NATURAL HEALTH

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

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

Symptom 1: Changes in Urination

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

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

What patients said:

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

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

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

Symptom 2: Swelling

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

What patients said:

"I remember a lot of swelling in my ankles. My ankles were so big I couldn't get my shoes on."

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

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

Symptom 3: Fatigue

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

What patients said:

"I was constantly exhausted and didn't have any pep or anything."

"I would sleep a lot. I'd come home from work and get right in that bed."

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

Symptom 4: Skin Rash/Itching

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

What patients said:

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

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

Symptom 5: Metallic Taste in Mouth/Ammonia Breath

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

What patients said:

"Foul taste in your mouth. Almost like you're drinking iron."

"You don't have the appetite you used to have."

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

Symptom 6: Nausea and Vomiting

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

What patients said:

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

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

Symptom 7: Shortness of Breath

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

What patients said:

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

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

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

Symptom 8: Feeling Cold

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

What patients said:

"I notice sometimes I get really cold, I get chills."

"Sometimes I get really, really cold. It could be hot, and I'd be cold."

Symptom 9: Dizziness and Trouble Concentrating

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

What patients said:

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

"I was always tired and dizzy."

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

Symptom 10: Leg/Flank Pain

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

What patients said:

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

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

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

Dialysis

In end-stage renal disease, kidney functions can be replaced only by dialysis or by kidney transplantation. See the Transplant section for more information about transplants. There are two types of dialysis 1) hemodialysis and 2) peritoneal dialysis.

Hemodialysis

Hemodialysis involves circulation of blood through a filter on a dialysis machine. Blood is cleansed of waste products and excess water. The acid levels and the concentration of various minerals such as sodium and potassium in the blood are normalized. The blood is then returned to the body.

• Long-term dialysis requires access to a blood vessel so that the machine has a way to remove and return blood to the body. This may be in the form of a dialysis catheter or an arteriovenous fistula or graft.
  
  
• A catheter may be either temporary or permanent. These catheters are either placed in the neck or the groin into a large blood vessel. These catheters are prone to infection and may also cause blood vessels to clot or narrow.
  
  
• The preferred access for hemodialysis is an arteriovenous fistula wherein an artery is directly joined to a vein. The vein takes two to four months to enlarge and mature before it can be used for dialysis. Once matured, two needles are placed into the vein for dialysis. One needle is used to draw blood and run through the dialysis machine. The second needle is to return the cleansed blood.
  
  
• An arteriovenous graft is placed in patients who have small veins or in whom a fistula has failed to develop. The graft is made of artificial material and the dialysis needles are inserted into the graft directly.
  
  
• These venous access devices usually can be placed with local anesthesia on an outpatient basis.
  
  
• Hemodialysis typically takes three to five hours and is needed three times a week.
  
  
• You will need to travel to a dialysis center for hemodialysis.
  
  
• Home hemodialysis is possible in some situations. A care partner is needed to assist you with the dialysis treatments. A family member or close friend are the usual options, though occasionally patients may hire a professional to assist with dialysis. Home hemodialysis may be performed as traditional three times a week treatments, long nocturnal (overnight) hemodialysis, or short daily hemodialysis. Daily hemodialysis and long nocturnal hemodialysis offer advantages in quality of life and better control of high blood pressure, anemia, and bone disease.

Peritoneal dialysis

Peritoneal dialysis utilizes the lining membrane (peritoneum) of the abdomen as a filter to clean blood and remove excess fluid. A catheter is implanted into the abdomen by a minor surgical procedure. Peritoneal dialysis may be performed manually or by using a machine to perform the dialysis at night.

• About 2 to 3 liters of dialysis fluid are infused into the abdominal cavity through this catheter. This fluid contains substances that pull wastes and excess water out of neighboring tissues.
  
  
• The fluid is allowed to dwell for two to several hours before being drained, taking the unwanted wastes and water with it.
  
  
• The fluid typically needs to be exchanged four to five times a day.
  
  
• Peritoneal dialysis offers much more freedom compared to hemodialysis since patients do not need to come to a dialysis center for their treatment. You can carry out many of your usual activities while undergoing this treatment. This may be the preferable therapy for children.

Most patients are candidates for both hemodialysis and peritoneal dialysis. There are little differences in outcomes between the two procedures. Your physician may recommend one kind of dialysis over the other based on your medical and surgical history. It is best to choose your modality of dialysis after understanding both procedures and matching them to your life style, daily activities, schedule, distance from the dialysis unit, support system, and personal preference.

There is no cure for chronic kidney disease. The four goals of therapy are as follows:

1. To slow the progression of disease

2. To treat underlying causes and contributing factors

3. To treat complications of disease

4. To replace lost kidney function

Strategies for slowing progression and treating conditions underlying chronic kidney disease include the following:

• Control of blood glucose: Maintaining good control of diabetes is critical. People with diabetes who do not control their blood glucose have a much higher risk of all complications of diabetes, including chronic kidney disease.
  
  
• Control of high blood pressure: This also slows progression of chronic kidney disease. It is recommended to keep your blood pressure below 130/80 mm Hg if you have kidney disease. It is often useful to monitor blood pressure at home. Blood pressure medications known as angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) have special benefit in protecting the kidneys.
  
  
• Diet: Diet control is essential to slowing progression of chronic kidney disease and should be done in close consultation with your health care provider and a dietitian. For some general guidelines, see the Self-Care at Home section of this article.

The complications of chronic kidney disease may require medical treatment.

• Fluid retention can be treated with any of a number of diuretic medications, which remove excess water from the body. However, these drugs are not suitable for all patients.
  
  
• Anemia can be treated with erythropoiesis stimulating agents. Erythropoiesis stimulating agents are a group of drugs that replace the deficiency of erythropoietin, which is normally produced by healthy kidneys. Often, patients treated with such drugs require either to take iron by mouth or sometimes even intravenously.
  
  
• Bone disease develops in patients due to an inability to excrete phosphorus and a failure to form activated Vitamin D. In such circumstances, your physician may prescribe drugs binding phosphorus in the gut, and may prescribe active forms of vitamin D.
  
  
• Acidosis may develop with kidney disease. The acidosis may cause breakdown of proteins, inflammation and bone disease. If the acidosis is significant, your doctor may use drugs such as sodium bicarbonate (baking soda) to correct the problem.

Chronic kidney disease usually causes no symptoms in its early stages. Only lab tests can detect any developing problems. Anyone at increased risk for chronic kidney disease should be routinely tested for development of this disease.

• Urine, blood, and imaging tests (x-rays) are used to detect kidney disease, as well as to follow its progress.
  
  
• All of these tests have limitations. They are often used together to develop a picture of the nature and extent of the kidney disease.
  
  
• In general, this testing can be performed on an outpatient basis.

Urine tests

Urinalysis: Analysis of the urine affords enormous insight into the function of the kidneys. The first step in urinalysis is doing a dipstick test. The dipstick has reagents that check the urine for the presence of various normal and abnormal constituents including protein. Then, the urine is examined under a microscope to look for red and white blood cells, and the presence of casts and crystals (solids).

Only minimal quantities of albumin (protein) are present in urine normally. A positive result on a dipstick test for protein is abnormal. More sensitive than a dipstick test for protein is a laboratory estimation of the urine albumin (protein) and creatinine in the urine. The ratio of albumin (protein) and creatinine in the urine provides a good estimate of albumin (protein) excretion per day.

Twenty-four-hour urine tests: This test requires you to collect all of your urine for 24 consecutive hours. The urine may be analyzed for protein and waste products (urea, nitrogen, and creatinine). The presence of protein in the urine indicates kidney damage. The amount of creatinine and urea excreted in the urine can be used to calculate the level of kidney function and the glomerular filtration rate (GFR).

Glomerular filtration rate (GFR): The GFR is a standard means of expressing overall kidney function. As kidney disease progresses, GFR falls. The normal GFR is about 100-140 mL/min in men and 85-115 mL/min in women. It decreases in most people with age. The GFR may be calculated from the amount of waste products in the 24-hour urine or by using special markers administered intravenously. Patients are divided into five stages of chronic kidney disease based on their GFR (see Table 1 above).

