On Thursday’s episode of Grey’s Anatomy (titled “Shiny Happy People”), a teenage patient called Hayley is thought to have schizophrenia after trying to claw her own eyes out. Not unlike a House episode we recently covered, the diagnosis turns out wrong and instead she is found to have a condition called superior canal dehiscence syndrome.

Photo by ABC

Danger level: Medium

What is it?

Superior canal dehiscence syndrome (SCDS) is a rare condition affecting the ear which causes the person having it to hear sounds inside their body, among other things. It was first described in 1998.

Who gets it?

Since the condition was first described only in 1998, not much is known in that area. A study conducted on cadavers (dead bodies) found ears matching the condition in about 0.5% of bodies checked.

It appears to affect women and men alike. The condition usually affects people around the age of 40, although it may start earlier or later.

What causes it?

Our ear, as we described here before, is divided into 3 parts: The outer ear, middle ear, and inner ear. Our inner ear is the innermost part, and it’s responsible for hearing and balance.

The inner ear.

Our inner ear is composed of 3 canals filled with fluid that sense our position in 3D, which helps us keep our balance. Just like a gyroscope that tells our brain the position of our head in real time. The superior canal is one of those canals.

Overlying the superior canal is one of our bones, called the temporal bone. In SCDS that bone is thinner than usual since it hasn’t developed properly.

Through a mechanism too complicated for this article, the symptoms of SCDS develop due to this bone defect.

How does it feel?

There are typical symptoms people with SCDS may experience:

1. Autophony – This means the person can hear their own speech or other noises inside their body (such as the heartbeat, eye movements, chewing, etc.) very loudly.
2. Dizziness/vertigo – Problems with balance, since, as mentioned above, our inner ear is responsible for keeping our balance. (You can learn about head spinning in our article published a while ago).
3. Tullio phenomenon – In this case, sound can cause the patient to lose balance. Sound can also cause rapid movement of the eyes, called a nystagmus.

These are the main symptoms, although there are others as well. This fascinating video shows a true story:

www.youtube.com/watch?v=f6vAkdGw8T4

How is it discovered?

One way is doing a CT scan of the temporal bone, which will show its thinning (or dehiscence).

There are other ways. Among them is the method shown in the Grey’s Anatomy episode, called a videonystagmography (VNG). In this method, hi-tech video goggles with infrared cameras are worn while doing things that can provoke rapid eye movements in the condition.

How is it treated?

The condition can be treated by a surgery, which repairs the gap in the temporal bone. Another surgical method is plugging the superior canal.

What happens after treatment?

The success rate of the operation is quite high. Most patients don’t have their old symptoms after the operation.

The bottom line – How do I avoid it?

There is no known way to prevent the condition.

If you happen to have SCDS, there’s a support group for you.

Related posts:

1. Meniere’s Disease – From Head Spinning To Hearing Loss
2. Familial Mediterranean fever – Fever and Inflammation Inside The Body
3. As Seen on Grey’s Anatomy – Tethered Spinal Cord Syndrome

This is part of our House MD Project series.

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


On episode 5 of season 1, called “Damned If You Do”, a nun by the name of Augustine appears at the clinic with rash on her hands. After attempting to treat a supposed allergy and almost killing her (due to a type of tea she drinks), Dr. House faces the challenge of diagnosing the source of her allergy. After a long episode of trial and errors, it is found that she is allergic to copper. More specifically – to a copper IUD implanted in her.

Dr. Chase and Sister Augustine on the “Damned If You Do” episode

Danger level: Medium

What is it?

Allergy is an abnormal response of our body’s immune system. The immune system contains types of cells that are supposed to fight infections in our bodies. That is, it’s designed to attack germs, viruses, and other harmful critters.

When you have an allergy to something, that something is usually harmless – like pollen, mold, animal dander. Yet the body recognizes it as something bad and starts the whole attacking process.

Who gets it?

