Kidney Function

A major function of the kidneys is to remove waste products and excess fluid from the body. These waste products and excess fluid are removed through urine.

The production of urine involves highly complex steps of excretion and reabsorption. This process is necessary to maintain a stable balance of body chemicals.

The critical regulation of the body’s salt, potassium, and acid content is performed by the kidneys. The kidneys also produce hormones and vitamins that affect the function of other organs. For example, a hormone produced by the kidneys stimulates red blood cell production. In addition, other hormones produced by the kidneys help regulate blood pressure and others help control calcium metabolism.

There are two kidneys, each about the size of a fist, located on either side of the spine at the lowest level of the rib cage. Each kidney contains about one million functioning units, called nephrons.

A nephron consists of a filtering unit of tiny blood vessels, called a glomerulus, attached to a tubule. When blood enters the glomerulus, it is filtered and the remaining fluid passes along the tubule. In the tubule, chemicals and water are either added to or removed from this filtered fluid, according to the body’s needs, with the final product being the urine we excrete.

As part of the urinary tract system, the human body contains two kidneys whose vital functions include processing urine and removing waste products and excess fluid from the body. In addition, the kidneys assist in maintaining healthy blood pressure by releasing a chemical into the bloodstream. When kidney disease strikes, the initial symptoms may be mild and the individual may not realize he has a problem.

Many people who have chronic kidney disease don’t know it, because the early signs can be very subtle. It can take many years to go from chronic kidney disease (CKD) to kidney failure. Some people with CKD live out their lives without ever reaching kidney failure.

However, for people at any stage of kidney disease, knowledge is power. Knowing the symptoms of kidney disease can help you get the treatment you need to feel your best. If you or someone you know has one or more of the following symptoms of kidney disease, or you are worried about kidney problems, see a doctor for blood and urine tests. Remember, many of the symptoms can be due to reasons other than kidney disease.

The only way to know the cause of your symptoms is to see your doctor.

Symptom 1: Changes in Urination

Kidneys make urine, so when the kidneys are failing, the urine may change. How?

• You may have to get up at night to urinate.
• Urine may be foamy or bubbly. You may urinate more often, or in greater amounts than usual, with pale urine.
• You may urinate less often, or in smaller amounts than usual with dark colored urine.
• Your urine may contain blood.
  

  

• You may feel pressure or have difficulty urinating.

What patients said:

“When you go to use the restroom, you couldn’t get it all out. And it would still feel just like tightness down there, there was so much pressure.”

“My urine is what I had started noticing. Then I was frequently going to the bathroom, and when I got there, nothing’s happening. You think, ‘Hey, I’ve got to go to the john,’ and you get there: two, three drops.”

“I was passing blood in my urine. It was so dark it looked like grape Kool-Aid. And when I went to the hospital they thought I was lying about what color it was.”

Symptom 2: Swelling

Failing kidneys don’t remove extra fluid, which builds up in your body causing swelling in the legs, ankles, feet, face, and/or hands.

What patients said:

“I remember a lot of swelling in my ankles. My ankles were so big I couldn’t get my shoes on.”

“My sister, her hair started to fall out, she was losing weight, but her face was really puffy, you know, and everything like that, before she found out what was going on with her.”

“Going to work one morning, my left ankle was swollen, real swollen, and I was very exhausted just walking to the bus stop. And I knew then that I had to see a doctor.”

Symptom 3: Fatigue

Healthy kidneys make a hormone called erythropoietin (a-rith’-ro-po’-uh-tin) that tells your body to make oxygen-carrying red blood cells. As the kidneys fail, they make less erythropoietin. With fewer red blood cells to carry oxygen, your muscles and brain become tired very quickly. This condition is called anemia, and it can be treated.

What patients said:

“I was constantly exhausted and didn’t have any pep or anything.”

“I would sleep a lot. I’d come home from work and get right in that bed.”

“It’s just like when you’re extremely tired all the time. Fatigued, and you’re just drained, even if you didn’t do anything, just totally drained.”

Symptom 4: Skin Rash/Itching

Kidneys remove wastes from the bloodstream. When the kidneys fail, the buildup of wastes in your blood can cause severe itching.

What patients said:

“It’s not really a skin itch or anything, it’s just right down to the bone. I had to get a brush and dig. My back was just bloody from scratching it so much.”

“My skin had broke out, I was itching and scratching a lot.”

Symptom 5: Metallic Taste in Mouth/Ammonia Breath

A buildup of wastes in the blood (called uremia) can make food taste different and cause bad breath. You may also notice that you stop liking to eat meat, or that you are losing weight because you just don’t feel like eating.

What patients said:

“Foul taste in your mouth. Almost like you’re drinking iron.”

“You don’t have the appetite you used to have.”

“Before I started dialysis, I must have lost around about 10 pounds.”

Symptom 6: Nausea and Vomiting

A severe buildup of wastes in the blood (uremia) can also cause nausea and vomiting. Loss of appetite can lead to weight loss.

What patients said:

“I had a lot of itching, and I was nauseated, throwing up all the time. I couldn’t keep anything down in my stomach.”

“When I got the nausea, I couldn’t eat and I had a hard time taking my blood pressure pills.”

Symptom 7: Shortness of Breath

Trouble catching your breath can be related to the kidneys in two ways. First, extra fluid in the body can build up in the lungs. And second, anemia (a shortage of oxygen-carrying red blood cells) can leave your body oxygen-starved and short of breath.

What patients said:

“At the times when I get the shortness of breath, it’s alarming to me. It just fears me. I think maybe I might fall or something so I usually go sit down for awhile.”

“I couldn’t sleep at night. I couldn’t catch my breath, like I was drowning or something. And, the bloating, can’t breathe, can’t walk anywhere. It was bad.”

“You go up a set of stairs and you’re out of breath, or you do work and you get tired and you have to stop.”

Symptom 8: Feeling Cold

Anemia can make you feel cold all the time, even in a warm room.

What patients said:

“I notice sometimes I get really cold, I get chills.”

“Sometimes I get really, really cold. It could be hot, and I’d be cold.”

Symptom 9: Dizziness and Trouble Concentrating

Anemia related to kidney failure means that your brain is not getting enough oxygen. This can lead to memory problems, trouble with concentration, and dizziness.

What patients said:

“I know I mentioned to my wife that my memory—I couldn’t remember what I did last week, or maybe what I had 2 days ago. I couldn’t really concentrate, because I like to work crossword puzzles and read a lot.”

“I was always tired and dizzy.”

“It got to the point, like, I used to be at work, and all of the sudden I’d start getting dizzy. So I was thinking maybe it was my blood pressure or else diabetes was going bad. That’s what was on my mind.”

Symptom 10: Leg/Flank Pain

Some people with kidney problems may have pain in the back or side related to the affected kidney. Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause pain.

What patients said:

“About 2 years ago, I was constantly going to the bathroom all the time, the lower part of my back was always hurting and I was wondering why…and they diagnosed that kidney problem.”

“And then you’re having to get up all time through the night, and then you have the side ache, a backache, and you can’t move.”

“At night, I would get a pain in my side. It was worse than labor pain. And I’d be crying and my husband would get up, everybody, rubbing my legs.”

Treatment of Kidney Diseases

Some kidney disease can be successfully treated and others progress to advanced kidney failure, requiring dialysis and/or transplantation.

For example, kidney infections and kidney stones can often be successfully treated. Chronic inflammation of the glomerulus (glomerulonephritis) is the most common kidney disease, which slowly progresses to kidney failure.

