“As a result, many parents are inundated with horror stories of vaccine dangers, all designed to eat away at them emotionally while the medical and scientific communities have mounted their characteristic response by sharing the facts, the data, and all of the reliable peer-reviewed and well-cited research to show that vaccines are safe and effective. ”
U.S. National Library of Medicine/National Institutes of Health
“Most cases of cough are temporary. But even a short-term cough can be a sign of a bigger health issue that needs to be addressed by a doctor. Here’s how to narrow down the possible culprits—from asthma to pneumonia to whooping cough says Peter Dicpinigaitis, MD, director of the Montefiore Cough Center and professor of clinical medicine at Albert Einstein College of Medicine in New York City.”
Fox News.
The cough reflex is one of humans’ most vital defenses, highly effective in clearing secretions and preventing foreign materials from entering the lower respiratory tract. However, when a pathological cough persists without serving any useful purpose, it can be highly irritating and disruptive, causing significant sleep disturbance, chest pain, urinary incontinence, frustration, anger, and depression. “It’s easy to underestimate the tremendous quality of life issue that cough is, not only for the patient but for the family. Some of our patients have been coughing every single day for ten, twenty, even thirty years,” founded at the Montefiore Cough Center, one of the few specialty cough centers in the United States.
The Montifiore Cough Center found the following information via there research:
Despite the prevalence of cough, researchers have yet to fully understand its mechanism and relationship with the brain. Stimulation of the vagus—a cranial nerve with motor function in the larynx, esophagus, lower respiratory tract, and ear—can stimulate the cough reflex. The transient receptor potential vanilloid (TRPV1) receptor, a sensory nerve channel known as a “cough receptor,” induces the reflex when stimulated by irritants such as capsaicin (derived from red chili peppers), hydrogen, heat, low pH, certain enzymes, and anandamide (a naturally occurring, euphoria-inducing brain neurotransmitter).
The cough mystery presents a particular challenge to those who attempt to diagnose and treat it. Physicians need to maintain the protective cough, an important barrier reflex that prevents complications like bronchitis, pneumonia, and lung collapse, but eliminate the maladaptive cough. To do this successfully, the cough’s underlying etiology must be identified and addressed.
Manypatients cough due to post-nasal drip, or upper airway cough syndrome (UACS). UACS is often treated with a combination of a first-generation decongestant /antihistamine and other nasal corticosteroids, nasal ipratropium bromide, or nasal cromolyn. Newer generation, non-sedating antihistamines such as Claritin, Zyrtec, and Allegra, which circumvent drowsiness because they don’t pass the blood-brain barrier, are ineffective for treating UACS-associated cough.
Asthma, whether “cough-variant” (where cough is the sole or predominant symptom) or “classic” (with symptoms including wheezing) is the second most common cause of chronic cough, found in 24-29% of patients at Montefiore. Coughing inflames the sensory afferent nerves (those that carry messages from receptors to the central nervous system). Leukotrienes, lipid mediators whose production also generates histamines, are thought to contribute to the inflammation. Asthma therapy (usually a combination of inhaled bronchodilators and steroids) can take up to eight weeks to show improvement. An oral leukotriene receptor antagonist known as zafirlukast has in some cases been more effective than steroids in reducing asthma-associated cough, possibly because it more effectively suppresses the interaction of eosinophils (white blood cells that fight concomitant infection during asthmatic reaction) with cough receptors. Non-asthmatic eosinophilic bronchitis, a condition characterized by chronic cough without the airway remodeling common to asthma, is often misdiagnosed as cough-variant asthma because it responds similarly to inhaled corticosteroids.
Gastroesophageal reflux disease (GERD) is among the most common etiologies of cough, and perhaps the most difficult to diagnose. Most patients with reflux-associated cough have no other symptoms of GERD, though the characteristic heartburn, nausea, and regurgitation may subsequently appear. The standard GI workup for GERD—endoscopy, barium esophagram, prolonged esophageal acid monitoring, and impedance monitoring—may not detect mild acid exposure, brief reflux events, rapid esophageal clearance, and distal or “high” reflux. “You might send your patient for a full GI workup and receive test results that are unremarkable, but that patient’s reflux still causes an incredibly life-jarring cough”.
