Painkillers may kill you!!

Painkiller (analgesic) is any medicine intended to relieve pain. Over-the-counter analgesics-that is, painkillers available without a prescription-include aspirin, acetaminophen, ibuprofen, naproxen sodium, and others. These drugs present no danger for most people when taken in the recommended dosage. But some conditions make taking even these common painkillers dangerous for the kidneys. Also, taking one of these drugs regularly over a long period of time may increase the risk for kidney problems. Most drugs that can cause kidney damage are excreted only through the kidneys. That is, they are not broken down by the liver, as alcohol is, or passed out of the body through the digestive tract.

 

Analgesic use has been associated with two different forms of kidney damage: acute renal failure and a type of chronic kidney disease called analgesic nephropathy.

Acute Kidney Failure

Some patient case reports have attributed incidents of sudden-onset acute kidney failure to the use of over-the-counter painkillers, including aspirin, ibuprofen, and naproxen sodium. Some of these patients experienced acute illnesses involving fluid loss or decreased fluid intake. Other patients in these reports had risk factors such as systemic lupus erythematosus, advanced age, chronic kidney disease, or recent heavy alcohol consumption. These cases involved a single dose in some instances and generally short-term analgesic use of not more than 10 days.
Acute kidney failure requires emergency dialysis to clean the blood. Kidney damage is frequently reversible, with normal kidney function returning after the emergency is over and the analgesic use is stopped.

Analgesic Nephropathy

A second form of kidney damage, called analgesic nephropathy, can result from taking painkillers every day for several years. Analgesic nephropathy is a chronic kidney disease that over years gradually leads to irreversible kidney failure and the permanent need for dialysis or a kidney transplant to restore kidney function. Researchers estimate that four out of 100,000 people will develop analgesic nephropathy. It is most common in women over 30.
The painkiller phenacetin has been taken off the market because of its association with analgesic nephropathy. Recent studies have suggested that longstanding daily use of analgesics such as acetaminophen or ibuprofen may also increase the risk of chronic kidney damage, but this evidence is not as clear.
In view of these findings, people with conditions that put them at risk for acute kidney failure should check with their health care provider before taking any analgesic medicine. People who take over-the-counter painkillers regularly should check with their primary care physician to make sure the drugs are not hurting their kidneys. The physician may be able to recommend a safer alternative and can order regular tests to monitor their kidney function.

Treatment

If you have been taking analgesics regularly to control chronic pain, you may be advised to find new ways to treat your pain, such as behavior modification or relaxation techniques. Depending on how much your kidney function has declined, you may be advised to change your diet, limit the fluids you drink, or take medications to avoid anemia and bone problems caused by kidney disease. Your doctor will monitor your kidney function with regular urine and blood tests.

Why do we cry when we laugh too hard?

  We cry when we're sad but why do we cry when we're overjoyed by something? Being sad and happy are two complete different thing. But we're also very emotional when we're very happy and very sad. Crying is a intense emotional response. When feelings overwhelm us, they show as tears.

We cry because when we laugh we put pressure on our tear ducts, so it forces the tears to come out.  Or in more biological way  tears also accompany the body's return to homeostasis after extreme excitation. So after a big laughing jag, tears are a sign that the body is returning to normal.

Acne Treatment

Acne is a skin condition that causes pimples or "zits." This includes whiteheads, blackheads, and red, inflammed patches of skin (such as cysts).

Causes, incidence, and risk factors

Acne occurs when tiny holes on the surface of the skin become clogged. These holes are called pores.

• Each pore opens to a follicle. A follicle contains a hair and an oil gland. The oil released by the gland helps remove old skin cells and keeps your skin soft.
• When glands produce too much oil, the pores can become blocked. Dirt, bacteria, and cells build up. The blockage is called a plug or comedone.
• If the top of the plug is white, it is called a whitehead.
• If the top of the plug is dark, it is called a blackhead.
• If the plug breaks open, swelling and red bumps occur.
• Acne that is deep in your skin can cause hard, painful cysts. This is called cystic acne.