Your doctor may recommend certain medications or suggest a specific diet for you.

Questions To Ask Your Doctor About Kidney Diseases

Are there any tests that need to be done to diagnose the kidney problem?

Are there any risks or side effects associated with these tests?

What caused the problem?

What type of kidney disease is it?

How serious is this condition?

What are the chances this could progress to kidney failure?

What type of treatment will you be recommending?

How effective is this treatment?

What should be expected from this treatment?

Are there any alternative treatments?

Will you be prescribing any medication?

What are the side effects?

This list of common cancer types includes cancers that are diagnosed with the greatest frequency in the United States, excluding nonmelanoma skin cancers. Cancer incidence and mortality statistics reported by the American Cancer Society¹ and other resources were used to create the list. To qualify as a common cancer, the estimated annual incidence for 2010 had to be 40,000 cases or more.

The most common type of cancer on the list is lung cancer, with more than 222,000 new cases expected in the United States in 2010. The cancer with the lowest incidence is leukemia. Leukemia as a cancer type includes acute lymphoblastic (or lymphoid) leukemia, chronic lymphocytic leukemia, acute myeloid leukemia, chronic myelogenous (or myeloid) leukemia, and other forms of leukemia. It is estimated that 43,050 new cases of leukemia will be diagnosed in the United States in 2010, with chronic lymphocytic leukemia being the most common type (approximately 14,990 new cases).

Because colon and rectal cancers are often referred to as “colorectal cancers,” these two cancer types are combined for the list. For 2010, the estimated number of new cases of colon cancer and rectal cancer are 102,900 and 39,670, respectively, adding to a total of 142,570 new cases of colorectal cancer.

Kidney cancers can be divided into two major groups, renal parenchyma cancers and renal pelvis cancers. Approximately 85 percent of kidney cancers develop in the renal parenchyma,² and nearly all of these cancers are renal cell cancers. The estimated number of new cases of renal cell cancer for 2010 is 49,504.

The following table gives the estimated numbers of new cases and deaths for each common cancer type:

References

1. American Cancer Society: Cancer Facts and Figures 2010. Atlanta, Ga: American Cancer Society, 2010.
2. Lipworth L, Tarone RE, McLaughlin JK: The epidemiology of renal cell carcinoma. Journal of Urology 176(6 pt 1):2353-2358, 2006.

What is lung cancer?

Lung cancer is a disease of uncontrolled cell growth in tissues of the lung. This growth may lead to metastasis, which is the invasion of adjacent tissue and infiltration beyond the lungs. The vast majority of primary lung cancers are carcinomas of the lung, derived from epithelial cells. Lung cancer, the most common cause of cancer-related death in men and women, is responsible for 1.3 millions deaths worldwide annually, as of 2004. The most common symptoms are shortness of breath, coughing (including coughing up blood), and weight loss.

The main types of lung cancer are small cell lung carcinoma and non-small cell lung carcinoma. This distinction is important, because the treatment varies; non-small cell lung carcinoma (NSCLC) is sometimes treated with surgery, while small cell lung carcinoma (SCLC) usually responds better to chemotherapy and radiation. The most common cause of lung cancer is long-term exposure to tobacco smoke. The occurrence of lung cancer in nonsmokers, who account for as many as 15% of cases, is often attributed to a combination of genetic factors, radon gas, asbestos and air pollution, including secondhand smoke.

Lung cancer may be seen on chest radiograph and computed tomograph (CT scan). The diagnosis is confirmed with a biopsy. This is usually performed by bronchoscopy or CT-guided biopsy. Treatment and prognosis depend upon the histological type of cancer, the stage (degree of spread), and the patient’s performance status. Possible treatments include surgery, chemotherapy, and radiotheraphy. Depending on the stage and treatment, the five-year survival rate is 14%.

Lung cancer starts when abnormal cells grow out of control in the lung. They can invade nearby tissues and form tumors. Lung cancer can start anywhere in the lungs and affect any part of the respiratory system.  The cancer cells can spread, or metastasize, to the lymph nodes and other parts of the body.

What causes lung cancer?

Most lung cancer is caused by smoking. Secondhand smoke also can cause lung cancer. Lung cancer is the leading cause of cancer deaths.  Being exposed to arsenic, asbestos, radioactive dust, or radon can increase your chances of getting lung cancer. People who are exposed to radiation at work or elsewhere have a higher chance of getting lung cancer.

What are the symptoms?

Early lung cancer doesn’t usually cause any symptoms. This is why it’s not usually found early.  In its advanced stage, cancer may affect how your lungs work. The first signs of lung cancer may include:

* Coughing.

* Wheezing.

* Feeling short of breath.

* Having blood in any mucus that you cough up.

If you have these symptoms and are worried about lung cancer, call your doctor.  Lung cancer may spread to the chest and then to other parts of the body. For example, if it spreads to the spine or bones, it may cause pain in the back or other bones or weakness in the arms or legs. If it spreads to the brain, it may cause seizures, headaches, or vision changes.

How is lung cancer diagnosed?

Your doctor will check your symptoms and ask questions about whether you smoke or have been exposed to another person’s smoke or to any cancer-causing substances. He or she will also ask about your medical history, including any history of cancer in your family. This information will help your doctor decide how likely it is that you have lung cancer and whether you need tests to be sure.  Lung cancer is usually first found on a chest X-ray or a CT scan. More tests are done to find out what kind of cancer cells you have and whether they have spread beyond your lung. These tests help your doctor and you find out what stage the cancer is in. The stage is a rating to measure how big the cancer is and how far it has spread.

How is it treated?

Treatment for lung cancer includes surgery, anti-cancer medicines (chemotherapy), radiation, or a mix of all three. It depends on what type of cancer you have and how much it has spread.  Few lung cancers are found in the early stages when treatment is most effective.  It can be very scary to learn that you may have lung cancer. Talking with your doctor or joining a support group may help you deal with your feelings. Having support from family and friends can help a lot. And staying as active as possible will also help.  Less than half of people who get lung cancer live 1 more year after the cancer is found. And only about 16 out of 100 people with lung cancer live for 5 or more years. It’s important to remember that everyone’s case is different and that these numbers may not show what will happen in your case.

Can you prevent lung cancer?

Lung cancer is one of the easiest cancers to prevent because most lung cancer is caused by smoking. So it is important to stop smoking—or to stop being around someone else’s smoke.  Even if you have smoked a long time, quitting can lower your chances of getting cancer. If you already have lung cancer, quitting makes your treatment work better and can help you live longer.

What is acute bronchitis?

Air is pulled into the lungs when we breathe, initially passing through the mouth, nose, and larynx (voicebox) into the trachea and continues en route to each lung via either the right or left bronchi (the bronchial tree – bronchi, bronchioles, and alveoli). Bronchi are formed as the lower part of the trachea divides into two tubes that lead to the lungs. As the bronchi get farther away from the trachea, each bronchial tube divides and gets smaller (resembling an inverted tree) to provide the air to lung tissue so that it can transfer oxygen to the blood stream and remove carbon dioxide (the waste product of metabolism).

Bronchitis describes inflammation of the bronchial tubes (inflammation = itis). The inflammation causes swelling of the lining of these breathing tubes, narrowing the tubes and promoting secretion of inflammatory fluid.

