Healthy-Women: 2007

Monday

Healthy Womens Diagnosis

Diagnosis

When is acupuncture an appropriate treatment? If you have localized pain, nausea and vomiting from chemotherapy or pregnancy, or are facing surgery and are worried about anesthesia-induced nausea, you may want to ask your health care professional about acupuncture. If you have had little or no success using conventional medicine, you may wish to ask your health care professional whether acupuncture might help. When the risks associated with conventional treatments are great or the outcomes uncertain, you might consider the safer option of acupuncture first. Often, acupuncture can be used effectively as adjunctive therapy to standard therapies.

There are other situations in which research on acupuncture's effectiveness is less convincing, yet still promising:

Addiction
Asthma
carpal tunnel syndrome
fibromyalgia
headache
low back pain
menstrual cramps
myofascial pain
osteoarthritis
stroke rehabilitation
tennis elbow

In fact, acupuncture is often used in combination with more conventional approaches for pain relief. Some medical professionals report better results by combining acupuncture and certain conventional pain-killing drugs than from using the drugs alone.

Studies suggest that acupuncture may also help relieve some of the physical problems associated with tension, stress, depression, anxiety and other emotional conditions.

Gastrointestinal disorders: spasm of the esophagus and cardia, hiccups, gastroptosis, acute and chronic gastritis, gastric hyperacidity, chronic duodenal ulcer, acute and chronic colitis, acute bacterial dysentery, paralytic ileus, spastic colon, constipation and diarrhea.
Respiratory disorders: sinusitis, rhinitis, sore throat, common cold, acute tonsillitis, bronchitis, asthma and recurrent chest infections.
euro logical disorders: headaches, migraine, trigeminal neuralgia, facial paralysis, facial tics, rib neuritis, frozen shoulder, intercostal neuralgia, sciatica and osteoarthritis, nocturnal enuresis, neurogenic bladder dysfunction, Meniere's syndrome, peripheral neuropathy, paralysis caused by poliomyelitis, paralysis after apoplectic fit.
Eye disorders: acute conjunctivitis, cataract, myopia and central retinitis.
Mouth/tooth disorders: toothache, pain after tooth extraction, gingivitis and pharyngitis. urinary, menstrual and reproductive problems.
orthopedic disorders: tennis elbow, sciatica, low back pain, rheumatoid arthritis, tendonitis and neck pain

One advantage of acupuncture is its extremely low incidence of major side effects-especially when compared to conventional medical treatments. A review of nine published surveys, documenting safety and adverse reactions associated with acupuncture, has been reported in the April 2001 issue of the American Journal of Medicine. The most common adverse events were needle pain (one percent to 45 percent) from treatments, tiredness (two percent to 41 percent), and bleeding (0.03 percent to 38 percent). Feelings of faintness and syncope were uncommon, with an incidence of 0 percent to 0.3 percent. Feelings of relaxation were reported by as many as 86 percent of patients. The report concluded that although the incidence of minor adverse events associated with acupuncture may be considerable, serious adverse events are rare.

Finding an Acupuncturist

If you think acupuncture is for you, you may need to find a health care professional, who is open to the possibility; many are skeptical. But there's also a good chance that your health care professional will be able to refer you to a licensed practitioner. Don't be surprised if you are referred to a physician: some neurologists, anesthesiologists and other physicians have training in acupuncture. Referrals for acupuncture from someone you trust are particularly important since state licensing and regulatory guidelines for acupuncturists vary widely.

Traditionally, acupuncture, even more than Western medicine, acknowledges the "art" of medicine. So recommendations from other health care providers, friends, and family can be very helpful.

Check treatment costs and insurance coverage. If your insurance company covers acupuncture treatment, it may have preferred providers or it may require precertification. Your physician or acupuncturist should inform you about the estimated number of treatments and the cost for each one.

The First Visit

During your first visit, the acupuncturist will probably ask about the condition and symptoms that led you to seek acupuncture. Discuss any health conditions you have: This is particularly true with pregnancy. Certain points shouldn't be stimulated during pregnancy-you may risk uterine contractions, premature labor and a possible miscarriage.

Take a list of all the medications you are taking; you will need to share this information with the acupuncturist. For instance, if you are taking anticoagulants (blood-thinning drugs), you are more prone to bleeding (although acupuncture generally doesn't draw blood), and you should warn the acupuncturist. Also let the practitioner know if you have a pacemaker or any other implanted medical device.

The acupuncturist will ask about your medical history, but he or she will probably also ask questions seemingly unrelated to medicine. This holistic approach is typical of many alternative and complementary therapies. It's the person, not only the symptoms and condition, which is being treated. The practitioner may take your pulse, examine your tongue and ears, and touch (palpate) parts of your body.

Ask about the treatment procedures that will be used and their likelihood of success for your condition or disease.

In the United States and Europe, the training and licensing of practitioners who provide acupuncture makes the spread of infectious diseases through the procedure extremely rare. If the practitioner is licensed, you can assume they know how to protect you from infectious diseases spread by contaminated needles. This may not be true in underdeveloped countries.

Allergies

It's hard to believe that items as unrelated as shellfish, pollen, animals, bee venom, peanuts and mold can all potentially lead to the same type of problem. What these substances have in common is that they are common allergens-they cause allergic reactions in some people.

With so many substances potentially causing so many problems, it's no wonder allergic diseases are among the major causes of illness and disability in the U.S., and the sixth leading cause of chronic disease in the U.S. Allergies affect as many as 60 million Americans, or one in every five adults and children, and are as common in women as in men. Thirty-five million people suffer from upper respiratory symptoms that are allergic reactions to airborne pollen; up to 10 million Americans are allergic to cats; and two million develop severe allergic reactions to insect stings. Food allergies are less common; and while about one out of three people say they have a food allergy, only about three percent to eight percent of children younger than three years old, and one percent of adults have true allergic reactions to foods. Unfortunately, about 200 deaths per year are attributed to food allergies.