Blood tests

Creatinine and urea (BUN) in the blood: Blood urea nitrogen and serum creatinine are the most commonly used blood tests to screen for, and monitor renal disease. Creatinine is a breakdown product of normal muscle breakdown. Urea is the waste product of breakdown of protein. The level of these substances rises in the blood as kidney function worsens.

Estimated GFR (eGFR): The laboratory or your physician may calculate an estimated GFR using the information from your blood work. It is important to be aware of your estimated GFR and stage of chronic kidney disease. Your physician uses your stage of kidney disease to recommend additional testing and suggestions on management.

Electrolyte levels and acid-base balance: Kidney dysfunction causes imbalances in electrolytes, especially potassium, phosphorus, and calcium. High potassium (hyperkalemia) is a particular concern. The acid-base balance of the blood is usually disrupted as well.

Decreased production of the active form of vitamin D can cause low levels of calcium in the blood. Inability to excrete phosphorus by failing kidneys causes its levels in the blood to rise. Testicular or ovarian hormone levels may also be abnormal.

Blood cell counts: Because kidney disease disrupts blood cell production and shortens the survival of red cells, the red blood cell count and hemoglobin may be low (anemia). Some patients may also have iron deficiency due to blood loss in their gastrointestinal system. Other nutritional deficiencies may also impair the production of red cells.

Other tests

Ultrasound: Ultrasound is often used in the diagnosis of kidney disease. An ultrasound is a noninvasive type of test. In general, kidneys are shrunken in size in chronic kidney disease, although they may be normal or even large in size in cases caused by adult polycystic kidney disease, diabetic nephropathy, and amyloidosis. Ultrasound may also be used to diagnose the presence of urinary obstruction, kidney stones and also to assess the blood flow into the kidneys.

Biopsy: A sample of the kidney tissue (biopsy) is sometimes required in cases in which the cause of the kidney disease is unclear. Usually, a biopsy can be collected with local anesthesia only by introducing a needle through the skin into the kidney. This is usually done as an outpatient procedure, though some institutions may require an overnight hospital stay.

The kidneys are remarkable in their ability to compensate for problems in their function. That is why chronic kidney disease may progress without symptoms for a long time until only very minimal kidney function is left.

Because the kidneys perform so many functions for the body, kidney disease can affect the body in a large number of different ways. Symptoms vary greatly. Several different body systems may be affected. Notably, most patients have no decrease in urine output even with very advanced chronic kidney disease.

• Fatigue and weakness (from anemia or accumulation of waste products in the body)
  
  
• Loss of appetite, nausea and vomiting
  
  
• Need to urinate frequently, especially at night
  
  
• Swelling of the legs and puffiness around the eyes (fluid retention)
  
  
• Itching, easy bruising, and pale skin (from anemia)
  
  
• Headaches, numbness in the feet or hands (peripheral neuropathy), disturbed sleep, altered mental status (encephalopathy from the accumulation of waste products or uremic poisons), and restless legs syndrome
  
  
• High blood pressure, chest pain due to pericarditis (inflammation around the heart)
  
  
• Shortness of breath from fluid in lungs
  
  
• Bleeding (poor blood clotting)
  
  
• Bone pain and fractures
  
  
• Decreased sexual interest and erectile dysfunction

• Chronic kidney disease is a growing health problem in the United States. A report by the Centers for Disease Control (CDC) determined that 16.8% of all adults above the age of 20 years have chronic kidney disease. Thus, one in six individuals have kidney disease, and over 400,000 patients are on dialysis or have received kidney transplants. About 67,000 people die each year because of kidney failure.
  
  
• The prevalence of chronic kidney disease has increased by 16% from the previous decade. The increasing incidence of diabetes mellitus, hypertension (high blood pressure), obesity, and an aging population have led to this increase in kidney disease.
  
  
• Chronic kidney disease is more prevalent among individuals above 60 years of age (39.4%).
  
  
• Kidney disease is more common among Hispanic, African American, Asian or Pacific Islander, and Native American people.

Although chronic kidney disease sometimes results from primary diseases of the kidneys themselves, the major causes are diabetes and high blood pressure.

• Type 1 and type 2 diabetes mellitus cause a condition called diabetic nephropathy, which is the leading cause of kidney disease in the United States.
  
  
• High blood pressure (hypertension), if not controlled, can damage the kidneys over time.
  
  
• Glomerulonephritis is the inflammation and damage of the filtration system of the kidneys and can cause kidney failure. Postinfectious conditions and lupus are among the many causes of glomerulonephritis.
  
  
• Polycystic kidney disease is an example of a hereditary cause of chronic kidney disease wherein both kidneys have multiple cysts.
  
  
• Use of analgesics such as acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) regularly over long durations of time can cause analgesic nephropathy, another cause of kidney disease. Certain other medications can also damage the kidneys.
  
  
• Clogging and hardening of the arteries (atherosclerosis) leading to the kidneys causes a condition called ischemic nephropathy, which is another cause of progressive kidney damage.
  
  
• Obstruction of the flow of urine by stones, an enlarged prostate, strictures (narrowings), or cancers may also cause kidney disease.
  
  
• Other causes of chronic kidney disease include HIV infection, sickle cell disease, heroin abuse, amyloidosis, kidney stones, chronic kidney infections, and certain cancers.

If you have any of the following conditions, you are at higher-than-normal risk of developing chronic renal disease. Your kidney functions may need to be monitored regularly.

The kidneys are a pair of bean-shaped organs that lie on either side of the spine in the lower middle of the back. Each kidney weighs about ¼ pound and contains approximately one million filtering units called nephrons. Each nephron is made of a glomerulus and a tubule. The glomerulus is a miniature filtering or sieving device while the tubule is a tiny tube like structure attached to the glomerulus.

The kidneys are connected to the urinary bladder by tubes called ureters. Urine is stored in the urinary bladder until the bladder is emptied by urinating. The bladder is connected to the outside of the body by another tube like structure called the urethra.

The main function of the kidneys is to remove waste products and excess water from the blood. The kidneys process about 200 liters of blood every day and produce about two liters of urine. The waste products are generated from normal metabolic processes including the breakdown of active tissues, ingested foods, and other substances. The kidneys allow consumption of a variety of foods, drugs, vitamins and supplements, additives, and excess fluids without worry that toxic by-products will build up to harmful levels. The kidney also plays a major role in regulating levels of various minerals such as calcium, sodium, and potassium in the blood.

• As the first step in filtration, blood is delivered into the glomeruli by microscopic leaky blood vessels called capillaries. Here, blood is filtered of waste products and fluid while red blood cells, proteins, and large molecules are retained in the capillaries. In addition to wastes, some useful substances are also filtered out. The filtrate collects in a sac called Bowman's capsule and drains into the tubule.
  
  
• The tubules are the next step in the filtration process. The tubules are lined with highly functional cells which process the filtrate, reabsorbing water and chemicals useful to the body while secreting some additional waste products into the tubule.

The kidneys also produce certain hormones that have important functions in the body, including the following:

• Activate form of vitamin D (calcitriol or 1,25 dihydroxy-vitamin D), which regulates absorption of calcium and phosphorus from foods, promoting formation of strong bone.
  
  
• Erythropoietin (EPO), which stimulates the bone marrow to produce red blood cells.
  
  
• Renin, which regulates blood volume and blood pressure.

What is the difference between kidney failure and kidney disease?

Kidney failure

• Kidney failure occurs when the kidneys partly or completely lose their ability to carry out normal functions.
  
  
• This is dangerous because water, waste, and toxic substances build up that normally are removed from the body by the kidneys.
  
  
• It also causes other problems such as anemia, high blood pressure, acidosis (excessive acidity of body fluids), disorders of cholesterol and fatty acids, and bone disease in the body by impairing hormone production by the kidneys.

Chronic kidney disease

Chronic kidney disease is when one suffers from gradual and usually permanent loss of kidney function over time. This happens gradually over time, usually months to years. Chronic kidney disease is divided into five stages of increasing severity (see Table 1 below). Stage 5 chronic kidney failure is also referred to as end-stage renal disease, wherein there is total or near-total loss of kidney function and patients need dialysis or transplantation to stay alive. The term "renal" refers to the kidney, so another name for kidney failure is "renal failure." Mild kidney disease is often called renal insufficiency.

