What is rabies?

Rabies is a serious disease that is caused by a virus. It is mainly a disease of animals, but humans can get rabies when animals infected with the disease bite them. The virus is transmitted to humans through the infected animal’s saliva. Very rare cases occur when infected saliva gets into someone’s eyes or mouth or into an open wound.

Infected wild animals – especially bats, but also skunks, raccoons, foxes, and coyotes – typically transmit the disease to humans. In the United States, dogs rarely transmit rabies to humans; however, outside the United States, infected dogs are the most common source of transmission to humans. Any mammal (i.e., warm-blooded animal with fur) can get rabies. Animals that are not mammals (e.g., birds, fish, snakes) cannot get rabies.

What are the symptoms of rabies?

Symptoms can appear as soon as a few days after being bitten by an infected animal. However, in most cases, symptoms may not appear until weeks or months later.

One of the most unique symptoms of rabies infection is a tingling or twitching sensation in the area around the animal bite. After the virus leaves the local bite area, it travels up a nearby nerve to the brain and can cause such symptoms as:

  • Pain.
  • Fatigue.
  • Headaches.
  • Fever.
  • Muscle spasms.
  • Irritability.
  • Excessive movements.
  • Agitation, aggressiveness.
  • Confusion.
  • Seizures.
  • Bizarre or abnormal thoughts.
  • Hallucinations.
  • Weakness, paralysis.
  • Increased production of saliva or tears.
  • Extreme sensitivity to bright lights, sounds, or touch.
  • Difficulty speaking.

At advance stages of the infection (when the infection spreads to other parts of the nervous system), the following symptoms can develop:

  • Double vision.
  • Problems moving facial muscles.
  • Abnormal movements of the diaphragm and muscles that control breathing.
  • Difficulty swallowing and increased production of saliva, causing the “foaming at the mouth” usually associated with a rabies infection.

MANAGEMENT AND TREATMENT

How is rabies treated?

Rabies is both prevented and treated with a rabies vaccine. The rabies vaccine is made from killed rabies virus. The vaccine cannot cause rabies. Current vaccines are relatively painless and given in the arm similar to other common vaccines.

A special immune globulin can also be helpful in some cases. When it is useful; starting early is important. A medical professional can help you determine if rabies immune globulin is appropriate for your case.

To treat rabies:

If you have been bitten by an animal or exposed to rabies, call your doctor and go to a nearby emergency room immediately. Once there, the doctor will clean the wound thoroughly and give a tetanus shot if you are not up-to-date with your tetanus immunization.

The decision to treat rabies right away by beginning a series of rabies vaccine shots will be based on a number of factors. These include:

  • The circumstances of the bite (whether the bite provoked or unprovoked).
  • The type of animal (wild or domestic; species of animal).
  • The animal’s vaccination history (whether or not it is vaccinated).
  • Any recommendations from local health authorities regarding the circumstance surrounding the bite.

How dangerous is rabies if it is not treated?

Rabies is almost always fatal if it is left untreated. In fact, once someone with rabies starts experiencing symptoms, they usually do not survive. This is why it is very important to seek medical attention right away following an animal bite, especially if the bite is from a wild animal.

Is the rabies vaccine safe?

The risk of the vaccine causing serious harm is very small. Current vaccines used in the United States cause fewer bad reactions than previous rabies vaccines. Typical mild problems include soreness, redness, swelling, or itching at the sit of the shot. Other mild problems can include headache, nauseaabdominal pain, muscle aches, and dizziness.

More moderate to severe vaccine side effects include hives, joint pain, and fever. Signs of a severe allergic reaction include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, rapid heartbeat, or dizziness. Waiting in the doctor’s office or emergency area for 30 minutes after a vaccine will usually provide time to see if a severe allergic reaction will occur. If you experience any moderate to severe side effects, call your doctor right away.

How can I prevent rabies?

People at high risk of exposure to rabies should get the rabies vaccine before they come in contact with animals that might have rabies. Such people include veterinarians, animal handlers, and all rabies healthcare and scientific workers. Other people should consider pre-exposure vaccination. This group includes people whose activities bring them in frequent contact with animals that could be rabid. Also, international travelers who may visit parts of the world where rabies is common should get a pre-exposure vaccine.

The pre-exposure vaccination schedule consists of 3 doses, given as follows:

  • First dose given.
  • Second dose given 7 days after first dose.
  • Third dose given 21 days or 28 days after first dose.

If the decision is made to begin the rabies vaccine shots and you have never been vaccinated against rabies:

  • You should get 5 doses of the rabies vaccine – first dose immediately, then additional doses 3, 7, 14, and 28 days after the first dose.
  • You should also get a shot of Rabies Immune Globulin at the same time as the first dose of rabies vaccine.

If you have been previously vaccinated against rabies:

  • You should get 2 doses of the rabies vaccine – the first dose immediately, and the second dose 3 days later.
  • You do not need to get a shot of Rabies Immune Globulin.

What are the immediate steps I need to take in case of an animal bite?

  • Wash the bite area with soap and water for 5 to 10 minutes.
  • Cover the bite area with a clean bandage.
  • Call your doctor and go to a nearby emergency room.
  • If you know the animal’s owner, get all the information about the animal, including vaccination status and owner’s name and address. Call your local health department, especially if the animal hasn’t been vaccinated.
  • If you don’t know the animal’s owner or if a wild animal bites you, immediately call your local animal control authorities to get help finding the animal that caused the bite. The animal will need to be confined and observed for signs of rabies.