Acute bronchitis describes the inflammation of the bronchi usually caused by a viral infection, although bacteria and chemicals also may cause acute bronchitis. Bronchiolitis is a term that describes inflammation of the smaller bronchi referred to as bronchioles. In infants, this is usually caused by respiratory syncytial viruses (RSV), and affects the small bronchi and bronchioles more than the large. In adults, other viruses as well as some bacteria can cause bronchiolitis and often manifest as a persistent cough at times productive of small plugs of mucus.

Acute bronchitis is as mentioned above, is a cough that begins suddenly usually due to a viral infection involving the larger airways. Colds (also known as viral upper airway infections) often involve the throat (pharyngitis) and nasal passages, and at times the larynx (resulting in a diminished hoarse voices, also known as laryngitis). Symptoms can include a runny nose, nasal stuffiness, and sore throat. Croup usually occurs in infants and young children and involves the voice box and upper large airways (the trachea and large bronchi).

Chronic bronchitis for research purposes is defined as a daily cough with sputum production for at least three months, two years in a row. Chronic bronchitis is a diagnosis usually made based on clinical findings of a long term persistent cough usually associated with tobacco abuse. From a pathologic standpoint, characteristic microscopic findings involving inflammatory cells in seen in airway tissue samples make the diagnosis. When referring to pulmonary function testing, a decrease in the ratio of the volume of airflow at 1 second when compared to total airflow is less than 70%. This confirms the presence of obstructive airways disease of which chronic bronchitis is one type. Certain findings can be seen on imaging studies (chest X-ray, and CT or MRL og the lungs)4 to suggest the presence of chronic bronchitis; usually this involves an appearance of thickened tubes.

What causes acute bronchitis?

• Acute bronchitis occurs most often due to a viral infection that causes the inner lining of the bronchial tubes to become inflamed and undergo the changes that occur with any inflammation in the body. Common viruses include the rhinovirus, respiratory syncytial virus (RSV), and the influenza virus.
• Bacteria can also cause bronchitis (a few examples include, Mycoplasma, Pneumococcus, Klebsiella, Haemophilus).
• Chemical irritants (for example, tobacco smoke, gastric reflux, solvents) can cause acute bronchitis.

What are the risk factors for acute bronchitis?

Bronchitis describes inflammation of the bronchial tubes. Smoking is a key risk factor for developing acute bronchitis. Any other illnesses that predispose to similar inflammation also increase that risk (for example,asthma patients and patients allergic to airborne chemicals).

What are the symptoms of acute bronchitis?

Inflammation of the bronchial tubes narrows the inside opening of the bronchial tubes. Narrowing of the bronchial tubes result in increased resistance, this increase makes it more difficult for air to move to and from the lungs. This can cause wheezing, coughing, and shortness of breath. The cough may consist of sputum due to the secretions from the inflamed cells that line the bronchi. By coughing, the body attempts to expel secretions that clog the bronchial tubes. If these secretions contain certain inflammatory cells, discoloration of the mucus may result often in a green or yellow color. Sometimes the severity of the inflammation may result in some bleeding.

As with any other infection, there may be associated fever, chills, aches, soreness and the general sensation of feeling poorly or malaise.

When does a cold become acute bronchitis?

Anatomically, the larynx divides the upper and lower airways. Colds tend to affect the mouth, throat, and nasal passages while bronchitis describes specific inflammation of the bronchial tubes. The two illnesses can exist at the same time and may be caused by the same virus infection. A cold does not necessarily lead to bronchitis.

When should I call my doctor about my cough?

While a cough can be irritating and interfere with activities such as sleep, by itself, it needs little care. Drinking plenty of fluids to prevent dehydration, humidifying the air, and occasionally medication to suppress the cough are appropriate home care treatments.

However, medical care should be accessed immediately should shortness of breath occur. Fever, chills, wheezing, and signs of dehydration (lightheadedness, weakness, rapid heart rate) are also reasons to seek medical care. Most coughs tend to subside after a few days. If the cough persists and mucus tends to be discolored, one should seek medical care.

In patients with asthma, wheezing may increase with acute bronchitis. Use of a prescribed albuterol inhaler (Ventolin HFA, Proventil HFA, ProAir) is reasonable; however, asthma patients should contact their health care practitioner if the symptoms of wheezing and shortness of breath do not resolve promptly.

Supporting Research

Frank LG. The efficacy of Echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double blind, placebo-controlled study. J Comp Alt Med. 2000;6(4):327-334.

Guo R, Pittler MH, Ernst E. Complementary medicine for treating or preventing influenza or influenza-like illness. Am J Med. 2007 Nov;120(11):923-929.e3. Review.

Hasani A, Pavia D, Toms N, Dilworth P, Agnew JE. Effect of aromatics on lung mucociliary clearance in patients with chronic airways obstruction. J Altern Complement Med. 2003 Apr;9(2):243-9.

Jackson IM, et al. Efficacy and tolerability of oral acetylcysteine (Fabrol) in chronic bronchitis: a double-blind placebo controlled study. J Int Med Res. 1984; 12(3): 198-206.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors’ Guide. New York, NY: Warner Books; 1996: 210.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:40-43.

Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Complement Med. 2000;6(4):327-334.

Lindgren A, Stroh E, Montnemery P, Nihlen U, Jakobsson K, Axmon A. Traffic-related air polution associated with prevalence of asthma and COPD/chronic bronchitis. A cross-sectional study in Southern Sweden. Int J Health Geogr. 2009;8:2.

Lizogub VG, Riley DS, Heger M. Efficacy of a pelargonium sidoides preparation in patients with the common cold: a randomized, double blind, placebo-controlled clinical trial. Explore (NY). 2007 Nov-Dec;3(6):573-84.

Mahady GB. Echinacea: recommendations for its use in prophylaxis and treatment of upper respiratory tract infections. Nutr Clin Care. 2001;4(4):199-208.

Mandell: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed. Philadelphia, PA: Churchill Livingstone. 2009; Ch. 61

Matthys H, Heger M. Treatment of acute bronchitis with a liquid herbal drug preparation from Pelargonium sidoides (EPs 7630): a randomised, double-blind, placebo-controlled, multicentre study. Curr Med Res Opin. 2007 Feb;23(2):323-31.

Melchart D, Walther E, Linde K, Brandmaier R, Lersch C. Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial. Arch Fam Med. 1998;7:541–545.

What Is Asthma?

Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing.

The coughing often occurs at night or early in the morning.  Asthma affects people of all ages, but it most often starts in childhood.

In the United States, more than 22 million people are known to have asthma. Nearly 6 million of these people are children. Overview  The airways are tubes that carry air into and out of your lungs. People who have asthma have inflamed airways. This makes the airways swollen and very sensitive. They tend to react strongly to certain substances that are breathed in.  When the airways react, the muscles around them tighten. This causes the airways to narrow, and less air flows to your lungs. The swelling also can worsen, making the airways even narrower. Cells in the airways may make more mucus than normal. Mucus is a sticky, thick liquid that can further narrow your airways.  This chain reaction can result in asthma symptoms. Symptoms can happen each time the airways are irritated.

Asthma

Figure A shows the location of the lungs and airways in the body. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway during asthma symptoms.

Sometimes symptoms are mild and go away on their own or after minimal treatment with an asthma medicine. At other times, symptoms continue to get worse. When symptoms get more intense and/or additional symptoms appear, this is an asthma attack. Asthma attacks also are called flareups or exacerbations.

It’s important to treat symptoms when you first notice them. This will help prevent the symptoms from worsening and causing a severe asthma attack. Severe asthma attacks may require emergency care, and they can cause death.