Not everyone gets allergies. The tendency to develop an allergy is tied to several factors:

• Heredity – Allergic conditions tend to run in families. If neither one of your parents has allergies, you have about 15% chances of being allergic. If one of them is allergic, your risk rises to 30%. If both – 60%.
• Environment – It’s not enough to have a tendency to allergic reactions. You have to be exposed to the material you’re allergic to.

What causes it?

When you’re exposed to something you’re allergic to (called an allergen), the body produces antibodies. These are molecules designed to attack foreign intruders. There are all sorts of antibodies. The ones in an allergic reaction are of the IgE type.

Those IgE antibodies attach to a type of cells called mast cells. They, in turn, release chemicals (like histamine) into the blood that cause the symptoms.

This video shows this nicely (although a little more elaborately) -

How does it feel?

When you’re allergic to something you inhaled or something that touches your skin, common reactions include -

• Itchy, watery eyes
• A runny nose and sneezing
• Rashes
• Feeling tired or ill

When you’re allergic to a certain food you may feel stomach cramps, vomit or have diarrhea. When you’re allergic to an insect bite, you may see local swelling, redness or pain.

Anaphylaxis is a severe reaction as part of an allergy which is also life threatening. It includes reactions in your skin, respiratory system (you may choke), digestive system, your heart and blood vessels and your nervous system. You get the picture…

On that episode of house, the nun had an anaphylaxis when staying in the clean room.

Copper allergy / IUD allergy

In the House episode, the nun had an allergy to copper, and specifically to an IUD device implanted in her.

Problem is – the device was implanted years before. So how come she wasn’t allergic till now?

Allergies can be tricky that way. People can have a first exposure to an allergen, which causes the reaction described above. From then on, there’s a period of sensitization, which can take from months to years, after which another exposure to the allergen can cause an allergic reaction.

In the House episode, the nun was first exposed to copper in her IUD, but a reaction didn’t happen until she was exposed to copper again – this time through contact with copper cookware she washed.

How is it discovered?

When the doctor suspects you have an allergy, they can run a skin test. In it, an extract of an allergen is applied to your skin (after scratching your skin or pricking it to expose it to the material. That’s why it’s called a prick test). If your skin reacts to the allergen it will show as an inflammation in that area.

Skin prick test. Photo by Lindspetrol

Another option is a blood test – which can identify IgE’s specific to certain allergens.

How is it treated?

There’s no cure for allergies, but there are medications that can ease the symptoms. Covering all of them is beyond the scope of this article. Their names contain antihistamines, corticosteroids, and others.

Besides that, the treatment for anaphylaxis (see above) is epinephrine, which can save your life. Sometimes people with tendencies to severe reactions find themselves with no hospital in their vicinity. For that matter an epinephrine pen was invented, which you carry with you in your pocket and can save your life.

The bottom line – How do I avoid it?

Once you know you’re allergic to something, avoiding that allergen can prevent the symptoms.

Related posts:

1. Colchicine Overdose (As Seen on House MD)
2. Ornithine Transcarbamylase Deficiency– What If You Couldn’t Eat Steaks? (As Seen on House MD)
3. Naphthalene Poisoning – When Mothballs Kill More Than Just Moths (As Seen on House MD)

On the last episode of Grey’s Anatomy (which, we know, was two weeks ago – sorry for the delay) Dr Bailey recalls a case in her intern year that helped her become the doctor she is today.

The patient presented in the episode had chronic pain and she’s been through many surgeries, including having her ovaries removed, but nothing worked. That led Dr Bailey (then called Mandy) to the diagnosis of porphyria.

Danger level: Medium

What is it?

Porphyria is a group of diseases resulting in the buildup in the body of materials called porphyrins and related materials, leading to abdominal pain, constipation and muscle weakness.

There are 2 types: Acute porphyria and cutaneous porphyria. We will discuss acute porphyria here.

Who gets it?

Acute porphyria is quite rare – it happens to 1-5 people out of 100,000 in the US. Outside the US it can be much higher: in Sweden, for example, it happens to 60-100 people out of 100,000.

It affects women 1.5-2 times more than it affects men. It usually happens around ages 18-40.

What causes it?

Our body produces a substance called heme. It can be found in all of our body, but mostly in red blood cells, our bone marrow and our liver.