Chronic cough can also result from laryngopharyngeal reflux (LPR), a subtype of GERD in which reflux reaches the upper airways. People with LPR often cough when eating, drinking, laughing, talking on the telephone, or getting up in the morning, and may experience hoarseness or other voice change.
The current GERD diagnostic options and treatment therapies may be inadequate, though better options are beginning to emerge. Twenty-four-hour catheter-based pH monitoring, for example, is invasive and often inconclusive as patients typically modify their activity and diet the day they wear the nasal catheter. Better but costlier options include the Bravo™ pH Monitoring System, in which a tubeless monitoring capsule is placed in the mucosal wall of the esophagus, transmitting pH data to a pager-sized receiver worn on patient’s belt over a 48-hour period; and Multichannel Intraluminal Impedance (MII) Testing, which assesses acid and non-acid reflux, adequacy of acid suppression, and symptom-reflux association. Treatment for GERD—usually aggressive acid suppression therapy, an approach that requires significant diet and lifestyle modification—may still be inadequate, and the addition of prokinetic therapy with additional medication may be necessary. Those who don’t respond sufficiently to acid suppression and prokinetic therapy may be candidates for laparoscopic Nissen fundoplication, or “antireflux surgery,” which, based on small published reports, has yielded quality of life improvements in up to 90% of patients who have undergone it.
Postinfectious or postviral cough, a harsh, dry, persistent hack remaining from an upper respiratory infection, has been historically difficult to treat. This cough creates persistent airway inflammation, which in turn causes enhanced cough sensitivity, creating a vicious cycle that inhibits healing. Postviral coughs can persist for weeks or even months and may respond to antiinflammatory agents, such as inhaled and oral steroids.
More effective cough treatment options are needed, yet no new antitussive drugs have been developed in the last half century. With the discovery of TRPV1, however, pharmaceutical companies’ interest in these medications has surged. Numerous potential novel antitussive agents are now being studied, including antagonists to eosinophil, tachykinin receptor, 5-HT receptor, and TRPV1 receptor; agonists to the delta-opioid receptor, NOP receptor, and GABA-B; endogenous cannabinoids, and large conductance Ca+2-activated K+-channel openers.
The idiopathic (unexplained) cough remains a mystery. Patients with this cough—predominantly peri-menopausal women with a lower capsaicin threshold, many of whom have had an upper respiratory infection preceding symptom onset—may have been inadequately diagnosed. However, even after aggressive, comprehensive testing and treatment, some continue to cough. A percentage of these patients are reported to have lymphocytic airway inflammation and autoimmune diseases, but the link is neither consistent nor definitive.
Chronic cough is the most common reason that patients seek medical care, yet only a fraction of people with UACS, asthma, non-asthmatic eosinophilic bronchitis, or GERD actually experience this symptom, a phenomenon yet to be understood. These individuals may possess an intrinsically hypersensitive cough reflex, more easily triggered by aggravating factors to produce the reaction.
Although cough has been historically under-researched relative to its importance as a medical problem, the last decade has witnessed a significant increase in scientific activity dedicated to understanding the mechanism of cough, and identifying more effective therapies.
“Crohn’s disease may affect as many as 780,000 Americans. Men and Women are equally likely to be affected, and while the disease can occur at any age, Crohn’s is more prevalent among adolescents and young adults between the ages of 15 and 35.”.
Crohn’s and Colitis Foundation
Several categories of drugs may be effective in treating ulcerative colitis. The type you take will depend on the severity of your condition. The drugs that work well for some people may not work for others, so it may take time to find a medication that helps you. In addition, because some drugs have serious side effects, you’ll need to weigh the benefits and risks of any treatment.
Anti-inflammatory drugs are often the first step in the treatment of ulcerative colitis. They include:
These drugs also reduce inflammation, but they do so by suppressing the immune system response that starts the process of inflammation. For some people, a combination of these drugs works better than one drug alone.
