Menopause

Menopause (signs, symptoms, diagnosis, treatment)

Menopause is a normal part of ageing for a woman and literally means "last period". The term, however, is commonly used to describe the years when the ovaries gradually begin to produce fewer eggs and less of the female hormones oestrogen and progesterone. This reduction in hormone production causes the periods to become progressively more irregular until they stop altogether, and produces physical and psychological symptoms in many women.

 

Menopause is generally considered complete when a woman has not had a period for one year. Menopause, often referred to as "the change of life", usually occurs between the ages of 45 – 55 years with the average age being 52 years.  Premature (early onset) menopause is when periods stop before the age of 40 years. 

 

Consideration of treatment and lifestyle change options may depend on the severity of a woman's symptoms.

 

Why does menopause occur?

 

At birth, the ovaries contain a lifetime supply of eggs stored in small follicles. At puberty, hormones produced by the pituitary gland in the brain stimulate the ovaries to begin releasing eggs each month (ovulation). This prompts oestrogen and progesterone to be released by the ovaries, which in turn stimulate the lining of the uterus (endometrium) to thicken in preparation for the implantation of a fertilised egg.  If an egg is not fertilised the endometrium is shed and a period occurs.  This entire process is known as the menstrual cycle.

 

As a woman ages the number of follicles in her ovaries decreases and the ovaries produce fewer hormones. Menopause occurs when the ovaries fail to produce enough hormones to stimulate the monthly growth of the endometrium, and periods stop permanently.

 

The timeframe from when symptoms first appear to when menopause occurs may be several years. This timeframe is medically referred to as the climacteric or the perimenopause.

 

After menopause a woman's risk of heart disease (including high blood pressure, heart attack and stroke) increases and becomes as high as it is for men.  The risk of developing osteoporosis (bone thinning) is also increased.

 

There are three types of menopause: natural, premature, and artificial.

 

Natural menopause occurs when levels of oestrogen and progesterone decline naturally.

 

Premature (early) menopause is when periods stop before the age of 40 years. This can be due to many reasons including medical conditions such as diabetes or thyroid disease, and surgery or medications that have affected the blood supply to the ovaries. Genetic factors may also play a part as premature menopause can run in families. Women who smoke are also more likely to go through premature menopause. Sometimes, however, there is no identifiable cause.

 

Artificial (surgical) menopause is a consequence of surgical removal of both ovaries or destruction of the ovaries by some cancer treatments. With artificial menopause there is a sudden drop in hormone levels and menopausal symptoms begin abruptly. Often the symptoms experienced are more severe than those experienced with natural or premature menopause.

 

 

Signs and symptoms

 

Often the first symptom of impending menopause is a change in bleeding patterns. Periods may become lighter or heavier, longer or shorter, the time between periods may increase and there may be occasional missed periods. These changes may occur gradually in some women, yet are more abrupt in others.

 

There are also a wide range of physical and psychological signs and symptoms associated with menopause. In some women they are very mild while in others they are more severe. They may last for only a few months, or may continue for several years. The average length of time for menopausal symptoms to be experienced is three to five years.

 

Physical signs and symptoms may include:

 

• Hot flushes (occurring in approximately 60% of women)
• Sweats (often at night)
• Tiredness
• Headaches
• Joint and bone pain
• Palpitations
• Unusual skin sensations
• Vaginal dryness, incontinence and infections of the urinary tract and vagina may occur due to the thinning of the vagina and bladder walls.

 Psychological signs and symptoms may include:

 

• Anxiety
• Reduced interest in sex
• Irritability and mood swings
• Difficulty concentrating
• Loss of confidence
• Forgetfulness
• Difficulty sleeping
• Depression

 

Diagnosis

 

There is no one test to diagnose menopause. Symptoms experienced may indicate that menopause is imminent, however menopause can only be confirmed retrospectively after periods have been absent for one year. Blood tests may be taken at this time as the levels of hormones produced by the pituitary gland - follicle stimulating hormone (FSH) and luteinizing hormone (LH) – may be higher if menopause has occurred.

 

A change in bleeding patterns, particularly where periods become heavier, and an absence of periods (amenorrhoea) can indicate various medical conditions. It is therefore advisable to consult a doctor before assuming that the changes are menopausal symptoms.  Also, if bleeding occurs after periods have been absent for a year, a doctor should be consulted, as this is not considered normal.

 

 

Treatment

 

The intensity and frequency of menopausal symptoms vary from woman to woman.  If symptoms are problematic, or a woman is at high risk of developing osteoporosis or heart disease, medical treatment may be recommended.  Ultimately, the decision to have treatment is a very personal one and should be made by the woman only after receiving a full explanation from her doctor of the benefits and counter benefits of the various treatment options.

 

Treatment options include:

 

Hormone Replacement Therapy (HRT)

HRT involves replacing hormones previously produced by the ovaries.  It can be effective in relieving the symptoms of hot flushes, night sweats and dryness of the vagina.  HRT can also help to reduce the risk of heart disease and osteoporosis following menopause.  Facial hirsutism (excess hair growth) can increase after menopause due to hormonal changes.  This growth may be slowed with HRT.