Outlook  Asthma can’t be cured. Even when you feel fine, you still have the disease and it can flare up at any time.  But with today’s knowledge and treatments, most people who have asthma are able to manage the disease. They have few, if any, symptoms. They can live normal, active lives and sleep through the night without interruption from asthma.  For successful, comprehensive, and ongoing treatment, take an active role in managing your disease. Build strong partnerships with your doctor and other clinicians on your health care team.

Asthma Causes

The exact cause of asthma is not known.

• What all people with asthma have in common is chronic airway inflammation and excessive airway sensitivity to various triggers.
• Research has focused on why some people develop asthma while others do not.
• Some people are born with the tendency to have asthma, while others are not. Scientists are trying to find the genes that cause this tendency.
• The environment you live in and the way you live partly determine whether you have asthma attacks.

An asthma attack is a reaction to a trigger. It is similar in many ways to an allergic reaction.

• An allergic reaction is a response by the body’s immune system to an “invader.”
• When the cells of the immune system sense an invader, they set off a series of reactions that help fight off the invader.
• It is this series of reactions that causes the production of mucus and bronchospasms. These responses cause the symptoms of an asthma attack.
• In asthma, the “invaders” are the triggers listed below. Triggers vary among individuals.
• Because asthma is a type of allergic reaction, it is sometimes called reactive airway disease.

Each person with asthma has his or her own unique set of triggers. Most triggers cause attacks in some people with asthma and not in others. Common triggers of asthma attacks are the following:

• exposure to tobacco or wood smoke,
• breathing polluted air,
• inhaling other respiratory irritants such as perfumes or cleaning products,
• exposure to airway irritants at the workplace,
• breathing in allergy-causing substances (allergens) such as molds, dust, or animal  dander.
• an upper respiratory infection, such as a cold, flu, sinusitis, or bronchitis,
• exposure to cold, dry weather,
• emotional excitement or stress,
• physical exertion or exercise,
• reflux of stomach acid known as gastroesophageal reflux disease, or GERD,
• sulfites, an additive to some foods and wine, and
• menstruation: In some, not all, women, asthma symptoms are closely tied to the menstrual cycle.

Risk factors for developing asthma:

• hay fever (allergic rhinitis) and other allergies — this is the single biggest risk factor;
• eczema: another type of allergy affecting the skin; and
• genetic predisposition: a parent, brother, or sister also has asthma.

Asthma Symptoms

When the breathing passages become irritated or infected, an attack is triggered. The attack may come on suddenly or develop slowly over several days or hours. The main symptoms that signal an attack are as follows:

• wheezing,

• breathlessness,
• chest tightness,
• coughing, and
• difficulty speaking.

Symptoms may occur during the day or at night. If they happen at night, they may disturb your sleep.

Wheezing is the most common symptom of an asthma attack.

• Wheezing is a musical, whistling, or hissing sound with breathing.
• Wheezes are most often heard during exhalation, but they can occur during breathing in (inhaling).
• Not all asthmatics wheeze, and not all people who wheeze are asthmatics.

Current guidelines for the care of people with asthma include classifying the severity of asthma symptoms, as
follows:

• Mild intermittent: This includes attacks no more than twice a week and nighttime attacks no more than twice a month. Attacks last no more than a few hours to days. Severity of attacks varies, but there are no symptoms between attacks.
• Mild persistent: This includes attacks more than twice a week, but not every day, and nighttime symptoms more than twice a month. Attacks are sometimes severe enough to interrupt regular activities.
• Moderate persistent: This includes daily attacks and nighttime symptoms more than once a week. More severe attacks occur at least twice a week and may last for days. Attacks require daily use of quick-relief (rescue) medication and changes in daily activities.
• Severe persistent: This includes frequent severe attacks, continual daytime symptoms, and frequent nighttime symptoms. Symptoms require limits on daily activities.

Just because a person has mild or moderate asthma does not mean that he or she cannot have a severe attack. The severity of asthma can change over time, either for better or for worse.

Asthma Treatment

Since asthma is a chronic disease, treatment goes on for a very long time. Some people have to stay on treatment for the rest of their lives. The best way to improve your condition and live your life on your terms is to learn all you can about your asthma and what you can do to make it better.

• Become a partner with your health-care provider and his or her support staff. Use the resources they can offer — information, education, and expertise — to help yourself.
• Become aware of your asthma triggers and do what you can to avoid them.
• Follow the treatment recommendations of your health-care provider. Understand your treatment. Know what each drug does and how it is used.
• See your health-care provider as scheduled.
• Report any changes or worsening of your symptoms promptly.
• Report any side effects you are having with your medications.

These are the goals of treatment:

• prevent ongoing and bothersome symptoms;
• prevent asthma attacks;
• prevent attacks severe enough to require a visit to your provider or an emergency department or hospitalization;
• carry on with normal activities;
• maintain normal or near-normal lung function; and
• have as few side effects of medication as possible.

Asthma

In layman’s terms, asthma makes the airways inside your lungs very sensitive, which in turn makes them inflamed. When someone with asthma breathes something that irritates their already inflamed lungs, the airways get narrower and less air flows through to lung tissues. See your health care professional if you suspect asthma. There are many treatments to help you and your loved one.

Bronchitis

Bronchitis is inflammation of the tubes that carry air to the lungs (bronchial tubes). When these tubes are inflamed, they swell and produce mucus. The swollen tubes and increased mucus trigger coughing and may make it more difficult for you to breathe.

Lung Cancer

Cancers that begin in the lungs are divided into two major types, non-small cell lung cancer and small cell lung cancer, depending on how the cells look under a microscope. More than 87 percent of lung cancers are smoking-related. However, not all smokers develop lung cancer.

Pneumonia

Pneumonia is a general term for a lung infection that can make it hard for you to breathe. In adults older than 65, pneumonia is often serious (and can be deadly) and may need to be treated in the hospital. Always see your doctor if you or your loved one has trouble breathing.

Emphysema

Emphysema is a long-term lung disease that occurs when the tiny air sacs in the lungs are damaged, often as a result of long-term smoking.

Cystic Fibrosis

Cystic fibrosis is usually diagnosed in childhood and it is a chronic disease that that causes mucus to become thick, dry, and sticky. The mucus builds up and clogs passages in many of the body’s organs. In the lungs, the mucus can lead to serious breathing problems and lung disease.

What causes migraine headaches?

The typical migraine headache is unilateral (affecting one half of the head) and pulsating, lasting from 4 to 72 hours; symptoms include nausea, vomiting, photophobia (increased sensitivity to light), and phonopia (increased sensitivity to sound). Approximately one-third of people who suffer migraine headache perceive an aura—unusual visual, olfactory, or other sensory experiences that are a sign that the migraine will soon occur.

Initial treatment is with analgesics for the headache, an antiemetic for the nausea, and the avoidance of triggering conditions. The cause of migraine headache is unknown; the most common theory is a disorder of the serotonergic control system.

The signs and symptoms of migraine vary among patients. Therefore, what a patient experiences before, during and after an attack cannot be defined exactly. The four phases of a migraine attack listed below are common but not necessarily experienced by all migraine sufferers. Additionally, the phases experienced and the symptoms experienced during them can vary from one migraine attack to another in the same migraineur:

1. The prodrome, which occurs hours or days before the headache.
2. The aura, which immediately precedes the headache.
3. The pain phase, also known as headache phase.
4. The postdrome.

Prodrome phase

Prodromal symptoms occur in 40–60% of migraineurs (migraine sufferers). This phase may consist of altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, craving for certain food (e.g. chocolate), stiff muscles (especially in the neck), constipation or diarrhea, increased urination, and other visceral symptoms. These symptoms usually precede the headache phase of the migraine attack by several hours or days, and experience teaches the patient or observant family how to detect that a migraine attack is near.