Acne is most common in teenagers, but anyone can get acne, even babies. Three out of four teenagers have some acne. Hormonal changes may cause the skin to be more oily.
Acne tends to run in families. It may be triggered by:

• Hormonal changes related to puberty, menstrual periods, pregnancy, birth control pills, or stress
• Greasy or oily cosmetic and hair products
• Certain drugs (such as steroids, testosterone, estrogen, and phenytoin)
• High levels of humidity and sweating

Research does not show that chocolate, nuts, and greasy foods cause acne. However, diets high in refined sugars may be related to acne.

Symptoms

Acne commonly appears on the face and shoulders, but it may also occur on the trunk, arms, legs, and buttocks.

• Blackheads
• Crusting of skin bumps
• Cysts
• Papules (small red bumps)
• Pustules
• Redness around the skin eruptions
• Scarring of the skin
• Whiteheads

Signs and tests

Your doctor can diagnose acne by looking at your skin. Testing is usually not needed.

Treatment

SELF-CARE
Steps you can take to help your acne:

• Clean your skin gently with a mild, nondrying soap (such as Dove, Neutrogena, Cetaphil, CeraVe, or Basics). Remove all dirt or make-up. Wash once or twice a day, including after exercising. However, avoid scrubbing or repeated skin washing.
• Shampoo your hair daily, especially if it is oily. Comb or pull your hair back to keep the hair out of your face.

What NOT to do:

• Try not to squeeze, scratch, pick, or rub the pimples. Although it might be tempting to do this, it can lead to skin infections and scarring.
• Avoid wearing tight headbands, baseball caps, and other hats
• Avoid touching your face with your hands or fingers.
• Avoid greasy cosmetics or creams. Take off make-up at night. Look for water-based or "noncomedogenic" formulas. Noncomedogenic products have been tested and proven not to clog pores and cause acne.

If these steps do not clear up the blemishes, try over-the-counter acne medications. You apply these products directly to your skin.

• They may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid.
• They work by killing bacteria, drying up skin oils, or causing the top layer of your skin to peel.
• They may cause redness or peeling of the skin.

A small amount of sun exposure may improve acne a little, but mostly it just hides the acne. However, too much exposure to sunlight or ultraviolet rays is not recommended because it increases the risk for skin cancer.

PRESCRIPTION MEDICINES
If pimples are still a problem, a health care provider can prescribe stronger medications and discuss other options with you.
Antibiotics may help some people with acne:

• Oral antibiotics (taken by mouth) such as tetracycline, doxycycline, minocycline, erythromycin, trimethoprim, and amoxicillin
• Topical antibiotics (applied to the skin) such as clindamycin, erythromycin, or dapsone

Creams or gels applied to the skin may be prescribed:

• Retinoic acid cream or gel (tretinoin, Retin-A)
• Prescription formulas of benzoyl peroxide, sulfur, resorcinol, or salicylic acid
• Topical azelaic acid

For women whose acne is caused or made worse by hormones:

• A pill called spironolactone may help
• Birth control pills may help in some cases, though they may make acne worse

Minor procedures or treatments may also be helpful:

• A laser procedure called photodynamic therapy
• Your doctor may also suggest chemical skin peeling, removal of scars by dermabrasion, or removal, drainage, or injection of cysts with cortisone

People who have cystic acne and scarring may try a medicine called isotretinoin (Accutane). You will be watched closely when taking this medicine because of its side effects.
Pregnant women should NOT take Accutane, because it causes severe birth defects. Women taking Accutane must use two forms of birth control before starting the drug and enroll in the iPledge program. Your doctor will follow you on this drug and you will have regular blood tests.

Expectation

Acne usually goes away after the teenage years, but it may last into middle age. The condition often responds well to treatment after 6 - 8 weeks, but it may flare up from time to time.
Scarring may occur if severe acne is not treated. Some people, especially teenagers, can become very depressed if acne is not treated.

References

Acne, rosacea, and related disorders. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 7.

Sinusitis

Sinusitis is inflammation of the sinuses that occurs with an infection from a virus, bacteria, or fungus.