An allergy is a reaction of a person's immune system to a normally harmless substance, one that doesn't cause problems for most people. In the allergic woman, the offending substance causes the immune system-which functions as the body's defense against invading agents such as bacteria and viruses-to respond to a "false alarm." Her immune system treats the allergen as an invader by generating large amounts of a type of antibody-a disease-fighting protein known as IgE-that attaches to the body's tissue and blood cells. The cells are then triggered to release powerful inflammatory chemicals like histamine, cytokines and leukotrienes. These chemicals act on tissues in various parts of the body, such as the respiratory system, and cause the symptoms of the allergy.

Allergies can be more than just bothersome. While some allergies cause symptoms of rhinitis like sneezing, runny nose and watery eyes; skin irritations like itching and hives or eczema; or gastrointestinal distress; in some people, the allergic response can lead to anaphylaxis or anaphylactic shock-a sudden and sometimes deadly drop in blood pressure. Anaphylactic shock can potentially stop the heart or lead to complete closure of air passages, causing death by suffocation.

Allergies that result in respiratory symptoms can be caused by pollens, molds and fungi, dust or dust mites, animals, medications, foods, latex and other substances. Food allergies, which can cause a wide variety of symptoms, are most commonly caused by shellfish and other fish, peanuts and other nuts, wheat, soy, dairy and eggs. Contact allergies, or allergic reactions caused by a person's skin coming in contact with a substance, are most usually caused by, nickel, polishes, rugs, fabric softeners, deodorants, cosmetics, perfumes, preservatives, dyes, and foam insulation. And don't forget plants like poison ivy, poison oak and sumac. There is a compound in these plants that can cause severe skin reactions in people who are allergic-up to 85 percent of Americans.

Allergies have a genetic component. If one parent has allergies, chances are one in three that each child will have an allergy. If both parents have allergies, it is much more likely (seven in 10) that their children will have allergies. Adults usually do not lose their allergies, but children can sometimes outgrow them. In addition, while people are born with a genetic predisposition to allergies, sometimes they don't develop them until well into adulthood. Exactly what turns these genes on and when remains a bit of a mystery. Some researchers speculate that the more you are exposed to a potential allergen, the more antibodies to that allergen you can build up, until finally one day, they are released in an allergic reaction. Once you become "sensitized," you're going to get recurring symptoms every time you are exposed to the allergen.

Asthma

Asthma is a lung condition that makes the primary airways -- known as the bronchi -- in the lungs swollen and inflamed all of the time. People who have asthma are more sensitive than other people to things inhaled from the environment, known as triggers. These triggers make the muscles in an asthma sufferer's lungs tighten, constricting the air passages and making breathing difficult. In addition, cells in the lungs produce more mucus in response to a trigger. The mucus clogs up the bronchial tubes, which contributes to breathing problems. The airways also swell and become inflamed with white blood cells. When the lungs react to a trigger, what's known as an "asthma attack" occurs. Wheezing, coughing, and/or tightness in the chest and shortness of breath are all hallmark symptoms of a classic asthma attack. This life-long condition can't be cured, but it can be controlled with the proper diagnosis and treatment.

Who's At Risk?

Obesity significantly increases a person's risk of developing the condition. Heredity is also thought to play a role. Children of parents with asthma are at greater risk for developing the condition. Pollution, poor air quality in urban environments, poverty and lack of patient education are also factors contributing to rising asthma and asthma-related complication rates. People who have allergies have the greatest risk of developing asthma, and those raised in environments where they were exposed to cigarette smoke also have a much higher incidence of the condition.

Women and Asthma.

Women may first develop asthma during or after pregnancy, though the condition may also improve during pregnancy. There is some evidence that asthma may be affected by hormonal changes during a woman's cycle and can be triggered prior to or during the menstrual period. Women are 25 percent more likely than men to die from asthma, according to the National Center for Health Statistics.

Researchers aren't sure why some people's airways are more sensitive to things in the environment. Asthma sufferers may have allergies to certain substances, known as allergens, which can trigger an attack. But, not all asthma sufferers have defined allergies.

Common Asthma Triggers

Common allergens include: dust mites, mold, pollen, certain foods or chemicals commonly used in food processing and feather bedding. Contrary to popular belief, dog and cat fur don't cause allergies. Rather, a protein found in the pet's saliva, dander and urine causes allergies in some individuals, according to the American Academy of Allergy, Asthma, and Immunology (AAAI). Other things can irritate the already-sensitive air passages of asthma or allergy sufferers. Common irritants include cigarette smoke, perfumes, cold air, exercise and pollution.

Controlling asthma includes short-term relief of symptoms and long-term strategies to prevent attacks from occurring. Medications and behavioral approaches, such as avoiding asthma triggers, for example, are both important to managing asthma successfully. Another critical part of asthma management is education and close consultation with your health care team. New medications are available and older methods are being improved. Asthma symptoms that recur frequently, even when medication is taken regularly, can be a sign that a re-assessment with a health care professional is necessary.

Atherosclerosis

Altherosclerosis

Diseases caused by atherosclerosis are the leading cause of illness and death for both men and women in the U.S, according to the National Heart, Lung, and Blood Institute. Although breast cancer is often the illness most feared by women, the disease affects one out of nine women over the lifetime, compared to coronary heart disease, which affects one out of every two women over the lifetime. Atherosclerosis is often the first stage of coronary heart disease (CHD).

Often referred to as "hardening of the arteries," atherosclerosis occurs when your arteries narrow and become less flexible. This happens when cholesterol, fatty substances, cell waste products, calcium and fibrin—collectively called plaque—collect on the inner walls. The arteries respond to the buildup by becoming inflamed, which, in turn, results in the formation of scar tissue and the collection of other cells in the affected areas, further narrowing the artery.

Atherosclerosis can affect medium and large arteries anywhere in your body. If someone has atherosclerosis in one part of their body, they typically will also have atherosclerosis in other parts of their bodies. Atherosclerosis restricts blood flow, thus limiting the amount of oxygen available to your organs. When blood flow to the heart is reduced, for instance, chest pain, or angina, may result. Similarly, when blood flow to the arteries in the legs is reduced, leg pain called claudication may result.