Aura phase

For the 20-30% of migraine sufferers who experience migraine with aura, this aura comprises focal neurological phenomena that precede or accompany the attack. They appear gradually over 5 to 20 minutes and generally last fewer than 60 minutes. The headache phase of the migraine attack usually begins within 60 minutes of the end of the aura phase, but it is sometimes delayed up to several hours, and it can be missing entirely. Symptoms of migraine aura can be visual, sensory, or motor in nature^.

Visual aura is the most common of the neurological events. There is a disturbance of vision consisting usually of unformed flashes of white and/or black or rarely of multicolored lights (photosia) or formations of dazzling zig zag lines (scintillating scotoma; often arranged like the battlements of a castle, hence the alternative terms “fortification spectra” or “teichopsia”. Some patients complain of blurred or shimmering or cloudy vision, as though they were looking through thick or smoked glass, or in some cases tunnel vision and hemianopsia. The somatosensory aura of migraine consists of digitolingual or cheiro-oral paresthesias, a feeling of pins-and-needles experienced in the hand and arm as well as in the nose-mouth area on the same side. Paresthesia migrate up the arm and then extend to involve the face, lips and tongue.

There are migraine headache variants, some originate in the brainstem (featuring intercellular transport dysfunction of calcium and potassium ions) and some are genetically disposed.  Studies of twins indicate a 60 to 65 percent genetic influence upon their propensity to develop migraine headache. Moreover, fluctuating hormone levels indicate a migraine relation: 75 percent of adult patients are women, although migraine affects approximately equal numbers of prepubescent boys and girls; propensity to migraine headache is known to disappear during pregnancy, although in some women migraines may become more frequent during pregnancy^.

Pain Phase

The typical migraine headache is unilateral, throbbing, and moderate to severe and can be aggravated by physical activity. Not all these features are necessary. The pain may be bilateral at the onset or start on one side and become generalized, and usually it alternates sides from one attack to the next. The onset is usually gradual. The pain peaks and then subsides and usually lasts 4 to 72 hours in adults and 1 to 48 hours in children. The frequency of attacks is extremely variable, from a few in a lifetime to several a week, and the average migraineur experiences one to three headaches a month. The head pain varies greatly in intensity.

The pain of migraine is invariably accompanied by other features. Nuasea occurs in almost 90 percent of patients, and vomiting occurs in about one third of patients. Many patients experience sensory hyperexcitability manifested by photophobia, phonophobia, and osmophobia and seek a dark and quiet room. Blurred vision, nasal stuffiness, diarrhea, polyuria, pallor or sweating may be noted during the headache phase. There may be localized edema of the scalp or face, scalp tenderness, prominence of a vein or artery in the temple, or stiffness and tenderness of the neck. Impairment of concentration and mood are common. The extremities tend to feel cold and moist. Vertigo may be experienced; a variation of the typical migraine, called vestibular migraine, has also been described. Lightheadedness, rather than true vertigo, and a feeling of faintness may occur.

Postdrome phase

The patient may feel tired or “hungover” and have head pain, cognitive difficulties, gastrointestinal symptoms, mood changes, and weakness. Some people feel unusually refreshed or euphoric after an attack, whereas others note depression and malaise. Often, some of the minor headache phase symptoms may continue, such as loss of appetite, photophobia, and lightheadedness. For some patients, a 5- to 6-hour nap may reduce the pain, but slight headaches may still occur when the patient stands or sits quickly. These symptoms may go away after a good night’s rest, although there is no guarantee. Some people may suffer and recover differently than others.

What is stress?

Stress is simply a fact of nature — forces from the outside world affecting the individual. The individual responds to stress in ways that affect the individual as well as their environment. Hence, all living creatures are in a constant interchange with their surroundings (the ecosystem), both physically and behaviorally. This interplay of forces, or energy, is of course present in the relationships between all matter in the universe, whether it is living (animate) or not living (inanimate). However, there are critical differences in how different living creatures relate to their environment. These differences have far-reaching consequences for survival. Because of the overabundance of stress in our modern lives, we usually think of stress as a negative experience, but from a biological point of view, stress can be a neutral, negative, or positive experience.

In general, stress is related to both external and internal factors. External factors include the physical environment, including your job, your relationships with others, your home, and all the situations, challenges, difficulties, and expectations you’re confronted with on a daily basis. Internal factors determine your body’s ability to respond to, and deal with, the external stress-inducing factors. Internal factors which influence your ability to handle stress include your nutritional status, overall health and fitness levels, emotional well-being, and the amount of sleep and rest you get.

Stress has driven evolutionary change (the development and natural selection of species over time). Thus, the species that adapted best to the causes of stress (stressors) have survived and evolved into the plant and animal kingdoms we now observe. Man is the most adaptive creature on the planet because of the evolution of the human brain, especially the part called the neo-cortex. This adaptability is largely due to the changes and stressors that we have faced and mastered. Therefore, we, unlike other animals, can live in any climate or ecosystem, at various altitudes, and avoid the danger of predators. Moreover, most recently, we have learned to live in the air, under the sea, and even in space, where no living creatures that we know of have ever survived.

Stress Management

How to Reduce, prevent, and Cope with Stress

It may seem that there’s nothing you can do about your stress level. The bills aren’t going to stop coming, there will never be more hours in the day for all your errands, and your career or family responsibilities will always be demanding. But you have a lot more control than you might think. In fact, the simple realization that you’re in control of your life is the foundation of stress management.

Managing stress is all about taking charge: taking charge of your thoughts, your emotions, your schedule, your environment, and the way you deal with problems. The ultimate goal is a balanced life, with time for work, relationships, relaxation, and fun – plus the resilience to hold up under pressure and meet challenges head on.

Identify the sources of stress in your life

Stress management starts with identifying the sources of stress in your life. This isn’t as easy as it sounds. Your true sources of stress aren’t always obvious, and it’s all too easy to overlook your own stress-inducing thoughts, feelings, and behaviors. Sure, you may know that you’re constantly worried about work deadlines. But maybe it’s your procrastination, rather than the actual job demands, that leads to deadline stress.

To identify your true sources of stress, look closely at your habits, attitude, and excuses:

* Do you explain away stress as temporary (“I just have a million things going on right now”) even though you can’t remember the last time you took a breather?
* Do you define stress as an integral part of your work or home life (“Things are always crazy around here”) or as a part of your personality (“I have a lot of nervous energy, that’s all”).
* Do you blame your stress on other people or outside events, or view it as entirely normal and unexceptional?

Until you accept responsibility for the role you play in creating or maintaining it, your stress level will remain outside your control.

Start a stress journal

A stress journal can help you identify the regular stressors in your life and the way you deal with them. Each time you feel stressed, keep track of it in your journal. As you keep a daily log, you will begin to see patterns and common themes. Write down:

* What caused your stress (make a guess if you’re unsure).
* How you felt, both physically and emotionally.
* How you acted in response.
* What you did to make yourself feel better.

Look at how you currently cope with stress

Think about the ways you currently manage and cope with stress in your life. Your stress journal can help you identify them. Are your coping strategies healthy or unhealthy, helpful or unproductive? Unfortunately, many people cope with stress in ways that compound the problem.