Unlike chronic kidney disease, acute kidney failure develops rapidly, over days or weeks.

• Acute kidney failure usually develops in response to a disorder that directly affects the kidney, its blood supply, or urine flow from it.
  
  
• Acute kidney failure usually does not cause permanent damage to the kidneys. With appropriate treatment of the underlying condition, it is often reversible, with complete recovery.
  
  
• In some cases, though, it may progress to chronic kidney disease.

For more, please read the Kidney Failure article.

Table 1. Stages of Chronic Kidney Disease

Stage	Description	GFR* mL/min/1.73m2
1	Slight kidney damage with normal or increased filtration	More than 90
2	Mild decrease in kidney function	60-89
3	Moderate decrease in kidney function	30-59
4	Severe decrease in kidney function	15-29
5	Kidney failure requiring dialysis or transplantation	Less than 15

*GFR is glomerular filtration rate, a measurement of the kidney's function.

The question is, “How much blood moves through your heart valves in one hour?”

A. 5 gallons
B. 10 gallons
C. 50 gallons
D. 100 gallons
E. 500 gallons of blood

Your heart has four valves. Normally, these valves open to let blood flow through or out of your heart, and then shut to keep it from flowing backward. But sometimes they don't work properly. What can happen?

• Blood can leak back through the valve in the wrong direction, which is called regurgitation
• One of the valves, the mitral valve, sometimes has "floppy" flaps and doesn't close tightly. This is called mitral valve prolapse, and it's one of the most common heart valve conditions. Sometimes it causes regurgitation
• When the valve doesn't open enough, which blocks blood flow, it is called stenosis

Valve problems can be present at birth or caused by infections, heart attacks, or heart disease or damage. Some valve problems are minor and do not need treatment. Others might require medicine, medical procedures or surgery to repair or replace the valve.

Alternative Names

Valve replacement; Valve repair; Heart valve prosthesis

Definition

Heart valve surgery is used to repair or replace diseased heart valves

Description

There are four valves in your heart:

1. Aortic valve
2. Mitral valve
3. Tricuspid valve
4. Pulmonary valve

The valves control the direction of blood flow through your heart. The opening and closing of the heart valves produce the sound of the heartbeat.

Heart valve surgery is open-heart surgery that is done while you are under general anesthesia. A cut is made through the breast bone (sternum). Your blood is routed away from your heart to a heart-lung bypass machine. This machine keeps the blood circulating while your heart is being operated on.

Valves may be repaired or replaced. Replacement heart valves are either natural (biologic) or artificial (mechanical):

• Natural valves are from human donors (cadavers).
• Modified natural valves come from animal donors. (Porcine valves are from pigs, bovine are from cows.) These are placed in synthetic rings.
• Artificial valves are made of metal.

If you receive an artificial valve, you may need to take lifelong medication to prevent blood clots. Natural valves rarely require lifelong medication.

Why the Procedure is Performed

Heart valve surgery may be recommended for the following conditions:

• Narrowing of the heart valve (stenosis)
• Leaking of the heart valve (regurgitation)

Valve problems may be caused by:

• Birth defects
• Calcium deposits (calcification)
• Infections such as rheumatic fever
• Medications

Defective valves may cause congestive heart failure and infections (infective endocarditis).

Risks

The risks for any anesthesia include:

• Problems breathing
• Reactions to medications

The risks for any surgery include:

• Bleeding
• Infection

The risks for cardiac surgery include:

• Death
• Heart attack
• Irregular heartbeat (arrhythmia)
• Kidney failure
• Stroke
• Temporary confusion after surgery due to the heart-lung machine

It is very important to take steps to prevent valve infections. You may need to take antibiotics indefinitely, or before dental work and other invasive procedures.

After the Procedure

The success rate of heart valve surgery is high. The operation can relieve your symptoms and prolong your life.

The death rate averages 2% to 5%, depending on the heart valve. About 2 of every 3 patients who received an artificial mitral valve are still alive 9 years after the surgery.

The clicking of the mechanical heart valve may be heard in the chest. This is normal.

Outlook (Prognosis)

You will stay in an intensive care unit for the first 2 or 3 days following the operation. Your heart functions will be monitored constantly. The average hospital stay is 1 - 2 weeks. Complete recovery will take a few weeks to several months, depending on your health before surgery.

Cancer is treated with surgery, chemotherapy, or radiation — or sometimes a combination of these treatments. The choice of treatment depends on:

• the type of cancer someone has (the kind of abnormal cells causing the cancer)
• the stage of the tumor (meaning how much the cancer has spread within the body, if at all)

Surgery is the oldest form of treatment for cancer — 3 out of every 5 people with cancer will have an operation to remove it. During surgery, the doctor tries to take out as many cancer cells as possible. Some healthy cells or tissue may also be removed to make sure that all the cancer is gone.

Chemotherapy (say: kee-mo-ther-uh-pee) is the use of anti-cancer medicines (drugs) to treat cancer. These medicines are sometimes taken as a pill, but usually are given through a special intravenous (say: in-truh-vee-nus) line, also called an IV. An IV is a tiny plastic catheter (straw-like tube) that is put into a vein through someone's skin, usually on the arm. The catheter is attached to a bag that holds the medicine. The medicine flows from the bag into a vein, which puts the medicine into the blood, where it can travel throughout the body and attack cancer cells.

Chemotherapy is usually given over a number of weeks to months. Often, a permanent catheter is placed under the skin into a larger blood vessel of the upper chest. This way, a person can easily get several courses of chemotherapy and other medicines through this catheter without having a new IV needle put in. The catheter remains under the skin until all the cancer treatment is completed.

Radiation (say: ray-dee-ay-shun) therapy uses high-energy waves, such as X-rays (invisible waves that can pass through most parts of the body), to damage and destroy cancer cells. It can cause tumors to shrink and even go away completely. Radiation therapy is one of the most common treatments for cancer. Many people with cancer find it goes away after receiving radiation treatments.

With both chemotherapy and radiation, kids may experience side effects. A side effect is an extra problem that's caused by the treatment. Radiation and anti-cancer drugs are very good at destroying cancer cells but, unfortunately, they also destroy healthy cells. This can cause problems such as loss of appetite, tiredness, vomiting, or hair loss. With radiation, a person might have red or irritated skin in the area that's being treated. But all these problems go away and hair grows back after the treatment is over. During the treatment, certain medicines can help a kid feel better.

While treatment is still going on, a kid might not be able to attend school or be around crowds of people — the kid needs to rest and avoid getting infections, such as the flu, when he or she already isn't feeling well. The body may have more trouble fighting off infections because of the cancer or side effects of the treatment.

Getting Better

Remission (say: ree-mih-shun) is a great word for anyone who has cancer. It means all signs of cancer are gone from the body. After surgery or treatment with radiation or chemotherapy, a doctor will then do tests to see if the cancer is still there. If there are no signs of cancer, then the kid is in remission.

Remission is the goal when any kid with cancer goes to the hospital for treatment. Sometimes, this means additional chemotherapy might be needed for a while to keep cancer cells from coming back. And luckily, for many kids, continued remission is the very happy end of their cancer experience.

It can take a while for a doctor to figure out a kid has cancer. That's because the symptoms cancer can cause — weight loss, fevers, swollen glands, or feeling overly tired or sick for a while — usually are not caused by cancer. When a kid has these problems, it's often caused by something less serious, like an infection. With medical testing, the doctor can figure out what's causing the trouble.

If the doctor suspects cancer, he or she can do tests to figure out if that's the problem. A doctor might order X-rays and blood tests and recommend the person go to see an oncologist (say: on-kah-luh-jist). An oncologist is a doctor who takes care of and treats cancer patients. The oncologist will likely run other tests to find out if someone really has cancer. If so, tests can determine what kind of cancer it is and if it has spread to other parts of the body. Based on the results, the doctor will decide the best way to treat it.