  Causes, incidence, and risk factors

The sinuses are air-filled spaces in the skull (behind the forehead, nasal bones, cheeks, and eyes). Healthy sinuses contain no bacteria or other germs. Usually, mucus is able to drain out and air is able to circulate.
When the sinus openings become blocked or too much mucus builds up, bacteria and other germs can grow more easily.
Sinusitis can occur from one of these conditions:

• Small hairs (cilia) in the sinuses, which help move mucus out, do not work properly due to some medical conditions.
• Colds and allergies may cause too much mucus to be made or block the opening of the sinuses.
• A deviated nasal septum, nasal bone spur, or nasal polyps may block the opening of the sinuses.

Sinusitis can be called:

• Acute, when symptoms are present for 4 weeks or less. It is caused by bacteria growing in the sinuses.
• Chronic, when swelling and inflammation of the sinuses are present for longer than 3 months. It may be caused by bacteria or a fungus.

The following may increase your risk or your child's risk of developing sinusitis:

• Allergic rhinitis or hay fever
• Cystic fibrosis
• Day care
• Diseases that prevent the cilia from working properly
• Changes in altitude (flying or scuba diving)
• Large adenoids
• Smoking
• Weakened immune system from HIV or chemotherapy

Symptoms

The symptoms of acute sinusitis in adults usually follow a cold that does not improve, or one that gets worse after 5 - 7 days of symptoms. Symptoms include:

• Bad breath or loss of smell
• Cough, often worse at night
• Fatigue and generally not feeling well
• Fever
• Headache -- pressure-like pain, pain behind the eyes, toothache, or tenderness of the face
• Nasal stuffiness and discharge
• Sore throat and postnasal drip

Symptoms of chronic sinusitis are the same as those of acute sinusitis, but tend to be milder and last longer than 12 weeks.
Symptoms of sinusitis in children include:

• Cold or respiratory illness that has been improving and then begins to get worse
• High fever, along with a darkened nasal discharge, for at least 3 days
• Nasal discharge, with or without a cough, that has been present for more than 10 days and is not improving

Signs and tests

The doctor will examine you or your child for sinusitis by:

• Looking in the nose for signs of polyps
• Shining a light against the sinus (transillumination) for signs of inflammation
• Tapping over a sinus area to find infection

Regular x-rays of the sinuses are not very accurate for diagnosing sinusitis.

Viewing the sinuses through a fiberoptic scope (called nasal endoscopy or rhinoscopy) may help diagnose sinusitis. This is usually done by doctors who specialize in ear, nose, and throat problems (ENTs).
Imaging tests that may be used to decide on treatment are:

• A CT scan of the sinuses to help diagnose sinusitis or view the bones and tissues of the sinuses more closely
• An MRI of the sinuses if there might be a tumor or fungal infection

If you or your child has sinusitis that does not go away or keeps returning, other tests may include:

• Allergy testing
• Blood tests for HIV or other tests for poor immune function
• Ciliary function tests
• Nasal cultures
• Nasal cytology
• Sweat chloride tests for cystic fibrosis

Treatment

SELF CARE
Try the following measures to help reduce congestion in your sinuses:

• Apply a warm, moist washcloth to your face several times a day.
• Drink plenty of fluids to thin the mucus.
• Inhale steam 2 - 4 times per day (for example, while sitting in the bathroom with the shower running).
• Spray with nasal saline several times per day.
• Use a humidifier.
• Use a Neti pot to flush the sinuses.

Be careful with over-the-counter spray nasal decongestants. They may help at first, but using them for more than 3 - 5 days can make nasal stuffiness worse.
Also, for sinus pain or pressure:

• Avoid flying when you are congested.
• Avoid temperature extremes, sudden changes in temperature, and bending forward with your head down.
• Try acetaminophen or ibuprofen.