Unhealthy ways of coping with stress

These coping strategies may temporarily reduce stress, but they cause more damage in the long run:

* Smoking
* Drinking too much
* Overeating or undereating
* Zoning out for hours in front of the TV or computer
* Withdrawing from friends, family, and activities
* Using pills or drugs to relax
* Sleeping too much
* Procrastinating
* Filling up every minute of the day to avoid facing problems
* Taking out your stress on others (lashing out, angry outbursts, physical violence)

Stress management strategy #1: Avoid unnecessary stress

Not all stress can be avoided, and it’s not healthy to avoid a situation that needs to be addressed. You may be surprised, however, by the number of stressors in your life that you can eliminate.

* Learn how to say “no” – Know your limits and stick to them. Whether in your personal or professional life, refuse to accept added responsibilities when you’re close to reaching them. Taking on more than you can handle is a surefire recipe for stress.
* Avoid people who stress you out – If someone consistently causes stress in your life and you can’t turn the relationship around, limit the amount of time you spend with that person or end the relationship entirely.
* Take control of your environment – If the evening news makes you anxious, turn the TV off. If traffic’s got you tense, take a longer but less-traveled route. If going to the market is an unpleasant chore, do your grocery shopping online.
* Avoid hot-button topics – If you get upset over religion or politics, cross them off your conversation list. If you repeatedly argue about the same subject with the same people, stop bringing it up or excuse yourself when it’s the topic of discussion.
* Pare down your to-do list – Analyze your schedule, responsibilities, and daily tasks. If you’ve got too much on your plate, distinguish between the “shoulds” and the “musts.” Drop tasks that aren’t truly necessary to the bottom of the list or eliminate them entirely.

Stress management strategy #2: Alter the situation

If you can’t avoid a stressful situation, try to alter it. Figure out what you can do to change things so the problem doesn’t present itself in the future. Often, this involves changing the way you communicate and operate in your daily life.

* Express your feelings instead of bottling them up. If something or someone is bothering you, communicate your concerns in an open and respectful way. If you don’t voice your feelings, resentment will build and the situation will likely remain the same.
* Be willing to compromise. When you ask someone to change their behavior, be willing to do the same. If you both are willing to bend at least a little, you’ll have a good chance of finding a happy middle ground.
* Be more assertive. Don’t take a backseat in your own life. Deal with problems head on, doing your best to anticipate and prevent them. If you’ve got an exam to study for and your chatty roommate just got home, say up front that you only have five minutes to talk.
* Manage your time better. Poor time management can cause a lot of stress. When you’re stretched too thin and running behind, it’s hard to stay calm and focused. But if you plan ahead and make sure you don’t overextend yourself, you can alter the amount of stress you’re under.

Stress management strategy #3: Adapt to the stressor

If you can’t change the stressor, change yourself. You can adapt to stressful situations and regain your sense of control by changing your expectations and attitude.

* Reframe problems. Try to view stressful situations from a more positive perspective. Rather than fuming about a traffic jam, look at it as an opportunity to pause and regroup, listen to your favorite radio station, or enjoy some alone time.
* Look at the big picture. Take perspective of the stressful situation. Ask yourself how important it will be in the long run. Will it matter in a month? A year? Is it really worth getting upset over? If the answer is no, focus your time and energy elsewhere.
* Adjust your standards. Perfectionism is a major source of avoidable stress. Stop setting yourself up for failure by demanding perfection. Set reasonable standards for yourself and others, and learn to be okay with “good enough.”
* Focus on the positive. When stress is getting you down, take a moment to reflect on all the things you appreciate in your life, including your own positive qualities and gifts. This simple strategy can help you keep things in perspective.

Stress management strategy #4: Accept the things you can’t change

Some sources of stress are unavoidable. You can’t prevent or change stressors such as the death of a loved one, a serious illness, or a national recession. In such cases, the best way to cope with stress is to accept things as they are. Acceptance may be difficult, but in the long run, it’s easier than railing against a situation you can’t change.

* Don’t try to control the uncontrollable. Many things in life are beyond our control— particularly the behavior of other people. Rather than stressing out over them, focus on the things you can control such as the way you choose to react to problems.
* Look for the upside. As the saying goes, “What doesn’t kill us makes us stronger.” When facing major challenges, try to look at them as opportunities for personal growth. If your own poor choices contributed to a stressful situation, reflect on them and learn from your mistakes.
* Share your feelings. Talk to a trusted friend or make an appointment with a therapist. Expressing what you’re going through can be very cathartic, even if there’s nothing you can do to alter the stressful situation.
* Learn to forgive. Accept the fact that we live in an imperfect world and that people make mistakes. Let go of anger and resentments. Free yourself from negative energy by forgiving and moving on.

Stress management strategy #5: Make time for fun and relaxation

Beyond a take-charge approach and a positive attitude, you can reduce stress in your life by nurturing yourself. If you regularly make time for fun and relaxation, you’ll be in a better place to handle life’s stressors when they inevitably come.
Healthy ways to relax and recharge

* Go for a walk.
* Spend time in nature.
* Call a good friend.
* Sweat out tension with a good workout.
* Write in your journal.
* Take a long bath.
* Light scented candles
* Savor a warm cup of coffee or tea.
* Play with a pet.
* Work in your garden.
* Get a massage.
* Curl up with a good book.
* Listen to music.
* Watch a comedy

Don’t get so caught up in the hustle and bustle of life that you forget to take care of your own needs. Nurturing yourself is a necessity, not a luxury.

* Set aside relaxation time. Include rest and relaxation in your daily schedule. Don’t allow other obligations to encroach. This is your time to take a break from all responsibilities and recharge your batteries.
* Connect with others. Spend time with positive people who enhance your life. A strong support system will buffer you from the negative effects of stress.
* Do something you enjoy every day. Make time for leisure activities that bring you joy, whether it be stargazing, playing the piano, or working on your bike.
* Keep your sense of humor. This includes the ability to laugh at yourself. The act of laughing helps your body fight stress in a number of ways.

Stress management strategy #6: Adopt a healthy lifestyle

You can increase your resistance to stress by strengthening your physical health.

* Exercise regularly. Physical activity plays a key role in reducing and preventing the effects of stress. Make time for at least 30 minutes of exercise, three times per week. Nothing beats aerobic exercise for releasing pent-up stress and tension.
* Eat a healthy diet. Well-nourished bodies are better prepared to cope with stress, so be mindful of what you eat. Start your day right with breakfast, and keep your energy up and your mind clear with balanced, nutritious meals throughout the day.
* Reduce caffeine and sugar. The temporary “highs” caffeine and sugar provide often end in with a crash in mood and energy. By reducing the amount of coffee, soft drinks, chocolate, and sugar snacks in your diet, you’ll feel more relaxed and you’ll sleep better.
* Avoid alcohol, cigarettes, and drugs. Self-medicating with alcohol or drugs may provide an easy escape from stress, but the relief is only temporary. Don’t avoid or mask the issue at hand; deal with problems head on and with a clear mind.
* Get enough sleep. Adequate sleep fuels your mind, as well as your body. Feeling tired will increase your stress because it may cause you to think irrationally.

What is Gout?

Gout is one of the most painful forms of arthritis. Gout attack can strike without warning with intense pain usually in the joint of the big toe. But, it may also include the ankles, heels, instep, knees, elbows, hips, thumbs, or fingers.

Gout develops when too much uric acid builds up in your body. Sharp needle-like urate crystals form around your joints beginning in your big toe. Gout does not happen overnight. It is the result of a build-up process that may take months or years. When it reaches a critical level, you get a painful gout attack.