One test that an oncologist (or a surgeon) may perform is a biopsy (say: by-op-see). During a biopsy, a piece of tissue is removed from a tumor or a place in the body where cancer is suspected, like the bone marrow. Don't worry — someone getting this test will get special medicine to keep him or her comfortable during the biopsy. The sample that's collected will be examined under a microscope for cancer cells.

The sooner cancer is found and treatment begins, the better someone's chances are for a full recovery and cure.

You probably know a kid who had chickenpox — maybe even you. But you probably don't know any kids who've had cancer. If you packed a large football stadium with kids, probably only one child in that stadium would have cancer.

Doctors aren't sure why some people get cancer and others don't. They do know that cancer is not contagious. You can't catch it from someone else who has it — cancer isn't caused by germs, like colds or the flu are. So don't be afraid of other kids — or anyone else — with cancer. You can talk to, play with, and hug someone with cancer.

Kids can't get cancer from anything they do either. Some kids think that a bump on the head causes brain cancer or that bad people get cancer. This isn't true! Kids don't do anything wrong to get cancer. But some unhealthy habits, especially cigarette smoking or drinking too much alcohol every day, can make you a lot more likely to get cancer when you become an adult.

Cancer is actually a group of many related diseases that all have to do with cells. Cells are the very small units that make up all living things, including the human body. There are billions of cells in each person's body.

Cancer happens when cells that are not normal grow and spread very fast. Normal body cells grow and divide and know to stop growing. Over time, they also die. Unlike these normal cells, cancer cells just continue to grow and divide out of control and don't die when they're supposed to.

Cancer cells usually group or clump together to form tumors (say: too-mers). A growing tumor becomes a lump of cancer cells that can destroy the normal cells around the tumor and damage the body's healthy tissues. This can make someone very sick.

Sometimes cancer cells break away from the original tumor and travel to other areas of the body, where they keep growing and can go on to form new tumors. This is how cancer spreads. The spread of a tumor to a new place in the body is called metastasis (say: meh-tas-tuh-sis).

Definition

Liver problems include a wide range of diseases and conditions that can affect your liver. Your liver is an organ about the size of a football that sits just under your rib cage on the right side of your abdomen. Without your liver, you couldn't digest food and absorb nutrients, get rid of toxic substances from your body or stay alive.

Liver problems can be inherited, or liver problems can occur in response to viruses and chemicals. Some liver problems are temporary and go away on their own, while other liver problems can last for a long time and lead to serious complications.

Symptoms

Signs and symptoms of liver problems include:

• Discolored skin and eyes that appear yellowish
• Abdominal pain and swelling
• Itchy skin that doesn't seem to go away
• Dark urine color
• Pale stool color
• Bloody or tar-colored stool
• Chronic fatigue
• Nausea
• Loss of appetite

When to see a doctor
Make an appointment with your doctor if you have any persistent signs or symptoms that worry you. Seek immediate medical attention if you have abdominal pain that is so severe that you can't stay still.

Causes

• Acute liver failure
• Alcoholic hepatitis
• Alpha-1-antitrypsin deficiency
• Autoimmune hepatitis
• Bile duct obstruction
• Chronic liver failure
• Cirrhosis
• Enlarged liver
• Gilbert syndrome
• Hemochromatosis
• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis D
• Hepatitis E
• Liver adenoma
• Liver cancer
• Liver cyst
• Liver hemangioma
• Liver nodule (focal nodular hyperplasia)
• Nonalcoholic fatty liver disease
• Parasitic infection
• Portal vein thrombosis
• Primary biliary cirrhosis
• Toxic hepatitis
• Wilson's disease

Risk factors

Factors that may increase your risk of liver problems include:

• A job that exposes you to other people's blood and body fluids
• Blood transfusion before 1992
• Body piercings
• Certain herbs and supplements
• Certain prescription medications
• Diabetes
• Heavy alcohol use
• High levels of triglycerides in your blood
• Injecting drugs using shared needles
• Obesity
• Tattoos
• Unprotected sex
• Working with chemicals or toxins without following safety precautions

Preparing for your appointment

If you suspect you have a liver problem, start by first seeing your family doctor or a general practitioner. If it's determined that you may have liver problems, you may be referred to a doctor who specializes in the liver (hepatologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For liver problems, some basic questions to ask your doctor include:

• What is likely causing my liver problems?
• What kinds of tests do I need?
• Are my liver problems temporary or chronic?
• Can my liver problems be treated?
• Are there treatments to relieve my signs and symptoms?
• Should I stop taking certain medications or supplements?
• Should I avoid alcohol?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions at any time that you don't understand something.

Tests and diagnosis

• Blood tests. A group of blood tests called liver function tests can be used to diagnose liver problems. Other blood tests can be done to look for specific liver problems or inherited conditions that affect the liver.
• Imaging tests. Procedures that create pictures of your liver, such as computerized tomography (CT) scan, magnetic resonance imaging (MRI) and ultrasound, can reveal liver problems.
• Tests of liver tissue. A procedure to remove tissue from your liver (liver biopsy) may help in diagnosing liver problems. Liver biopsy is most often done using a long needle inserted through the skin to extract a tissue sample (needle biopsy). The tissue sample is sent to a laboratory where it can be examined under a microscope.

Treatments and drugs

Treatment for liver problems depends on your diagnosis. Some liver problems can be treated with medications. Others may require surgery.

Liver transplant may ultimately be required for liver problems that cause liver failure.

Alternative medicine

Some herbal supplements used as alternative medicine treatments can be harmful to your liver. To protect your liver, talk with your doctor about the potential risks before you take:

• Black cohosh
• Certain Chinese herbs, including ma-huang
• Chaparral
• Comfrey
• Germander
• Greater celandine
• Kava
• Mistletoe
• Pennyroyal
• Skullcap
• Valerian

Prevention

Prevent liver problems by protecting your liver. For example:

• Drink alcohol in moderation, if at all. Limit the amount of alcohol you drink to no more than one drink a day for women and no more than two drinks a day for men.
• Avoid risky behavior. Get help if you use illicit intravenous drugs. Don't share needles used to inject drugs. If you choose to have sex, use condoms. If you choose to have tattoos or body piercings, be picky about cleanliness and safety when it comes to selecting a shop.
• Get vaccinated. If you're at increased risk of contracting hepatitis or if you've already been infected with any form of the hepatitis virus, talk to your doctor about getting the hepatitis B vaccine. A vaccine is also available for hepatitis A.
• Use medications wisely. Only use prescription and nonprescription drugs when you need them and take only the recommended doses. Don't mix medications and alcohol. Talk to your doctor before mixing herbal supplements or prescription or nonprescription drugs.
• Avoid contact with other people's blood and body fluids. Hepatitis viruses can be spread by accidental needle sticks or improper cleanup of blood or body fluids. It's also possible to become infected by sharing razor blades or toothbrushes.
• Take care with aerosol sprays. When you use an aerosol cleaner, make sure the room is ventilated, or wear a mask. Take similar protective measures when spraying insecticides, fungicides, paint and other toxic chemicals. Always follow the manufacturer's instructions.
• Watch what gets on your skin. When using insecticides and other toxic chemicals, cover your skin with gloves, long sleeves, a hat and a mask.
• Choose a healthy diet. Choose a plant-based diet with a variety of fruits and vegetables. Limit high-fat foods.
• Maintain a healthy weight. Obesity can cause a condition called nonalcoholic fatty liver disease, which may include fatty liver, hepatitis and cirrhosis.

Your liver is the largest organ inside your body. It is also one of the most important. The liver has many jobs, including changing food into energy and cleaning alcohol and poisons from the blood. Your liver also makes bile, a yellowish-green liquid that helps with digestion.

There are many kinds of liver diseases. Viruses cause some of them, like hepatitis A, hepatitis B and hepatitis C. Others can be the result of drugs, poisons or drinking too much alcohol. If the liver forms scar tissue because of an illness, it's called cirrhosis. Jaundice, or yellowing of the skin, can be one sign of liver disease.

Like other parts of your body, cancer can affect the liver. You could also inherit a liver disease such as hemochromatosis

Most heart attacks occur as a result of coronary artery disease (CAD). CAD is the buildup over time of a material called plaque on the inner walls of the coronary arteries. Eventually, a section of plaque can break open, causing a blood clot to form at the site. A heart attack occurs if the clot becomes large enough to cut off most or all of the blood flow through the artery.