 

HRT can be given as tablets, skin patches and as vaginal preparations such as creams and pessaries. Vaginal preparations can help to reduce symptoms of vaginal dryness, incontinence and bladder and vaginal infections.

 

Some forms of HRT may increase the risk of endometrial cancer and using some forms of HRT for longer than 5 years may increase the risk of breast cancer.  However, recent research has indicated that some forms of HRT may help to reduce the risk of Alzheimer's disease and bowel cancer and may help to prevent some aspects of skin ageing. As there are many different forms of HRT it is important to discuss with a doctor which type and delivery method is most appropriate.

 

Alternative therapies

Some women have found that alternative therapies have proved successful in reducing menopausal symptoms. These include natural hormones, herbal preparations, vitamins and minerals and homeopathic remedies.

 

Examples of these include black cohosh, ginkgo biloba, evening primrose oil, vitamins B, C and E, ginseng, garlic, camomile, St. Johns Wort and soy based phyto-oestrogens (natural hormones). Treatments such as acupuncture, massage and reflexology have also proved successful for some women.

 

Unsupervised use of alternative therapies, particularly herbal preparations, can cause adverse effects and monitoring by a health practitioner trained in their use is strongly advised.  It is also advisable to discuss the intended use of these therapies with a doctor, especially if taking prescription medications.

 

Lifestyle factors

 

Changes in lifestyle can help to reduce the severity of menopausal symptoms and decrease the risk of osteoporosis and heart disease. Diet and exercise are two very important aspects of these lifestyle changes.

 

Diet

Women need a higher intake of calcium and vitamin D after menopause to help reduce the risk of osteoporosis.  Excellent dietary sources of calcium include low fat dairy products (milk, cheese, yoghurt), nuts, dark green vegetables (eg: broccoli, spinach) and fish with bones in (eg: sardines, salmon).  Vitamin D, which helps the body to absorb calcium, is manufactured by the skin after exposure to sunlight.  Small quantities are found in foods such as dairy products and eggs.

 

An intake of at least 1000mg of calcium daily is recommended for women after menopause.  If the diet contains insufficient amounts of calcium and vitamin D, dietary supplements may be required.

 

Eating a healthy balanced diet that is low in fat and refined sugars and maintaining a healthy body weight is recommended.  Limiting alcohol and caffeine and not smoking are also important.

 

Exercise

Regular weight-bearing exercise such as walking, dancing, tennis, aerobics or golf helps in maintaining a healthy weight, fitness and general wellbeing.  Exercise also helps to decrease the risk of osteoporosis by strengthening the bones and may assist in reducing the severity of menopausal symptoms such as hot flushes. Specific pelvic floor exercises can help to reduce urinary problems such as incontinence and pain on urination.

 

Rest and stress reduction also play an important role in managing menopause symptoms.  Fatigue and stress can worsen symptoms, so employing strategies to ensure adequate rest is attained and stress is managed will assist in alleviating symptoms.

What is Cholesterol? What Causes High Cholesterol?

Cholesterol is a lipid (fat) which is produced by the liver. Cholesterol is vital for normal body function. Every cell in our body has cholesterol in its outer layer.

Cholesterol is a waxy steroid and is transported in the blood plasma of all animals. It is the main sterol synthesized by animals - small amounts are also synthesized in plants and fungi. A sterol is a steroid sub-group.

Cholesterol levels among US adults today are generally higher than in all other industrial nations. During the 1990s there was some concern about cholesterol levels in American children. According to the CDC (Centers for Disease Control and Prevention), nearly 1 in every 10 children/adolescents in the USA has elevated total cholesterol levels; and this was after concentrations had dropped over a 20-year period.

The word "cholesterol" comes from the Greek word chole, meaning "bile", and the Greek wordstereos, meaning "solid, stiff".

What are the functions of cholesterol?

• It builds and maintains cell membranes (outer layer), it prevents crystallization of hydrocarbons in the membrane
• It is essential for determining which molecules can pass into the cell and which cannot (cell membrane permeability)
• It is involved in the production of sex hormones (androgens and estrogens)
• It is essential for the production of hormones released by the adrenal glands (cortisol, corticosterone, aldosterone, and others)
• It aids in the production of bile
• It converts sunshine to vitamin D. Scientists from the Rockefeller University were surprised to find that taking vitamin D supplements do not seem to reduce the risk of cholesterol-related cardiovascular disease.
• It is important for the metabolism of fat soluble vitamins, including vitamins A, D, E, and K
• It insulates nerve fibers

There are three main types of lipoproteins

Cholesterol is carried in the blood by molecules called lipoproteins. A lipoprotein is any complex or compound containing both lipid (fat) and protein. The three main types are:

• LDL (low density lipoprotein) - people often refer to it as bad cholesterol. LDL carries cholesterol from the liver to cells. If too much is carried, too much for the cells to use, there can be a harmful buildup of LDL. This lipoprotein can increase the risk of arterial disease if levels rise too high. Most human blood contains approximately 70% LDL - this may vary, depending on the person.