History of Gout

The first written description of gout dates from 2,600 BC, when Egyptians noted gouty arthritis of the big toe. Around 400 BC, the Greekphysician Hippocrates also commented on gout. Writing ca. 30 AD, Aulus Cornelius Celsus appeared to recognize many of the features of gout, including its link with a urinary solute, late onset in women, linkage with alcohol, and perhaps even prevention by dairy products:

“Again thick urine, the sediment from which is white, indicates that pain and disease are to be apprehended in the region of joints or viscera. … Joint troubles in the hands and feet are very frequent and persistent, such as occur in cases of podagra and cheiragra. These seldom attack eunuchs or boys before coition with a woman, or women except those in whom the menses have become suppressed. Upon the commencement of pain blood should be let; for when this is carried out at once in the first stages it ensures health, often for a year, sometimes for always. Some also, when they have washed themselves out by drinking asses’ milk, evade this disease in perpetuity; some have obtained lifelong security by refraining from wine, mead and venery for a whole year; indeed this course should be adopted especially after the primary attack, even although it has subsided.^“

Colchicum was described for treatment of rheumatism and swelling in the Ebers Papyrus, ca. 1500 B.C. The use of Colchicum corm for gout probably traces back to ca. 550 A.D., as the “hermodactyl” recommended by Alexander of Tralles. Colchicum corm was used by Ibn Sina and other Islamic physicians, was recommended by Ambroise PAre in the sixteenth century, and appeared in the London. In 1833 P.L. Geiger purified an active ingredient, which he named Colchicine. Colchicum was brought to America by Benjamin Franklin; Franklin suffered from gout himself and had written humorous doggerel about the disease during his stint as Envoy to France. As a drug predating the FDA, colchicine was sold as a generic in the United States for many years. In 2009 the FDA approved colchicine for gout flares, awarding Colcrys a three year term of market exclusivity, prohibiting generic sales, and increasing the price of the drug from $9 to $485 per bottle.

Around 200 AD, the Roman gladiatorial surgeon Galen described gout as a discharge of the four humors of the body in unbalanced amounts into the joints. The word “gout” was initially used by Randolphus of Bocking, around 1200 AD. It is derived from the Latin word “gutta”, meaning “a drop” (of liquid)^.

Historical treatments for gout include gin and numerous medications that have since been found to be not effective. Sodium Bicarbonate (baking soda) is a traditional remedy, thought to work by raising blood pH (lowering blood acidity). However, the added sodium may be inappropriate for some people.

What Causes Gout?

Gout is caused by too much uric acid in the blood (hyperuricemia). Hyperuricemia is caused by a combination of several factors. You are more likely to get hyperuricemia and gout if you:

• Have family members with the disease
• Are a male over 30 years
• Are overweight
• Drink 2 or more alcoholic drinks (especially beer) a day
• Drink 2 or more sweetened soft drinks per day
• Eat excessive amounts of red meats, internal organs, yeast, poultry or seafood
• Smoke 2 or more cigarettes per day
• Regularly use some medicines such as diuretics, aspirin, cyclosporine, or levodopa.

Hyperuricemia is the underlying cause of gout. This can occur for a number of reasons including dietary, genetic, or underexcretion of urate^. About 10% of people with hyperuricemia develop gout.

Gout Treatments

The first thing a doctor gives you is a strong pain killer. This provides only short term relief of pain, and it does not really solve the problem. Various prescription drugs are available for treating gout. These are harsh synthetic chemicals that may have harmful side effects if taken for long periods.

Highly toxic Colchicine is sometimes prescribed for gout. Colchicine is natural poison that may cause vomiting, diarhea, abdominal cramps, kidney failure and in high concentration even death.

Because of the harmful side effects of drugs, many people are choosing an alternative natural cures.

Sign And Symptoms

Tophi of the knee.

Gout usually presents as recurrent attacks of acute inflammatory arthritis (a red, tender, hot, swollen joint). The joint that is most commonly affected is the first metatarsalphalangeal joint at the base of the big toe (approximately 75 percent of first attacks) and when this occurs it is known as podagra. The reason gout usually presents in the feet is in part due to the lower temperature^.

People with long-standing hyperuricemia can form tophi (uric acid crystal deposits) in tissues. These are usually hard, non-painful deposits. Extensive tophi that invade bone are associated with arthritis due to bone erosion.

Elevated levels of urine uric acid can lead to uric-acid crystals precipitating in the kidneys which may form kidney stones and lead to urate nephropathy^.

Lifestyle

About 12% of gout is attributed to dietary causes. This includes a strong association with the consumption of alcohol, sugar, and meat and seafood. The intake of dairy products, vegetables, and the total protein intake do not affect the occurrence of gout.

A sedentary lifestyle also increases the risk of developing the disease.

Medical Condition

Gout may present as a complication of other medical conditions.

• Metabolic Syndrome(the combination of hypertension, diabetes, dyslipidemia, truncal obesity, increased cardiovascular disease risk)
• Leukemia

Gout also can develop as a co-morbidity of other diseases, including polycythemia, intake of cytotoxics,obesity, diabetes, hypertension, renal disorders, and hemolytic anemia. Gout is an important complication in a minority of solid organ transplants^.

Gout may occur as a result of renal failure^.

Some studies have established a statistical connection between gout and lead poisoning, and a significant correlation between levels of lead in the body, urate excretion and gout. It is known that lead sugar was formerly used to sweeten wine. This condition is then known as saturnine gout, as saturnus is the alchemical term for metallic lead.

Uric Acid

Gout occurs when crystals of uric acid, in the form of monosodium urate, precipitate on the articular cartilage of joints, on tendons, and in the surrounding tissues. Uric acid is a normal component of  blood serum. Uric acid is more likely to form into crystals when there is hyperuricemia, although hyperuricemia is 10 times more common without clinical gout than with it. Gout can also occur when serum uric acid is normal, and when it is abnormally low (hypouricemia). Paradoxically, acute attacks of gout can occur together with a sudden decrease in serum uric acid, such as due to use of drugs (uricosurics, xanthine oxidase inhibitors), or total parental nutrition. However, the sudden decrease may be a consequence of abrupt formation of crystals (removing uric acid from the serum), rather than a cause.Regardless of the serum concentration of uric acid, precipitation of uric acid is markedly enhanced when the blood pH is low (acidosis). A similar pH-sensitive effect occurs in urine, contributing to uric acid nephrolithiasis (kidney stones).

Uric acid is a product of purine metabolism, and in humans is normally excreted in the urine. Purines are generated by the body via breakdown of cells in normal cellular turnover, and also are ingested as part of a normal diet. The kidneys are responsible for approximately two-thirds of uric acid excretion, with the liver responsible for the rest.

Prevention

Both lifestyle modifications and medication can decrease uric acid levels. Medications however are not usually started until one to two weeks after an acute attack has resolved due to theoretical concerns of worsening the attack. They are often not recommended until after a second attack of gout has occurred, unless destructive joint changes, tophi, or urate nephropathy exists^. It is not until this point that medications have been found to be cost effective. Urate lowering measures should be titrated to decrease serum uric acid levels below 360 µmol/L (6 mg/dL)^.

A vitamin is an organic compound required as a nutrient in tiny amounts by an organism.The term ‘vitamin’ first became popular in the early 1800s as a portmanteau of the words ‘vital’ and ‘mineral’, though the actual meaning of the word has developed somewhat since that time. A compound is called a vitamin when it cannot be synthesized in sufficient quantities by an organism, and must be obtained from the diet. Thus, the term is conditional both on the circumstances and the particular organism. For example, ascorbic acid functions as vitamin C for some animals but not others, and vitamins D, K and biotin are required in the human diet only in certain circumstances.The term vitamin does not include other essential nutrients such as dietary minerals, essential fatty acids, or essential amino acids, nor does it encompass the large number of other nutrients that promote health but are otherwise required less often.