As the disease progresses, atherosclerosis can completely clog arteries, cutting off blood flow. This usually happens suddenly when a blood clot forms in the damaged arteries on top of the atherosclerosis. This is especially dangerous in arteries near the brain, heart or other vital organs. If blood flow to the heart is nearly or completely blocked, a heart attack results and muscle cells in the heart die. The result is permanent heart damage. Similarly, if blood flow is abruptly cut off to the brain, this can cause a stroke, which may also result in permanent brain damage. And if blood flow is abruptly cut off to the legs, the leg may have to be amputated. Thus atherosclerosis can lead to serious life-threatening complications if not addressed early through prevention and early treatment.

Atherosclerotic plaques have a cholesterol- or lipid-rich core covered by a fibrous cap. If this cap ruptures, it exposes this lipid-rich core to blood. The sticky core attracts platelets, forming a blood clot, called a thrombus, at the site. This clot can completely clog the artery and cut off blood flow.

More mature plaques (stable plaques) have a thick fibrous cap, which is less likely to rupture. Softer, fattier plaques (unstable plaques) have a weaker cap and are more likely to rupture.

Two thirds of sudden total or near total blockage (called an occlusion) develops in arteries that were less than 50 percent narrowed, and 97 percent of plaque rupture occurs in arteries with less than 70 percent narrowing.

So the degree of narrowing in a particular artery does not necessarily predict complete blockage in that same artery.

Tighter or narrower arteries may cause angina, but are not necessarily more likely to rupture. However, the total amount of plaque or atherosclerosis in all your arteries predicts your risk of a heart attack.

We don't know what causes plaque to begin building up in arteries. Some experts think plaque begins to accumulate in places where the inner layer of an artery is damaged.

The specific arteries most at risk for atherosclerosis-induced blockage are those going to your brain (carotid), heart (coronary) and legs (femoral or iliac). Atherosclerosis in the legs is the most common form of peripheral arterial disease (PAD) and can lead to intermittent claudication—severe pain, aching or cramping when walking, numbness, reduced circulation, and if left untreated, gangrene (death of tissue).

Risk Factors for Atherosclerosis:

Over the last two decades, researchers have identified many risk factors for developing cardiovascular diseases. They include:

Elevated cholesterol levels (both total cholesterol and LDL ("bad") cholesterol)
Elevated triglyceride levels
High blood pressure hypertension
Cigarette smoke
Low HDL cholesterol (the "good" cholesterol that clears away artery-clogging LDL cholesterol—the "bad" cholesterol)
Diabetes (elevated blood sugar)
Advanced age

Age

Generally, women over age 55 and men over age 45 are at greatest risk for developing atherosclerosis. The risk of cardiovascular events increases with age.

Global Risk Factor Assessment

The Framingham Risk Score is a useful, office-based risk prediction model. It assigns a point score for each major risk factor to predict your 10-year risk of developing future cardiovascular events. You can estimate your own 10-year risk at: http://hp2010.nhlbihin.net

If you have more than a 20 percent risk of future cardiac events over the next 10 years, you should be treated very aggressively, the same as someone with known heart disease. Intermediate risk individuals with scores between 10 percent and 20 percent should have further risk evaluation. Low-risk individuals with scores of less than 10 percent usually don't need drug therapy, but should make lifestyle changes such as diet and exercise, which are recommended for everyone.

Other risk factors for coronary heart disease include:

A family history of early heart disease
Obesity
Metabolic syndrome
Physical inactivity and sedentary lifestyle
Postmenopausal status
High levels of homocysteine
Family History

Even though it is not included in the Framingham Risk Score, family history is one of the biggest risk factors overall for atherosclerosis. Your risk is greater if your father or brother was diagnosed before age 55, if your mother or sister was diagnosed before age 65, or if you have a sibling with early coronary disease.

Post-menopausal status

A woman's risk of developing atherosclerosis and heart disease increases once she reaches menopause. Prior to menopause, women are mainly protected from heart disease by estrogen, the reproductive hormone produced by the ovaries. This protection is why women tend to develop heart disease 10 years after men. However this 10-year protection is not seen in women who smoke or those with diabetes.

Among its many roles, estrogen helps keep arteries free from plaque by improving the ratio of LDL (low-density lipoprotein) and HDL (high-density lipoprotein) cholesterol. It also increases the amount of HDL cholesterol, which helps clear arteries of LDL cholesterol—the kind that most contributes to plaque build up.

Estrogen also helps keep the lining of your blood vessels strong and pliable, which helps reduce your risk of atherosclerosis. Despite the theoretical benefits of estrogen, replacing natural estrogen hormones with drugs after menopause is not an effective way to prevent heart disease, and may even be harmful.

High Cholesterol

High cholesterol

More than half of women over age 55 need to lower their blood cholesterol, and a quarter of all American women have blood cholesterol levels high enough to pose a serious risk for coronary heart disease-a result of atherosclerosis.

Cholesterol begins collecting in the walls of the arteries at an early age. In fact, the earliest type of arterial lesion, the "fatty streak," is present even in young children.

According to the National Cholesterol Education Program (NCEP), elevated LDL cholesterol is a major cause of coronary heart disease. That's why the NCEP panel recommends aggressive treatment. Treatment may include lifestyle changes, such as exercising more and reducing the amount of saturated fat in your diet, and medication. A combination of approaches is typically recommended.

Other lipid abnormalities, such as elevated triglycerides or low HDL (the good cholesterol), are also associated with increased cardiovascular risk.

Cigarette smoking

Smoking accelerates the development of atherosclerosis, increases blood pressure and restricts the amount of oxygen the blood supplies to the body. Quitting smoking dramatically and immediately lowers the risk of a heart attack and also reduces the risk of a second heart attack in people who have already had one.

Diabetes

Having diabetes poses as great a risk for having a heart attack in 10 years as heart disease itself, according to NHLBI. In fact, cardiovascular disease is the leading cause of diabetes-related deaths. People with diabetes who have not yet had a heart attack have the same risk of future heart attack as someone with known coronary heart disease. Because their risk of heart attack is so high, NHLBI recommends that people with diabetes be treated aggressively with LDL cholesterol lowering medication and carefully manage their blood sugar to reduce their cardiovascular risk.

