This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!) On episode 1 of season 7 (named “Now What”), the hospital’s only neurosurgeon, Dr. Richardson, has a severe nausea which doesn’t respond to strong anti-nausea drugs. The team treats him with stronger medications for his nausea – it passes but he starts to hallucinate and behave oddly. At first, the team thinks his behavior is a side effect of the drugs they gave him and test for a bunch of diseases like hepatitis and peptic ulcer. Only when they start to think of his behavior as a new symptom, and after they find out he was at a sea-food festival several days before, they diagnose him with toad egg poisoning

[Photo from episode]

Photo by Fox

Danger Level: High

What is it?

The poison in toad eggs is the venom of the Cane Toad. The venom is usually located in the salivary glands of the frog and on the skin, and rarely it can also pass to the eggs. The toad venom is also used in Chinese medications, so consuming these medications might also cause poisoning: it is the main ingredient in a medicine called Chan-Su which is used mostly as a topical aphrodisiac (and was banned from the Uniter States after four men died after trying to swallow it), and is also an ingredient of Kyushin, which is used in Chinese medicine to treat heart problems.

What causes it?

The toad poison contains a substance called Bufotenin, which is very similar to a cardiac medication called Digoxin (used to treat heart failure and certain abnormal heart rhythms). Digoxin can be toxic in high doses, and the toad venom causes symptoms similar to an overdose.

How does it feel?

The venom of the toad causes several symptoms:

• Nausea with vomiting and possible abdominal pain.
• Cardiac symptoms – mostly problems with the heart rate (which are called arrhythmias), which can be deadly. You might feel heart palpitations.
• Mental symptoms, such as hallucinations. The cane toad is also known as the “hallucinogenic toad” – licking its skin can cause hallucinations which last for about an hour. However, mental symptoms are less described in toad venom poisoning.

Photo by Doug Greenberg

How is it discovered?

The doctors will suspect this if there is a story of eating certain foods such as toad soup, toad cake or toad eggs, or if the patient uses one of the Chinese medications mentioned above. They will test your blood for potassium levels (if it’s high – this is usually a bad sign, since it may cause the heart rhythm problems mentioned above) and for the level of Digoxin (this test can also identify the poison). They will also do an ECG to look for problems with the heart rate.

How is it treated?

There is an antibody for Digoxin which can be used to treat toad venom poisoning as well and has been proved to save lives. Besides that, the treatment focuses on stopping the symptoms.

The bottom line – how do I avoid it?

It’s important to be aware of the possibility of poisoning, and seek medical help if you start feeling nausea or have heart palpitations after eating foods which contain toad. Also, avoid topical aphrodisiacs containing Chan-Su, which are marketed as “Rockhard”, “Love Stone”, or “chan su” – and are forbidden to import to the United States.

Related posts:

1. Radiation Poisoning– What it Can Do To You (As Seen on House MD)
2. Organophosphate Poisoning – Getting Poisoned by Pesticides (As Seen on House MD)
3. Naphthalene Poisoning – When Mothballs Kill More Than Just Moths (As Seen on House MD)

This week, more than 1,000 people got sick and 16 died in an outbreak of HUS – a disease related to the bacteria E. coli. Initially cucumbers imported from Spain were blamed to be contaminated with the bacteria, but today this theory was proved wrong, and the source of the infection remains a mystery. What exactly is HUS, and what can you do to avoid it?

Initially, Germans have been warned not to eat cucumbers. (Photo by kobiz7)

Danger Level: High

What is it?

Hemolytic Uremic Syndrome (HUS) is a disease that causes anemia, renal failure and a low platelet count in the blood.

Who gets it?

Most cases of HUS develop in young children, but it can certainly happen in adolescents and adults as well.

It can affect men and women alike.

It’s usually not very common, occurring to 0.5-2 people out of 100,000 in the US per year.

What causes it?

The most common cause for HUS is infection with E. Coli bacteria. E. coli (or by its full name, Escherichia coli) is actually a large group of germs, some of them live in the intestines of healthy people. The type of E. coli which causes HUS is a violent type, which produces a toxin called Shiga-Like Toxin. The toxin is absorbed to the blood through the intestines, and damages the cells that create the most internal layer of blood vessels – especially in the kidney but also in other organs. This damage causes all the symptoms of HUS.

You can get infected with this type of E. coli by eating contaminated and undercooked meat or produce, drinking unpasteurized contaminated milk or swimming in contaminated pools and lakes. It can also be transferred by contact with infected people, for example – in day-cares.

E. coli (Photo by Phil Moyer)

There are other not-common causes for HUS, including:

• Other infections: Some other bacterial and viral infections can also cause HUS, but this is much less common.
• Medications: Several medications can (rarely) cause HUS, including birth control pills, some chemotherapy drugs and cyclosporine – which is used to suppress the immune system (for example after an organ transplant).
• Other diseases: Systemic Lupus Erythematosus (SLE), Preeclampsia and inflammation in the kidneys after radiation treatments.
• Some cases are genetic.