• HDL (high density lipoprotein) - people often refer to it as good cholesterol. Experts say HDL prevents arterial disease. HDL does the opposite of LDL - HDL takes the cholesterol away from the cells and back to the liver. In the liver it is either broken down or expelled from the body as waste.


• Triglycerides - these are the chemical forms in which most fat exists in the body, as well as in food. They are present in blood plasma. Triglycerides, in association with cholesterol, form the plasma lipids (blood fat). Triglycerides in plasma originate either from fats in our food, or are made in the body from other energy sources, such as carbohydrates. Calories we consume but are not used immediately by our tissues are converted into triglycerides and stored in fat cells. When your body needs energy and there is no food as an energy source, triglycerides will be released from fat cells and used as energy - hormones control this process.

What are normal cholesterol levels?

The amount of cholesterol in human blood can vary from 3.6 mmol/liter to 7.8 mmol/liter. The National Health Service (NHS), UK, says that any reading over 6 mmol/liter is high, and will significantly raise the risk of arterial disease. The UK Department of Health recommends a target cholesterol level of under 5 mmo/liter. Unfortunately, two-thirds of all UK adults have a total cholesterol level of at least five (average men 5.5, average women 5.6). 

Below is a list of cholesterol levels and how most doctors would categorize them in mg/dl (milligrams/deciliter) and 5mmol/liter (millimoles/liter).

• Desirable - Less than 200 mg/dL
• Bordeline high - 200 to 239 mg/dL
• High - 240 mg/dL and above


• Optimum level: less than 5mmol/liter
• Mildly high cholesterol level: between 5 to 6.4mmol/liter
• Moderately high cholesterol level: between 6.5 to 7.8mmol/liter
• Very high cholesterol level: above 7.8mmol/liter

Dangers of high cholesterol levels

High cholesterol levels can cause:

• Atherosclerosis - narrowing of the arteries.


• Higher coronary heart disease risk - an abnormality of the arteries that supply blood and oxygen to the heart.


• Heart attack - occurs when the supply of blood and oxygen to an area of heart muscle is blocked, usually by a clot in a coronary artery. This causes your heart muscle to die.


• Angina - chest pain or discomfort that occurs when your heart muscle does not get enough blood.


• Other cardiovascular conditions - diseases of the heart and blood vessels.


• Stroke and mini-stroke - occurs when a blood clot blocks an artery or vein, interrupting the flow to an area of the brain. Can also occur when a blood vessel breaks. Brain cells begin to die.

If both blood cholesterol and triglyceride levels are high, the risk of developing coronary heart disease rises significantly.

7 Sex Positions Men Love

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The bedroom moves that men love: try these sex positions tonight.

Want to spice things up in the bedroom? Make his night anddrive him crazy with these sex positions that men love. Ultimately, sex is about love and intimacy, so while the positions are part of the fun, the real payoff is the way various maneuvers allow you to connect and explore each other in different ways.

1. Woman on Top: Ask your guy what drives him crazy in the bedroom, and we're betting he'll say it's pleasing you. This sexy position puts you in the driver's seat, and that's exactly where he wants you. Take advantage of being in control and set the pace according to what you like, leaving his hands free to roam. The bonus? He loves having your curves in full view…so flip on the lights and give him a show.

More from YourTango: What Is 'Honey Sex' And Why Is It Bad For You?

2. Missionary: This standard go-to is a favorite because it puts him in control, while still being intimate: your hips are free to do all the work, and you can lock lips and eyes with ease. And while he's in the power position on top of you, the two of you can set the pace together. If you want him to go slower or deeper, put your hands on his hips and guide him. The best sex is like a conversation, and missionary allows you to communicate with your bodies.

3. Reverse Cowgirl: This reverse variation of the woman on top position is the best of both worlds for your guy. It gives him the sexy view he gets during doggie style but it puts you in control. This position doesn't allow for a ton of touching or eye contact, but it's a nice contrast to some of the more classic, romantic positions. If you're craving a connection flash a look back at him while you're doing your thing—it'll drive both of you over the edge.

4. Doggie Style: This rear entry positions puts him in control, allowing him to call the shots and to go at the speed that's best for him. Plus, it allows for deeper penetration, making him feel like king in the bedroom. Some women love the intense full feeling, but if it feels like too much, let him know. Communication is key to enjoying sex and experiencing the full psychological benefits of physical intimacy.

5. Standing Up: Getting it on while standing up is probably not your go-to move, but it's perfect for that sweaty, gotta-have-you-now sex that'll make him feel irresistible. Whether he's bending you over the new kitchen table or you're steadying yourself against the wall, this spontaneous position is perfect for a quickie.

Breast Implants -- Through the Armpits

When M.A. starting thinking about getting breast implants, she remembered a co-worker who once had the same procedure. (M.A. asked to remain unidentified for medical privacy.)

A 30-year-old, single working mom of a seven-year-old son, M.A. watched as the co-worker searched the Internet for just the right Las Vegas plastic surgeon with impressive training and the best possible before and after pictures of his work.

Before M.A. had a child, she was a full D cup. But child birth and nursing naturally cause changes in the body, and her bust line shrunk to a full C and then to a full A.