Atherosclerosis Symptoms

Symptoms of Atherosclerosis:

Often, you will experience no symptoms of atherosclerosis until the disease has progressed significantly. However, there are some conditions that may suggest atherosclerosis is present, although these conditions may also happen for other reasons.

Angina. If clogged arteries prevent enough oxygen-carrying blood from reaching your heart, the heart may respond with pain called angina pectoris. Episodes of angina occur when the heart's need for oxygen increases beyond the oxygen available from the blood nourishing the heart. Silent angina occurs when the same inadequate blood supply causes no symptoms.

Physical exertion is the most common trigger for angina. Other triggers can be emotional stress, extreme cold or heat, heavy meals, alcohol and cigarette smoking. The pain is a pressing or squeezing pain, usually felt in the chest or sometimes in the shoulders, arms, neck, jaws or back.

Angina suggests that coronary heart disease exists. People with angina have an increased risk of heart attack compared with those who have no symptoms. When the pattern of angina changes—if episodes become more frequent, last longer or occur without exercise—your risk of heart attack in subsequent days or weeks is much higher and you should see your health care professional immediately.

If you have angina, learn its pattern—what causes an angina attack, what it feels like, how long episodes usually last and whether medication relieves the attack. Angina is usually relieved in a few minutes by resting or taking prescribed angina medicine, such as nitroglycerin.

Episodes of angina seldom cause permanent damage to heart muscle.

Heart attack pain may be similar to angina, but the symptoms of angina quickly disappear with rest. Heart attack pain, however, usually persists despite resting or taking nitroglycerin and should be evaluated immediately. Like angina, heart attack pain can be a pressure or tightness in chest, arms, back or neck. Often symptoms include shortness of breath, sweating, nausea, vomiting, indigestion or dizziness. Women, especially those with diabetes, may not have the typical symptoms of chest pain like men, but other symptoms such as shortness of breath or indigestion. A heart attack is an emergency. A delay in treatment could mean more of the heart muscle tissue is permanently damaged. If you think you're having a heart attack, take an aspirin (which reduces blood clotting) and get medical help immediately.

Cardiac arrhythmias. These occur when the heart momentarily beats too fast or beats irregularly. Chest pain, dizziness and shortness of breath are symptoms of cardiac arrhythmias. Atherosclerosis is one cause of rapid or irregular heartbeat; however, it can also be caused by angina, valvular heart disease, blood clots, thyroid abnormalities, electrolyte imbalance or previous heart damage. Arrhythmias may be frequent or infrequent.
Silent ischemia. Sometimes atherosclerosis causes no symptoms. Silent ischemia is a condition caused by atherosclerosis, but isn't associated with the chest pain or other symptoms common to other types of heart conditions. This condition occurs when arteries with atherosclerosis can't deliver enough blood to the heart. An electrocardiogram (EKG or ECG), a measurement of electrical impulses produced by the heart, may indicate silent ischemia. However, unless you know your risks for heart disease and decide, with the advice of your health care professional, that you need a heart checkup, you may never know you have ischemia. People with diabetes are especially at risk for this condition.
Intermittent claudication. This leg disorder predominantly affects elderly people. It causes severe pain, aching or cramping in the legs when you walk due to atherosclerosis in the major arteries that supply blood to the legs (femoral and iliac). Severe cases of peripheral arterial disease can lead to gangrene and amputation.
Transient ischemic attack (TIA). If you experience a sudden onset of weakness or numbness on one side of your face, arm, or leg, or an inability to talk or find words, or lose vision in one eye, you may be having a mini-stroke or TIA. Neurological symptoms that last less than 24 hours are called TIAs, where as symptoms that persist for longer periods are classified as strokes.

They are often the result of atherosclerosis in the arteries that supply blood to the brain, such as the carotid arteries. This is very serious. If you experience these symptoms, seek medical attention immediately. This is the brain's equivalent of a "heart attack," during which the brain is deprived of oxygen-carrying blood supply. Any delay in medical treatment may permanently damage your brain.

Bacterial Vaginosis

Bacterial vaginosis (BV) is the most common of three vaginal infections that fall under the category known as vaginitis. The other two infections are trichomoniasis, a sexually transmitted disease, and the fungal infection commonly known as a yeast infection.

BV is the least understood and most often ignored or misdiagnosed of these conditions. However, it is gaining more attention as more research shows that untreated BV can lead to significant health complications, including premature delivery, postpartum infections, clinically apparent and subclinical pelvic inflammatory disease (PID), post-surgical complications (after abortion, hysterectomy, cesarean section and other reproductive procedures), increased vulnerability to HIV infection and, possibly, infertility.

BV is not considered a sexually transmitted disease. Although it is less common in women who have never had sex, there is evidence that it could be linked to having a new sex partner or multiple sex partners. Also, douching appears to increase the risk of developing BV.

BV has gone by different names in the past, including non-specific vaginitis and Gardnerella vaginalis vaginitis. BV is a lot simpler to remember but there is nothing simple about this condition and it is not harmless, as was once believed.

BV is actually a syndrome resulting from an imbalance in the different types of bacteria in the vagina (also called vaginal "flora"). A healthy vagina has numerous organisms that naturally live there. The vast majority--about 95 percent--belong to a type of bacteria called lactobacillus.

There are several different kinds of lactobacillus, at least one of which is responsible for keeping the vagina's pH at normal levels. When these levels become unbalanced, the certain microorganisms may overtake the normal flora leading to a low-grade infection that often produces an abnormal vaginal discharge.

Alzheimer's Disease

Alzheimer's disease:

Alzheimer's disease (AD) is perhaps one of the best-known illnesses associated with older age. A complex disease that affects the brain, it now affects roughly 4.5 million individuals in the U.S. according to the Alzheimer's Association, a national network of advocates and chapters committed to finding a cure for Alzheimer's and helping those affected by the disease.

As the U.S. population grows older, the number of people with AD is expected to increase. But AD is not a normal or an inevitable part of aging. It is a progressive disease that starts in one part of the brain and gradually invades other regions. As it progresses, AD destroys nerve cells within the brain and the connections between them, leaving behind clumps of proteins called plaques and twisted fibers. Over time, this destruction erodes the most vital abilities of human nature: language, learning, memory and reason. Personality and behavior also are dramatically affected by AD.