Heme is created in our body out of materials called porphyrins. In the body, the machines that are responsible for converting materials from one type to another are called enzymes. In acute porphyria, one of these enzymes is defective, meaning that instead of converting to heme, porphyrins accumulate in the body.

The problem with the enzyme is usually genetic, meaning you inherit it from your parents.

Having the defective enzyme isn’t always enough. People with the defect might not have any symptoms, a condition which is called latent porphyria. Sometimes, though, there are triggers in the environment which call our body to produce more heme – meaning it will need extra-action from the enzyme. In this case, the symptoms may begin.

Examples of such triggers:

• Certain drugs – Such as some forms of antibiotics, but even birth control pills.
• Surgery
• Stress
• Smoking
• Dieting/fasting
• Infections
• Alcohol use
• Sun exposure
• Excess iron in the body

How does it feel?

Acute porphyria mainly affects our nervous system (we mentioned above another type – cutaneous porphyria – this type affects mainly the skin).

What does a person with acute porphyria feel?

• Abdominal pain
• Constipation
• Vomiting
• Diarrhea
• Pain in the arms, legs or back
• Muscle pain, tingling, numbness or paralysis
• Seizures
• Fever
• Confusion
• Hallucincations
• Disorientation
• Paranoia
• Red urine
• High blood pressure

How is it discovered?

There are several ways to discover when someone has porphyria:

1. Urine test: In it, the high level of porphyrins in the body will be shown.
2. Stool test: Sometimes porphyrins can be detected in the feces better than in the blood.

How is it treated?

There are several ways to treat this condition:

1. Hemin or hematin: This is a form of heme that the doctor injects to your body. This way the body will have enough heme and not try to create more of it (which in this disease will lead to more porphyrins accumulating).
2. Stopping any triggers: Such as medications that may have led to the condition, or an infection.
3. Intravenous sugar (glucose) – Can also inhibit the body’s need to produce heme.
4. A high-carbohydrate diet – Forget Atkins. This is true only for attacks of the disease, not between them.
5. Pain killers 

What happens after treatment?

Porphyria is a life-long disease with symptoms that come and go, more in some people, and less in others. Avoidance of triggers can help reduce the time between attacks.

The bottom line – How do I avoid it?

You can’t prevent having the disease itself (it’s genetic). But if you know you have it, taking the following steps may help avoid attacks:

1. Avoid medications known as triggers (consult your doctor about this)
2. Don’t use alcohol or illicit drugs
3. Avoid fasting or dieting too heavily
4. Don’t smoke
5. Minimize sun exposure. When outdoors, wear protective clothing and use sunscreen.
6. Treat infections promptly.
7. Reduce stress

Family members of people with porphyria are advised to undergo genetic testing, to discover if they have the defect themselves.

Related posts:

1. Acute Pancreatitis – A Dangerous Condition Which Can Be Caused by Drinking Alcohol
2. As Seen on Grey’s Anatomy – Tay-Sachs Disease – Fat Accumulating in The Brain
3. Acute Pericarditis – Inflammation of Your Heart’s Covering

Summer’s going away, at least around these parts of the woods. Many of you may be going to the pool to enjoy what’s left of it. Read on to find out about otitis externa – an ear infection you can catch while swimming there.

Danger level: Medium

What is it?

Otitis externa is an inflammation of the outer part of the ear causing earache.

Who gets it?

In the US, otitis externa happens to 4 out of every 1000 people each year.

It’s most common in swimmers, divers, and others whose ears are exposed to water for a long period of time.

It can be seen in all ages, but is most common around 7-12 years.

What causes it?

Our ear has an inner and an outer part. The outer part is the one spanning from the ear you can see, inside until the eardrum. The inner part is the part which comes after the eardrum. When your outer ear gets inflamed, the condition is called otitis externa. When the inner part gets inflamed, it is called otitis media, which we will cover in a future article.