“Breast augmentation was something I wanted to do just for myself”

Breast Enlargement

"Breast augmentation was something I wanted to do just for myself," says M.A. who, inspired by her friend's experience, turned to the Internet. There, she found a discussion group that explained what breast augmentation was like from the very first consult to final healing. She also watched each and every episode of Dr. 90210 with a hungry eye.

Moreover, M.A. has a special medical consideration and kept an eye out for a Las Vegas plastic surgeon who has some extra experience with her particular condition.

"My ethnic background is Philipino and I know from past experience that my scars will be keloid." (Read more about scar revision.)

Keloid scars result from an overgrowth of tissue at the site of a surgical incision or other skin injury. Keloids are firm, rubbery lesions or shiny, fibrous nodules, and can be lighter or darker than the surrounding skin. (Read more about keloids.)

"Due to the keloid scarring, the surgical incisions to place the implants could only be in my armpits where they would be hidden," she says.

Breast Augmentation Photos

Patient M.A. at age 29 before her breasts implant procedure (left), and three months after the procedure (right), M.A. is a full D cup.(Photos, courtesy of Dr. Cambeiro, M.D.)

Breast Implant Surgery

Being ever the wise consumer, M.A. arranged consults with several Las Vegas plastic surgeons. Her continuing research kept bringing her back to information about a board certified Las Vegas plastic surgeon, Arthur Cambeiro, M.D., who appeared to be the only local board certified plastic surgeon with patients who were also subject to keloid scarring. She saw a second surgeon and made a non-refundable deposit on a breast enlargement.

"While waiting for the appointment, I continued researching and was constantly referred back to Dr. Cambeiro," she says. "Eventually, I decided to go with him, even though I had to forfeit the deposit with the second surgeon."

After the procedure, M.A. was delighted with the results. However, the keloids did, as expected, develop on her incisions.

Breast Surgery

M.A. chose saline breast implants, placed under the chest muscle, and inserted through the armpit (this method reduces the visibility of scaring). She had the procedure on a Friday and returned to work the following Tuesday, wearing loose, flowing clothing. She reports feeling pain only in her back from sitting up while sleeping during recuperation. It was such an effort to get back up after reclining, she decided to just sit on her couch for a while.

“I continued researching and was constantly referred back to Dr. Cambeiro”

"Even though I wanted breast enlargement, I'm still shy and modest and did not want to show off my new bust line with a plunging neckline and the like," she says. "Happily, nobody at work noticed I had the enhancement done."

Next, Dr. Cambeiro worked over the next year to lessen the appearance of her keloid scars and made sure that they were even with the rest of her skin. Untreated keloids scars almost always bulge above the surface of the surrounding skin.

"The scars are now just a little darker and rougher than the rest of my skin but are completely hidden," M.A. says. "The people who've seen me in a bathing suit, and knew me before I got pregnant, tell me the implants are just the right size for me and that I look totally natural.

"I couldn't be more pleased!"

Malaria

The Facts on Malaria

Malaria is a parasitic infection spread by Anopheles mosquitoes. The Plasmodium parasite that causes malaria is neither a virus nor a bacterium - it is a single-celled parasite that multiplies in red blood cells of humans as well as in the mosquito intestine.

When the female mosquito feeds on an infected person, male and female forms of the parasite are ingested from human blood. Subsequently, the male and female forms of the parasite meet and mate in the mosquito gut, and the infective forms are passed into another human when the mosquito feeds again.

Malaria is a significant global problem. There are approximately 216 million cases of the disease worldwide, killing about 655,000 people every year. Malaria is prevalent in Africa, Asia, the Middle East, Central South America, Hispaniola (Haiti and the Dominican Republic), and Oceania (Papua New Guinea, Irian Jaya, and the Solomon Islands).

Each year, up to 1 million Canadians travel to malaria-endemic areas. This results in 350 to 1,000 annual cases of malaria in Canada.

Although the parasite has progressively developed resistance to several older antimalarial medications, there are still many safe and effective medications both for treatment and prevention.

There are four species of the Plasmodium parasite that can cause malaria in humans: P. falciparum, P. vivax, P. ovale, and P. malariae. The first two types are the most common. Plasmodium falciparum is the most dangerous of these parasites because the infection can kill rapidly (within several days), whereas the other species cause illness but not death. Falciparum malaria is particularly frequent in sub-Saharan Africa and Oceania.

Causes of Malaria

You can only get malaria if you're bitten by an infected mosquito, or if you receive infected blood from someone during a blood transfusion. Malaria can also be transmitted from mother to child during pregnancy.

The mosquitoes that carry Plasmodium parasite get it from biting a person or animal that's already been infected. The parasite then goes through various changes that enable it to infect the next creature the mosquito bites. Once it's in you, it multiplies in the liver and changes again, getting ready to infect the next mosquito that bites you. It then enters the bloodstream and invades red blood cells. Eventually, the infected red blood cells burst. This sends the parasites throughout the body and causes symptoms of malaria.

Malaria has been with us long enough to have changed our genes. The reason why many people of African descent suffer from the blood disease sickle cell anemia is because the gene that causes it also confers some immunity to malaria. In Africa, people with a sickle cell gene are more likely to survive and have children. The same is true of thalassemia, a hereditary disease found in people of Mediterranean, Asian, or African American descent. (See the article on "Anemia" for more information.)

