Amyotrophic lateral sclerosis (ALS)

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Amyotrophic lateral sclerosis (a-my-o-TROE-fik LAT-ur-ul skluh-ROE-sis), or ALS, is a progressive nervous system disease that affects nerve cells in the brain and spinal cord, causing loss of muscle control.

ALS is often called Lou Gehrig’s disease, after the baseball player who was diagnosed with it. Doctors usually don’t know why ALS occurs. Some cases are inherited.

ALS often begins with muscle twitching and weakness in a limb, or slurred speech. Eventually, ALS affects control of the muscles needed to move, speak, eat and breathe. There is no cure for this fatal disease.

Signs and symptoms of ALS vary greatly from person to person, depending on which neurons are affected. Signs and symptoms might include:

Difficulty walking or doing normal daily activities
Tripping and falling
Weakness in your leg, feet or ankles
Hand weakness or clumsiness
Slurred speech or trouble swallowing
Muscle cramps and twitching in your arms, shoulders and tongue
Inappropriate crying, laughing or yawning
Cognitive and behavioral changes
ALS often starts in the hands, feet or limbs, and then spreads to other parts of your body. As the disease advances and nerve cells are destroyed, your muscles get weaker. This eventually affects chewing, swallowing, speaking and breathing.

There’s generally no pain in the early stages of ALS, and pain is uncommon in the later stages. ALS doesn’t usually affect your bladder control or your senses.

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Causes Heartburn

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Heartburn occurs when stomach acid backs up into the tube that carries food from your mouth to your stomach (esophagus).

Normally when you swallow, a band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to flow down into your stomach. Then the muscle tightens again.

If the lower esophageal sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus (acid reflux) and cause heartburn. The acid backup may be worse when you’re bent over or lying down.

If the lower esophageal sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus (acid reflux) and cause heartburn. The acid backup may be worse when you’re bent over or lying down.

Risk factors

Certain foods and drinks can trigger heartburn in some people, including:

  • Spicy foods
  • Onions
  • Citrus products
  • Tomato products, such as ketchup
  • Fatty or fried foods
  • Peppermint
  • Chocolate
  • Alcohol, carbonated beverages, coffee or other caffeinated beverages
  • Large or fatty meals

Being overweight or pregnant also can increase your risk of experiencing heartburn.


Heartburn that occurs frequently and interferes with your routine is considered gastroesophageal reflux disease (GERD). GERD treatment may require prescription medications and, occasionally, surgery or other procedures. GERD can seriously damage your esophagus or lead to precancerous changes in the esophagus called Barrett’s esophagus.

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Upper jaw (maxillary osteotomy)

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Surgery on the upper jaw may be performed to correct:

Significantly receded or protruding upper jaw
Too much or too little of the teeth showing
Open bite
Reduced facial growth of the middle of the face (midfacial hypoplasia)
Your surgeon cuts the bone above your teeth so that the entire top jaw — including the roof of your mouth and your upper teeth — can move as one unit. The jaw and upper teeth are moved forward until they fit properly with the lower teeth. This can be planned on a computer to determine if additional work, such as orthodontics, will be needed to help correct any remaining fit difference.

An open bite occurs when excess bone grows above the molars, causing what’s normally a flat, even surface to become angled. To fix this, your surgeon shaves away or removes the excess bone.

Once the jaw is realigned, plates and screws hold the bone in its new position.

Lower jaw (mandibular osteotomy)
The lower jaw is divided and the front section is moved forward or backward and secured with plates and screws.
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A mandibular osteotomy can correct:

Receding lower jaw
Protruding lower jaw
The surgeon makes cuts behind the molars and lengthwise down the jawbone so the front of the jaw can move as one unit. The jaw can then be moved to its new position either forward or backward. Plates and screws hold the jawbone together as it heals.

Chin surgery (genioplasty)
Illustration of chin surgery, showing how the jaw is divided and moved forward.
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A genioplasty can correct a small chin (deficient chin). A small chin often accompanies a severely receded lower jaw.