Immunosuppressant drugs include:
You may need additional medications to manage specific symptoms of ulcerative colitis. Always talk with your doctor before using over-the-counter medications. He or she may recommend one or more of the following.
Surgery can often eliminate ulcerative colitis. But that usually means removing your entire colon and rectum (proctocolectomy).
In most cases, this involves a procedure called ileal pouch anal anastomosis. This procedure eliminates the need to wear a bag to collect stool. Your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus, allowing you to expel waste relatively normally.
In some cases a pouch is not possible. Instead, surgeons create a permanent opening in your abdomen (ileal stoma) through which stool is passed for collection in an attached bag.
You will need more-frequent screening for colon cancer because of your increased risk. The recommended schedule will depend on the location of your disease and how long you have had it.
If your disease involves more than your rectum, you will require a surveillance colonoscopy every one to two years. You will need a surveillance colonoscopy beginning as soon as eight years after diagnosis if the majority of your colon is involved, or 15 years if only the left side of your colon is involved.
Many people with digestive disorders have used some form of complementary and alternative (CAM) therapy.
Some commonly used therapies include:
There is currently no cure for Crohn’s disease, and there is no one treatment that works for everyone. The goal of medical treatment is to reduce the inflammation that triggers your signs and symptoms. It is also to improve long-term prognosis by limiting complications. In the best cases, this may lead not only to symptom relief but also to long-term remission.
Anti-inflammatory drugs are often the first step in the treatment of inflammatory bowel disease. They include:
These drugs also reduce inflammation, but they target your immune system, which produces the substances that cause inflammation. For some people, a combination of these drugs works better than one drug alone. Immunosuppressant drugs include:
Antibiotics can reduce the amount of drainage and sometimes heal fistulas and abscesses in people with Crohn’s disease. Some researchers also think antibiotics help reduce harmful intestinal bacteria that may play a role in activating the intestinal immune system, leading to inflammation. Frequently prescribed antibiotics include ciprofloxacin (Cipro) and metronidazole (Flagyl).
In addition to controlling inflammation, some medications may help relieve your signs and symptoms, but always talk to your doctor before taking any over-the-counter medications. Depending on the severity of your Crohn’s disease, your doctor may recommend one or more of the following:
Your doctor may recommend a special diet given via a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition) to treat your Crohn’s disease. This can improve your overall nutrition and allow the bowel to rest. Bowel rest can reduce inflammation in the short term.
Your doctor may use nutrition therapy short term and combine it with medications, such as immune system suppressors. Enteral and parenteral nutrition are typically used to get people healthier prior to surgery or when other medications fail to control symptoms.
Your doctor may also recommend a low residue or low-fiber diet to reduce the risk of intestinal blockage if you have a narrowed bowel (stricture). A low residue diet is designed to reduce the size and number of your stools.
If diet and lifestyle changes, drug therapy, or other treatments don’t relieve your signs and symptoms, your doctor may recommend surgery. Nearly half of those with Crohn’s disease will require at least one surgery. However, surgery does not cure Crohn’s disease.
During surgery, your surgeon removes a damaged portion of your digestive tract and then reconnects the healthy sections. Surgery may also be used to close fistulas and drain abscesses.
The benefits of surgery for Crohn’s disease are usually temporary. The disease often recurs, frequently near the reconnected tissue. The best approach is to follow surgery with medication to minimize the risk of recurrence.
Many people with digestive disorders have used some form of complementary and alternative medicine (CAM). However, there are few well-designed studies of their safety and effectiveness.
Some commonly used therapies include:
“It is important to know that Crohn’s disease is not the same thing as ulcerative colitis, another type of Inorganic Bowel Disease. The symptoms of these two illnesses are quite similar, but the areas affected in the gastrointestinal tract (GI tract) are different.”
Crohn’s and Colitis Foundation
IBD refers to both Crohn’s disease and ulcerative colitis, however they can be distinguished from one another by their symptoms, GI involvement, biopsy, and antibody testing.
You’ve had stomach cramps for weeks, you’re exhausted and losing weight, and you keep having to run to the bathroom. What’s going on?