How does it feel?

1. Food Poisoning: The first symptoms are food-poisoning symptoms caused by the E. coli bacteria themselves. This can include abdominal pain, a fever, vomiting and diarrhea which usually becomes bloody at some point. these symptoms appear 5-10 days before all the other symptoms.
2. Anemia: This causes the sick person to look pale and be pretty tired, weak and irritable.
3. Bleeding: There might be external bleeding (from the nose of mouth) or bleeding under the skin, which looks like small unexplained bruises. this is caused by a low number of platelets, which are the cells in our body responsible for blood clots.
4. Kidney Failure: Can cause the body to produce less urine.

The story of 16-year-old Aly, who recovered from HUS

How is it discovered?

When suspecting HUS, the doctors will draw some blood. They will check several things: Complete Blood Count will let them know if there is anemia or low platelets, and kidney function tests will determine if there is kidney failure. They will also look at the blood under a microscope. Other tests that might be needed are a urine test (to look for blood in the urine) and a stool sample (to look for the germs).

How is it treated?

The treatment is given in the hospital, and the goal is to relieve the symptoms:

• The most important part of the treatment is dialysis treatments until the kidneys start working again. If the disease is diagnosed early enough, dialysis might not be needed. The doctors can save the kidneys from failing by giving a lot of fluids.
• The anemia is treated with blood transfusions, and the bleeding problems with platelet transfusions.
• Another possible treatment is plasma-exchange (also called plasmapheresis) – in which blood is removed from the body and blood from a donor is returned back. This is used to remove elements that cause the disease from the blood.

Although the cause is an infection, antibiotics are not part of the treatment.

Dialysis treatment.

What happens after treatment?

In most cases (about 90%, and especially in children), if the disease is discovered early enough and treated correctly, the patient recovers. The other 10% might die or remain with chronic kidney failure which will require dialysis treatments for the rest of their life or a kidney transplant. Some of the people who recover will develop kidney problems or hypertension later in life.

The bottom line – how do I avoid it?

The best way to avoid HUS is to avoid food-poisoning with E. coli – this can be done in several ways:

• Treating foods carefully: You should wash hands often when cooking, keep meat in the refrigerator or freezer, wash fruit and vegetables under running water, cook meat thoroughly without leaving pink areas (if you have a thermometer for cooking, cook to a temperature of at least 160°F [70°C]).
• Avoiding certain foods: Especially undercooked meat, unpasteurized milk and cider. Drink only clean water. Remember that the contaminated food will not necessarily look spoiled of taste bad.
• Avoid swimming in dirty lakes and pools.
• If you have diarrhea – wash hands often.

Related posts:

1. Everything You Need To Know About Fast Food – An Infographic
2. In the News – Hodgkin’s Disease
3. Naphthalene Poisoning – When Mothballs Kill More Than Just Moths (As Seen on House MD)

This is part of our House MD Project series.

Make sure to tune in tomorrow for a medical recap of tonight’s finale!

Click here to read the connection to the episode (spoiler alert!)


On episode 22 of season 7, named “After Hours”, a woman named Darrien is bleeding after a stabbing to her body. Her blood pressure and heart rate are almost missing on one side of her body, meaning something is blocking one of the arteries there. She then starts hallucinating due to an interruption of blood flow to her brain. Fever also develops, hinting at an infection. Turns out her symptoms were due to an infection with entamoeba, a parasite, which was released to her bloodstream by the stabbing.

Photo by NBCUniversal

Danger level: Medium

What is it?

Entamoeba histolytica is a parasite which can infect humans. It can infect the large intestine and sometimes the liver and other organs, causing a condition called amebiasis.

Who gets it?

It’s estimated that about 10% of the world’s population are infected with Entamoeba histolytica. It’s more common in some areas of the world where sanitation is poor, such as Central and South America, Africa, and Asia. In the United States it is estimated that about 4% of the population are infected – most of them are immigrants or people who have traveled to countries where it’s more common.

What causes it?

The infection, as mentioned above, is caused by a parasite – an ameba named Entamoeba histolytica, seen under a microscope in this photo:

The parasite can exist in 2 forms: One active (called a trophozoite) and one dormant – called a cyst. Infection occurs when a person swallows cysts. They hatch in the body, releasing trophozoites. These in turn start multiplying and can cause wounds in the lining of the intestines. They can also spread to the liver and other places.

Some trophozoites become cysts again, and are excreted in the feces, helping the infection spread.