Typically, surgeons can alter the jaw and restructure the chin during the same surgery. The surgeon cuts a piece of the chin bone on the front of the jaw, moves it forward, and secures it in a new position with plates and screws.

After the procedure
After surgery, your doctor will provide you with instructions. These usually include:

What you can eat
Oral hygiene
Avoiding tobacco
Avoiding strenuous activity
Medications to control pain
When to return to work or school, which is usually in one to three weeks
Initial jaw healing typically takes about six weeks after surgery, but complete healing can take up to 12 weeks.

After initial jaw healing — at about six weeks — your orthodontist finishes aligning your teeth with braces. The entire orthodontic process, including surgery and braces, may take several years. Once the braces are removed, retainers to hold tooth position may be used.

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Amyloidosis (am-uh-loi-DO-sis) is a rare disease that occurs when an abnormal protein, called amyloid, builds up in your organs and interferes with their normal function.

Amyloid isn’t normally found in the body, but it can be formed from several different types of protein. Organs that may be affected include the heart, kidneys, liver, spleen, nervous system and digestive tract.

Some varieties of amyloidosis occur in association with other diseases. These types may improve with treatment of the underlying disease. Some varieties of amyloidosis may lead to life-threatening organ failure.

Treatments may include chemotherapy similar to that used to combat cancer. Your doctor may suggest medications to reduce amyloid production and to control symptoms. Some people may benefit from organ or stem cell transplants.

Purpura around the eyes, a sign of amyloidosis
Purpura around the eyesOpen pop-up dialog boxEnlarged tongue, a sign of amyloidosis
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You may not experience signs and symptoms of amyloidosis until the condition is advanced. When signs and symptoms are evident, they depend on which of your organs are affected.

Signs and symptoms of amyloidosis may include:

Swelling of your ankles and legs
Severe fatigue and weakness
Shortness of breath with minimal exertion
Unable to lie flat in bed due to shortness of breath
Numbness, tingling or pain in your hands or feet, especially pain in your wrist (carpal tunnel syndrome)
Diarrhea, possibly with blood, or constipation
Unintentional weight loss of more than 10 pounds (4.5 kilograms)
An enlarged tongue, which sometimes looks rippled around its edge
Skin changes, such as thickening or easy bruising, and purplish patches around the eyes
An irregular heartbeat
Difficulty swallowing
When to see a doctor
See your doctor if you persistently experience any of the signs or symptoms associated with amyloidosis.

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Continuous cycling peritoneal dialysis (CCPD)

Also known as automated peritoneal dialysis (APD), this method uses a machine (automated cycler) that performs multiple exchanges at night while you sleep. The cycler automatically fills your abdomen with dialysate, allows it to dwell there and then drains it to a sterile bag that you empty in the morning.


You must remain attached to the machine for about 10 to 12 hours at night.
You aren’t connected to the machine during the day. But in the morning you begin one exchange with a dwell time that lasts the entire day.
You might have a lower risk of peritonitis because you connect and disconnect to the dialysis equipment less frequently than you do with CAPD.
To determine the method of exchange that’s best for you, your doctor will consider your medical condition, lifestyle and personal preferences. Your doctor might suggest certain modifications to individualize your program.

Many factors affect how well peritoneal dialysis works in removing wastes and extra fluid from your blood. These factors include:

Your size APD
How quickly your peritoneum filters waste
How much dialysis solution you use
The number of daily exchanges
Length of dwell times
The concentration of sugar in the dialysis solution
To check if your dialysis is removing enough waste products, your doctor is likely to recommend tests, such as:

Peritoneal equilibration test (PET). This test compares samples of your blood and your dialysis solution during an exchange. The results indicate whether waste toxins pass quickly or slowly from your blood into the dialysate. That information helps determine whether your dialysis would be improved if the solution stayed in your abdomen for a shorter or longer time.
Clearance test. A blood sample and a sample of used dialysis solution are analyzed to determine how much of a certain waste product (urea) is being removed from your blood during dialysis. If you still produce urine, your doctor may also take a urine sample to measure its urea concentration.
If the test results show that your dialysis schedule is not removing enough wastes, your doctor might change your dialysis routine to:

Increase the number of exchanges
Increase the amount of dialysate you use for each exchange
Use a dialysate with a higher concentration of dextrose
You can improve your dialysis results and your overall health by eating the right foods, including foods low in sodium and phosphorus. A dietitian can help you develop an individualized meal plan. Your diet will be based on your weight, your personal preferences, and your remaining kidney function and other medical conditions, such as diabetes or high blood pressure APD.