Our ear is built so that infections will not occur in it. To prevent infections from happening, it has a few things going for it:

1. Cerumen (earwax) – This is a substance which created an acid environment in our ear. This repels bacteria and prevents infection. It also repels water, and collects debris in the ear, moving it out of the ear.
2. The ear’s shape – Our ear canal has a downward direction. This helps us get rid of water accumulating in the ear.

In swimmer’s ear, bacteria overcome these defenses and cause an infection and inflammation in our ear. How can they do that?

1. Swimming a lot (or getting a lot of water in your ears for other reasons) thins out the earwax, making it less protective.
2. A breakage of the skin can happen – This can happen when using a cotton swab (Q-tip) to clean the ear. It is recommended that you don’t clean your ears using a cotton swab, as this can expose you to an infection. Believe it or not, our body gets rid of the excess earwax by itself, and you really don’t need to mess with it.

How does it feel?

Swimmer’s ear can cause pain. The pain may get worse by touching the earlobe or when chewing.

Other things which can be felt include itching, a feeling of fullness in the ear, a yellow discharge from the ear, redness in the ear canal or skin of the ear.

Otitis externa (swimmer’s ear). Photo by Dale Miller.

How is it discovered?

Usually, a physical exam in which the doctor will look at your ear canal with an otoscope to see that it’s red and swollen.

How is it treated?

Otitis externa is treated using eardrops which contain antibiotics (which fight the germs causing the infection) and sometimes also steroids (which lessen the inflammation in the ear).

What happens after treatment?

Most people improve within 48-72 hours of starting the antibiotics.

If not treated properly, two things can happen:

1. Chronic otitis externa – This is defined as an infection which lasts more than 4 weeks or happens more than 4 times a year.
2. Necrotizing otitis externa – This usually happens to diabetics and older people. In this case, the infection spreads to the bones around the ear, which can also damage nerves in the area and may lead to death.

The bottom line – How do I avoid it?

1. Keep your ears dry – Dry them after swimming or showering. You can do this by shaking your head to remove water from the ear canal, or using the corner of a towel.
2. Don’t use any foreign objects in your ear – And yes, this includes cotton swabs. Also fingernails may damage the ear canal, so don’t poke fingers inside to clean the ear.

This video, featuring Dr. John Hong of NBC, sums it all up:

Related posts:

1. Labyrinthitis – An Ear Infection Causing Loss of Balance
2. 8 Home Remedies for Summer’s Problems
3. Superior Canal Dehiscence Syndrome – Hearing Sounds Inside Your Own Body (As Seen on Grey’s Anatomy)

Danger level: Medium

What is it?

Asthma is a disease which affects the airways, causing attacks in which breathing is difficult.

Who gets it?

In the Unites States, about 5-10% of the population (or 22 million people) are affected by asthma (6 million of them are children).

Around the world, asthma is more common in industrialized countries, such as Canada, England, Australia, Germany, and New Zealand. 2-10% (300 million) of people worldwide have asthma.

Until puberty, asthma is more common in boys than girls (twice as much). From then on there is no difference. About 2/3 of all asthma cases are discovered before age 18.

The following are considered risk factors, meaning they increase your risk of having asthma:

1. A family history of asthma – Asthma is partly genetic, meaning that if someone in your family has it, your chances of getting it are higher.

2. Frequent infections in your airways as a child

3. Living in an urban area, especially one that contains a lot of air pollution

What causes it?

Asthma causes an inflammation in our airways – these are the “tubes” that lead from our mouth to our lungs. This causes 3 things:

1. Airway obstruction – Our airways are surrounded by muscle. Normally, this muscle is relaxed, so air can move freely to our lungs and back out. In asthma, these muscles tighten and also produce a liquid called mucus. Those things cause the airways to get obstructed, so air can’t move freely.

2. Inflammation – Besides the attacks which cause momentary blocks in the airways, there is also an ongoing inflammation, which can cause long term damage to the airways if not treated.

3. Airway irritability – The airways in asthma patients are very sensitive to things healthy people usually don’t react to, such as pollen or dust. These things can bring about asthma attacks, which involve obstruction of the airways.