Now how do people actually get to swallowing the parasite, or how do they infect themselves? The cysts can spread from person to person or through food or water. In places where there is poor sanitation, food and water can be contaminated with feces containing the ameba. If soil is polluted by human feces, fruits and vegetables growing in it will be infected as well. If someone doesn’t wash hands properly after going to the toilet, the infection can spread. You’re getting the idea…

How does it feel?

In many people (about 80%), the infection isn’t felt at all. When it is felt, symptoms start within about 2-4 weeks of ingesting the parasite, and can include flatulence, abdominal pain, diarrhea, or constipation. In some cases a dysentery may be caused, meaning there is blood and mucus in the feces. Fever may also develop. Blockage as well as perforation of the intestines can occur.

Sometimes the ameba may spread to the liver, causing an abscess (a localized collection of pus). The person would feel fever and chills, sweating, nausea and vomiting, and weight loss. Rarely, the ameba can spread to other areas of the body (even the brain).

This vivid video sums it up:

How is it discovered?

A stool sample has to be examined to find the ameba. Sometimes a tube with a camera (colonoscope) can be inserted to the colon to collect a sample from a wound caused by the ameba, to look at under a microscope.

To find a liver abscess, an imaging method such as an ultrasound, CT or MRI can be used. Blood tests can also help with the discovery of the parasite.

How is it treated?

An antibiotic is given that can kill the ameba. An example of such a drug is metronidazole (which was mentioned on House).

The bottom line – How do I avoid it?

When travelling to an area known to have poor sanitary conditions, make sure to drink only bottled water, tap water that’s been boiled for at least 1 minute, or bubbly water or soda drinks from sealed cans.

Do not drink fountain drinks or any drinks with ice cubes. Do not eat fresh fruit or vegetables you didn’t peel yourself. Do not eat dairy products that may not have been pasteurized. And don’t eat anything sold by street vendors.

If you have been infected, you can minimize risk of infection to others by washing your hands with soap and water after using the toilet, after changing diapers, and before handling food.

Related posts:

1. Malaria – A Deadly Infection Passed On By Mosquitoes (As Seen on House MD)
2. Gas Gangrene – An Infection That Can Rapidly Kill Your Muscles (As Seen on House MD)
3. Common Variable Immunodeficiency (CVID)–When a Cold Can Threaten Your Life (As Seen on House MD)

Danger level: Low

What is it?

Irritable bowel syndrome (IBS) is a chronic condition of the digestive system causing pain and a change in bowel habits.

Who gets it?

It’s estimated that as much as 10-20% of the population in the US suffer from IBS.

Women are 2-3 times more likely to develop IBS than men in Western countries. In the Indian subcontinent, on the other hand, 70-80% of sufferers are men.

The condition starts before age 35 in about 50% of people.

If you have someone in your close family (parents, siblings) with IBS, you may have a higher chance of developing it yourself.

What causes it?

The reason behind IBS isn’t known yet, although there are many theories.

The symptoms of IBS (which we will discuss next) are caused by changes in our bowel habits. Our intestines move the food we eat along the gastrointestinal tract by contraction and relaxation of muscles in the intestines’ walls.

In IBS, these contractions may be stronger and longer, leading to food passing more quickly than normal in the intestines. This can cause gas, bloating and diarrhea. In other people, contractions may be weaker, causing the stools to stay longer in the intestines, making them hard and dry. This may lead to constipation.

The intestines. For some people, they just don’t work the way they’re supposed to. Photo by Curious Expeditions. 

People with IBS have a sensitivity to certain triggers which other people don’t respond to. For example -

1. Foods: Some foods worsen the symptoms in some IBS patients. Examples of such foods include chocolate, milk and alcohol. Also carbonated beverages and some fruits and vegetables may cause discomfort.
2. Stress: Stressful events may aggravate the symptoms.

How does it feel?

1. Abdominal pain – The pain is usually crampy and located in the lower left abdomen. Sometimes, as mentioned above, stress and eating may worsen the pain. Going to the toilet may relieve the pain.

   
   Abdominal pain is the most common symptom of IBS. Photo by Peter Gerdes.

2. Changes in bowel habits – This can include diarrhea, constipation, or an alternation between the two. The diarrhea usually happens during the daytime, most often in the mornings or after meals. People often feel they just have to run to the toilet, and after emptying they often feel not completely emptied. The constipation can last from days to months.
3. Other symptoms – These can include bloating, gas, belching, heartburn, difficulty swallowing, an early feeling of fullness with eating, and nausea.

How is it discovered?

There are no specific tests which can be done to determine if you have IBS. Instead, there are some criteria, called the Rome 3 diagnostic criteria for IBS, which may help the doctor (and you) determine if you have IBS.

The criteria say that if you have abdominal pain or discomfort that lasts for at least 3 days per month in the last 3 months which are associated with either:

- Improvement with defecation

- It started with a change in bowel frequency

- It started with  a change in the appearance of stools

Then you may have IBS.