Coronary Artery With Plaque Buildup

The illustration shows a normal artery with normal blood flow (figure A) and an artery containing plaque buildup (figure B).

The blocked blood flow prevents oxygen-rich blood from reaching the part of the heart muscle fed by the artery. The lack of oxygen damages the heart muscle. If the blockage isn’t treated quickly, the damaged heart muscle begins to die.

Heart attack also can occur due to problems with the very small, microscopic blood vessels of the heart. This condition is called microvascular disease. It’s believed to be more common in women than in men.

Another less common cause of heart attack is a severe spasm (tightening) of a coronary artery that cuts off blood flow through the artery. These spasms can occur in coronary arteries that don’t have CAD. It’s not always clear what causes a coronary artery spasm, but sometimes it can be related to:

• Taking certain drugs, such as cocaine
• Emotional stress or pain
• Exposure to extreme cold
• Cigarette smoking

The animation below shows how a heart attack occurs. Click the “start” button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.

A heart attack occurs when blood flow to a section of heart muscle becomes blocked. If the flow of blood isn’t restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die.

Heart attack is a leading killer of both men and women in the United States. But fortunately, today there are excellent treatments for heart attack that can save lives and prevent disabilities. Treatment is most effective when started within 1 hour of the beginning of symptoms. If you think you or someone you’re with is having a heart attack, call 9–1–1 right away.
Overview

Heart attacks occur most often as a result of a condition called coronary artery disease (CAD). In CAD, a fatty material called plaque (plak) builds up over many years on the inside walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). Eventually, an area of plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery.
Heart With Muscle Damage and a Blocked Artery

Figure A shows an overview of the heart and coronary artery. Figure B shows a cross-section of the coronary artery with plaque buildup and a blood clot.

Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot.

During a heart attack, if the blockage in the coronary artery isn’t treated quickly, the heart muscle will begin to die and be replaced by scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.

Severe problems linked to heart attack can include heart failure and life-threatening arrhythmias (irregular heartbeats). Heart failure is a condition in which the heart can’t pump enough blood throughout the body. Ventricular fibrillation is a serious arrhythmia that can cause death if not treated quickly.
Get Help Quickly

Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment is most effective when started within 1 hour of the beginning of symptoms.

The most common heart attack signs and symptoms are:

* Chest discomfort or pain—uncomfortable pressure, squeezing, fullness, or pain in the center of the chest that can be mild or strong. This discomfort or pain lasts more than a few minutes or goes away and comes back.
* Upper body discomfort in one or both arms, the back, neck, jaw, or stomach.
* Shortness of breath may occur with or before chest discomfort.
* Other signs include nausea (feeling sick to your stomach), vomiting, lightheadedness or fainting, or breaking out in a cold sweat.

If you think you or someone you know may be having a heart attack:

* Call 9–1–1 within a few minutes—5 at the most—of the start of symptoms.
* If your symptoms stop completely in less than 5 minutes, still call your doctor.
* Only take an ambulance to the hospital. Going in a private car can delay treatment.
* Take a nitroglycerin pill if your doctor has prescribed this type of medicine.

Outlook

Each year, about 1.1 million people in the United States have heart attacks, and almost half of them die. CAD, which often results in a heart attack, is the leading killer of both men and women in the United States.

Many more people could recover from heart attacks if they got help faster. Of the people who die from heart attacks, about half die within an hour of the first symptoms and before they reach the hospital.

Kids usually don't have any symptoms of heart and blood vessel problems. But by starting heart-healthy habits right now, kids can reduce the chance they will ever need to worry about cardiovascular disease.

So what should you do? Don't smoke, for one. And be sure to eat healthy, exercise, and maintain a healthy weight. Your heart and blood vessels will thank you later!

Many people do not realize they have cardiovascular disease until they have chest pain, a heart attack, or stroke. These kinds of problems often need immediate attention and the person may need to go to the emergency department of a hospital.

If it's not an emergency and a doctor suspects the person could have cardiovascular disease, the doctor can do some tests to find out more about how the heart and blood vessels are working. These tests include:

• Electrocardiogram (say: eh-lek-tro-kar-dee-uh-gram). This test records the heart's electrical activity. A doctor puts the patient on a monitor and watches the machine to see the heart beat and determine if it's normal.
• Echocardiogram (say: eh-ko-kar-dee-uh-gram). This test uses sound waves to diagnose heart problems. These waves are bounced off the parts of the heart, creating a picture of the heart that is displayed on a monitor.
• Stress test. For this test, the person exercises while the doctor checks the electrocardiogram machine to see how the heart muscle reacts.
• Catheterization (say: kah-thuh-tuh-ruh-zay-shun). This test uses a long, thin tube that is inserted into the patient's body to inject a special dye. It can locate narrowed areas in arteries due to plaque buildup and find other problems.
• Carotid (say: kuh-rah-tid) artery scan. This test uses sound waves to check for blockages in the carotid artery, a large blood vessel in the neck that supplies blood to the brain.

• Surgeries

  If the doctor finds that a patient has cardiovascular disease, he or she will talk with the patient about how stopping smoking, losing weight, eating a healthy diet, and getting exercise can help. The person also may need to take medicine, have surgery, or both.

  There are different surgeries for the heart and blood vessels. These include:

• Angioplasty (say: an-jee-uh-plas-tee). This opens a blocked vessel by using a balloon-like device at an artery's narrowest point. The doctor may also insert a stent, which is a tiny, stainless steel tube that props the vessel open and makes sure it stays clear.
• Atherectomy (say: ah-thuh-rek-tuh-mee). This involves cutting the plaque out of an artery, so blood can flow freely.
• Bypass surgery. This involves taking part of an artery or vein from another part of the body (like the arm or leg) and using it to channel blood around a blocked area in an artery.
• Pacemakers. A pacemaker is a small electronic device that's put inside the body to regulate the heartbeat.
• Valve replacement. If a heart valve is damaged or isn't working, a surgeon can replace it.
• Carotid endarterectomy (say: en-dar-tuh-rek-tuh-me). During this procedure, a surgeon removes plaque deposits from the carotid artery to prevent a stroke.

If someone you know is getting one of these operations, you might feel worried. The good news is that these surgeries can help prevent heart attacks, strokes, and other problems. The amount of time the person will need to spend in the hospital will vary, depending on the operation and the person's health. The person may be tired and worn out after the surgery, but you can help by making a "Get Well" card and paying a visit.

Heart disease isn't contagious — you can't catch it like you can the flu or a cold. Instead, there are certain things that increase a person's chances of getting cardiovascular disease. Doctors call these things risk factors.

Some of these risk factors a person can't do anything about, like being older and having other people in the family who have had the same problems. But people do have control over some risk factors — smoking, having high blood pressure, being overweight, and not exercising can increase the risk of getting cardiovascular disease.

The heart is the center of the cardiovascular system. Through the body's blood vessels, the heart pumps blood to all of the body's cells. The blood carries oxygen, which the cells need. Cardiovascular disease is a group of problems that occur when the heart and blood vessels aren't working the way they should.

Here are some of the problems that go along with cardiovascular disease:

• Arteriosclerosis (say: ar-teer-ee-oh-skluh-row-sus). Also called hardening of the arteries, arteriosclerosis means the arteries become thickened and are no longer as flexible.
• Atherosclerosis (say: ah-thuh-row-skluh-row-sus). People with atherosclerosis have a buildup of cholesterol and fat that makes their arteries narrower so less blood can flow through. Those deposits are called plaque.
• Angina (say: an-jy-nuh). People with angina feel a pain in the chest that means the heart isn't getting enough blood.
• Heart attack. This is when a blood clot or other blockage cuts blood flow to a part of the heart.
• Stroke. when part of the brain doesn't get enough blood due to a clot or a burst blood vessel.

Research in the Del E. Webb Neuroscience, Aging and Stem Cell Research Center is attacking the problem of heart disease on two fronts. Investigators are employing strategies based on cell and molecular biology to stave off the death of heart cells and to develop replacement cells that can rebuild damaged organs. This two-pronged approach can be thought of as: "Protecting what you have and replacing what you've lost."