Gastrochisis

What Is Gastroschisis?

Gastroschisis is a birth defect that develops in a baby while a woman is pregnant. This condition occurs when an opening forms in the baby’s abdominal wall. The baby’s bowel pushes through this hole. The bowel then develops outside of the baby’s body in the amniotic fluid.

The opening is most often on the right side of the baby’s belly button. It can be large or small, but is typically one to two inches in size. In more severe cases, the stomach and/or liver can sometimes make their way through the opening as well.

Because the bowel is outside of the baby’s body, it is unprotected. That means there is a chance it can become irritated, swollen and damaged.

This condition is relatively rare but has seen an increase in recent years. It occurs in about one in every 2,000 babies. It develops early in pregnancy, during the fourth through eighth weeks. Gastroschisis occurs due to a weakness in the baby’s abdominal wall muscles near the umbilical cord. If your baby develops this condition during your pregnancy, you will not experience any symptoms related to it.

Gastroschisis can be repaired with surgery after your baby is born. It is usually not associated with other malformations.

What Causes Gastroschisis?

The exact cause of gastroschisis is not known. It does not appear to be inherited. Having one baby with gastroschisis does not make it more likely that you would have another baby with the condition.

Severity of Gastroschisis

Gastroschisis is labeled as simple or complicated. This is based on how inflamed the bowel and/or organs are that have moved through the opening.

With simple gastroschisis

With complicated gastroschisis, one or more of the following occurs:

  • The bowel outside of the baby’s body is extremely damaged, e.g., a portion of the tissue has died (called necrosis), or the bowel has become twisted or tangled.
  • Intestinal atresia, which occurs when part of the baby’s bowel doesn’t form completely, or the intestine is blocked.
  • Other organs, such as the stomach or liver, protrude out of the opening as well.

Simple cases are more common than complicated ones.

Gastroschisis Evaluation and Diagnosis

It is possible for gastroschisis to be detected in the third month of pregnancy. However, we most often perform evaluations for it at 20-24 weeks, after it has shown up on an ultrasound. It is most commonly diagnosed by ultrasound around weeks 18-20 of pregnancy.

Some women are referred to us for gastroschisis late in pregnancy. We see them within two weeks of their referral. It is important to make a diagnosis and delivery plan as early as possible.

In babies with gastroschisis, the ultrasound will show loops of bowel floating freely. This often shows up when a woman goes in for a routine ultrasound with her obstetrician (OB). It is at this point that most of our patients affected by gastroschisis are referred to hospitals. Here, we’ll work with you to assess how severe your case is and create a plan for the remainder of your pregnancy. We will also talk to you about what to expect after delivery.

An evaluation for gastroschisis consists:

  • An ultrasound (we can use an ultrasound performed within two weeks of your appointment with us, or one will be done on the day of your evaluation)
  • Possibly an MRI and/or a fetal echocardiogram to test your baby’s heart function
  • A meeting with a nurse, social worker and genetic counselor
  • A team meeting with a maternal-fetal medicine specialist (MFM), pediatric surgeon and neonatologist

An important part of the evaluation is determining whether the condition is gastroschisis or omphalocele. These conditions can sometimes look similar on an ultrasound. In omphalocele, a sac from the umbilical cord covers and protects the intestines that are outside of the baby’s body.

After your tests are complete, our team of experts meets with you to discuss the extent of the baby’s condition and its impact on the rest of the pregnancy. We’ll also cover medical treatments that might be needed right after the birth of your child, and long-term prognosis of babies with gastroschisis.

For patients who are local or plan to deliver locally, we also discuss:

  • Delivery at one of our level III hospitals
  • Transferring your baby to Cincinnati Children’s
  • Postnatal surgical care for your baby
  • Length of stay in the neonatal intensive care unit (NICU)
  • Possible complications that could arise

We recommend frequent ultrasounds throughout the remainder of your pregnancy. These will help to monitor your baby’s health, the severity of the gastroschisis, and how it evolves.

Gastroschisis Treatment Options

There are no fetal interventions recommended for babies with gastroschisis. The condition cannot be corrected while you are pregnant. Rather, it must be treated right after your baby is born.

Any baby with gastroschisis must have surgery after birth. An infant cannot survive with his or her bowel outside of the body.

After your baby is born, doctors will assess how severe the gastroschisis is. The type of repair needed depends on how much bowel and/or organs are outside of your baby’s belly and any inflammation or damage to those tissues.

Primary Repair

With a simple gastroschisis, treatment often is what’s called a “primary repair.” This is a surgery where the bowel is placed back inside of the baby’s belly and the abdominal opening is closed. When possible, this surgery is done the day your baby is born.

This type of repair is performed when there’s relatively small amount of bowel outside of the belly, and the bowel is not overly swollen or damaged.

What is polio?

Poliomyelitis (polio) is a disease caused by poliovirus. It happens mostly in children younger than 5 and in parts of the world that have not yet seen wide-scale vaccination.

What causes polio?

A virus called poliovirus causes polio. The virus enters the body through the mouth or nose, getting into the digestive and respiratory (breathing) systems. It multiplies in the throat and intestines. From there, it can enter the bloodstream. It can also attack the nervous system, the nerve network that helps the brain communicate with the rest of the body.

There are three strains of poliovirus: types 1, 2 and 3. Types 2 and 3 have been eradicated (eliminated), but type 1 still affects people in a few countries.