Taking your medications as prescribed also is important for getting the best possible results. While receiving peritoneal dialysis, you’ll likely need various medications to control your blood pressure, stimulate production of red blood cells, control the levels of certain nutrients in your blood and prevent the buildup of phosphorus in your blood.

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Causes : Cardiogenic shock

Cardiogenic shock

In most cases, a lack of oxygen to your heart, usually from a heart attack, damages its main pumping chamber (left ventricle). Without oxygen-rich blood circulating to that area of your heart, the heart muscle can weaken and go into cardiogenic shock.

Rarely, damage to your heart’s right ventricle, which sends blood to your lungs to receive oxygen, leads to cardiogenic shock.

Other possible causes of cardiogenic shock include:

  • Inflammation of the heart muscle (myocarditis)
  • Infection of the heart valves (endocarditis)
  • Weakened heart from any cause
  • Drug overdoses or poisoning with substances that can affect your heart’s pumping ability

Risk factors

If you have a heart attack, your risk of developing cardiogenic shock increases if you:

  • Are older
  • Have a history of heart failure or heart attack
  • Have blockages (coronary artery disease) in several of your heart’s main arteries
  • Have diabetes or high blood pressure
  • Are female


If not treated immediately, cardiogenic shock can be fatal. Another serious complication is damage to your liver, kidneys or other organs from lack of oxygen, which can be permanent.


The best way to prevent cardiogenic shock is to make lifestyle changes to keep your heart healthy and your blood pressure in check.

  • Don’t smoke and avoid secondhand smoke. Several years after quitting smoking, your risk of stroke is the same as that of a nonsmoker.
  • Maintain a healthy weight. Being overweight contributes to other risk factors for heart attack and cardiogenic shock, such as high blood pressure, cardiovascular disease and diabetes. Losing just 10 pounds (4.5 kilograms) can lower blood pressure and improve cholesterol levels.
  • Eat less cholesterol and saturated fat. Limiting these, especially saturated fat, can reduce your risk of heart disease. Avoid trans fat.
  • Limit added sugar and alcohol. This will help you avoid nutrient-poor calories and help you maintain a healthy weight.
  • Exercise regularly. Exercise can lower your blood pressure, increase your level of high-density lipoprotein (HDL) cholesterol, and improve the overall health of your blood vessels and heart. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week.

If you have a heart attack, quick action can help prevent cardiogenic shock. Seek emergency medical help if you think you’re having a heart attack.

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Frozen shoulder

Frozen Shoulder - Adhesive Capsulitis

Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by stiffness and pain in your shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years.

Your risk of developing frozen shoulder increases if you’re recovering from a medical condition or procedure that prevents you from moving your arm — such as a stroke or a mastectomy.

Treatment for frozens shoulder involves range-of-motion exercises and, sometimes, corticosteroids and numbing medications injected into the joint capsule. In a small percentage of cases, arthroscopic surgery may be indicated to loosen the joint capsule so that it can move more freely.

It’s unusual for frozens shoulder to recur in the same shoulder, but some people can develop it in the opposite shoulder.


Frozen shoulder typically develops slowly, and in three stages. Each stage can last a number of months.

  • Freezing stage. Any movement of your shoulder causes pain, and your shoulder’s range of motion starts to become limited.
  • Frozen stage. Pain may begin to diminish during this stage. However, your shoulder becomes stiffer, and using it becomes more difficult.
  • Thawing stage. The range of motion in your shoulder begins to improve.

For some people, the pain worsens at night, sometimes disrupting sleep.