Alzheimer's disease is the most common causes of dementia in older people. Dementia is a medical term used to describe general mental deterioration severe enough to disrupt a person's normal activities and relationships. AD usually begins in people who are 65 or older, but it can affect individuals as young as 40, though development of AD in younger adults is considered rare. An estimated 3 percent of people between the ages of 65 and 74 have AD, and close to half of adults in the U.S. aged 85 and older are believed to have the disease.

There is no evidence that women are at greater risk than men for developing the disease. However, the fact that women live longer than men means that more women have the disease at any one time than men.

Early symptoms of the disease include forgetfulness, difficulty using or remembering words and difficulty concentrating. For some individuals, these early symptoms of AD may be mistaken for what many people consider "natural" symptoms of aging. But, symptoms caused by AD worsen over time, while the short-term memory problems that trouble many people as they age do not progress to more serious symptoms.

The severity and progression of AD symptoms do not follow any pattern and vary greatly from person to person with the condition. Some people have AD only for the last five years of life, while others may live with it for as many as 20 years.

Symptoms of Alzheimer's disease are divided into three phases: mild, moderate and severe, though the stages often overlap. Because Alzheimer's causes damage directly to the patient's brain, unpredictable and uncharacteristic behavior is common in AD patients.

Mild symptoms include:

confusion and memory loss
personality changes
judgment problems
difficulties with routine tasks
getting lost or disoriented in familiar places

Moderate symptoms include:

difficulty with personal care (bathing, dressing, feeding)
anxiety, agitation, paranoia
insomnia or sleep disturbances
wandering and pacing
trouble with or inability to recognize familiar faces

Severe symptoms include:

loss of speech
loss of appetite
loss of bladder and bowel control
complete dependence on caregiver

The major risk factor for AD is age. According to the Alzheimer's Association, in the general population a person's risk of developing any form of dementia, including Alzheimer's, doubles approximately every five years after age 65.

Although researchers still don't know for sure what causes Alzheimer's disease, most believe it is related to the abnormal processing of normal brain proteins, particularly amyloid precursor protein and tau, another type of protein. For some reason, later in life these proteins, which serve a normal function, begin to be abnormally processed and assemble themselves into lesions. These lesions, called neurofibrillary tangles and senile (amyloid) plaques (often simply referred to as plaques), destroy parts of the brain. Other theories link the disease's development to the death of cells critical for maintaining levels of certain brain chemicals required for cognition; chronic inflammation; accumulation of heavy metals in the brain; and vascular factors that affect the health of blood vessels in the brain. Another potential risk factor is severe head injury.

At one time, combination hormone therapy was thought to potentially reduce a woman's risk of developing dementia and Alzheimer's. However, major new research published in the Journal of the American Medical Association actually linked the use of one type of hormone therapy to an increased risk of dementia, including Alzheimer's disease. The research, released in May 2003 as part of the Women's Health Initiative Memory Study (WHIMS), found an increased risk of developing dementia in a study of women 65 and older taking Prempro, a form of estrogen plus progestin hormone therapy.

To date, there is no cure for AD or any proven way to slow it down. The good news is that scientists are learning more about the disease each day, including information about the role genes may play in the condition's development, and how to treat and manage it as it progresses.

If you think you have AD or suspect someone you know might be experiencing symptoms, it's important to consult with medical professionals as soon as possible. Early diagnosis can help rule out other medical reasons for symptoms. Because AD eventually affects an individual's ability to care for him or herself, short- and long-term planning is important. The earlier you can develop a support system, as well as review financial and medical management strategies, the better. Issues to consider include: caregiving support and establishing a power of attorney and a living will, as well as making other end-of-life decisions.

The Alzheimer's Association and related support groups can provide additional information about AD and the needs you and your family are likely to face. It's natural to feel overwhelmed by such a diagnosis. These organizations, together with your medical team, can help you cope.

Acupuncture

Acupuncture is an important component of Traditional Oriental Medicine (TOM) that involves the insertion of thin needles at specific points (acupoints), which are primarily located along meridians. The TOM theory of acupuncture is based in part on the premise that there are patterns of energy flow composed of Qi (pronounced chee) throughout the body. This energy flow is required for good health; blockages in Qi lead to pain and ill health. (All traditional oriental medicine practices are focused on improving the flow and balance of Qi.) Thus, according to TOM practitioners, the use of acupuncture stimulates certain points in the energy channels, restoring (or maintaining) a healthy flow and balance. TOM practitioners use acupuncture to treat and prevent a range of conditions and illnesses, even colds and flu. In the U.S., one of its most common uses is to relieve pain, but it is also used for a host of other conditions ranging from ear, nose and throat disease to neurological and respiratory problems and even depression. Acupuncture may be the only intervention used, or it may be used in conjunction with other Oriental therapies such as herbs, or with more conventional therapies.

Acupuncture as a therapeutic intervention is widely practiced in the United States. An estimated 15 million Americans have undergone acupuncture, and about five million undergo the treatment each year. People may find the procedure painless, although some points in some patients may be quite sensitive. Depending on your practitioner, the needles may be twirled or warmed.

Widely practiced around the world, especially in Asia (the practice originated in China) and Europe, acupuncture didn't gain a notable following in the U.S. until the 1970s, after President Richard Nixon's visit to the People's Republic of China. James Reston, a member of the press corps accompanying Nixon, also piqued public interest when he wrote about how physicians in Beijing eased his post-surgery abdominal pain with needles. Acupuncture has been gaining popularity in the U.S. ever since.