In some parts of the world, a live poliovirus vaccine is still used. This oral live virus vaccine can very rarely cause polio. In the United States and many areas of the world, this live virus vaccine is no longer used and an inactivated vaccine that cannot cause polio is used instead.

Is poliovirus contagious?

Poliovirus is very contagious, and a person can transmit (spread) it even if they aren’t sick. The virus goes from person to person in two ways.

People with poliovirus in their bodies shed the virus through their feces (poop). The virus can then spread to other people when they swallow contaminated water or food. This exposure is more likely in areas that have poor hygiene or weak systems to clean water.

A person can also pick up the virus after someone sneezes or coughs. If you get droplets of an infected person’s phlegm or mucus in your mouth or nose, you can become infected.

What are the symptoms of polio?

About 90% of people infected with poliovirus have no signs of the disease or just mild symptoms. If symptoms do occur, they usually appear about seven to 10 days after exposure to the virus. But symptoms can take as long as 35 days to show up.

Early symptoms of polio are like those of influenza and last about two to 10 days:

  • Fatigue .
  • Fever .
  • Headache.
  • Neck stiffness.
  • Pain in the arms and legs.
  • Vomiting.

While most people fully recover from polio, the disease can cause very serious problems. These problems can sometimes develop quickly (hours after infection) and include:

  • Numbness , a feeling ofpins and needles or tingling in the legs or arms.
  • Paralysis,in the legs, arms or torso.
  • Trouble breathing because of muscle paralysis in the lungs.
  • Death when the muscles you use to breathe become paralyzed.

How is polio diagnosed?

If you have symptoms of polio, contact a healthcare provider. The healthcare provider will ask you about your symptoms and whether you have traveled recently.

Because polio symptoms look a lot like flu symptoms, the healthcare provider may order tests to rule out more common viral conditions.

To confirm polio, a healthcare provider will take a small sample of:

  • Cerebrospinal fluid (liquid around the brain and spinal cord).
  • Saliva from your throat.
  • Stool (poop).

The healthcare team will look at the sample under a microscope to identify poliovirus.

How is polio treated?

While there’s no cure for polio, and no way to prevent paralysis, some things may keep you more comfortable:

. Fluids (such as water, juice and broth).

. Heat to soothe the muscles

. Medications that relax the muscles, also called antispasmodic drugs.

. Pain relievers, such as NSAIDS (non steroidal anti inflammatory drugs) .

. Physical therapy and exercises to help protect the muscles.

. Rest.

. Mechanical ventilation , or a machine that helps you breathe.

How do I prevent polio?

The best prevention against polio is a series of four vaccine shots in the arm or leg.

The inactivated polio vaccine used in the United States is very effective and safe, and cannot cause polio.

The recommended vaccination schedule for children is based on age:

  • First shot when 2 months old.
  • Second shot when 4 months old.
  • Third shot between 6 and 18 months old.
  • A “booster” shot when 4 to 6 years old, for an extra dose to secure protection.

If you didn’t get polio vaccines as a child, you should get three shots in adulthood:

  • First dose at any time.
  • Second dose a month or two later.
  • Final dose six to 12 months after the second.

If you didn’t get all your vaccine doses during childhood, you should get the remaining shots as an adult.

Who should get the vaccine?

Everyone should get vaccinated for polio, preferably during childhood. But even if you’ve had all the normal polio doses, you may need a booster shot if:

  • You work in a lab where you might come into contact with poliovirus.
  • You work with patients who may have gotten exposed to poliovirus.
  • You’re planning to travel to certain areas of the world. (Check the list of countries where polio remains a risk, and talk to your healthcare provider.)

Are polio vaccines safe?

The Centers for Disease Control and Prevention (CDC) considers polio vaccines to be very safe. The CDC tracks vaccine safety and problems.

Any vaccine may cause:

  • Allergic reaction.
  • Pain that lasts awhile (in rare cases).
  • Redness where the needle entered the skin.
  • Soreness in the area where you got the shot.

If you’re not feeling well after a shot or have an allergic reaction, tell your healthcare provider. Also touch base with your provider before future doses.

What does post-polio syndrome feel like?

Symptoms of post-polio syndrome may start slowly and then get worse. They’re like the symptoms of polio:

  • Fatigue.
  • Muscle atrophy (slow decrease in muscle size).
  • New weakness in the same muscles that polio affected.
  • Pain in the joints.
  • Scoliosis (curved spine).

Symptoms of post-polio syndrome are rarely life-threatening, but they can cause difficulties with:

  • Breathing.
  • Participating in normal activities.
  • Sleeping.
  • Swallowing.

Is post-polio syndrome contagious, too?

Post-polio syndrome is not contagious. Only someone who once had polio can have the syndrome.

What are nasal polyps?

What are nasal polyps?

Nasal polyps are painless and benign (not cancerous) growths. They’re found in nasal passages and sinuses, hollow spaces in the bones around your nose. They form from mucous membranes — thin, soft tissue that lines these body parts.

Nasal polyps can get irritated and swollen, partially blocking the nasal passages and sinuses.

Who gets nasal polyps?

Nasal polyps don’t tend to develop until well into adulthood, when people are in their 30s or 40s. They’re usually linked with some cause of inflammation in the nose, such as:

  • Asthma
  • Allergic Rhinitis or other allergies, such as to aspirin or fungus/fungi
  • Chronic rhinosinusitis (CRS).
  • Cystic fibrosis
  • Repeat sinus infections or other infections.