On the protection front, Professor Rolf Bodmer and Assistant Professor Giovanni Paternostro are using genetics to examine how hearts age. It has been known for many years that the ability of a heart to adapt to stress and recover decreases with age, but the underlying biology is not well understood. Bodmer and Paternostro use a simple organism, the fruit fly, which has been studied by geneticists for a century, to identify the genes that control the aging process.

In flies, just as in humans, aged hearts do not withstand stress as well as younger hearts. Paternostro has found mutant flies whose hearts appear perennially robust. He and his colleagues are currently working to isolate and examine the genes that cause these mutations. Bodmer and his team are studying a number of genes that are believed to cause heart defects in humans born with Downs syndrome, a birth defect caused by the presence of an extra copy of chromosome 21. These genes have “cousins” in flies, and Bodmer’s group has found that several of them do affect heart function. Bodmer’s group has also identified genes in flies that cause their hearts to age prematurely or, conversely, to remain young relative to the age of the fly. Many of these genes are also found in humans, and a number of them are associated with congenital heart malformations. By manipulating some of the genes they have found, Bodmer’s laboratory can cause hearts to age more slowly than normal. Their hope is that drugs or genetic therapies can be devised, based on their work, that will help to delay or treat heart failure in humans.

Other Burnham scientists are working on strategies to replace heart tissue damaged by disease. These strategies employ stem cells, relatively immature cells that can be directed to become different types of specialized cells, including, it is hoped, cardiac muscle cells, known as cardiomyocytes. These newly-derived heart cells would then be grafted to fill the lesions created by cardiac disease.

Professor Mark Mercola has identified a number of genes that guide initial formation of the heart in developing embryos. His laboratory has applied this knowledge to induce mouse embryonic tissue and embryonic stem cells to take on heart-like properties. For instance, a dish of cultured cells will beat in unison, much like the rhythmic beating displayed by a functioning heart. Their work indicates that it should be possible to develop protocols to induce stem cells to differentiate into functioning cardiac cells.

Cardiomyocytes derived from embryonic stem cells can be cultured in the same dish with genuine cardiac muscle cells, and in fact, some will "pair up" with the mature cells and take on heart-like appearance and function. Mercola and his team have shown that problems develop, however, with these stem cell-derived “heart” cells. The cells appear normal for a time, but then undergo hypertrophy, similar to the enlarged heart cells seen in people with heart failure. Although the cells appear normal alone, contact with normal functioning cardiomyocytes triggers their abnormal growth.

In collaboration with Assistant Professor Vincent Chen, Mercola’s group is examining how the stem cells in these cultures are communicating with their mature cardiomyocyte neighbors. Cardiac cells are "electrically coupled," and exchange signals that allow them to beat in harmony. Chen’s expertise in measuring electrical activity in cells and the communication between them is allowing the team to characterize the electrical behavior of the differentiated stem cells and compare it to that of normal mature cardiomyocytes. The results of this work should constitute a basis for developing methods to normalize electrical activity in differentiated stem cells.

Mercola’s laboratory is also collaborating with a team of chemists to develop candidate drugs to combat the hypertrophy seen in heart-like stem cells. He and his colleagues have identified one chemical compound that appears to block this trend in the stem cells co-cultured with mature heart cells. Now, the team will use their knowledge of the signaling that triggers the stem cells’ abnormal growth to develop drugs that are particularly suited to block the abnormal growth. They are also pursuing other potential compounds that may lead to new agents to protect against enlarged hearts in patients with chronic heart disease.

When engineering heart tissue from stem cells, however, scientists will need to be careful not to halt their proliferation too soon. Otherwise, they will not obtain sufficient tissue to transplant. If the cells mature too soon, they stop dividing; if they do not mature and keep dividing too long, they risk displaying the hypertrophy described above. Therefore, a balance needs to be achieved between cell division and maturation.

One way to control that balance is to replicate the mechanisms the developing embryo uses to ensure it has enough cells to build heart muscle. Mercola’s group is studying a number of genes that control cell proliferation during embryonic heart development. One of these is called Notch, which prevents heart cells from reaching a point at which they can no longer divide. Their long-term goal is to develop protocols, using a combination of genetic and drug-based approaches, that will balance division and maturation appropriately in differentiating stem cells. Such protocols should result in a population of healthy, mature cardiac cells that can be transplanted into patients suffering from heart disease.

If you are dehydrated, your health care provider may prescribe IV fluids to help you feel better.

If you are experiencing significant nausea and vomiting, you will receive medicines to help control these symptoms.

If your symptoms are well controlled, you can be cared for at home. If dehydration or other symptoms are severe or if you are showing signs of confusion or delirium, then you may be hospitalized.

The treatment that has shown the most promise in chronic hepatitis C is an agent called pegylated interferon alpha (Pegasys, PEG-Intron). This agent is often combined with an antiviral drug called ribavirin (Virazole).

• Decisions to start medications for treatment of hepatitis C are usually made in consultation with a gastroenterologist or liver specialist (hepatologist).
• The decision is based on the results of lab tests of liver function, on results of tests for HCV and liver biopsy, and on the person's age and general medical condition.

Certain medical conditions preclude the use of interferon.

• Depression and certain other mental and neurologic disorders
• Active alcohol or drug abuse
• Autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, or psoriasis
• Low blood hemoglobin level (anemia) or blood cell counts
• Cirrhosis that is severe enough to cause symptoms such as jaundice, wasting, fluid retention that causes swelling, or mental disturbances

Your health care provider will interview you about your illness. You will be asked about your symptoms and about any exposures to hepatitis viruses.

If your doctor determines that you may be at risk for contracting hepatitis, you will have blood drawn. The laboratory will be able to determine whether you have been exposed to HCV and certain other hepatitis viruses.

• Several tests are available for this, but the most widely used test detects antibodies to these viruses. Antibodies are substances made by your body's immune system to defend against a specific infection. You won't have the antibody unless you have been infected with HCV unless the test was performed so soon after exposure that your immune system did not have time to make the antibody.
• Tests are also available to identify which of the 6 known strains (genotypes) of the virus is causing the infection. This can help determine the best treatment plan.

The laboratory will also do several tests to determine how well your liver is functioning.

• Other tests will probably be done to check the effects of the infection on other body systems, such as the kidneys.
• If you have had a large amount of vomiting or have not been able to take in liquids, your blood electrolytes will be checked to see if they are in balance.

Liver biopsy is the ultimate test in hepatitis C. It is not necessary for diagnosis but gives useful information about the stage of disease (the amount of liver damage that has already occurred).

Although hepatitis C damages the liver, 80% of people with the disease do not have symptoms. In those who do, symptoms may not appear for 10-20 years, or even longer. Even then, the symptoms usually come and go and are mild and vague. Unfortunately, by the time symptoms appear, the damage may be very serious.

• A minority of people have symptoms during the early acute phase of the infection. These symptoms typically develop 5-12 weeks after exposure to HCV. Some people describe the symptoms as being flulike. The symptoms may last a few weeks or months.
  • Nausea
  • Vomiting
  • Diarrhea
  • Loss of appetite

  • Fatigue

  • Pain over the liver (on the right side of the abdomen, just under the rib cage)
  • Jaundice - A condition in which the skin and the whites of the eyes turn yellow
  • Dark-colored urine (may look like cola or tea)
  • Stools become pale in color (grayish or clay colored)

• Prolonged nausea and vomiting can cause dehydration. If you have been vomiting repeatedly, you may notice the following symptoms:
  • Fatigue or weakness
  • Confusion or difficulty concentrating
  • Headache
  • Not urinating
  • Irritability

• Chronic hepatitis C can lead to cirrhosis of the liver in many people, a condition traditionally associated with alcoholism. Cirrhosis is a condition in which healthy liver tissue is replaced by fibrous tissue, followed by scarlike hardening. As this happens, the liver gradually begins to fail, or lose its ability to carry out its normal functions. Eventually, symptoms develop. Symptoms of cirrhosis include the following:
  • Fluid retention causing swelling of the belly (ascites), legs, or whole body
  • Persistent jaundice
  • Fatigue
  • Disturbances in sleeping
  • Itchy skin
  • Loss of appetite, weight loss, wasting
  • Vomiting with blood in the vomit
  • Mental disturbances such as confusion, lethargy, extreme sleepiness, or hallucinations (hepatic encephalopathy)

• HCV is not related to the other viruses that cause hepatitis. Like the other hepatitis viruses, however, it is contagious. The hepatitis C virus is transmitted mainly by contact with blood or blood products.
  • Sharing of contaminated needles among IV drug users is the most common mode of transmission. Using a needle to inject recreational drugs, even once several years ago, is a risk factor for hepatitis C.
  • Transfusion with infected blood or blood products, hemodialysis, or transplantation of organs from infected donors was once a common mode of transmission but is now rare.