Symptoms and Complications of Malaria

Symptoms usually appear about 12 to 14 days after infection. People with malaria have the following symptoms:

• abdominal pain
• chills and sweats
• diarrhea, nausea, and vomiting (these symptoms only appear sometimes)
• headache
• high fevers
• low blood pressure causing dizziness if moving from a lying or sitting position to a standing position (also called orthostatic hypotension)
• muscle aches
• poor appetite

In people infected with P. falciparum, the following symptoms may also occur:

• anemia caused by the destruction of infected red blood cells
• extreme tiredness, delirium, unconsciousness, convulsions, and coma
• kidney failure
• pulmonary edema (a serious condition where fluid builds up in the lungs, which can lead to severe breathing problems)

P. vivax and P. ovale can lie inactive in the liver for up to a year before causing symptoms. They can then remain dormant in the liver again and cause later relapses.P. vivax is the most common type in North America.

Bones Cancer

What Is Bone Cancer?

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

Cancers can be discovered in bones in a number of different circumstances. When canceris located in the bones, it is important to differentiate whether this cancer has spread from another site to the bones or whether the cancer originated in the bone tissue itself. This distinction is important not only for the sake of correct terminology, but also to accurately determine which treatment options are appropriate.

There are more than 100 types of cancer, and each cancer type is named for the organ or tissue in which it begins. When cancer cells spread, they may travel via the lymphatic channels to lymph nodes, or they may enter the bloodstream and travel to other organs or locations in the body that are distant from the site of the original, or primary, tumor. It is not unusual for cancers that originate in other parts of the body to spread to the bones and begin growing there. Certain types of cancers are particularly likely to spread to the bones. Cancers that commonly metastasize, or spread, to the bones include breast cancer, lung cancer, thyroid cancer, prostate cancer, and cancers of the kidney.

It is important to note that when these other types of cancer spread to the bone, they are still named for the tissue or organ where they arose and are not termed "bone" cancer. For example, breast cancer that has spread to the bones is referred to as metastatic breast cancer and not bone cancer.

In contrast to cancers which have spread to the bone, true bone cancers are tumors that arise from the tissues of the bones. These cancers, called primary bone cancers, are quite rare in comparison to cancers that have spread to the bones.

True bone cancer affects over 2,000 people in the United States each year. It is found most often in the bones of the arms and legs, but it can occur in any bone. Children and young people are more likely than adults to develop bone cancer. The symptoms of bone cancer tend to develop slowly and depend on the type, location, and size of the tumor. Pain is the most frequent symptom of bone cancer, but sometimes a lump on the bone can be felt through the skin.

Get the facts on the types, treatment, and prognosis of bone cancer »

Bone cancer facts

• The majority of cancer involving the bones is metastatic disease from other remote cancers. Primary bone cancer is much rarer.
• Not all bone tumors are cancerous.
• The most common symptom of bone cancer is pain. The pain is usually mild initially and gradually becomes more intense.
• Treatment of bone cancer includes a combination of surgery,chemotherapy, and radiation therapy.
• Treatment is based on the size and location of the cancer and whether or not the cancer has spread from the bone to surrounding tissues.

What are bones for?

Your body has 206 bones. These bones serve many different functions. First, your bones provide structure to your body and help provide its shape. Muscles attach to the bones and allow you to move. Without the bones, your body would be an unstructured pile of soft tissues and you would be unable to stand, walk, or move. Second, the bones help to protect the more fragile organs of the body. For example, the bones of the skull protect the brain, the vertebrae of the spine protect the spinal cord, and the ribs protect the heart and lungs. Third, the bones contain bone marrow, which produces and stores new blood cells. Finally, the bones help control your body's collection of various proteins and nutrients including calcium and phosphorus.

What is cancer?

Your body is made up of many small structures called cells. There are many different types of cells that grow to form the different parts of your body. During normal growth and development, these cells continuously grow, divide, and make new cells. This process continues throughout life even after you are no longer growing. The cells continue to divide and make new cells to replace old and damaged cells. In a healthy person, the body is able to control the growth and division of cells according to the needs of the body. Cancer is when this normal control of cells is lost and the cells begin to grow and divide in an uncontrolled manner. The cells also become abnormal and have altered functions in patients with cancer. The cancer cells can become very destructive to the surrounding cells and can invade normal organs and tissues, disrupting their function.

There are many different type of cancer. The cancer is usually named based on the type of cell from which the cancer initially grows. For example,lung cancer is caused by uncontrolled cells that form the lungs and breast cancer by cells that form the breast. A tumor is a collection of abnormal cells grouped together. However, not all tumors are cancerous. A tumor can be benign (not cancerous) or malignant (cancerous). Benign tumors are usually less dangerous and are not able to spread to other parts of the body. Benign tumors can still be dangerous. They can continue to grow and expand locally. This can lead to compression and damage to the surrounding structures. Malignant tumors are usually more serious and can spread to other areas in the body. The ability of cancer cells to leave their initial location and move to another location in the body is called metastasis. Metastasis can occur by the cancer cells entering the body's bloodstream or lymphatic system to travel to other sites in the body. When cancer cells metastasize to other parts of the body, they are still named by the original type of abnormal cell. For example, if a group of breast cells becomes cancerous and metastasizes to the bones or liver, it is called metastatic breast cancer instead of bone cancer or liver cancer. Many different types of cancer are able to metastasize to the bones. The most common types of cancer that spread to the bones are cancers of the lung, breast, prostate, thyroid, and kidney. Cancers arising from lymphatic or blood cells, includinglymphoma and multiple myeloma, can also frequently affect the bones.