This video gives a graphic illustration of the process:

The following things are known to trigger asthma attacks in people with the disease (they change among different people):

a. Airborne materials, such as pollen, animal dander, mold, cockroaches and dust mites

b. Respiratory infections – Such as the common cold

c. Exercise

d. Cold air

e. Smoke

f. Certain medications – Such as aspirin, beta blockers and others.

g. Strong emotions and stress

How does it feel?

Asthma attacks include the following things:

1. Shortness of breath

2. Coughing

3. Wheezing – This is a whistling sound characteristic of asthma patients. It’s heard when you take the air out.

4. Chest tightness or pain

The severity of the disease is different for different people. In some people attacks may appear only after exercise, while in others they may come a few times a day, making their lives miserable.

This video shows someone with an attack who unfortunately ran out of medications and was waiting for an ambulance. Notice the coughing and the whistling sounds when he takes out air. (And please don’t try this at home…)

How is it discovered?

If someone comes to the doctor when they are having an attack, it can be pretty simple (as you can see in the video above) to know that they have asthma.

Unfortunately, by the time someone arrives at the doctor’s, the attacks are often gone. Besides, other diseases can have similar symptoms. Therefore these tests were invented which can discover asthma:

1. Pulmonary function tests – These are special tests done to test the patient’s breathing pattern when they breath into a machine. The pattern in asthma patients is pretty characteristic.

2. Challenge tests – Certain substances, when inhaled by people with asthma, can trigger an attack. Using these substances (such as one called metacholine) helps in diagnosing asthma.

3. Chest X-ray – Can be used to rule out other conditions (such as pneumonia).

How is it treated?

There are a few things which can be done to treat asthma:

1. Avoiding triggers

2. Medications – There are short-term drugs and long-term drugs. The short-term ones are used to control attacks. The long-term drugs are used to control the inflammation in the airways, which prevents long-term damage to them.

We won’t go into much detail about the types of drugs available, but some examples of long-term drugs include corticosteroids, beta agonists, and others.
Short-term drugs are drugs that are usually inhaled, and that cause dilatation of the constricted airways, thereby making it easier to breath. These drugs are taken through special inhalers, such as the one in the picture:

An asthma inhaler. Photo by net_efekt.

What happens after treatment?

Except in very difficult cases, these drugs help to live a normal life with asthma.

Also, about 50% of children diagnosed with asthma are asthma-free after 10 years (in adults the disease doesn’t tend to go away as much).

The bottom line – How do I avoid it?

You can’t avoid asthma altogether, since, as mentioned above, the disease is probably genetic.

What you can do is decrease your risk of having attacks, by following these rules:

1. Stick to your medications

2. Identify your triggers and avoid them – One way of doing this is to keep a diary in which you write down factors you encountered before attacks (such as cold air, a virus, cigarette smoke, etc.). Then take measures to minimize your exposure to these things.

3. Treat allergies – Asthma attacks can also be triggered by any allergies you may have. You should avoid or minimize contact with the substance you are allergic to.
Also consider allergy shots (consult your doctor about those).

4. Get a flu vaccine – Every year. The flu almost always makes asthma much worse.

On a final note, we try to give you a personal angle about diseases we cover here. This time, you can get it by visiting The Angry Asthma Mama blog and The Asthma Mom.

Related posts:

1. Understanding Heart Attacks – Part 2 – Angina Pectoris
2. Cluster Headaches – Excruciating Attacks of Headaches
3. Understanding Heart Attacks – Part 3 – Myocardial Infarction

Danger level: Medium

What is it?

Osteoporosis (the word is in Greek: “Osteo” means bone, and “porosis” means holes) is a condition in which bones become thin and weakened, which makes them susceptible to fractures.

Who gets it?

About 10 million people in the US, and 200 million people worldwide have osteoporosis. One in 3 women and one in 5 men over the age of 50 will experience fractures as a result of osteoporosis.

White people (especially of northern European origin) as well as Asians are at an increased risk. The condition is also more common in women – 4 times more common.