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Cancer rehabilitation

Cancer Physiotherapy

Cancer rehabilitation is a program that helps people with cancer maintain and restore physical and emotional well-being. Cancer rehabilitation is available before, during and after cancer treatment.

Cancers rehabilitation involves many types of specialists working together to develop a personal rehabilitation plan that considers your preferences, strengths and goals. Participating in the cancers rehabilitation program may help you experience a fuller or quicker recovery.

Cancers rehabilitation professionals at  the help and expertise that you need to:

  • Improve your endurance, strength and mobility
  • Increase your confidence and self-esteem
  • Make the activities of daily living and caring for yourself easier
  • Help you cope with anxiety, distress or other emotional issues
  • Reduce fatigue, pain and other lingering side effects
  • Return to work
  • Formulate a long-term plan for cancer survivorship

The cancer rehabilitation services at Mayo Clinic can benefit all people with cancer who experience a change in quality of life after diagnosis, including all types and stages of cancer.

” The cancer rehabilitation services at Mayo Clinic can benefit all people with cancer who experience a change in quality of life after diagnosis, including all types and stages of cancer. “

Why it’s done

Cancer rehabilitation is a program that helps people with cancer maintain and restore their physical and emotional well-being. It can help people with cancer recover more quickly and more fully from cancer treatment.

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Why Does My Pet Make Me Sneeze?

 Allergies  Slideshows Why Does My

Why Do Dogs Sneeze?
Dogs sneezing can be a common occurrence, but sometimes you may notice your dog sneezing during unusual times or more than usual. In this article we investigate the causes of sneezing in dogs and what it could mean for your dog.

A dog sneezing is common, normal and really cute to watch! But why do dogs sneeze and what does it mean?

When it comes to sneezing in dogs, it doesn’t tend mean that your dog has a cold, like sneezing usually means in humans. In fact, dogs sneeze for a large amount of reasons. It can be due to something minor like a reaction to dust, or more serious. Or it might be a “play sneeze” – more on that later. It all depends on how often your dog is sneezing and what colour the discharge is.

In most instances, your dog is sneezing in response to an irritant in the upper airway of the dog’s nose. The dog then sneezes to expel the irritant, much like humans do! There can be many other reasons why your dog is sneezing though, so we’ve made this guide so you can find out why do dogs sneeze?

Why do dogs sneeze?

There are loads of reasons why your dog is sneezing. It could be an irritant in their nose like dust, household products, perfume or even pollen. Sneezing in dogs can also be due to something stuck in their nose, such as dirt from digging!

If your dog is sneezing a lot, it may be a reaction to something in the atmosphere. Be careful when spraying items around your pet as it may irritate their nose. Hunting dogs and those that snuffle in the undergrowth can also get lots of unusual things stuck up their nose like fragments of twigs and leaves. If your dog likes to wander nose-first through the undergrowth, be sure to be on the lookout for this.

Usually sneezing helps the dog to expel the item on its own, but if their nose is bleeding or they keep pawing at their nose and sneezing, consult your vet as they may need to remove the object.

Why do dogs sneeze when playing?

Many dog owners notice that dogs often sneeze when they are playing or excited by something. This is called “play sneezing” and it’s normal and harmless. It just means that your dog is having loads of fun!

Dogs sneeze when playing to signal that their behaviour is only play, and that they’re enjoying themselves. Sneezing when playing is particularly common in small breeds but many dogs do it. If your dog is sneezing when you’re playing together, there’s usually no need to worry.

Dogs playing together with toy

Can dogs get nasal infections?

Usually, the reason why your dog is sneezing is a one-off reaction to the something in the air or a play sneeze. However, if your pooch is sneezing regularly, it could be a nasal infection. Generally, dogs that have upper respiratory tract infections are more likely to cough rather than sneeze, but it’s still worth consulting your vet if symptoms persist.

Aspergillus fungus is a common nasal infection caused by inhalation of a fungus from dust, hay or bits of grass. Symptoms include sneezing, nose pain, nosebleeds, discharge and visible swelling. If your dog demonstrates any of these symptoms you should take them to a vet as soon as possible.

