, and even play music for the patient are important because it's possible that the person may be able to hear what's going on, even if he or she can't respond.

What Happens After a Coma?

Usually, a coma does not last more than a few weeks. Sometimes, however, a person stays in a coma for a long time — even years — and will be able to do very little except breathe on his or her own.

Most people do come out of comas, however. Some of them are able to return to the normal lives they had before they got sick. On TV, someone in a coma usually wakes up right away, looks around, and is able to think and talk normally. But in real life, this rarely happens. When coming out of a coma, a person will often be confused and can only slowly respond to what's going on. It will take time for the person to start feeling better.

Whether someone fully returns to normal after being in a coma depends on what caused the coma and how badly the brain may have been hurt. Sometimes people who come out of comas are just as they were before — they can remember what happened to them before the coma and can do everything they used to do. Other people may need therapy to relearn basic things like tying their shoes, eating with a fork or spoon, or learning to walk all over again. They may also have problems with speaking orremembering things.

Over time and with the help of therapists, however, many people who have been in a coma can make a lot of progress. They may not be exactly like they were before the coma, but they can do a lot of things and enjoy life with their family and friends.