In terms of age, osteoporosis occurs in women after menopause, meaning it’s most common in women in the ages 50-70. Another form of osteoporosis, called senile osteoporosis, isn’t related to menopause and can happen to both men and women, usually after the age of 70.

On top of all of those, there are a few risk factors, which can put you at risk of developing osteoporosis:

1. A family history – Osteoporosis runs in families. If you have a parent or sibling with osteoporosis you are at greater risk of developing it yourself.
2. Your build – Men and women who are very thin or have small body frames are at a greater risk (since they have less bone to begin with).
3. Smoking – Osteoporosis is just one of the many perks you get when you smoke.
4. Excessive drinking – Excessive drinking of alcohol interferes with the body’s ability to build bone.
5. A sedentary lifestyle – Exercise accelerates the process of bone building. Not doing it raises your risk for osteoporosis.

What causes it?

Our bones aren’t stagnant. A process called bone remodeling is always at work, in which new bone (made of minerals like calcium) is formed and old bone is broken down. Early in life (up until our mid 30s or so) this process is even – the amount of bone that is breaking down equals the amount of new bone being formed. At that time, though, the breakdown starts to outpace the building process. This causes the bones to become thinner.

During that time, though, this process isn’t significant.

In women, around age 50-60, menopause occurs. This is the time when the body stops producing the hormone estrogen. As its levels drop, bone loss increases dramatically. This doesn’t mean it doesn’t happen to men, but the process in them is slower, so the disease happens at an older age.

Our bones get thinner and are at a risk of breaking when we reach a certain age. Photo by BillRhodesPhoto.

How does it feel?

In the early stages of the disease usually there are no symptoms, but when fractures start to occur, the symptoms begin. Most of the fractures in osteoporosis occur in the spine, hip or wrist. Symptoms which appear when the fractures occur include:

1. Back pain – Due to fractures in the vertebra.
2. Loss of height, and an accompanying stooped posture
3. The fractures themselves – Which are disabling.

It’s important to note that since the bones are so brittle in this condition, you don’t need a lot to happen in order to have a fracture. Even mild stresses like bending over, lifting a vacuum cleaner or coughing can cause a fracture.

This video explains it:

How is it discovered?

A special x-ray picture called dual energy X-ray absorptiometry (DEXA) is used to detect if you have osteoporosis. It measures the density of bones in the spine, hip and wrist (the areas most involved in the disease). You should consult you doctor about taking this test if you’re a woman and you’re older than 65, post menopausal or have any of the other risk factors mentioned above.

How is it treated?

There are a few ways to treat osteoporosis:

1. Medications – A group of drugs called bisphosphonates are the most common drugs used to treat osteoporosis. They inhibit the process in which bones are broken down, thereby slowing the disease process.
2. Calcium – Since calcium is a mineral used in building bone, supplementing with it is one of the treatments for osteoporosis. In order for calcium to absorb better in the body, you should also take vitamin D.
3. Exercise – Doing aerobics, weight bearing exercises and resistance exercises help in the building of new bone and the slowing down of the disease.

What happens after treatment?

It’s important to not reach a stage when the fractures occur. Hip fractures, for example, can lead to complications (such as deep vein thrombosis and others), and can lead to major disability and even death.

If you do adhere to the treatment, though, you will most probably die with the disease instead of from it.

The bottom line – How do I avoid it?

1. Exercise – It’s recommended that you get at least 30 minutes of exercise each day to strengthen your bones and prevent osteoporosis. Exercise stimulates your bones to create new bone. Examples of exercises you can do include aerobics, climbing stairs, dancing, jogging, running and walking.
2. Get enough calcium and vitamin D in your diet – Not getting enough calcium will cause your body to break down bones (which contain it) when it needs it. Eating low-fat or fat-free dairy products and other calcium-rich foods, or even taking calcium supplements, can help prevent osteoporosis. Since vitamin D helps the body absorb calcium, taking it is also important.
3. Quit smoking
4. Don’t drink too much alcohol
5. Don’t drink too many soft drinks – Especially cola drinks, since the extra phosphorus in them binds with calcium and prevents it from being absorbed in the body.