The National Institutes of Health (NIH) has given a big boost to acupuncture, holding that it is safe and, for some conditions, proven effective. The NIH has funded a variety of research projects relating to the safety and effectiveness of acupuncture. (See the "Research" section of this report). An NIH panel found that acupuncture can relieve nausea associated with chemotherapy, anesthesia or pregnancy and lessen the pain from dental surgery. There's also evidence supporting it as an effective way to treat headaches, menstrual cramps, tennis elbow, fibromyalgia, low back pain and arthritis. Acupuncture also may be used for carpal tunnel syndrome, asthma, addiction, myofascial pain and for rehabilitation following stroke. More recent evidence suggests that hypertension and certain cardiovascular diseases can be improved by treatment with acupuncture, according to a June 2000 workshop sponsored by the NIH on complementary and alternative medicine in cardiovascular, lung and blood research.

The World Health Organization (WHO), using different criteria, has recognized acupuncture as an appropriate treatment for more than 40 conditions, including certain digestive, respiratory, neurological, muscular, urinary, menstrual and reproductive disorders.

The way acupuncture is practiced here, for the most part, is different from how it is currently practiced in China. "Medical acupuncture" refers to acupuncture practiced by a Western physician. Physicians as well as non-physicians who are licensed to practice acupuncture (LACs) will often use a variety of styles of acupuncture. The most common style taught in American schools is called Traditional Chinese Medicine (TCM) acupuncture, but five element, auricular, and neuro-anatomical acupuncture are also widely used.

Scientists are finding it hard to reconcile the traditional explanation of how acupuncture works with standard Western medical models. Although several studies have documented acupuncture's efficacy and effectiveness, much remains to be learned about the mechanisms of action from a Western perspective.

Human and animal studies show that acupuncture can generate various biological responses-some close to the insertion point and others at a distance. It is well established that acupuncture stimulates the release of naturally occurring chemicals and hormones, especially endorphins. Endorphins can change the experience of pain, influence the body's self-regulating systems, and. promote physical and emotional well-being. Research has shown that several types of opioids may be released into the central nervous system during acupuncture treatment, thereby reducing pain.

Associated mechanisms are also at work:

Electromagnetic signals: Evidence suggests that acupuncture points are strategic conductors of electromagnetic signals. It is possible that electromagnetic signals can work outside of standard nerve conducted functions.
Brain blood flow: Studies indicate that acupuncture clearly affects blood flow to centers of the brain and the central nervous system related to sensation and involuntary body functions, such as immune reactions and the regulation of blood pressure, blood flow, oxygenation and body temperature. Specific activation of certain brain regions, including some of the pain perception centers (such as the limbic area and hypothalamus) can be demonstrated during the application of acupuncture.

Ultimately, scientists don't know exactly which mechanisms make acupuncture effective; more research is needed. It is often believed that to get the best results, treatments need to be individualized. That's one of many reasons acupuncture is more difficult to research than a standard pharmaceutical medication.

Bipolar Disorder

Bipolar disorder is one of the most distinct and dramatic of mental illnesses. It is characterized by intense episodes of elation or irritability and despair, with any combination of mood experiences in between, including periods of normal moods. Mood changes are accompanied by changes in behavior, such as altered patterns of sleep and activity. According to the National Institute of Mental Health, about 5.7 million Americans, or 2.6 percent of the population, have bipolar disorder in a given year. It is less common than other forms of depression, such as major depression, also called 'unipolar' disorder, or simply, "depression."

The classic form of bipolar disorder, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes, called hypomania, that alternate with depression; this form of the illness is called bipolar II disorder.

Studies show that men and women are equally likely to develop bipolar disorder; however, there is some evidence that women may have more depressive and fewer manic episodes than men with the illness. Women seem to have "mixed states" (mania or hypomania occurring at the same time as depression) more often than men. Also, women are more likely to have the rapid cycling form of the disease, which is characterized by four or more episodes of depression, mania or hypomania a year, and may be more resistant to standard treatments. Women are also more likely to have bipolar II disorder.

The symptoms of bipolar disorder can be severe and life threatening. Bipolar disease is not curable. However, medication can help many people achieve remission of symptoms. Treatment and maintenance of this disorder is necessary throughout a person's life once bipolar disorder is diagnosed.

Like some other illnesses that require life-long treatment, bipolar disorder poses unique medical challenges for women with the disorder who are considering pregnancy. According to the National Alliance on Mental Illness, pregnant women and new mothers with bipolar disorder have seven times the risk of hospitalization and two times the risk of a recurrent episode compared to women who are not pregnant or who have not recently delivered.

So a woman with bipolar disorder who wants to become pregnant should discuss her treatment options with her health care team prior to conception, if possible, or as early in her pregnancy as possible. Concerns exist about the potential, harmful effects mood-stabilizing medications used to treat bipolar disorder may have on the developing fetus and the nursing infant.

Breast Reconstruction

The American Cancer Society estimates that 270,000 women will be diagnosed with breast cancer this year. Although many will be able to have breast conserving surgery, i.e., lumpectomy, many will need or prefer a mastectomy, or complete removal of the breast.

Some women need this procedure, because the cancer cannot be completely removed with lumpectomy alone. Others prefer it, fearing a recurrence or hoping to avoid the weeks of radiation often required after a lumpectomy.

Additionally, hundreds of other women at very high risk of breast cancer will undergo prophylactic mastectomy, or removal of their breasts to prevent breast cancer.

To many women, the loss of a breast is a devastating occurrence, one that strikes at their very sense of self. They may feel less feminine without a breast, find it awkward to have a missing breast or breasts under clothes, and find using a prosthesis, or rubber breast form, difficult. Thus, many women choose to undergo breast reconstruction after mastectomy.

In 2004, about 62,000 women underwent some form of breast reconstruction, according to the American Society of Plastic Surgeons. That figure represents a 22 percent decrease since 2000, likely due to the greater number of breast conserving surgeries being performed today.

Overall, however, studies find that breast reconstruction surgery is underutilized. A recent report published in the Journal of the American Medical Association showed that of the 51,000 women identified who underwent a mastectomy between 1998 and 2002; only 16.5 percent had a reconstruction.

This study also found that the decision to have reconstruction is significantly affected by where you live, your race, age and stage of cancer. Specifically, the researchers found, African-American, Hispanic and Asian women were significantly less likely to have immediate or slightly delayed reconstruction than white women.