IBS isn’t a life threatening disorder, but other diseases that may be life threatening may show up with the same symptoms. This is why the doctor may perform tests to rule out other conditions before deciding you have IBS.

How is it treated?

There is really no cure for IBS, so treatment is usually a long term process. Treatment includes:

1. Monitoring symptoms – This helps to identify which things cause you to feel worse so that you may avoid them. It can be done with a daily diary.
2. Diet changes – Eliminating foods that may worsen your symptoms is part of the treatment. It shouldn’t be done without a doctor’s consultation, though. This may include lowering your daily intake of dairy products, eating less foods that may cause gas, eating foods which may be easier to digest, and increasing your dietary fiber.
3. Psychosocial therapy – Since stress and anxiety may worsen the disease for some people, learning to deal with them may ease the disease.
4. Medications – None of those cure the disease, but may help with the symptoms. Consult your doctor for info about those.

What happens after treatment?

Although IBS can cause substantial physical discomfort and emotional distress, the condition isn’t life threatening. Most people with the condition learn to control their symptoms with time.

The bottom line – How do I avoid it?

There is no known way to prevent IBS, since no one really knows what causes it. If you do have the condition, dealing with stress and eating a proper diet may help to avoid its symptoms.

This video showcases a personal story of IBS, as seen on the Discovery Channel:

Do you suffer from IBS or know someone who does? Share your story in the comments below.

Related posts:

1. Crohn’s Disease – Inflammation in The Intestines Which Can Influence Your Whole Life
2. Asperger Syndrome – A Life of Misunderstandings
3. Peptic Ulcer Disease – Wounds in your stomach and intestines

Danger level: High

What is it?

Diverticulitis is an inflammation of pouches (called diverticula) in the wall of your intestines.

Who gets it?

You are more likely to get diverticula (pouches in the wall of your intestines) as you age: less than 5% of people before age 40 get it, while at age 85 it happens to more than 65% of people.

In the world, diverticulitis occurs more frequently in Western countries, a fact which is probably related to the diet in these countries (it has become more common in Japan, for example, when the country adopted a more Western lifestyle).

There are a few risk factors – things which put you at a greater risk of getting diverticulitis:

1. Too little fiber in your diet – A high fiber diet helps keep stools soft. Fiber moves quickly through our digestive system, helping it to function properly. The diet in industrialized countries today is relatively low in fiber (which can be found in foods such as fruit, vegetables, oat bran, whole wheat bread and others).

   
   Fiber. You have to eat enough of it to prevent diverticulitis. Photo by Mr. T in DC.

2. Lack of exercise – The exact reason behind this isn’t understood.
3. Obesity – Being overweight increases the odds of developing diverticulitis. You can find out if you’re overweight by calculating your BMI.

What causes it?

Without enough fiber in our diet, which usually adds bulk to the stool, the intestines have to work harder to push the stool forwards. This causes pressure on the intestine’s wall, causing pouches (called diverticula) to form in weak places in the wall of the intestine.

Diverticulitis is the formation of pouches in the wall of your large intestine.

These pouches can just lie there aimlessly, or can cause trouble. There are 2 things which can happen to them:

1. Diverticulitis – This is the subject of this article. Diverticulitis (or an inflammation of the pouches) occurs when bacteria get trapped in the pouches, leading to infection or inflammation there.
2. Hemorrhage – Sometimes a blood vessel adjacent to one of these pouches may rupture, which can cause massive bleeding.

How does it feel?

The most common symptom in diverticulitis is abdominal pain, located in the left lower part of the abdomen. The pain is often sudden and severe (but it can less commonly start milder and progress). The pain can radiate as well, and be felt in the groin or the back.

Other things that can appear along with the pain include a change in bowel habits, tenderness when touching the abdomen, nausea and vomiting, fever and chills, constipation or diarrhea.

How is it discovered?

Besides a physical check-up, the doctor may run some blood tests (they will take a test called a complete blood count, which will tell if you have an infection) and take some images of your abdomen, for example using a CT scan.

How is it treated?

The treatment depends on the severity of the disease, as well as other things, such as if you’ve had attacks before.

The initial treatment usually includes fluids given through the vein, while withholding eating anything, to not put a burden on the intestines. Also, since diverticulitis is usually related to an infection, antibiotics are given.

In more problematic situations (such as when an abscess develops) a surgery may be needed.

What happens after treatment?

If diverticulitis isn’t treated on time, the intestines may rupture, which can be a life threatening situation. Therefore, if you experience the symptoms mentioned above it’s important that you seek immediate medical care.

Even when the condition is treated, in some people it tends to recur. In these cases, surgery may be needed.

The bottom line – How do I avoid it?