Most of the time, when people have cancer in their bones, it is caused by cancer that has spread from elsewhere in the body to the bones. It is much less common to have a true bone cancer, a cancer that arises from cells that make up the bone. It is important to determine whether the cancer in the bone is from another site or is from a cancer of the bone cells themselves. The treatments for cancers that have metastasized to the bone are often based on the initial type of cancer.

Cataracts

What Are Cataracts? What Causes Cataracts?

Cataracts are cloudy areas in the lens inside the eye - which is normally clear. Cataracts can develop in one or both eyes. If they develop in both eyes, one will be more severely affected than the other. A normally clear lens allows light to pass through to the back of the eye, so that the patient can see well-defined images. If a part of the lens becomes opaque light does not pass through easily and the patient's vision becomes blurry - like looking through cloudy water or a fogged-up window. The more opaque (cloudier) the lens becomes, the worse the person's vision will be. 

According to Medilexicon's medical dictionary, cataract is "Complete or partial opacity of the ocular lens.".

There are two types of cataracts:

• Age related cataracts - they appear later in life; the most common form.


• Congenital cataracts (childhood cataracts) - these may be present when the baby is born, or shortly after birth. Cataracts may also be diagnosed in older babies and children - these are sometimes referred to as developmental, infantile or juvenile cataracts.Researchers from the University Zurich were the first to identify the chromosomal location and exact molecular defect in the coding region of the gene responsible for a childhood cataract.

The rest of this article focuses just on age-related cataracts.

A patient with cataracts will eventually find it hard to read, or drive a car - especially during the night. Even seeing people's facial expressions becomes difficult. Cataracts are not usually painful. The patient's long-distance vision is more severely affected at first. 

Articles About Eye Diseases

What Is AMD? What Is Macular Degeneration?

What Is Glaucoma? What Causes Glaucoma?

As cataracts develop very slowly most people do not know they have them at first. However, the clouding progresses and vision will gradually get worse. Stronger lighting and eyeglasses can help improve vision. Nevertheless, eventually the vision impairment affects the patient's ability to carry out everyday tasks. At this point the individual will need surgery. Fortunately, cataract surgery is usually a very effective and safe procedure. 

Cataracts cause more vision problems globally than any other eye condition or disease - especially in developing countries, where they are much more common among poor people,according to a study carried out in Kenya, The Philippines, and Bangladesh.

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Some studies indicate that cataracts are more common among elderly people further down the socioeconomic ladder in the USA - prevalence of cataracts causing significant visual problems appears high among older U.S. Hispanics who also often encounter barriers to access to care (in the USA "Hispanics" refers to Americans of Latin American origin, not people who originate from Spain). 

Both men and women are affected equally.

According to the National Health Service (NHS), UK, approximately one third of people aged 65 or over have cataracts in one or both eyes.

Factors that may increase the risk of developing cataracts

We are all at risk of developing cataracts because we will all get old one day - the greatest risk factor is age. In the USA approximately 50% of people aged 65 or more have some degree of lens clouding. 70% of Americans aged 75 or more have their vision significantly impaired by cataracts. 

Researchers at the Wilmer Eye Institute at The Johns Hopkins Medical Institutions, Baltimore predicted that the number of people in the USA affected by cataracts is estimated to rise to 30.1 million people in the next 20 years, an increase of 50 percent, because people will live longer.

The following factors may increase a person's chances of developing cataracts:

• Age


• Close relatives who have/had cataracts (family history)


• Diabetes


• Ionizing radiation exposure - airline pilots have an increased risk of nuclear cataracts compared with non-pilots, and that risk is associated with cumulative exposure to cosmic radiation, scientists from the University of Iceland reported.
  
  The five-year incidence of nuclear cataract was 40% lower for statin users after adjusting for several factors, compared to non-statin users, another study found.


• Long-term exposure to bright sunlight


• Long-term use of corticosteroids - many people with asthma rely on inhaled, and sometimes oral, steroids, as do people with chronic obstructive pulmonary disease. A study conducted by the Centre for Vision Research, University of Sydney, Australia, revealed that cataract risk is higher for patients taking these medications.


• Previous eye inflammation


• Previous eye injury


• Exposure to lead - lifetime lead exposure may increase the risk of developing cataracts, scientists from the National Institute of Environmental Health Sciences, USA revealed.


• Crystallins loss of function - A specific type of protein (crystallins) begins to lose function as the eye ages. As the protein loses function, small peptides, made of 10 to 15 amino acids, start forming and accelerate cataract formation in the eye, a study revealed.

What are the symptoms of age-related cataracts?