Do nasal polyps happen on one side or both sides of the nose?

Nasal polyps usually appear on both sides. A growth on only one side may actually be something else, such as a cancerous tumor.

What causes nasal polyps?

Polyps develop because the mucous membranes lining the nose or sinuses change. The membranes become inflamed for a long time or become inflamed over and over again. The inflammation features swelling, redness and fluid buildup.

Researchers believe that allergies and infections cause the inflammation. They think that because they’ve studied tissue taken from nasal polyps. Those samples contained extra eosinophils, white blood cells linked to infections and allergic reactions. The evidence points to inflammation causing small growths filled with fluid. Those growths then turn into polyps.

What are the symptoms of nasal polyps?

Small polyps may not cause any symptoms. But as they grow, they may lead to:

  • Headaches.
  • Loss of smell or taste.
  • Nasal congestion (stuffy nose).
  • Nasal drainage (runny nose).
  • Nosebleeds.
  • Postnasal drip (constantly feeling like you have to clear your throat).
  • Pressure or pain in the sinuses, face or top teeth.
  • Snoring

When polyps get big enough, they can block the nasal passages and sinuses, leading to:

  • Frequent asthma attacks in people with asthma.
  • Repeated sinus infections.
  • Sleep apnea  or other trouble sleeping.
  • Trouble breathing, even in people who don’t have asthma.

How are nasal polyps diagnosed?

If you have symptoms of nasal polyps, talk to a healthcare provider.

  • Ask about your health history, especially allergies, infections and asthma.
  • Ask you about your symptoms and how long you’ve had them.
  • Look inside your nose with a nasal endoscope (thin, flexible tube with a tiny camera and light).
  • Order a CT scan to take detailed pictures inside your sinuses.

How are nasal obstructions treated?

Not all patients can be cured of nasal polyps, but several treatments can help:

  • Steroid sprays to shrink polyps and improve symptoms.
  • Oral steroids (pills you swallow).
  • Injections (shots) under the skin to deliver a medicine called dupilumab.
  • Outpatient (no overnight stay) surgery to place a tiny stent. It props open the nasal passages and delivers steroids or other medications.
  • Outpatient surgery using endoscopy to remove polyps when other treatments don’t work.

What is Cholelithiasis?

Cholelithiasis is a medical condition where hard, pebble-like deposits develop within the gallbladder of an individual. They are also known as gallstones. These stones can be as small as a grain of sand or as large as a golf ball. The gallbladder is a small organ present in the abdominal cavity of human beings whose function is to store the bile. When stones develop within this organ, it may give rise to excruciating pain along with jaundice. Treatment is essential immediately after detection as gallstones may lead to severe complications.

There are two types of gallstones

Cholesterol Stones

The most prevalent kind, approximately 80 per cent of all gallstones fall into this category. They are made of cholesterol and are yellow-green.

Pigment Stones

Also called bilirubin stones, these stones are made of bilirubin, and they mostly develop at the time of haemolysis ( the destruction of red blood cells in the body ). They are dark brown or black in color

How does Cholelithiasis occur?

The exact cause for the occurrence of cholelithiasis has not been determined. Recent studies hint that the presence of excess cholesterol in the blood may be responsible for the formation of cholesterol stones. When bile in the liver cannot dissolve excess cholesterol, it develops into gallstone.

Similarly, the pigment stones develop as a result of abundant bilirubin in the body. Specific conditions like liver damage or blood disorders lead to the formation of excess bilirubin which the gallbladder is unable to break down. It may result in the development of hard, dark coloured pigment stones within the gallbladder.

Who is Prone to Cholelithiasis?

The risk of developing cholelithiasis.

  • Age above 40 years.
  • Family history of cholelithiasis.
  • Organ transplant or bone marrow transplant.
  • Diabetes
  • Cirrhosis of the liver.
  • Medical conditions like haemolytic anaemia and sickle cell anaemia.

What are the Symptoms of Cholelithiasis? How is Cholelithiasis Diagnosed?

The symptoms of cholelithiasis include:

  • Pain on the right side of the upper abdomen.
  • Nausea and vomiting.
  • Fever.
  • Jaundice.
  • Dark coloured stools.
  • Dark coloured urine discharge.
  • Diarrhoea.

In some cases, when cholelithiasis does not produce any symptoms, its known as “silent gallstones” or “asymptomatic cholelithiasis.” The pain occurs when these gallstones block the pathway of the cystic duct or common bile duct. This condition is also known as biliary colic. In 80 per cent of the cases, gallstones remain asymptomatic. The patient remains unaware of this condition until it gets detected through X-Ray at the time of routine health analysis.

Diagnosis

In most of the cases, cholelithiasis gets diagnosed at the time of routine health check-up through X-Rays and lower abdomen ultrasound examination. However, if the patient experiences sharp pain in the middle to the upper abdomen, the doctor performs a physical exam to detect abnormalities in the physical characteristic of the body. If he notices a yellow tint on the skin and in the eyes, he diagnostic tests like ultrasound examination, abdominal CT scan, gallbladder radionuclide scan and Endoscopic retrograde cholangiopancreatography (ERCP). All these tests help in the confirmation or ruling out of cholelithiasis in patients. The gallbladder radionuclide scan helps to find out whether there is an infection or blockage associated with the cholelithiasis.

What are the Complications of Cholelithiasis?