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

Related posts:

1. Paget Disease of Bone – Bone Deformity For An Unknown Reason
2. Multiple Myeloma – Bone Marrow Cells Taking Over
3. Parkinson’s Disease – 1 Out of 100 People Over Age 60

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.

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1. Crohn’s Disease – Inflammation in The Intestines Which Can Influence Your Whole Life
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Danger level: Medium

What is it?

Psoriasis is a skin disorder causing red scaly patches on the skin.

Who gets it?

In the United States, 2-2.6% of the white population and 1.3% of African Americans have psoriasis, with about 200,000 new cases each year. Worldwide it affects about 1-5% of the population.

It’s more common in Caucasians, and a little more common in women than in men. It usually starts around age 20, but can start at any age.

In about 40% of people with psoriasis there is also a family history of psoriasis, since it probably has a genetic cause.

What causes it?

Our skin has many layers. In normal skin, new cells form all the time and move up the skin layers until they reach the most superficial layer. When they do, these cells die and then shed. This process takes between 28-30 days.

In psoriasis, new cells grow and move up the layers much faster: it takes them 3-4 days. The buildup of cells on the skin’s surface forms the scales and patches in the disease.

A piece of skin showing its layers. In psoriasis, skin cells move up the layers too fast, accumulating on the surface.

What causes this? One of the theories around psoriasis claims that it is an autoimmune disease. This means that the body’s immune system, which is usually meant to fight infections, also fights the body’s skin cells. (We covered other types of autoimmune diseases here before, such as Graves disease, vitiligo, lupus, and others). This results in an inflammation of the skin and the fast renewal of skin cells.

Outbreaks of psoriasis are caused by known triggers:

1. An injury to the skin
2. Emotional stress
3. Infections, such as a throat infection
4. Cold weather
5. Smoking
6. Heavy alcohol consumption
7. Some drugs – Such as lithium (for bipolar disorder), beta blockers (for high blood pressure), drugs against malaria and others.

How does it feel?

The symptoms in psoriasis include:

1. Areas of skin that are dry or red. They are usually also covered with silvery-white scales, and sometimes with raised edges.
   The skin in psoriasis. Photo by Marnanel.
2. These skin areas appear thick, but they bleed easily if the scales are picked up or rubbed off.
3. Itching
4. Nail abnormalities: Such as pitting (indentations on the nail), a change of color, or crumbly nails.
5. Sometimes psoriasis can also affect the joints, causing inflammation in them, which can cause them to swell and be stiff and painful.

The areas of the skin that are usually most involved in the disease are the scalp, the back of the elbows and knees, the buttocks, and the penis. The disease can affect just a few spots of skin or can cover large skin areas.

Although not life-threatening, psoriasis can greatly affect a person’s self-image.

How is it discovered?

Usually the doctor can decide that a person has psoriasis by looking at the skin. It some cases, they may perform a skin biopsy, in which a piece of skin is cut and looked at under the microscope, to make certain that it’s indeed psoriasis and not some other similar disease.

How is it treated?

There is no cure for psoriasis, but treatments are available to interrupt the cycle of fast skin cell renewal and to remove the scaly skin patches.

There are 3 types of treatment for psoriasis:

1. Medicines applied to the skin – This includes creams and ointments you rub on your skin. Usually these are used for a disease which is mild or moderate. More severe cases require other methods.
   Creams used here include steroid creams, vitamin D creams, retinoid creams and others.
2. Light therapy – Ultraviolet light is the light produced by the sun, and which can also be produced artificially by special machines. It’s been found that exposure to ultraviolet light slows the skin turnover in the disease and improves the scaling and inflammation of the skin. It’s important to do this under a doctor’s guidance, since too much exposure to ultraviolet light can be dangerous.
3. Drugs – There are some medications which can be taken by mouth to help treat psoriasis. They are usually given in severe cases. These include retinoids, methotrexate, cyclosporin and others.

What happens after treatment?

As mentioned above, there is no cure for psoriasis, and it lasts for life. Treatment, if taken, can greatly reduce the symptoms of the disease, even in severe cases.