Symptoms usually creep up many years after onset - usually when the person is elderly. Progressively, more of the lens becomes cloudy. People with mild cataracts will not notice they have it for a long time. 

Cataracts often affect both eyes, but rarely equally. 

People with cataracts may have the following symptoms:

• Blurry, cloudy, or misty vision.


• Some describe it as similar to looking through frosted glass.


• Vision may be affected by small spots or dots.


• The patient sees small patches which blur parts of his/her field of vision.


• Vision gets worse when lights are dim.


• Vision is sometimes worse when light is very bright (glare).


• Some people with cataracts also comment that colors appear less clear and faded.


• Reading becomes very difficult, and eventually impossible.


• Glasses need to be changed more frequently.


• Eventually wearing glasses becomes less effective.


• In some rare cases patients can see a halo around bright objects, such as car headlights or street lights.


• Double vision in one eye (rare).

As the person's vision deteriorates, and the glare of oncoming headlights and street lights gets worse, driving becomes awkward and potentially very dangerous - research carried out by optometrists and psychologists in Australia shows that motorists suffering from cataracts are less able to spot potentially dangerous hazards on the roads. Drivers with cataracts eventually start suffering from eyestrain and find themselves blinking more frequently in an attempt to clear their vision. 

Cataracts do not usually cause any change in the appearance of the eye. Any discomforts, such as irritation, aching, itching or redness are most likely caused by some other eye disorder.

Cataracts are not hazardous to the sufferer's health, or the health of the eye. If the cataract becomes hypermature (completely white), the sufferer may experience inflammation, headacheand some pain. Hypermature cataracts need to be removed if there is inflammation or pain.

How are cataracts diagnosed?

Anybody who experiences vision problems should see a GP (general practitioner, primary care physician), an ophthalmologist, or an optometrist. The GP will most likely refer the patient to an ophthalmologist, or an optometrist.

• Ophthalmologist - a doctor who specializes in the medical and surgical care of the eye.


• Optometrist - a person practicing eye care, but does not perform surgery.

The eye specialist will carry out a number of tests. These may include:

• Visual acuity test - this tests how clearly the individual can see an object. It tests the person's sharpness of vision. The patient reads letters from across a room. The two eyes are tested separately (one is covered). By using a chart with progressively smaller letters, the specialist can determine how acute the patient's vision is. The chart is called a Snellen Eye Chart.
  
  Sometimes the chart has to be read twice - once with, and once without bright lights. This will give an indication of glare sensitivity.


• Slit-lamp examination - this is a microscope which allows the specialist to see the structures at the front of the eye. An intense line of sight (a slit) is used to illuminate the cornea, iris, lens, as well as the space between the iris and the cornea. The slit makes it possible for the specialist to see these structures in small sections, making it easier to spot any problems.


• Retinal examination - eye drops are administered which dilate the pupils, providing a bigger window to the back of the eyes. The specialist examines the lens for signs of cataract with either an ophthalmoscope or a slit lamp. If signs of cataract are found, the specialist can also determine how dense the clouding is. Most specialists will check forglaucoma at the same time, and perhaps some other eye conditions/diseases.
  
  The pupils will remain dilated for a few hours after the examination before the eye drops gradually lose their effect. During this time the patient may find it harder to focus on close objects. It is advisable to wear sunglasses, especially if it is a bright day. Driving is not advisable until the pupils are back to their normal size.


• Measuring a protein related to cataract formation - A device based on a laser light technique called dynamic light scattering can safely eye test for measuring a protein related to cataract formation, according to researchers at the National Eye Institute, USA.

Although an eye test may help confirm a cataract diagnosis, it may not always reflect the patient's quality of life. Some patients who do badly in a test seem to have no problem with daily function, while others who may do well insist that their eyesight is poor and does interfere with ordinary activities.

Treatment for cataracts

If the patient is found to be only mildly affected surgical treatment may not be needed. During its early stages, stronger glasses and brighter lights may help improve vision. The following simple approaches may assist people who are not ready yet to have surgery:

• Make sure your glasses are the most accurate prescription possible.
• Use a magnifying glass for reading.
• Get brighter lamps for your house. Halogen lights may help a lot.
• Wear sunglasses to reduce glare on sunny days.
• Try to refrain from driving at night.

Surgery

However, these are only temporary measures - the cataracts will continue developing and gradually impair eyesight more. 

Patients who take alpha-blockers or are considering taking alpha-blockers should be aware that the drugs may increase the difficulty of cataract surgery. While Flomax (an alpha-blocker) is largely prescribed to men to treat prostate enlargement, some women also take the drug to treat urinary retention problems. Other alpha-blockers are used to treat hypertension. The American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery issued an advisory telling patients and GPs to inform their surgeon if they are taking alpha-blockers, or took them in the past. Once informed, the ophthalmologist can anticipate certain problems and employ different surgical techniques that help to achieve excellent outcomes. 

When the cataracts are severe the only effective treatment is surgery. The specialist will recommend surgery if the patient:

• Is having trouble looking after himself/herself.
• Is having difficulties looking after someone else.
• Cannot drive, or finds driving difficult.
• Has problems leaving the house.
• Finds it hard to see or recognize people's faces.
• Has problems doing his/her job.
• Cannot read properly.
• Can no longer watch television properly.