1. Eat a fiber-rich diet – You should replace low-fiber foods (such as white bread, white rice, candy and chips) with fiber-containing foods (whole-grain bread, brown rice, fruits and vegetables). The nutrition labels on foods will show you how much fiber the food has, like in the following example (information by nutritiondata.com):

   

   The recommended amount of fiber per day is at least 25-30 grams.

2. Get regular exercise
3. Drink lots of fluids – This prevents you from having chronic constipation, which can contribute to the pressure on the intestine’s wall.

Have you experienced diverticulitis and have tips of your own to share? Let us know in the comments.

Related posts:

1. Refsum Disease–Losing Your Vision and Sense of Smell, All Because of Your Diet (As Seen on House MD)
2. Why Staying Up Late Isn’t Good for Your Diet

Danger: Medium

What is it?

Peptic ulcer disease (PUD) is a condition in which wounds form in the digestive tract, mainly in the stomach or the duodenum (a part of the intestine).

Who gets it?

You have about a 10% chance of having PUD during your lifetime. In the United States, about 4 million people get it each year.

The two main groups of people who get it are people who are treated with nonsteroidal anti-inflammatory medications (such as ibuprofen) and those who are infected with a specific germ called helicobacter pylori (see ahead).

What causes it?

Our stomach releases acid, which helps in the process of food breakdown in the body. Under normal conditions, the body can protect itself from that acid since it has a protective lining on the stomach and the duodenum. There’s usually a balance between the secretion of acid and the protective lining. When that balance is disrupted, a peptic ulcer can occur.

The following things are known to change that balance and bring about ulcers:

1. Infection with a germ called Helicobacter pylori (H. pylori) – There are estimates that about half of the world’s population are infected with it. The relationship between ulcers and H. pylori wasn’t known until 1982, when a researcher decided to prove his theory of a connection between the two by swallowing these bacteria. Not long after, he had ulcers.
   H. pylori is responsible for 90% of ulcers in the duodenum and 70% in the stomach.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin: These are drugs used to treat pain, inflammation and fever. Everyone uses them from time to time. You might know them by their names: aspirin, ibuprofen (Advil, Motrin, Midol), naproxen (Aleve, Anaprox, Naprosyn), and others.
3. Zollinger-ellison syndrome: This is a rare tumor which we will cover here in the future. It causes extra secretion of acid.
4. Others: Other reasons include smoking, radiation therapy (such as for cancer), chemotherapy for cancer and others.

  
Aspirin. It and other NSAIDs can cause peptic ulcers. Photo by ragesoss.

This video shows how an ulcer develops:

How does it feel?

The main thing you feel when you have a peptic ulcer is abdominal pain (although you may also not feel it at all). The pain is usually located in the upper abdomen. If the ulcer is located in the duodenum, the pain is usually relieved by eating food. If it’s located in the stomach, it usually gets worse by eating.

If an ulcer isn’t treated properly, it can develop complications. These include:

1. Bleeding
2. Perforation – A hole through the wall of the stomach or duodenum
3. Gastric outlet obstruction – If the ulcer causes a swelling which blocks the passageway leading from the stomach to the small intestine. This can bring about early satiety when eating, a feeling of fullness, nausea and vomiting.

Since these complications may be life threatening, it’s important to seek treatment if you have a peptic ulcer.

How is it discovered?

There are a few things which can be done to discover a peptic ulcer:

1. H. pylori testing – There are several tests which can detect if you are infected with this germ. These tests include blood tests, tests for your breath and tests for your stool. If you are positive, you will be treated for infection and then get re-checked to see if the germ is gone.
2. Upper endoscopy – This is a tube with a camera inserted through your mouth to your intestines or stomach to see the appearance there. This is done more in older people or people with other symptoms such as weight loss, to rule out the possibility that the symptoms are caused by cancer and not by a peptic ulcer. A biopsy of the intestine or stomach can be taken during that test.

How is it treated?

There are a few ways to treat peptic ulcers:

1. Stopping taking NSAIDs – If they are the cause of the ulcer.
2. Treating H. pylori – This involves taking several medications together for about 7-14 days.
3. Acid suppression drugs – If there is no known infection with H. pylori, these drugs can also be used. They suppress the release of acid from the stomach.
4. Surgery – If complications develop, a surgery may be needed.

What happens after treatment?

Most patients are treated successfully with the cure of H pylori infection, avoidance of NSAIDs, and the use of acid suppression drugs.

In the past, more people had to be treated with surgery. Since the discovery of H. pylori and the above treatments, surgeries are rarely needed today.

The bottom line – How do I prevent it?

You can avoid having peptic ulcers or having them recurring if you follow these tips:

1. Quit smoking
2. Avoid heavy alcohol use
3. Don’t overuse NSAIDs
4. Contact your doctor if you have the symptoms mentioned above

Know of any tips of your own? Share them in the comments.