If left untreated for a prolonged period, gallstones may lead to severe complications like:

Acute Cholecystitis

Here the gallstones block the cystic duct which supplies the bile juice from the gallbladder. It results in inflammation, infection, along with excruciating pain in the abdominal region. Approximately 1-3 per cent of patients having gallstones may develop cholecystitis in the future.

Other complications of cholelithiasis include sepsis (infection in the blood), gallbladder cancer, cholangitis (a disorder in the gallbladder), fever, chills, jaundice, pain in the abdomen, and appetite loss.

What is the Treatment for Cholelithiasis?

If Cholelithiasis becomes symptomatic, surgery is the best treatment. This process is known as a cholecystectomy. Earlier, surgeons usually performed open cholecystectomy or removal of the entire gallbladder to eliminate the stones. Nowadays, laparoscopic cholecystectomy is a more common course of treatment. Some doctors also use chemicals like chenodeoxycholic acids (CDCA) or ursodeoxycholic acid (UDCA, ursodiol) to dissolve the gallstones and flush it out through urine. However, a higher probability of recurrence of cholelithiasis exists, and this treatment takes a longer time to show effective results.

What is Myasthenia Gravis.

Myasthenia gravis is a chronic neuromuscular disease that leads to fluctuating muscle weakness and fatigue. The disease is characterized by variable degrees of weakness of the skeletal muscles. The name myasthenia gravis is derived from a Latin word, meaning “grave muscle weakness.”

The muscle weakness happens mainly due to the circulation of antibodies which block nicotinic acetylcholine receptors at the postsynaptic neuromuscular junction. By blocking the ability of the neurotransmitter acetylcholine to bind to these receptors in the muscle, these antibodies deter motor neurons from signalling the muscle to contract.

Alternatively, in a much rarer form, muscle weakness is the result of a genetic defect in some portion of the neuromuscular junction that is inherited at birth as compared to the development through passive transmission from the mother’s immune system at birth or through autoimmunity later in life.

Symptoms of myasthenia gravis include:

  • Hoarse voice.
  • Double vision.
  • Drooping of eyelids.
  • Difficulty in talking.
  • Difficulty in swallowing or chewing.
  • Problems in lifting objects and walking upstairs.
  • Difficulty in breathing due to muscular weakness.

Although myasthenia gravis could affect any of the muscles that you control voluntarily, certain muscle groups are more commonly affected than others, some of them are:

  1. Eye Muscles
  • Double vision.
  • Drooping of one or both eyelids.
  1. Face and Throat Muscles
  • Altered speaking.
  • Difficulty swallowing.
  • Problems in chewing.
  • Limited facial expressions.

Myasthenia Gravis Causes

Myasthenia gravis is resulted by a defect in the transmission of nerve impulses to muscles. It occurs when normal communication between the nerve and muscle is interrupted at the neuromuscular junction—the place where nerve cells connect with the muscles they control.

This neuromuscular disease is caused by transmission defects in nerve impulses to muscles. The neuromuscular junction is apparently affected: acetylcholine, which produces muscle contraction under normal conditions no longer produces the contractions necessary to muscle movement.

Myasthenia Gravis Causes

Myasthenia gravis is resulted by a defect in the transmission of nerve impulses to muscles. It occurs when normal communication between the nerve and muscle is interrupted at the neuromuscular junction—the place where nerve cells connect with the muscles they control.

This neuromuscular disease is caused by transmission defects in nerve impulses to muscles. The neuromuscular junction is apparently affected: acetylcholine, which produces muscle contraction under normal conditions no longer produces the contractions necessary to muscle movement.

Myasthenia Gravis Treatment

Myasthenia gravis is believed to be caused by variations in certain genes. The disorder occurs when the immune system malfunctions and attacks the body’s tissues. There is no cure for myasthenia gravis. The goal of treatment is to manage symptoms and control the activity of your immune system through the below-mentioned ways:

  • Medication.
  • Plasma Exchange.
  • Lifestyle Changes.
  • Thymus Gland Removal.
  • Intravenous Immune Globulin.
  • Avoid stress and heat exposure.
  • Rest to help minimize muscle weakness.

What are hiccups?

Hiccups are repetitive, uncontrollable contractions of the diaphragm muscle. Your diaphragm is the muscle just below your lungs. It marks the boundary between your chest and abdomen.

The diaphragm regulates breathing. When your diaphragm contracts, your lungs take in oxygen. When your diaphragm relaxes, your lungs release carbon dioxide.

The diaphragm contracting out of rhythm causes hiccups. Each spasm of the diaphragm makes the larynx and vocal cords close suddenly. This results in a sudden rush of air into the lungs. Your body reacts with a gasp or chirp, creating the sound characteristic of hiccups.

Onset of hiccups

There’s no way to anticipate hiccups. With each spasm, there’s usually a slight tightening of the chest or throat prior to making the distinctive hiccup sound.

Most cases of hiccups start and end abruptly, for no discernable reason. Episodes generally last only a few minutes.

Hiccups that last longer than 48 hours are considered persistent. Hiccups that last longer than two months are considered intractable, or difficult to manage.c

Causes

Numerous causes of hiccups have been identified. However, there’s no definitive list of triggers. Hiccups often come and go for no apparent reason.

Possible common causes of short-term hiccups include:

  • overeating
  • eating spicy food
  • consuming alcohol
  • drinking carbonated beverages, such as sodas
  • consuming very hot or very cold foods
  • a sudden change in air temperature
  • swallowing air while chewing gum
  • excitement or emotional stress
  • aerophagia (swallowing too much air)

Hiccups that last longer than 48 hours are categorized by the type of irritant that caused the episode.