MEDICATIONS AND OTHER TREATMENTS
Antibiotics are usually not needed for acute sinusitis. Most of these infections go away on their own. Even when antibiotics do help, they may only slightly reduce the time you or your child is sick. Antibiotics may be prescribed sooner for:

• Children with nasal discharge, possibly with a cough, that is not getting better after 2 - 3 weeks
• Fever higher than 102.2° Fahrenheit (39° Celsius)
• Headache or pain in the face
• Severe swelling around the eyes

Acute sinusitis should be treated for 10 - 14 days. Chronic sinusitis should be treated for 3 - 4 weeks. Some people with chronic sinusitis may need special medicines to treat fungal infections.
At some point, your doctor will consider:

• Other prescription medications
• More testing
• Referral to an ear, nose, and throat (ENT) or allergy specialist

Other treatments for sinusitis include:

• Allergy shots (immunotherapy) to help prevent the disease from returning
• Avoiding allergy triggers
• Nasal corticosteroid sprays and antihistamines to decrease swelling, especially if there are nasal polyps or allergies

Surgery to enlarge the sinus opening and drain the sinuses may also be needed, especially in patients whose symptoms do not go away after 3 months of treatment, or in patients who have more than two or three episodes of acute sinusitis each year. An ENT specialist (also known as an otolaryngologist) can perform this surgery.
Most fungal sinus infections need surgery. Surgery to repair a deviated septum or nasal polyps may prevent the condition from returning.

Expectations (prognosis)

Sinus infections can usually be cured with self-care measures and medical treatment. If you are having repeated attacks, you should be checked for causes such as nasal polyps or other problems, such as allergies.

Complications

Although very rare, complications may include:

• Abscess
• Bone infection (osteomyelitis)
• Meningitis
• Skin infection around the eye (orbital cellulitis)

Calling your health care provider

Call your doctor if:

• Your symptoms last longer than 10 - 14 days or you have a cold that gets worse after 7 days
• You have a severe headache that is not relieved by over-the-counter pain medicine
• You have a fever
• You still have symptoms after taking all of your antibiotics properly
• You have any changes in your vision during a sinus infection

A green or yellow discharge does not mean that you definitely have a sinus infection or need antibiotics.

Prevention

The best way to prevent sinusitis is to avoid or quickly treat flus and colds:

• Eat plenty of fruits and vegetables, which are rich in antioxidants and other chemicals that could boost your immune system and help your body resist infection.
• Get an influenza vaccine each year.
• Reduce stress.
• Wash your hands often, particularly after shaking hands with others.

Other tips for preventing sinusitis:

• Avoid smoke and pollutants.
• Drink plenty of fluids to increase moisture in your body.
• Take decongestants during an upper respiratory infection.
• Treat allergies quickly and appropriately.
• Use a humidifier to increase moisture in your nose and sinuses.

Spinal Stenosis

Spinal stenosis is narrowing of the spinal column that causes pressure on the spinal cord, or narrowing of the openings (called neural foramina) where spinal nerves leave the spinal column.

 

 

Causes, incidence, and risk factors

Spinal stenosis usually occurs as a person ages and the disks become drier and start to bulge. At the same time, the bones and ligaments of the spine thickens or grow larger due to arthritis or long-term swelling (inflammation).
Spinal stenosis may also be caused by:

• Arthritis of the spine, usually in middle-aged or elderly people
• Bone diseases, such as Paget's disease of bone and achondroplasia
• Defect or growth in the spine that was present from birth (congenital defect)
• Herniated or slipped disk, which often happened in the past
• Injury that causes pressure on the nerve roots or the spinal cord
• Tumors in the spine.
  
  
  
  
  
  

  Cervical Stenosis

  It may cause pain as well as tingling or numbness that radiates from the neck, down the shoulders and into the arms and hands. Pressure on the spinal cord, as it runs through the cervical spine, can cause weakness and spasticity in the arms and legs, called cervical spondylotic myelopathy. Spasticity means you lose control over your muscles and have difficulty walking, placing your feet, or dropping objects. You may have trouble with balance and coordination such as shuffling or tripping while walking. 
  
  

  Thoracic Stenosis

  Thoracic spinal stenosis occurs when the spinal canal in the middle part of your back becomes narrowed. This creates pressure on your spine and can cause pain in your back and legs, loss of bladder or bowel function, and problems with balance. It is a rare condition. 
  