If you choose to have breast reconstruction, you have two main options: breast implants, using silicone spheres filled with silicone gel or saline, or autologous reconstruction, which uses fat and tissue from your abdomen, back, buttocks or hips to shape a new breast. In many instances, reconstruction can be performed immediately after surgery, so you never wake up without a breast.

If you have health insurance, your carrier must pay for the procedure. The 1998 Federal Breast Reconstruction Law requires all health insurance companies to cover reconstruction of the breast on which mastectomy has been performed, and surgery and reconstruction of the other breast to produce a symmetrical appearance.

If you don't have health insurance, talk to your surgeon and the hospital about negotiating a discount rate. Many are willing to do that for women without insurance. You may also qualify for health insurance under your state's Medicaid program or other health-coverage programs for low- and moderate-income individuals.

Cervical Cancer

Cancer of the cervix is the second most common type of cancer found in women after breast cancer in the world. In the United States, cervical cancer is the twelfth most common cancer in women, affecting an estimated 500,000 women worldwide each year. The American Cancer Society estimates that about 9,710 cases of invasive cervical cancer will be diagnosed in the United States in 2006, and about 3,700 women will die from the disease.

Cervical cancer is a disease in which cancer cells are found in the tissues of the cervix. The cervix, the lower part of the uterus, connects the body of the uterus to the vagina. Nearly all cases of cervical cancer can be linked to the human papillomavirus, or HPV, a sexually transmitted virus.

The normal cervix is a healthy pink color and is covered with scale-like cells called squamous cells. The cervical canal is lined with another kind of cell called columnar cells. But the area where the two cells meet—called the squamocolumnar junction and transformation zone (T-zone)—is the most likely area for abnormal cells to develop. The T-zone is more exposed on the cervix of young women (teens through 20s), making them more susceptible to cervical infections.

Health care professionals use the Pap test to find cellular abnormalities in cervical tissue that has already or may become cancerous. The earlier cervical cancer is diagnosed, the better the chance for a cure. The American Cancer Society reports that both incidence and deaths from cervical cancer have declined markedly over the last several decades, due to more frequent detection of preinvasive and cancerous lesions of the cervix from increased Pap screening. There is a direct relationship between the use of the Pap smear as a screening tool for cervical cancer and the reduction of the incidence of cervical cancer, according to the American Society for Clinical Pathologists.

In its earliest stages, cervical cancer usually causes no symptoms. Irregular bleeding, bleeding or pain during sex, or vaginal discharge may be symptoms of more advanced disease. These symptoms should always be discussed with a health care professional.

All women are at risk for developing the disease, but several factors can increase a woman's risk of developing cervical cancer, according to the American Cancer Society:

Infection with human papillomavirus (HPV), a common sexually transmitted disease in the U.S. (Most women and men who have been sexually active have been exposed to the HPV virus, which is spread through skin-to-skin contact with an HPV-infected area. However, certain types of sexual behavior increase a woman's risk of getting an HPV infection, such as having sex at an early age, having many sexual partners and having unprotected sex at any age.)
Recent studies find that using condoms cannot completely protect against HPV because the virus is passed by way of skin-to-skin contact, including the skin in the genital area that may not be covered by a condom. Correct and consistent condom use is still important, however, to protect against AIDS and other sexually transmitted diseases.
Smoking cigarettes, which exposes the body to cancer-causing chemicals absorbed initially by the lungs but then carried in the bloodstream throughout the body. The chemicals produced by tobacco smoke may damage the DNA in cells of the cervix and make cancer more likely to occur there.
Infection with chlamydia bacteria, which is spread by sexual contact and may or may not cause symptoms. Researchers don't know exactly why chlamydia infection increases cervical cancer risk, but they think it might be because active immune system cells at the site of a chlamydia infection might damage normal cells and cause them to turn cancerous.
A diet low in fruits and vegetables. Women who don't eat many fruits and vegetables miss out on the protective antioxidants and phytochemicals such as vitamins A, C, E and beta-carotene, which have all been shown to help prevent cervical cancer and other forms of cancer.
A compromised immune system related to certain illnesses such as human immunodeficiency virus (HIV) infection. Being HIV positive makes a woman's immune system less able to fight cancers such as cervical cancer.
A family history of cervical cancer—your mother or sister had cervical cancer—may mean you have a genetic tendency for the disease. This could be because such women are genetically less able to fight off HPV infection than other women.
Exposure in utero to diethylstilbestrol (DES), a synthetic hormone that was prescribed to pregnant women between 1940 and 1971 to prevent miscarriages. For every 1,000 women whose mother took DES when she was pregnant, about one develops clear-cell adenocarcinoma (cancer) of the vagina or cervix.
Long-term oral contraceptive (OC) use (five or more years) may very slightly increase a woman's risk of cancer of the cervix, according to some statistical evidence. The American Cancer Society advises women to discuss the benefits of OC use versus this very slight potential risk with their health care professionals.

More than twice as many African-American women die from cervical cancer as Caucasian women. Additionally, Hispanic women and Native-American women have higher rates of cervical cancer than Caucasian women. Rates of cervical cancer are also increasing among Vietnamese women. Lack of access to health services (and therefore, less screening), cultural influences and diagnosis of cancer at more advanced stages are all possible reasons for these differences.

Women of all ages are at risk of cervical cancer, but half of those diagnosed are between ages 35 and 55, with the average age of diagnosis of 47 years. Regardless, it is important that even postmenopausal women continue having regular Pap tests if they still have a cervix. Even if a woman's cervix was removed during a hysterectomy (as 90 percent are), if she had a suspicious Pap before her surgery, she should continue Pap tests.

The benefits of the Pap test are clear: The overall death rate in the United States from the disease has declined by 74 percent since the introduction of the Pap test in the 1950s.

Although both the incidence and death rates of cervical cancer are going down, it is still the 12th most common cancer in women, which may be related to the epidemic of infection with HPV. According to the CDC, approximately 20 million people are currently infected with HPV. As many as 75 percent of the reproductive-age population has been infected with one or more types of HPV, and up to 5.5 million new infections occur each year.