The majority of persistent hiccups are caused by injury or irritation to either the vagus or phrenic nerve. The vagus and phrenic nerves control the movement of your diaphragm. These nerves may be affected by:

  • irritation of your eardrum, which may be caused by a foreign object
  • throat irritation or soreness
  • a goiter (enlargement of the thyroid gland)
  • gastroesophageal reflux (stomach acid backing up into the esophagus, the tube that moves food from the mouth to the stomach)
  • an esophageal tumor or cyst

Other causes of hiccups may involve the central nervous system (CNS). The CNS consists of the brain and spinal cord. If the CNS is damaged, your body may lose the ability to control hiccups.

CNS damage that may lead to persistent hiccups includes:

Hiccups that last for longer periods can also be caused by:

Sometimes, a medical procedure can accidentally cause you to develop long-term hiccups. These procedures are used to treat or diagnose other conditions and include:

  • use of catheters to access the heart muscle
  • placement of an esophageal stent to prop open the esophagus
  • bronchoscopy (when an instrument is used to look inside your lungs)
  • tracheostomy (creation of a surgical opening in the neck to allow breathing around an airway obstruction)

Risk factors for hiccups

Hiccups can occur at any age. They can even occur while a fetus is still in the mother’s womb. However, there are several factors that can increase your likelihood of developing hiccups.

You may be more susceptible if you:

  • are male
  • experience intense mental or emotional responses, ranging from anxiety to excitement
  • have received general anesthesia (you were put to sleep during surgery)
  • had surgery, especially abdominal surgery

Everything You Need to Know About Hiccups

What are hiccups?

Hiccups are repetitive, uncontrollable contractions of the diaphragm muscle. Your diaphragm is the muscle just below your lungs. It marks the boundary between your chest and abdomen.

The diaphragm regulates breathing. When your diaphragm contracts, your lungs take in oxygen. When your diaphragm relaxes, your lungs release carbon dioxide.

The diaphragm contracting out of rhythm causes hiccups. Each spasm of the diaphragm makes the larynx and vocal cords close suddenly. This results in a sudden rush of air into the lungs. Your body reacts with a gasp or chirp, creating the sound characteristic of hiccups.

Singultus is the medical term for hiccups.null

Onset of hiccups

There’s no way to anticipate hiccups. With each spasm, there’s usually a slight tightening of the chest or throat prior to making the distinctive hiccup sound.

Most cases of hiccups start and end abruptly, for no discernable reason. Episodes generally last only a few minutes.

Hiccups that last longer than 48 hours are considered persistent. Hiccups that last longer than two months are considered intractable, or difficult to manage.

Causes of hiccups

Numerous causes of hiccups have been identified. However, there’s no definitive list of triggers. Hiccups often come and go for no apparent reason.

Possible common causes of short-term hiccups include:

  • overeating
  • eating spicy food
  • consuming alcohol
  • drinking carbonated beverages, such as sodas
  • consuming very hot or very cold foods
  • a sudden change in air temperature
  • swallowing air while chewing gum
  • excitement or emotional stress
  • aerophagia (swallowing too much air)

Hiccups that last longer than 48 hours are categorized by the type of irritant that caused the episode.

The majority of persistent hiccups are caused by injury or irritation to either the vagus or phrenic nerve. The vagus and phrenic nerves control the movement of your diaphragm. These nerves may be affected by:

Other causes of hiccups may involve the central nervous system (CNS). The CNS consists of the brain and spinal cord. If the CNS is damaged, your body may lose the ability to control hiccups.

CNS damage that may lead to persistent hiccups includes:

Hiccups that last for longer periods can also be caused by:

Sometimes, a medical procedure can accidentally cause you to develop long-term hiccups. These procedures are used to treat or diagnose other conditions and include:

  • use of catheters to access the heart muscle
  • placement of an esophageal stent to prop open the esophagus
  • bronchoscopy (when an instrument is used to look inside your lungs)
  • tracheostomy (creation of a surgical opening in the neck to allow breathing around an airway obstruction)

Risk factors for hiccups

Hiccups can occur at any age. They can even occur while a fetus is still in the mother’s womb. However, there are several factors that can increase your likelihood of developing hiccups.

You may be more susceptible if you:

  • are male
  • experience intense mental or emotional responses, ranging from anxiety to excitement
  • have received general anesthesia (you were put to sleep during surgery)
  • had surgery, especially abdominal surgery

Treating hiccups

Most hiccups aren’t an emergency, or anything to worry about. However, a prolonged episode can be uncomfortable and disruptive to daily life.

Contact a doctor if you have hiccups that last longer than two days. They can determine the severity of your hiccups in relation to your overall health and other conditions.

There are numerous options for treating hiccups. Typically, a short-term case of hiccups will take care of itself. However, the discomfort may make waiting out hiccups unbearable if they last longer than a few minutes.

Although none of these have been proven to stop hiccups, the following potential treatments for hiccups can be tried at home:

  • Breathe into a paper bag.
  • Eat a teaspoon of granulated sugar.
  • Hold your breath.
  • Drink a glass of cold water.
  • Pull on your tongue.
  • Lift your uvula with a spoon. Your uvula is the fleshy piece of tissue that’s suspended above the back of your throat.
  • Attempt to purposefully gasp or belch.
  • Bring your knees to your chest and maintain this position.
  • Try the Valsalva maneuver by shutting your mouth and nose and exhaling forcibly.
  • Relax and breathe in a slow, controlled manner.