Related posts:

1. Crohn’s Disease – Inflammation in The Intestines Which Can Influence Your Whole Life
2. Irritable Bowel Syndrome (IBS) – How the Intestines Can Affect Your Whole Life
3. Gastroesophageal Reflux Disease – Very Common But Not So Innocent

Danger level: High

What is it?

Carcinoid tumor is a type of slow-growing cancer which can grow in several places in the body. It usually forms in the intestines, but can also appear in the lungs, in other places in the digestive system (such as the stomach) and in other organs.

Who gets it?

In the United States, about 1.5 people in 100,000 have a carcinoid tumor.

There are a few risk factors which can put you at risk of developing this tumor:

1. Smoking – As in many other tumors, smoking can also increase your risk of having a carcinoid tumor.
2. Family history – If you have someone in your family with a syndrome called Multiple Endocrine Neoplasia type 1 (or MEN1 for short) you might be at risk.
3. Certain medical conditions – These conditions affect the stomach’s ability to produce acid, which is produced by the stomach under normal conditions. Conditions here include atrophic gastritis, pernicious anemia and Zollinger-Ellison syndrome. They all put you at greater risk for developing a carcinoid tumor.

What causes it?

Most of us know that our digestive system (the stomach, intestines, etc.) helps us break down the food we eat and digest it. One of the less known abilities of this system is to produce hormones (these are chemicals which affect cells in other parts of the body). Our digestive tract is lined by cells which can produce hormones (as well as other cells). Carcinoid tumors arise from these cells (and that is why carcinoid tumors can sometimes produce hormones themselves, as you’ll see ahead).

In carcinoid, these cells multiply uncontrollably to form masses, which are the tumor.

A part of the small intestine with a round mass in it – this is the carcinoid tumor.

How does it feel?

There are 3 things that can be felt in a carcinoid tumor:

1. Nothing – Often these tumors don’t show any signs of existence in their early stages, and you can go about unaware you have them.
2. Things that occur when there are tumors in the intestines – Carcinoid isn’t the only tumor which can occur in the intestines. It and other tumors there usually can cause a set of symptoms due to their location. These include abdominal pain, obstruction of the intestines (which will cause vomiting and bloating, among other things), diarrhea and weight loss.
3. Things specific to carcinoid tumors – Above we mentioned that these tumors can produce hormones. In less than 10% of cases, this brings about a set of symptoms called the carcinoid syndrome. Things it can include:
   a. Flushing (redness) of the skin
   b. Diarrhea
   c. Enlargement of the liver
   d. Problems with the heart valves
   e. Asthma

How is it discovered?

There are a few ways in which these tumors can be discovered:

1. Accidentally – Since a lot of the time these tumors don’t produce any symptoms, sometimes they’d be found in surgery done for other reasons.
2. High levels of the hormones in the urine – As mentioned above, these tumors can produce chemicals. An example of this is 5-HIAA, which can be found in high levels in the urine. Blood tests can also be used to discover the tumor.
3. Body imaging – Using a CT scan, an MRI or some other form of imaging, will show the tumor itself.

How is it treated?

The main treatment for carcinoid is surgery to take out the tumor. If the tumor is detected early, it can be removed completely in surgery (depending on where it’s at in the body). Unfortunately, most of these tumors are at an advanced stage when they are finally discovered, so removing them completely is usually not an option.

These tumors tend to spread (send metastases) to the liver. In which case, a simple removal of the tumor in the intestines isn’t enough.  A liver surgery, a liver transplant or a procedure which will stop the blood supply to the tumor in the liver is performed. Chemotherapy may also be used.

This video tells the story of Ruth Gerdes, whose carcinoid tumor reached the liver, and how she was cured of it:

For people with the carcinoid syndrome, there are certain medications, which can help greatly.

What happens after treatment?

If a tumor is taken out completely about 100% of people will continue living cancer-free. If the tumor spreads, the chances are lower for survival, but are still high relative to other cancers.

Even if the tumor isn’t operable, people can still live for years, since it grows slowly.

The bottom line – How do I avoid it?

Preventing the risk factors mentioned above (smoking, the medical conditions mentioned) might prevent you from having a carcinoid tumor.

For more information, you can visit the Caring for Carcinoid Foundation’s blog.

Related posts:

1. As Seen on Grey’s Anatomy – Melanoma – You Can Avoid It if It’s Found on Time
2. Pheochromocytoma – A Rare Tumor That Can Cause Hypertension (As Seen on House MD)
3. Astrocytoma (Butterfly Tumor)–A Brain Tumor That Spreads To Both Sides (As Seen On Grey’s Anatomy)

Danger level: Medium

What is it?

Crohn’s disease is a condition in which there is a chronic inflammation in the intestines (you might also hear the name inflammatory bowel disease (IBD) when Crohn’s is mentioned).

Who gets it?