There are two types of vitamins: fat soluble and water soluble. When you eat foods that contain fat-soluble vitamins, the vitamins are stored in the fat tissues in your body and in your liver. They wait around in your body fat until your body needs them.

Fat-soluble vitamins are happy to stay stored in your body for awhile — some stay for a few days, some for up to 6 months! Then, when it’s time for them to be used, special carriers in your body take them to where they’re needed. Vitamins A, D, E, and K are all fat-soluble vitamins.

Water-soluble vitamins are different. When you eat foods that have water-soluble vitamins, the vitamins don’t get stored as much in your body. Instead, they travel through your bloodstream. Whatever your body doesn’t use comes out when you urinate (pee).

So these kinds of vitamins need to be replaced often because they don’t stick around! This crowd of vitamins includes vitamin C and the big group of B vitamins — B1 (thiamin), B2 (riboflavin), niacin, B6 (pyridoxine), folic acid, B12 (cobalamine), biotin, and pantothenic acid.

Vitamins are classified by their biological and chemical activity, not their structure. Thus, each “vitamin” may refer to several vitamer compounds that all show the biological activity associated with a particular vitamin. Such a set of chemicals are grouped under an alphabetized vitamin “generic descriptor” title, such as “vitamin A”, which includes the compounds retinal, retinol, and four known carotenoids. Vitamers by definition are convertable to the active form of the vitamin in the body, and are sometimes inter-convertable to one another as well.

Vitamins have diverse biochemical functions. Some have hormone-like functions as regulators of mineral metabolism (e.g. vitamin D), or regulators of cell and tissue growth and differentiation (e.g. some forms of vitamin A). Others function as antioxidants (e.g. vitamin E and sometimes vitamin C). The largest number of vitamins (e.g. B complex vitamins) function as precursors for enzyme cofactor bio-molecules (coenzymes), that help act as catalysts and substrates in metabolism. When acting as part of a catalyst, vitamins may be tightly bound to enzymes as part of prosthetic groups: for example, biotin is part of enzymes involved in making fatty acids. Vitamins may also be less tightly bound to enzyme catalysts as coenzymes, detachable molecules which function to carry chemical groups or electrons between molecules. For example, folic acid carries various forms of carbon group – methyl, formyl and methylene – in the cell. Although these roles in assisting enzyme reactions are vitamins’ best-known function, the other vitamin functions are equally important.

Until the 1900s, vitamins were obtained solely through food intake, and changes in diet (which, for example, could occur during a particular growing season) can alter the types and amounts of vitamins ingested. Vitamins have been produced as commodity chemicals and made widely available as inexpensive pills for several decades, allowing supplementation of the dietary intake.

Vitamin A

Benefits:
Vitamin A prevents eye problems, promotes a healthy immune system, is essential for the growth and development of cells, and keeps skin healthy.

Sources:
Good sources of vitamin A are milk, eggs, liver, fortified cereals, darkly colored orange or green vegetables (such as carrots, sweet potatoes, pumpkin, and kale), and orange fruits such as cantaloupe, apricots, peaches, papayas, and mangos.

Quantity:
Teen guys need 900 micrograms of vitamin A each day.
Teen girls need 700 micrograms each day. It is possible to get too much vitamin A, so be careful with supplements. Don’t take vitamin A supplements If you’re taking isotretinoin (such as Accutane) for acne or other skin problems.
Oral acne medicines are vitamin A supplements, and a continued excess of vitamin A can build up in the body, causing headaches, skin changes, or even liver damage.

Vitamin B1 (Thiamin)

Benefits:
Thiamin helps the body convert carbohydrates into energy and is necessary for the heart, muscles, and nervous system to function properly.

Sources:
People get thiamin from many different foods, including fortified breads, cereals, and pasta; meat and fish; dried beans, soy foods, and peas; and whole grains like wheat germ.

Quantity:
Teen guys need 1.2 mg of thiamin each day; teen girls need 1 mg.

Vitamin B2 (Riboflavin)

Benefits:
Riboflavin is essential for turning carbohydrates into energy and producing red blood cells. It is also important for vision.

Sources:
Some of the best sources of riboflavin are meat, eggs, legumes (like peas and lentils), nuts, dairy products, green leafy vegetables, broccoli, asparagus, and fortified cereals.

Quantity:
Teen guys need 1.3 mg of riboflavin per day and teen girls need 1 mg.

Vitamin B3 (Niacin)

Benefits:
Niacin helps the body turn food into energy. It helps maintain healthy skin and is important for nerve function.

Sources:
You’ll find niacin in red meat, poultry, fish, fortified hot and cold cereals, and peanuts.

Quantity:
Teen guys need 16 mg of niacin daily. Teen girls need 14 mg a day.

Vitamin B6

Benefits:
Vitamin B6 is important for normal brain and nerve function. It also helps the body break down proteins and make red blood cells.

Sources:
A wide variety of foods contain vitamin B6, including potatoes, bananas, beans, seeds, nuts, red meat, poultry, fish, eggs, spinach, and fortified cereals.

Quantity:
Teen guys need 1.3 mg of vitamin B6 daily and teen girls need 1.2 mg.

Vitamin B9 (Folate)

Benefits:
Folate helps the body make red blood cells. It is also needed to make DNA.

Sources:
Liver, dried beans and other legumes, green leafy vegetables, asparagus, and orange juice are good sources of this vitamin. So are fortified bread, rice, and cereals.

Quantity:
Teen girls and guys need 400 micrograms of folate daily.

Vitamin B12

Benefits:
Vitamin B12 helps to make red blood cells, and is important for nerve cell function.

Sources:
Vitamin B12 is found naturally in fish, red meat, poultry, milk, cheese, and eggs. It’s also added to some breakfast cereals.

Quantity:
Teens should get 2.4 micrograms of vitamin B12 daily.

Vitamin C

Benefits:
Vitamin C is needed to form collagen, a tissue that helps to hold cells together. It’s essential for healthy bones, teeth, gums, and blood vessels. It helps the body absorb iron and calcium, aids in wound healing, and contributes to brain function.

Sources:
You’ll find high levels of vitamin C in red berries, kiwi, red and green bell peppers, tomatoes, broccoli, spinach, and juices made from guava, grapefruit, and orange.

Quantity:
Teen guys need 75 mg (milligrams; 1 milligram equals 1,000 micrograms) and girls need 65 mg of vitamin C a day.

Vitamin D

Benefits:
Vitamin D strengthens bones because it helps the body absorb bone-building calcium.

Sources:
This vitamin is unique — your body manufactures it when you get sunlight on your skin! You can also get vitamin D from egg yolks, fish oils, and fortified foods like milk.

Quantity:
Teens need 10 micrograms (400 IU) of vitamin D from food or supplements every day. Ask your doctor if supplements are right for you.

Vitamin E

Benefits:
Vitamin E is an antioxidant and helps protect cells from damage. It is also important for the health of red blood cells.

Sources:
Vitamin E is found in many foods, such as vegetable oils, nuts, and green leafy vegetables. Avocados, wheat germ, and whole grains are also good sources.

Quantity:
Teen guys and girls need 15 mg of vitamin E every day.