It could be an inflammatory bowel disease (IBD). But which one?
There are two: Crohn’s disease and ulcerative colitis. They have a lot in common, including long-term inflammation in your digestive system. But they also have some key differences that affect treatment.
By the way, if you hear some people just say “ulcerative colitis” you have sores (ulcers) in the lining of your colon, as well as inflammation there. With Crohn’s disease you may have ulcers.
Facts on Ulcerative Colitis:
Belly cramps and pain, Diarrhea, Constipation, An urgent need to have a bowel movement, Feeling like your bowel movement wasn’t complete, Rectal bleeding, Fever, Smaller appetite, Weight loss, Fatigue, Night sweats, Problems with your period. You might skip them, or their timing might be harder to predict.
You might not have all of those symptoms all the time. Both conditions can come and go, switching between flares (when symptoms are worse) and remission (when symptoms ease up or stop).
Crohn’s and ulcerative colitis are most often diagnosed in teenagers and young adults — although they can happen at any age — and tend to run in families.
1.)Ulcerative colitis and Crohn’s disease affect men and women equally
2.)The symptoms of ulcerative colitis and Crohn’s disease are very similar
3.) Both diseases often develop in teenagers and young adults although the disease can occur at any age.
4.) The causes of both UC and Crohn’s disease are not known and both diseases have similar types of contributing factors such as environmental, genetic and an inappropriate response by the body’s immune system
2.) In Crohn’s disease, there are healthy parts of the intestine mixed in between inflamed areas. Ulcerative colitis, on the other hand, is continuous inflammation of the colon.
3.) Ulcerative colitis only affects the inner most lining of the colon while Crohn’s disease can occur in all the layers of the bowel walls.
Since the differences between the two conditions mostly revolve around where in the digestive system inflammation happens, the best way for a doctor to give you the right diagnosis is to take a look inside. To look inside is either a endoscopy or colonoscopy depending on where the M.D. thinks the disorder is located.
Prior to these invasive tests the M.D. might order:
X-rays that can show places where your intestine is blocked or unusually narrow.
Contrast X-rays, for which you’ll swallow a thick, chalky, barium liquid so doctors can see how it moves through your system.
CT scans and MRIs to rule out other conditions that might cause symptoms similar to an inflammatory bowel disease.
After the M.D. see’s something on these tests indicating more invasive tests now he or she may order:
Endoscopy, in which a doctor uses a tiny camera on a thin tube to see inside your digestive system.
Specific types of endoscopy can be:
Scientists are working to make two blood tests better at helping to diagnose ulcerative colitis and Crohn’s. They check on levels of certain antibodies found in the blood:
Sometimes, even after all these tests, doctors might not be able to tell which of the two conditions you have. That’s true for 1 in 10 people with IBD. They show signs of both diseases. So they get a diagnosis of “indeterminate colitis,” because it’s not clear which ailment it is.
Because of the similarities between the conditions, many treatments of ulcerative colitis and Crohn’s disease overlap. These things help for both:
“There are a lot of treatment options for thrombocytopenia and ITP. You’ll need to work with your doctor to weigh the pros and cons of each and find a therapy that’s right for you.”
WebMD
There are a lot of treatment options for thrombocytopenia and ITP. You’ll need to work with your doctor to weigh the pros and cons of each and find a therapy that’s right for you.
If you have ITP, your treatment depends on how severe a case you have. If it’s mild, you may only need to get regular checks of your platelet levels.
When you do need treatment, the goal is to get your platelet count to a level that’s high enough to prevent serious bleeding in the gut or brain.
Your doctor will likely suggest these treatments for ITP first:
Corticosteroids. Dexamethasone or prednisone is typically prescribed to raise your platelet count. You take it once a day in the form of a pill or tablet. An increased or normalized platelet count is generally seen within two weeks of therapy, particularly with high-dose dexamethasone. Your doctor will then likely gradually reduce your dose over the next 4 to 8 weeks. The treatment may have to be repeated, but once your platelet count is normalized, none is needed again.