• In 1992, a test became available for checking blood for HCV. Blood and blood products are now tested to ensure that they are not contaminated. As a result, cases of hepatitis C related to transfusion, hemodialysis, or transplantation have dropped to almost zero since then. Transfusion of blood or blood products before 1992 is a risk factor for hepatitis C.

• Less common causes of HCV transmission include the following:
  • From mother to infant at the time of childbirth
  • Through sexual intercourse with an infected person: Having multiple sex partners is a risk factor.
  • Needle sticks with HCV-contaminated blood: This is mostly seen in health care workers. The risk of developing HCV infection after a needle stick is about 5-10%.

• You cannot get hepatitis C by living with, being near, or touching someone with the disease. You can get the disease by sharing a razor, nail clippers, or other such items with an infected person.

• The source of transmission is unknown in about 10% of people with acute hepatitis C and in about 30% of people with chronic hepatitis C.

Hepatitis is a general term that means inflammation of the liver. This inflammation can be caused by infection. Hepatitis can also be caused by exposure to alcohol, certain medications, chemicals, poisons, and other toxins, or by other diseases. Hepatitis C virus (HCV) is one of the many viruses that can cause inflammation of the liver.

Inflammation of the liver caused by infection with HCV is referred to as hepatitis C.

• If the inflammation is not reversed, it becomes chronic (ongoing, long term) and can cause chronic liver disease, which can be serious or even fatal.
• At least 75% of people infected with hepatitis C develop chronic hepatitis C.
• If the disease progresses to the point at which the liver begins to fail (end stage liver disease), the only treatment is liver transplantation.

Hepatitis C is an increasing public health concern in the United States and throughout the world.

• HCV is one of the most common causes of chronic liver disease in the United States and the most common cause of chronic viral hepatitis.
• It is believed to be the cause of about 15-20% of all cases of acute (new, short term) viral hepatitis and half of all cases of cirrhosis, end-stage liver disease, and liver cancer.

About 4 million people in the United States have antibodies to HCV, meaning they have been infected with the virus at some point; as many as half of them do not know they have the infection.

Acute hepatitis B infection

The most severe effect of acute hepatitis B is dehydration from vomiting and diarrhea.

• If you are dehydrated, your doctor may prescribe IV fluid to help you feel better.
  
  
• If you are experiencing significant nausea and vomiting, you will receive medicines to control these symptoms.
  
  
• People whose symptoms are well controlled can be cared for at home.
  
  
• If dehydration or other symptoms are severe or if you are extremely confused or difficult to arouse, you may need to stay in the hospital.
  
  
• There is no treatment that can prevent acute HBV infection from becoming chronic.

Chronic hepatitis B infection

The degree of liver damage is related to the amount of active, replicating (multiplying) virus in the blood and liver. Regularly measuring the amount of HBV DNA in the blood gives a good idea of how fast the virus is multiplying. The treatments now in use are antiviral drugs, which stop the virus from multiplying.

• Antiviral agents, while the best therapy known for chronic hepatitis B, do not work in all individuals with the disease.
  
  
• Although there are several antiviral agents for chronic hepatitis B approved by the U.S. Food and Drug Administration (FDA), research is ongoing. This means that dosages and treatment recommendations are subject to change.
  
  
• Research is ongoing to find medications that work better with fewer side effects.
  

Antiviral therapy is not appropriate for everyone with chronic HBV infection. It is reserved for people whose infection is most likely to progress to chronic hepatitis B.

• Decisions to start medications for treatment of hepatitis B are made by you and your health care provider, often in consultation with a specialist in diseases of the digestive system (gastroenterologist) or liver (hepatologist).
  
  
• The decision is based on results of liver function tests, HBV DNA tests, and, frequently, liver biopsies after a complete history and physical examination.
  
  
• Depending on the results of these tests, you may decide to start therapy or to delay it until later.
  

Treatment is usually started when blood tests indicate that liver functions are deteriorating and the amount of replicating HBV is rising. The interval between diagnosis and starting treatment can be a year or two or several years. Many people may never require medication.

If you have chronic hepatitis B infection and think you might be pregnant, let your health care provider know right away. If you are pregnant and think you have been exposed to hepatitis B, let your health care provider know right away.

The goals of self-care are to relieve symptoms and prevent worsening of the disease.

• Drink plenty of fluids to prevent dehydration. Water is fine; broth, sports drinks, Jello, frozen ice treats (such as Popsicles), and fruit juices are even better because they provide calories.
• Avoid medicines and substances that can cause harm to the liver, such as acetaminophen (Tylenol).
• Avoid drinking alcohol until your health care provider OKs it. If your infection becomes chronic, you should avoid alcohol for the rest of your life.
• Avoid using drugs, even legal drugs, without consulting your doctor. Hepatitis can change the way drugs affect you. If you take prescription medications, continue taking them unless your health care provider has told you to stop. Do not start any new medication (prescription or nonprescription), herbs, or supplements without first talking to your health care provider.
• Try to eat enough for adequate nutrition. Eat foods that appeal to you, but try to maintain a balanced diet. Many people with hepatitis have the greatest urge to eat early in the day.
• Take it easy. Your activity level should match your energy level.
• Avoid prolonged, vigorous exercise until symptoms start to improve.
• Call your health care provider for advice if your condition worsens or new symptoms appear.

Acute hepatitis B usually goes away by itself and does not require medical treatment. If very severe, symptoms such as vomiting or diarrhea may require treatment to restore fluids and electrolytes. There are no medications that can prevent acute hepatitis B from becoming chronic.

If you have chronic hepatitis B, you should see your health care provider regularly.

• Half of all people infected with the hepatitis B virus have no symptoms.

• Symptoms develop within 30-180 days of exposure to the virus. The symptoms are often compared to flu. Most people think they have flu and never think about having HBV infection.
  • Appetite loss
  • Feeling tired (fatigue)
  • Nausea and vomiting
  • Itching all over the body
  • Pain over the liver (on the right side of the abdomen, under the lower rib cage)
  • Jaundice - A condition in which the skin and the whites of the eyes turn yellow in color
  • Urine becomes dark in color (like cola or tea).
  • Stools are pale in color (grayish or clay colored).

• Many types of acute viral hepatitis have similar symptoms (hepatitis A, hepatitis C).

• Fulminant hepatitis is an unusual illness. It is a severe form of acute hepatitis that can be life threatening if not treated right away. The symptoms develop very suddenly.
  • Mental disturbances such as confusion, lethargy, extreme sleepiness or hallucinations (hepatic encephalopathy)
  • Sudden collapse with fatigue
  • Jaundice
  • Swelling of the abdomen

• Prolonged nausea and vomiting can cause dehydration. If you have been vomiting repeatedly, you may notice these symptoms:
  • Feeling tired or weak
  • Feeling confused or having difficulty concentrating
  • Headache
  • Not urinating
  • Irritability

• Symptoms of liver failure may include the following:
  • Fluid retention causing swelling of the belly (ascites) and sometimes the legs
  • Weight gain due to ascites
  • Persistent jaundice
  • Loss of appetite, weight loss, wasting
  • Vomiting with blood in the vomit
  • Bleeding from the nose, mouth, or rectum or blood in the stool
  • Hepatic encephalopathy (excessive sleepiness, mental confusion, and in advanced stages, development of coma)

• The hepatitis B virus is known as a blood-borne virus because it is transmitted from one person to another via blood.
  • Semen and saliva, which contain small amounts of blood, also carry the virus.
  • The virus can be transmitted whenever any of these bodily fluids come in contact with the broken skin or a mucous membrane (in the mouth, genital organs, or rectum) of an uninfected person.