About 7 people out of 100,000 in the US (and about 1-10 out of 100,000 in Europe) get Crohn’s disease. More and more people have been getting the disease in the last 5 decades, especially in northern areas. It’s less common in other areas of the world, like Asia, South Africa and Latin America.

The disease can begin at two time periods in life – most commonly in the ages 15-30, but also at 60-80.

There are a few things known to increase the risk as well -

• Crohn’s is more common in Ashkenazi Jews.
• If you have a close family member with Crohn’s (parent, sibling, children) – your chances of getting it are also higher.
• Smokers have a higher chance of developing Crohn’s.

What causes it?

No one knows exactly why it is caused. It might be related to an over-reaction of the immune system to normal bacteria in the intestines, although other theories exist as well.

Whatever the cause may be, it causes an inflammation in the intestines (the small intestine as well as the large intestine). This inflammation causes damage to the intestines, which brings about the symptoms of the disease.

How does it feel?

Usually Crohn’s has a pattern of flares (when the disease worsens) and remissions (when it gets better).

The main symptoms of Crohn’s are abdominal pain and diarrhea (sometimes with blood). The diarrhea can appear many times a day (even 10-20), and even at night. This can cause weight loss, as well.

Other things which are related to our digestive system and that happen here can include mouth sores, bowel blockages, anal fissures (tears), and openings between organs (called fistulas).

Unfortunately, Crohn’s isn’t limited to our digestive system. Other things can happen here as well -

1. Growth failure – If the disease starts at an early age, there may be a problem with the growth of the child.
2. Fever
3. Inflammation in the eyes
4. Inflammation in the joints (which can also involve the spine)
5. Skin flares

And others…

This photo shows what happens on the inside of a Crohn patient’s intestines – You can see wounds (ulcers) all over the place. Photo by Samir.

How is it discovered?

There are several tests which can be done to discover Crohn’s. They include -

1. X-Rays or CT scans of the intestines
2. Colonoscopy – Which is a tube with a camera which is inserted into the intestines and can show what’s going on inside them (like in the picture above).
3. Biopsy – A sample of the intestines can be taken to see the disease under the microscope.

How is it treated?

There are two types of treatments for Crohn’s:

1. Medications – There are many drugs out there used to treat Crohn’s. They include drugs that take down the inflammation in the body (such as steroids and others), as well as antibiotics and other drugs.
2. Surgery – Sometimes the drugs won’t do the trick, and a surgery may be the only way to improve the symptoms. Surgery doesn’t cure the disease, though – it only takes down the diseased part of the intestines, but other parts can continue to develop the disease.

What happens after treatment?

Crohn’s is a chronic disease, meaning it can’t be cured. Flares of the disease can continue in spite of the treatment, although less severely.

People with Crohn’s are also more likely to develop colon cancer over time.

The bottom line – How do I avoid it?

Since the cause for Crohn’s isn’t known, there is currently no known way to prevent it.

This video tells the story of pro quarterback David Garrard and the effect Crohn’s disease had on his life:

For another personal story, you can read the living with Crohn’s disease blog, written by Scottie Roy.

If you had a brush with the disease or know of anyone who did you’re welcome to share it in the comments below.

Related posts:

1. Irritable Bowel Syndrome (IBS) – How the Intestines Can Affect Your Whole Life
2. Peptic Ulcer Disease – Wounds in your stomach and intestines
3. Behçet’s Disease – Inflammation of Your Blood Vessels, Throughout the Body (As Seen on House MD)

Danger level: Medium

What is it?

Asperger syndrome is one of the autistic spectrum disorders (ASD. Also called Pervasive Developmental Disorders (PDD)) (other disorders in this spectrum include autism, Rett syndrome and childhood disintegrative disorder), in which people have difficulties understanding how to interact socially.

Who gets it?

It’s not known exactly how many people there are with Asperger’s, and the estimation is anywhere between 1 in 250 people to 1 in 10,000 people.

Asperger syndrome is more common in males (4 times as much as in females). It’s most commonly discovered in the early school years.

What causes it?

The exact cause isn’t known. Since it tends to run in families, there might be a genetic reason for it.

How does it feel?

There are a few things that characterize people with Asperger’s:

1. Problems with social interaction – This includes -
   a. Problems using or understanding non-verbal cues, such as eye-to-eye contact, facial expressions, body postures, and gestures. For example. They will not understand a wink of the eye, the meaning of a face that shows disgust (for example) and so on.
   b. Problems developing relationships with others. It’s not that they don’t approach other people, but often it’s done awkwardly, such as by starting a one-sided speech about their favorite subject without understanding the listener’s reactions, such as the need for privacy or haste to leave. People may misinterpret this as being insensitive, which isn’t the case (they just can’t “read” the body language).
   c. People with Asperger’s will not try to share enjoyment, interests, or achievements with other people.