There are some side effects to prednisone, especially if you use it for a long time. Even after a short time, you can get irritable, have stomach upsets, and have other problems such as:
Besides side effects, another disadvantage to prednisone is that your platelet count may drop once you’ve finished your treatment.
IVIG (intravenous immune globulin). If you can’t get your platelet count up with prednisone, if you cannot tolerate steroids, or if your count drops after you’re done with your treatment, your doctor may suggest IVIG. You take this medication through an IV, usually for several hours a day over a period of 1 to 5 days.
Surgery. If you have ITP and other treatments haven’t raised your platelet levels enough, you may benefit from an operation to remove your spleen. That’s the organ that destroys your platelets, so taking it out can give your platelet count a boost. But this doesn’t always work.
Getting your spleen removed can make it harder for you to fight infections. Your infection risk is greatest in the first 3 months after your surgery.
Rituximab (Rituxan). This drug is a type of treatment known as biologic therapy. It attacks B cells, a type of white blood cell that can destroy platelets. It’s sometimes used if you have severe ITP despite treatment with steroids and you aren’t able to have surgery to remove your spleen. Your doctor may also suggest it if you’ve had your spleen removed but you still have low platelet counts.
Side effects for rituximab include:
Rho(D) immune globulin. This treatment, which you also take through an IV, is an alternative to traditional IVIG in patients who have Rh+ blood. It generally takes less than half an hour. The side effects are similar to IVIG.
If corticosteroids, IVIG, and Rho D aren’t improving your platelet count and you’re having bleeding problems, your doctor may switch to a second set of options. There are pros and cons for each. They include:
Thrombopoietin (TPO) receptor agonists. These drugs are also called platelet growth factors. If you have severely low platelets even after treatment with steroids, surgery to remove the spleen, or rituximab, you will likely do well on these medicines, but you may need to take them long-term.
A TPO drug may also be used in a patient who requires an increase in platelet count for a period of time, such as during an acute bleeding episode, in preparation for elective surgery, or while deciding about, planning, or awaiting a splenectomy.
If you’ve tried those and still can’t get your platelet count to the right level, your doctor may suggest these medicines:
A newer drug called Fostamatinib (Tavalisse), a spleen tyrosine kinase inhibitor, is designed to treat thrombocytopenia in adults with chronic ITP who haven’t responded to previous treatment. The initial dose is a pill twice a day.
Immunosuppresants, such as azathioprine (Imuran), cyclosporine, and mycophenolate mofetil (CellCept). They work by keeping your immune system in check.
Androgens, such as danazol (Danocrine). It’s not used in women because it can cause unwanted hair growth called hirsutism.
Vinca alkaloids, such as vinblastine, vincristine (Vincasar), and rarely, cyclophosphamide (Cytoxan). Doctors sometimes suggest these if you’re having severe bleeding and your platelet count isn’t getting a boost from other treatments.
You can still do a lot of things, but you may need to make some changes to your lifestyle to prevent getting hurt or cut. For instance, avoid sports such as football and downhill skiing.
Eat a healthy diet with lots of fruits and vegetables, especially leafy greens, to give your body the nutrients it needs. Ask your doctor if you should avoid food with quinine and aspartame, like tonic water, bitter lemon, bitter melon, some diet sodas, and sugar-free foods.
You shouldn’t take medicines that make bleeding easier, such as aspirin and ibuprofen.
Ask your doctor if it’s OK for you to drink alcohol, and if it is, how much.
Your case may be different from someone else’s. Your doctor will watch you to see how you’re doing. If your case is mild, you may not need any treatment. But even people who do need treatment can lead full lives.
Find out as much as you can about your condition so you can best manage it.
The Platelet Disorder Support Association has information about ITP and ways to connect with others who also have it.
“Thrombocytopenia (THROM-bo-si-to-PE-ne-ah) is a condition in which your blood has a lower than normal number of blood cell fragments called platelets (PLATE-lets). Platelets are made in your bone marrow along with other kinds of blood cells.”
National Heart, Lung and Blood Institute (NHLBI) – nih.gov
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