There is no way to prevent psoriasis, but if you have it, there are some things you can do to reduce the activity of the disease:

1. Keeping the skin moist
2. Avoiding cold, dry climates – As mentioned above, cold weather makes the disease worse.
3. Avoiding scratching the skin or skin injuries
4. Avoiding stress
5. Avoiding infections – Such as throat infections
6. Avoid medications which can worsen the disease (see above)
7. Limiting alcohol – To no more than 2 drinks a day for men and 1 for women.
8. Stopping smoking

The American Academy of Dermatology and the National Psoriasis Foundation have joined together to form the Stop Hiding from Psoriasis public education campaign.You can visit their website at stophiding.org and watch this video, featuring singer LeAnn Rimes.

Related posts:

1. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency – When Certain Conditions Can Destroy Blood Cells
2. Vitiligo, or Why Michael Jackson Has Turned White
3. Multiple Myeloma – Bone Marrow Cells Taking Over

Danger level: Medium

What is it?

G6PD deficiency is a hereditary disease causing anemia in certain situations.

Who gets it?

G6pd deficiency is an inherited disease. Its mode of inheritance is X-linked. This means that the mutation is caused in the X chromosome (one of our 46 chromosomes). For reasons beyond the scope of this article, this means that it almost always occurs only in males.

It’s most common in people of Mediterranean (Italian, Greek, Arab, Sephardic Jewish) or African origin (in the US, it occurs in about 10% of African Americans). It affects about 200 million people worldwide.

What causes it?

G6PD is an enzyme in our body which helps the body produce gluthatione. Gluthatione is a molecule which helps to protect the body against free radicals, which are harmful molecules. These molecules can damage our red blood cells under certain conditions.

In G6PD deficiency, like the name says, there’s a deficiency in the G6PD enzyme. This means that people with the disease don’t produce enough gluthatione to fight the free radicals, which puts their red blood cells at risk.

The bright side – the red blood cells aren’t at risk all the time, but only in certain situations which raise the level of free radicals:

1. Taking certain drugs – Such as dapsone, primaquine, sulfamethoxazole, doxorubicin, methylene blue.
2. Infections
3. Certain foods – Such as fava beans. The interesting thing is that people with G6PD deficiency don’t even have to eat the beans in order to cause damage to the blood cells – it’s enough that they inhale their pollen.
4. Diabetic ketoacidosis – This is a condition that can happen to people with diabetes.

How does it feel?

Most of the time, people with G6PD deficiency are well. When the conditions mentioned above occur, there is a destruction of red blood cells, which leads to anemia and sometimes jaundice (yellowing of the skin). The destruction of red blood cells is called hemolysis. It can happen within hours of exposure to the condition (drug, food, etc.).

The level of the deficiency in G6PD (meaning how much of it exists in the body) will determine how bad the condition will get. Sometimes the hemolysis can stop once you stop taking the drug (this is more common in people of African origin), but it can also continue after you’ve stopped taking it. In severe cases, damage to the kidneys can occur.

The most important thing here is what can happen to babies with G6PD deficiency. A lot of babies have jaundice on their first days. In G6PD deficiency, this jaundice can be prolonged, which can cause damage to the brain.

How is it discovered?

There are a few things that can be done to discover the disease:

1. A blood smear – In which some drops of blood are smeared against a piece of glass and then looked at under a microscope. Certain things can be seen in G6PD deficiency because of the destruction of blood cells.
2. Checking the level of G6PD – To see that it’s indeed low.

How is it treated?

Since the destruction of blood cells usually stops by itself, no treatment is usually necessary. In severe cases, blood transfusions might be necessary.

In babies with jaundice, usually a treatment with a special kind of light helps to resolve the problem.

The bottom line – How do I avoid it?

You can’t prevent having the defect in the gene which causes the deficiency in G6PD. What you can do is avoid the things mentioned above which can trigger the destruction of blood cells (not eat any fava beans (or smell their pollens), avoid the dangerous drugs, avoid infections).

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2. Multiple Myeloma – Bone Marrow Cells Taking Over
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