• People who are at increased risk of being infected with the hepatitis B virus include the following:
  • Men or women who have multiple sex partners, especially if they don't use a condom
  • Men who have sex with men
  • Men or women who have sex with a person infected with HBV
  • People with other sexually transmitted diseases
  • People who inject drugs with shared needles
  • People who receive transfusions of blood or blood products
  • People who undergo dialysis for kidney disease
  • Institutionalized mentally handicapped people and their attendants and family members
  • Health care workers who are stuck with needles or other sharp instruments contaminated with infected blood
  • Infants born to infected mothers

• In some cases, the source of transmission is never known.

• The younger you are when you become infected with the hepatitis B virus, the more likely you are to develop chronic hepatitis B. The rates of progression to chronic hepatitis B are as follows:
  • 90% of infants infected at birth
  • 30% of children infected at age 1-5 years
  • 6% of people infected after age 5 years
  • 5-10% of infected adults

• You cannot get hepatitis B from the following activities:
  • Being sneezed or coughed on
  • Hugging
  • Handshaking
  • Breastfeeding
  • Eating food or drinking water
  • Casual contact (such as an office or social setting)

Hepatitis is a general term that means inflammation of the liver. The liver can become inflamed as a result of infection, a disorder of the immune system, or exposure to alcohol, certain medications, toxins, or poisons.

• Hepatitis B is caused by infection with the hepatitis B virus (HBV). This infection has 2 phases: acute and chronic.
  • Acute (new, short-term) hepatitis B occurs shortly after exposure to the virus. A small number of people develop a very severe, life-threatening form of acute hepatitis called fulminant hepatitis.
  • Chronic (ongoing, long-term) hepatitis B is an infection with HBV that lasts longer than 6 months. Once the infection becomes chronic, it may never go away completely.
  • About 90-95% of people who are infected are able to fight off the virus so their infection never becomes chronic. Only about 5-10 percent of adults infected with HBV go on to develop chronic infection.
  • HBV infection is one of the most important causes of infectious hepatitis.

• People with chronic HBV infection are called chronic carriers. About two-thirds of these people do not themselves get sick or die of the virus, but they can transmit it to other people. The remaining one third develop chronic hepatitis B, a disease of the liver that can be very serious.
  • The liver is an essential organ that the body needs to stay alive. Its most important functions are filtering many drugs and toxins out of the blood, storing energy for later use, helping with the absorption of certain nutrients from food, and producing substances that fight infections and control bleeding.
  • The liver has an incredible ability to heal itself, but it can only heal itself if nothing is damaging it.
  • Liver damage in chronic hepatitis B, if not stopped, continues until the liver becomes hardened and scarlike. This is called cirrhosis, a condition traditionally associated with alcoholism. When this happens, the liver can no longer carry out its normal functions, a condition called liver failure. The only treatment for liver failure is liver transplant.
  • Chronic hepatitis B also can lead to a type of liver cancer known as hepatocellular carcinoma.
  • Any of these conditions can be fatal. About 15-25 percent of people with chronic hepatitis B die of liver disease.

• Hepatitis B is the most common serious liver infection in the world. Worldwide, about 350 million people are chronic carriers of HBV, of whom, more than 250,000 die from liver-related disease each year.

• In the United States, hepatitis B is largely a disease of young adults aged 20-50 years. About 1.25 million people are chronic carriers, and the disease causes about 5000 deaths each year.

• The good news is that infection with HBV is almost always preventable. You can protect yourself and your loved ones from hepatitis B.

The following measures can help you feel better while you are having symptoms.

• Take it easy; curtail your normal activities and spend time resting at home.
• Drink plenty of clear fluids to prevent dehydration.
• Avoid medicines and substances that can cause harm to the liver such as acetaminophen (Tylenol) and preparations that contain acetaminophen.
• Avoid alcoholic beverages, as these can worsen the effects of HAV on the liver.
• Avoid prolonged, vigorous exercise until symptoms start to improve.

Call your health care provider if symptoms worsen or a new symptom appears.

Be very careful about personal hygiene to avoid fecal-oral transmission to other members of the household.

There are no specific medicines to cure infection with hepatitis A. Most people require no treatment except to relieve symptoms.

If you have been exposed to someone who is infected with HAV, there is a treatment that may prevent you from becoming infected. It is called immune globulin and is more likely to be effective when given within 2 weeks of exposure.

Your health care provider will ask you questions about your illness. You will be asked about your symptoms and about any possible exposures to hepatitis.

If your health care provider determines that you may be at risk for contracting hepatitis, you will have blood drawn.

• The blood will be tested to determine how well your liver is functioning.
• A test will be done for antibody to hepatitis A. The test will show whether you have been exposed recently to HAV.
• Your blood probably will be tested for the hepatitis B and hepatitis C viruses as well.

If you have had a large amount of vomiting or have not been able to take in liquids, your blood electrolytes may be out of balance. Your blood chemistry may be tested to check this

Many people with HAV infection have no symptoms at all. Sometimes symptoms are so mild that they go unnoticed. Older people are more likely to have symptoms than children. People who do not have symptoms can still spread the virus.

• Symptoms of hepatitis A usually develop between 2 and 6 weeks after infection. The symptoms are usually not too severe and go away on their own, over time. The most common symptoms are as follows:
  • Nausea
  • Vomiting
  • Diarrhea, especially in children
  • Low-grade fever
  • Loss of appetite
  • Rash
  • Tiredness, fatigue
  • Jaundice - A yellow discoloration of the skin and the whites of the eyes
  • Urine is dark brownish in color, like cola or strong tea.
  • Pain in area of liver - On the right side of the abdomen, just under the rib cage

• If the vomiting is severe, dehydration may occur. The symptoms of dehydration include the following:
  • Feeling weak, tired, or "blah"
  • Feeling confused or unable to concentrate
  • Rapid heartbeat
  • Headache
  • Urinating less frequently than usual
  • Irritability

• Symptoms usually last less than two months, although they may last as long as nine months. About 15% of people infected with hepatitis A have symptoms that come and go for 6-9 months.

• Hepatitis does not occur simply from being near someone who has the disease at work or at school.

• The hepatitis A virus is found in the stools (feces) of people with hepatitis A. It is transmitted when a person puts something in his or her mouth that has been contaminated with the feces of an affected person. This is referred to as fecal-oral transmission.
  
  
  • If food or drinking water becomes contaminated with stool from an infected person (usually because of inadequate hand washing or poor sanitary conditions), the virus can quickly spread to anyone who drinks or swallows the contaminated food or water.
    
    
  • The virus can also be spread by eating raw or undercooked shellfish collected from water that has been contaminated by sewage.
    
    
  • The hepatitis A virus can be transmitted through blood transfusions, although this is extremely rare.
  
  
• People who are infected can start spreading the infection about 1 week after their own exposure. People who do not have symptoms can still spread the virus. Infection with HAV is known to occur throughout the world.
  
  
• The risk of infection is greatest in developing countries with poor sanitation or poor personal hygiene standards.
  
  
• Infection rates are also higher in areas where direct fecal-oral transmission is likely to occur, such as daycare centers, prisons, and mental institutions.
  
• People at increased risk for hepatitis A infection
  
  
  • Household contacts of people infected with HAV
    
    
  • Sexual partners of people infected with HAV
    
    
  • International travelers, especially to developing countries
    
    
  • Military personnel stationed abroad, especially in developing countries
    
    
  • Men who have sex with other men
    
    
  • Users of illegal drugs (injected or non-injected)
    
    
  • People who may come into contact with HAV at work
  
  
• Workers in professions such as health care, food preparation, and sewage and waste water management are not at greater risk of infection than the general public.
  
• People who live or work in close quarters, such as dormitories, prisons, and residential facilities, or work in or attend daycare facilities are at increased risk only if strict personal hygiene measures are not observed.