The cloudy lens is removed from the eye and an artificial clear plastic one is put in its place - an intraocular implant (intraocular lens). In most developed countries, and a growing number of developing countries, cataract operations are performed as keyhole surgery. The patient will be given a local anesthetic. He/she will not usually have to spend the night in hospital. The operation is commonly known as phacoemulsification or phaco extracapsular extraction. Laser surgery is not used for cataract procedures. (There are more details about the operation further down this page) 

Pre-operative assessment (assessment before surgery) 

The specialist will assess the patient's eyes and general health. During the pre-operative assessment the eye will be measured so that the replacement artificial lens can be prepared.

The day of the operation - before it begins

Eye drops that dilate (widen) the pupils will be administered just before the procedure. Sometimes the eye drops will also have anesthetic in them, or the doctor may inject the tissue around the eye for a local anesthetic. As soon as the anesthetic starts working the area will be numbed and the patient will feel nothing. During the operation he/she will be aware of a bright light, but will not be able to see what is happening. 

Various types of replacement lenses may be used:

• Monofocal lens - this is a fixed-strength lens which is set for one level of vision - usually distance vision.


• Multifocal lens - this type of lens may have two or more different strengths; near and distance vision.


• Accommodating lens - this type of lens is the most similar to the natural human lens. It allows the eye to focus on near and distant objects.

The operation

The eye surgeon makes a tiny cut in the cornea at the front. He/she then inserts a minute probe through the cut. The probe uses ultrasound and breaks up the cloudy lens into very small pieces which are sucked out. 

The artificial lens is then inserted through the cut. The lens sits in the lens capsule to keep it in place - the lens capsule is like a little pocket. When it is first inserted the lens is folded - it unfolds when in position. 

The whole procedure should not take more than about 30 minutes. Most patients will wear an eye pad for protection for a short while. 

Other procedures

• Manual extracapsular extraction - the lens is removed in one piece. No ultrasound is used to break it up. The surgeon will make a slightly larger cut in the eye.


• Intracapsular extraction - the lens capsule as well as the lens is removed. The artificial lens is sewn into the eye. This type of procedure is much less common.

After the operation

Most patients will experience vision improvement virtually immediately. It may take a while for the eye to settle down completely. The cut in the eye may occasionally need a stitch - in most cases, however, it is so small that it heals by itself. 

Patients should avoid vigorous activities for a while. Most individuals find they can go about their daily activities as soon as they get home. An appointment will be made to test the patient's vision. Most patients will need different glasses after their operation. The new glasses can only be determined after his/her vision has settled down - this can take several weeks. 

There is no other way to cure cataracts. Medications, dietary supplements, exercise or optical devices are not effective. As mentioned earlier, during the early stages there are some things the patient can do to help see things better - but they are only temporary.

Prevention of cataracts

To prevent suffering the complications of cataracts it is advisable to have regular eye exams, especially as you get older. The following steps are advisable to lower your risk of developing cataracts - some of them have convincing circumstantial evidence of their worth, while others (smoking, diet) are proven measures:

• Give up smoking - several studies have indicated that a higher percentage of smokers develop cataracts, compared to non-smokers. There are also indications that smokers are likely to experience cataract symptoms earlier. Smoking also increases the risk of other eye disease/conditions.


• Nutrition - eat plenty of fruits and vegetables, whole grains, unrefined carbohydrates, good quality fats (avocado, olive oil, omega oils), and either plant sourced proteins or lean animal sourced proteins.
  
  The findings by researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, USA suggest that vitamins and polyunsaturated fatty acids - two categories of nutrients believed to have health benefits - may both affect cataract development, although not necessarily in beneficial ways.
  
  Women who consume plenty of dark leafy vegetables which are rich in lutein and zeaxanthin, as well as sufficient vitamin E from supplements/foods seem to have better protection against developing cataracts, scientists from the Brigham & Women's Hospital and Harvard Medical School, Boston found.


• Sunlight - wear sunglasses that block ultraviolet B rays (UV radiation). Many people are not aware of the damage UV radiation can cause to the eyes - a study found that only 49% of Americans said UV protection was the most important factor when purchasing sunglasses.


• Sleep - make sure you get at least 7 hours of good quality, continuous sleep every night.


• Obesity - obesity significantly raises the risk of developing diabetes type 2, which in turn is an important cataract risk factor. Keeping your weight within the recommended limits will help prevent your risk from increasing.


• Diabetes - be careful to have your diabetes under control; follow your treatment plan assiduously.


• Exercise - Researchers from the U.S. Department of Energy's Lawrence Berkeley National Laboratory reported that running reduces the risk of both cataracts and age-related macular degeneration.

Complications

• Blindness - If the cataracts are left untreated, they may lead to blindness.


• Higher mortality rates - people aged 49 and older with cataract and those aged 49 to 74 years with age-related macular degeneration appear to have higher mortality rates over an 11-year period than those without such visual impairments, according to a study carried out by researchers at the University of Sydney, Australia.