   
   A smile. A person with Asperger syndrome might not understand the meaning behind it. Photo by *Zara.

2. Repeated behavior – This is also called “stereotyped behavior” -
   a. For example, they may stick to inflexible routines, move in repetitive ways.
   b. They may have interest in specific and narrow topics (such as deep fat fryers) without understanding the broader topic. For example, memorizing camera model numbers without a care for photography.

Those are the main features of Asperger’s, although there are others, such as language problems.

The following video is a documentary about Asperger Syndrome, made about David Jordan, who was diagnosed in 2002 -

Another good example is Dr. Virginia Dixon on the show Grey’s Anatomy (she was portrayed by actress Mary McDonnell on season 5). An excellent read on Asperger’s is The Curious Incident of the Dog in the Night-Time, which is told from the perspective of a boy with Asperger’s.

How is it discovered?

Usually Asperger’s isn’t diagnosed until about age 3, when social problems become apparent (although it might be diagnosed before that).

The doctor will diagnose Asperger’s based on the child’s story and examination.

How is it treated?

The treatment involves communication and social skills training. There are also appropriate educational services for people with Asperger’s.

What happens after treatment?

With effective treatment, children with Asperger Syndrome can learn to cope with their disabilities, but they may still find social situations and personal relationships challenging. Many adults with AS are able to work successfully in mainstream jobs, although they may continue to need encouragement and moral support to maintain an independent life.

There is no known way to prevent Asperger syndrome.

For further reading, you can visit the Life With Aspergers Blog or Marc’s Autism – Asperger’s Syndrome Blog.

Related posts:

1. Irritable Bowel Syndrome (IBS) – How the Intestines Can Affect Your Whole Life
2. Turner Syndrome – The Missing X
3. Treacher-Collins Syndrome – Being Born Without Cheek Bones (As Seen on Grey’s Anatomy)

Danger level: High

What is it?

Appendicitis is an inflammation of the appendix (a part of the intestine).

Who gets it?

In the US, appendicitis is the most common cause of abdominal pain which requires surgery.

It occurs in up to 7% of people in the US (it’s lower in countries where there is more dietary fiber in the diet), and occurs in about 250,000 people a year in the US. It’s 1.4 times more common in men than in women.

Appendicitis is most common in young people – it occurs mostly between ages 10 and 30, but it can happen at any age.

What causes it?

Let’s first start by explaining about the appendix. The appendix is a part of our intestines, as shown in this drawing:

The appendix is marked by a circle in this drawing.

Even though it’s part of our intestines, the appendix isn’t involved in anything related to food digestion. In fact, no one really knows what it’s there for (although there have been some suggestions in recent years).

Appendicitis occurs most commonly as a result of obstruction of the appendix. As a result, it gets filled with mucus and gets swollen, which causes pressure on the blood vessels going through it. When the blood vessels get pressured, they can’t supply the appendix with enough blood, which causes it to die. Germs see this as an opportunity for a feast, and start accumulating in the area, causing an infection. After this, the appendix can rupture, leading to an inflammation inside our abdomen, which can be life threatening.

This diagram summarizes the process to make it easier to understand -

What causes the appendix to get obstructed in the first place?

That depends on the age of the person with appendicitis:

• In young people – The cause is growth of the lymphoid tissue in the area (the lymphoid tissue is responsible for handling infections)
• In older people – It can occur as a result of a fecalith (a hard mass of feces) or because of a tumor in the area.

How does it feel?

The main thing that people feel when they have appendicitis is abdominal pain. It usually starts near the belly button, and then moves to the lower right side of the belly (but that’s not always the case and it can appear in other places as well). The pain can get worse by moving, sneezing or coughing.

Other things that can be present here are fever, loss of appetite, nausea and vomiting.

Unfortunately, all of these occur in less than half of people, which can sometimes make appendicitis hard to diagnose.

How is it discovered?

When the classic symptoms described above are present, it will be pretty clear to the doctor that this is appendicitis and no further tests need to be done, to save time.

If the doctor suspects appendicitis but is not sure, images of the abdomen using CT scan or an ultrasound may be done.

How is it treated?

The only treatment for appendicitis is surgery, in which the appendix is removed. Also antibiotics are given (since the germs in the appendix cause infection of the area).

What happens after treatment?

When the appendix is taken out on time without any complications, the disease usually goes away with it. However, if it’s not treated on time, the chance of dying from it is higher than 50%.

The bottom line – How do I avoid it?

There is no proven way to prevent appendicitis, but adding more fruit and vegetables to your diet may decrease your risk of having it.

Related posts:

1. Plummer’s Disease – A Small Mass That Causes Lots Of Trouble (As Seen On House MD)
2. Understanding Heart Attacks – Part 2 – Angina Pectoris
3. Understanding Heart Attacks – Part 3 – Myocardial Infarction