On rare occasions, persistent sneezing in dogs can also be caused by nasal mites. These tiny bugs get inside your dog’s nasal passages and are commonly picked up from digging in the dirt with their noses. Nasal mites are incredibly irritating for dogs and can cause nosebleeds and excess discharge from your dog’s nose. If you suspect your dog may have nasal mites, take them to the vet for treatment.

Other reasons why your dog may be sneezing:

  • Infected tooth. The third upper premolar has roots that are really close to the nasal passages, so if this tooth or any near to it are infected, it may cause your dog to sneeze.
  • Tumours. Very occasionally, persistent sneezing in dogs can be a sign of something serious, like a tumour. Second hand smoke is the main cause of tumours in dogs’ nasal passages and is more common in longer-nosed breeds. If you think your dog is unwell, take them to the vet for a diagnosis.
  • If your dog is a brachycephalic breed. These dog breeds such as Boston terrier, Bulldog and Pug have compressed nasal passages, so they’re much more likely to sneeze than other dogs.
dogs digging in the dirt

When is a sneeze, not a sneeze?

A sneeze isn’t always actually a sneeze in dogs. Sometimes your dog may be snorting, which if you have a healthy dog is usually a sign of an upper airway obstruction, so you should take your dog to a vet to have it looked at. Snorting is also common if your dog is overweight as the excess weight can make it harder for them to breathe.

Your dog may also be experiencing a reverse sneeze. This is most common in small breed dogs and brachycephalic breeds. When experiencing a reverse sneeze, air is pulled quickly and loudly in through the nose, resulting in a sudden loud noise like a honk. In fact, some owners think it sounds like the dog is laughing. Your dog will also stand with their elbows apart, head forwards or back before making the sound. Reverse sneezing rarely requires treatment, so you don’t usually need to worry if your dog does this.

With the outbreak of Coronavirus many owners wonder how to best take care of their dog during this uncertain time. We’ve answered the most frequently asked questions about Coronavirus and pets here.

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Peripheral Artery Disease (PAD)

Peripheral Arterial Disease: An under-recognized, slow-burning emergency |  Appalachian Regional Healthcare System

Leg pain and calf pain are often mistaken for either bone and joint disease or neurological disease. Most people have referred these symptoms to the elderly’s condition caused by excessive walking. In fact, these symptoms might potentially indicate peripheral artery disease.

What are peripheral arteries? 

Peripheral arteries are blood vessels that supply blood to the entire body except to the heart and brain. Peripheral arteries circulate blood flow to the limbs and extremities such as the arms, hands, legs and organs in abdominal cavity such as stomach and kidney. Peripheral arteries supply oxygen-rich blood to muscles, bones and nervous system thus its function is as crucial as coronary arteries.

What is peripheral artery disease?

Peripheral artery disease is a narrowing of the peripheral arteries, resulting in reduced blood supply to the limbs and extremities, especially the legs. Peripheral artery disease is often caused by atherosclerosis which is fatty deposits (plaques) built on the artery walls. Atherosclerotic plaques reduce blood flow to the limbs and cause symptoms, most notably leg pain when walking. Factors that increase risks of developing peripheral artery disease include:

  • High blood pressure
  • Diabetes
  • High blood cholesterol
  • Smoking
  • Obesity
  • Increasing age

Signs and symptoms of peripheral artery disease

Most common affected area is leg and signs and symptoms include:

  • Painful cramping in the legs or calf muscles after certain activities e.g. walking or climbing stairs (claudication)
  • Leg or foot numbness or weakness. A change in the color of the legs or feet. Coldness in the lower leg or foot.
  • Sores on the feet, heel or legs that do not heal properly. It is usually found in diabetic patients with impaired would healing process. If left untreated, tissue necrosis might develop.

If the condition progresses, pain may occur at rest. Pain may occur in one or both sides of the limbs. If pain is intense, it can disrupt sleep. Hanging legs over the edge of the bed or walking around may temporarily relieve the pain.

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