  

  Lumbar Spinal Stenosis

   Lumbar spinal stenosis occurs when the spinal canal in your lower back becomes narrowed. This creates pressure on your spine and can cause pain, weakness, or numbness in your lower back, buttocks, legs, and feet. It is a common condition as people age, and it is most often caused by arthritis in the spine.

 

Symptoms

Often, symptoms will get worse slowly over time. Most often, symptoms will be on one side of the body or the other, but may involve both legs.
Symptoms include:

• Numbness, cramping, or pain in the back, buttocks, thighs, or calves, or in the neck, shoulders, or arms
• Weakness of part of a leg or arm

Symptoms are more likely to be present or get worse when you stand or walk. They will often lessen or disappear when you sit down or lean forward. Most people with spinal stenosis cannot walk for a long period of time.
Patients with spinal stenosis may be able to ride a bicycle with little pain.
More serious symptoms include:

• Difficulty or poor balance when walking
• Problems controlling urine or bowel movements

Signs and tests

During the physical exam, your doctor will try to find the location of the pain and figure out how it affects your movement. You will be asked to:

• Sit, stand, and walk. While you walk, your doctor may ask you to try walking on your toes and then your heels.
• Bend forward, backward, and sideways
• Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs.

Your doctor will also move your legs in different positions, including bending and straightening your knees. All the while, the doctor is checking your strength and your ability to move.
To test nerve function, the doctor will use a rubber hammer to check your reflexes. Touching your legs in many places with a pin, cotton swab, or feather tests how well you feel. Your doctor will tell you to speak up if there are areas where you have less feeling from the pin, cotton, or feather.
A brain and nervous system (neurological) examination can confirm leg weakness and decreased sensation in the legs. The following tests may be done:

• EMG
• Spinal MRI or spinal CT scan
• X-ray of the spine

Treatment

When your back pain does not go away, or it gets more painful at times, learning to take care of your back at home and prevent repeat episodes of your back pain can help you avoid surgery.
Your doctor and other health professionals will help you manage your pain and keep you as active as possible.

• Your doctor may refer you for physical therapy. The physical therapist will help you try to reduce your pain, using stretches. The therapist will show you how to do exercises that make your neck muscles stronger.
• You may also see a massage therapist, and someone who performs acupuncture. Sometimes a few visits will help your back or neck pain.
• Cold packs and heat therapy may help your pain during flare-ups.
• A number of different medications can help with your back pain. See also: Medicines for chronic pain

A type of talk therapy called cognitive behavioral therapymay be helpful if the pain is having a serious impact on your life. This technique helps you better understand your pain and teaches you how to manage back pain.
SURGERY
If the pain does not respond to these treatments, or you lose movement or feeling, you may need surgery. Surgery is done to relieve pressure on the nerves or spinal cord.
You and your doctor can decide when you need to have surgery for these symptoms. Spinal stenosis symptoms often become worse over time, but this may happen very slowly.

• People who had long-term back pain before their surgery are likely to still have some pain afterwards. Spinal fusion probably will not take away all the pain and other symptoms.
• Even when using MRI scans or other tests, it is hard for your surgeon to always predict whether you will improve and how much relief surgery will provide.

For more information about how surgery is done and who is most likely to benefit, see also:

• Foraminotomy
• Laminectomy
• Spinal fusion

Expectations (prognosis)

Many people with spinal stenosis are able to be active for many years with the condition, although they may need to make some changes in their activities or work.

Spine surgery will often partly or fully relieve symptoms. However, people who had long-term back pain before their surgery are still likely to have some pain afterward. Spinal fusion probably will not take away all of the pain and other symptoms.
Spine problems are possible after spine surgery. The area of the spinal column above and below a spinal fusion are more likely to be stressed when the spine moves. Also, if you needed more than one kind of back surgery (such as laminectomy and spinal fusion), you may be more likely to have future problems.

Complications

A lack of feeling can make you more likely to injure your legs or feet. Infections may get worse because you may not feel the pain. Changes caused by pressure on the nerves may be permanent, even if the pressure is relieved.