The following tests may be useful in determining the cause of persistent or intractable hiccups:

  • blood tests to identify signs of infection, diabetes, or kidney disease
  • liver function tests
  • imaging of the diaphragm with a chest X-ray, CT scan, or MRI
  • an echocardiogram to assess heart function
  • an endoscopy, which utilizes a thin, lighted tube with a camera on the end to investigate your esophagus, windpipe, stomach, and intestine
  • a bronchoscopy, which utilizes a thin, lighted tube with a camera on the end to examine your lungs and airways

Treating any underlying causes of your hiccups will usually make them go away. If persistent hiccups have no obvious cause, there are several anti-hiccup medications that may be prescribed. The more commonly used drugs include:

There are also more invasive options, which can be used to end extreme cases of hiccups. They include:

  • nasogastric intubation (insertion of a tube through your nose into your stomach)
  • an anesthetic injection to block your phrenic nerve
  • surgical implantation of a diaphragmatic pacemaker, a battery-powered device that stimulates your diaphragm and regulates breathing

Possible complications of untreated hiccups

A long-term episode of hiccups can be uncomfortable and even harmful to your health. If left untreated, prolonged hiccups can disturb your sleeping and eating patterns, leading to:

How to prevent hiccups

There’s no proven method for preventing hiccups. However, if you experience hiccups frequently, you can try to reduce your exposure to known triggers.

The following may help reduce your susceptibility to hiccups:

  • Don’t overeat.
  • Avoid carbonated beverages.
  • Protect yourself from sudden temperature changes.
  • Don’t drink alcohol.
  • Remain calm, and try to avoid intense emotional or physical reactions.

Who is at risk for developing blood clots?

Blood clots can affect people of all ages, according to the Centers for Disease Control and Prevention (CDC), and several factors can increase risks including hospital stay or surgery, obesity, hormonal birth control and injury.

The CDC estimates venous thromboembolism (VTE), or clotting in the veins, affects some 900,000 Americans annually, and 100,000 succumb to blood clots each year. VTE includes other forms like deep vein thrombosis (clotting usually in the legs or arms) and pulmonary embolism, a potentially fatal blockage in the lungs.

Another severe, rare type of clotting prompted federal health officials to recommend a pause in Johnson & Johnson COVID-19 vaccinations. On Tuesday, officials with the Food and Drug Administration said six instances of cerebral venous sinus thrombosis (CVST) in combination with low platelets was reported among over 6.8 million vaccine recipients. 

According to Johns Hopkins Medicine, CVST is a “rare form of stroke” said to affect five in 1 million people each year. It “occurs when a blood clot forms in the brain’s venous sinuses. This prevents blood from draining out of the brain. As a result, blood cells may break and leak blood into the brain tissues, forming a hemorrhage.”

All six cases involved women between the ages of 18 and 48, and symptoms occurred between six and 13 days post-vaccination. FDA officials said one case was fatal, and another patient is in critical condition. The pause will now give experts time to review available data and inform health care providers how to properly treat CVST with low platelets, which requires an alternative therapy compared to other clotting issues. 

So far, however, FDA and CDC officials said it was too early to single out particular subgroups considered at-risk for developing this type of clot after vaccination. 

Dr. Peter Marks, director at FDA Center for Biologics Evaluation and Research, said a probable cause behind the clotting that occurred among vaccine recipients might include a similar mechanism seen with AstraZeneca’s product, another adenoviral vector vaccine being rolled out in Europe, in which a rare immune response occured post-vaccination, leading to activation of platelets and “extremely rare” blood clots.

A safety committee for Europe’s regulator confirmed last week that the benefits of AstraZeneca’s COVID-19 vaccine continue to outweigh risks of side effects, after a review of rare and unusual blood clotting reports among vaccinated adults. Officials noted the clotting predominantly affects those younger than 60 and women, but could not recommend any specific measures to reduce risk.

“Based on the current available evidence, specific risk factors such as age, gender, or previous medical history of clotting disorders have not been able to be confirmed as the rare events are seen in all ages and in men and women,” said Emer Cooke, executive director of the European Medicines Agency (EMA).

 As of April 4, the EU drug safety database received 169 total cases of CVST and 53 cases of splanchnic vein thrombosis (SVT) amid a backdrop of 34 million vaccinated individuals.

Nevertheless, if an individual was vaccinated with the J&J shot over a month ago, the related risk of blood clotting is very low, FDA officials said. If vaccination occurred in the last couple of weeks, patients could monitor for severe headaches, abdominal pain, leg pain or shortness of breath. If these symptoms occur, individuals should contact their health care provider and seek medical treatment, the FDA said. Of note, these symptoms are different from the flu-like symptoms that can crop up in some people shortly after COVID-19 vaccination, and tend to resolve over several days.

“Right now, these adverse events appear to be extremely rare,” the FDA said on Twitter. “Treatment of this specific type of blood clot is different from the treatment that might typically be administered.”

At this time, there is no clear association between the clotting events and oral contraceptives, or the birth control pill, in the six reported cases, the FDA said. While the cases occurred in women under 50, not all the cases involved predisposing conditions. Dr. Janet Woodcock, acting FDA commissioner, noted it was difficult to form generalizations based on six reported cases, and officials would not speculate over the number of possible additional cases.

What is myocarditis?

Centers for Disease Control and Prevention (CDC) advisory panel is set to meet Wednesday to discuss reports of myocarditis and pericarditis in some COVID-19 mRNA vaccine recipients. Leading up to the meeting, the agency’s director, Dr. Rochelle Walensky, stressed that it’s a small fraction of recipients, mostly teens and young adults and that the risk for “mild” myocarditis remains “quite rare,” but what exactly is it, and what does it mean for those who do develop it

Myocarditis, pericarditis and endocarditis are the three main types of heart inflammation, with the diagnosis of each dependent on the location of the swelling. Myocarditis is inflammation of heart muscle, pericarditis is inflammation of the tissue that forms a sac around the heart and endocarditis is inflammation of the inner lining of the heart’s chambers and valves, according to the National Heart, Lung and Blood Institute. 

While the panel on Wednesday will discuss a potential link to mRNA vaccines, the most common causes of the inflammation include viral or bacterial infections and medical conditions that damage the heart and cause inflammation. It is estimated to impact thousands of adults and children around the world, but signs and symptoms may differ depending on where the inflammation occurs. 

For myocarditis specifically, symptoms may include shortness of breath, particularly when lying down or after exercise, fatigue, heart palpitations, chest pain or pressure, lightheadedness, swelling in the hands, legs, ankles and feet or a sudden loss of consciousness, according to the Myocarditis Foundation. 

The majority of cases, however, have no symptoms and are not diagnosed. For those who do seek medical treatment, physicians may order an electrocardiogram, an echocardiogram or a chest X-ray. 

The National Heart, Lung and Blood Institute notes that treatment will also depend on whether a patient is diagnosed with inflammation of the lining of the heart or valves, the heart muscle or the tissue surrounding the heart. Once diagnosed, treatment may involve medicines, a procedure or possibly even surgery to treat the condition and potential complications, which could include arrhythmia, irregular heartbeat or even heart failure. 

Seven cases of myocarditis-like symptoms in patients who had received a COVID-19 vaccine that were reported to the CDC were then detailed in a study published in Circulation. In those seven cases, all patients were males under age 40 who required hospitalization. None of the patients reported heart palpitations and none had signs of heart arrhythmias, a course of treatment varied but included beta-blocker and anti-inflammatory medications. All patients were discharged within two to four days after admission, and all symptoms had resolved before then. 

The American Heart Association at this time continues to recommend COVID-19 vaccine for all adults and children ages 12 and older, and notes that fewer than 1,000 cases have been reported amidst a backdrop of nearly 312 million doses of COVID-19 vaccines administered. 

Mastitis

Mastitis occurs when bacteria found on skin or saliva enter breast tissue through a milk duct or crack in the skin. Milk ducts are a part of the anatomy of the breast that carry milk to the nipples. All genders have milk ducts and can get mastitis.

Infection also happens when milk backs up due to a blocked milk duct or problematic breastfeeding technique. Bacteria grow in the stagnant milk. These factors increase the risk of a nursing mom developing mastitis:

  • Cracked, sore nipples.
  • Improper latching technique or using only one position to breastfeed.
  • Wearing tight-fitting bras that restrict milk flow.
  • Applying herbs to the breast to facilitate breast milk production.

What are the symptoms of mastitis?

Many people with mastitis develop a wedge-shaped red mark on one breast. (Rarely, mastitis affects both breasts.) The breast may be swollen and feel hot or tender to touch. You may also experience:

How is mastitis diagnosed?

Your healthcare provider will do a physical exam and check your symptoms to make a diagnosis. If you aren’t breastfeeding, you may get a mammogram or other tests to rule out breast cancer or a different breast condition.

How is mastitis managed or treated?

Your healthcare provider may prescribe an oral antibiotic to treat mastitis. The infection should clear up within 10 days but may last as long as three weeks. Mastitis sometimes goes away without medical treatment.

To reduce pain and inflammation, you can:

  • Apply warm, moist compresses to the affected breast every few hours or take a warm shower.
  • Breastfeed every two hours or more often to keep milk flowing through the milk ducts. If needed, use a breast pump to express milk between feedings.
  • Drink plenty of fluids and rest when possible.
  • Massage the area using a gentle circular motion starting at the outside of the affected area and working in toward the nipple.
  • Take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS).
  • Wear a supportive bra that doesn’t compress the breast.

What are the complications of mastitis?

If left untreated, a breast infection like mastitis can lead to a breast abscess. This type of abscess typically needs to be surgically drained. If you have an abscess that needs to be drained, your healthcare provider will perform minor surgery or use a small needle to drain the pus. Often, you may need to be admitted to the hospital for IV antibiotics. A breast abscess will not go away with warm compresses.

Prevention

Breastfeeding moms can take these steps to lower their chances of getting mastitis:

  • Air out your nipples after nursing.
  • Don’t wear nursing pads or tight-fitting bras that keep nipples moist.
  • Nurse your baby on one side, allowing the breast to empty, before switching to the other breast.
  • Switch up breastfeeding positions to fully empty all areas of the breast.
  • Use your finger to break your baby’s suction on a nipple if you need to stop a feeding.

When should I call the doctor?

You should call your healthcare provider if you experience:

  • Breast pain.
  • Changes in the way your breasts look or feel.
  • Newly discovered lump.
  • Nipple discharge.
  • Worsening of mastitis symptoms after 24 hours of antibiotics or at-home treatment.