There are more than 100 different strains of HPV, and approximately 15 types have been linked to cancer of the cervix. While most women who develop cervical cancer have HPV, not all women with the virus will develop cervical cancer. In fact, only a small proportion of women infected with HPV develop cervical cancer. Some types of HPV cause vaginal and vulvar warts; other strains cause the warts that sometimes develop on the hands or feet.

New Vaccine Offers Protection against HPV

Now there is something women can use to protect themselves against human papillomavirus (HPV)/cervical cancer in addition to regular Pap tests and safe sex: An HPV vaccine. The FDA recently approved the vaccine—called Gardasil—for women ages 13 to 26 after clinical trials showed the vaccine is safe and 100 percent effective in preventing HPV strains 16 and 18, which cause 70 percent of cervical cancers. Gardasil, given in three injections over six months, is also 99 percent effective in preventing HPV strains 6 and 11, which cause about 90 percent of genital wart cases. Although Gardasil prevents the bulk of HPV strains, it doesn't protect against all of them, so the FDA recommends it as a complement to Pap tests. Furthermore, the vaccine does not work if a woman is already infected with one of these HPV types. It has to be given before infection.

Chiropractic

The term "chiropractic" is derived from the Greek language and means "done by hand." Chiropractic therapy involves manual manipulation (primarily of the spine but can and often does include other manipulation of the musculoskeletal system (MSS) such as ankles, knees, hips, wrists, elbows, shoulders and ribs) to correct musculoskeletal disorders and improve overall health.

Chiropractic therapy is based on the theory that illness stems from blockages within spinal nerve roots, which exit the spine at regular intervals along its length. Chiropractors do not treat your illness unless the problem is directly musculoskeletally related. Instead, they seek to correct the MSS-related cause. If that problem is fixed, chiropractors say, the human body often has the ability to heal itself. So, chiropractors stress the importance of the relationship between the musculoskeletal system and the nervous system in regaining and sustaining health. They use adjustments, joint manipulation and other techniques to normalize spinal function, relieve various disorders and promote your body's natural healing process.

Chiropractors take a holistic approach to health, meaning they treat you and your body as a complete system. When one part or system is disabled, chiropractors believe it affects the entire system. They pay particular attention to preventive treatments to keep you well, such as changes in nutrition and exercise. The practice involves neither drugs nor surgery, but most chiropractors will advise you to consult with another health care professional if your condition requires a different type of treatment.

Spinal manipulation has been practiced for thousands of years, and modern chiropractic care is more than a century old. Modern chiropractic was initially established by Daniel David Palmer, who was seeking a way to cure disease without using drugs. Palmer concluded that most disease results from spinal misalignment (a concept that has since been discarded in the light of new evidence) and that many ailments are caused by the vertebrae impinging on spinal nerves. This impingement or blockage, he said at the turn of the 19th century, interferes with natural nerve transmission. He termed this condition "subluxation." Subluxation, he said, should be treated with manipulations or adjustments to properly align the spine and eliminate the blockage, restoring nerve transmission and allowing the body to heal itself. Dr. Palmer, however, was open to new scientific findings, something that was unusual at the turn of the 19th century.

Different Approaches

Today, there are several types of chiropractors, but most can be grouped into one of two basic schools. "Straight" chiropractors are purists, adhering to the philosophy that subluxations are responsible for most diseases. An element of this group spurns diagnosis and works to adhere to the early teachings of chiropractic. The much larger group -- historically called "mixers"-uses various approaches and isn't limited to manipulation and adjustments. They perform diagnosis to the level of the general medical practitioner in order to work more closely with physicians. Like straight chiropractors, many mixers believe that certain disease processes are attributable to subluxations: others disagree. These differences of opinion are fading, and according to a report by the U.S. Agency for Health Care Policy and Research, more than two-thirds of chiropractors use techniques other than manipulation (such as exercise, nutritional counseling and physiotherapy), but 93 percent of the conditions treated by chiropractors are musculoskeletal in nature.

The larger group generally promote chiropractors as primary health care providers and are members of the American Chiropractic Association (ACA), the largest professional association for chiropractors.

There's a third, much smaller group of practitioners-many represented by the National Association for Chiropractic Medicine (NACM). It doesn't publish either its numbers or the names of its members, preferring to remain secretive while it cooperates with individuals and groups that are hostile to the chiropractic profession. This group focuses only on musculoskeletal back disorders. They do not treat other conditions, limiting their practice to spinal manipulative therapy. NACM membership requirements state that a Doctor of Chiropractic Medicine must renounce the chiropractic hypothesis and/or philosophy: that is, that subluxation is the cause of disease. The chasm between the American Chiropractic Association-the largest and more progressive of the chiropractic groups-and the other groups is wide and contentious.

Applications

Some chiropractors limit their practices to back pain, headache and similar musculoskeletal complaints, but some contend that chiropractic manipulation is the appropriate treatment for a wide-range of conditions, including those that aren't related to the musculoskeletal system. Most also focus on preventive care, which may include regular adjustments of returning musculoskeletal imbalances for health maintenance.

Many health care professionals (including many chiropractors) contend that chiropractic treatment should focus only on musculoskeletal conditions. And, in fact, studies show that chiropractic manipulation seems to have the best results for acute back pain, particularly lower-back pain. It may also be an effective therapy for muscle spasms, nerve inflammation, headache, joint pain and various other musculoskeletal problems. According to a RAND study, more than 94 percent of all spinal manipulations are administered by chiropractors.

Many chiropractors also address problems unique to women, suggesting chiropractic care for pregnant and postpartum women, as well as those suffering from premenstrual syndrome and menstrual cramps. According to a study performed through the National University of Health Sciences, 88 percent of women receiving chiropractic treatment said it reduced menstrual pain. The Journal of Manipulative and Physiological Therapeutics reported that spinal manipulation might provide short-term relief of menstrual pain.

Chiropractic neurologists are a growing specialty, treating patients with a variety of conditions, including hyperactivity, attention deficit disorder and autism.

Sciatica (pain in the lower back and hip that spreads down the back of the thigh into the leg), asthma, high blood pressure, tension headaches, carpal tunnel syndrome, osteoporosis, severe temporomandibular joint dysfunction (TMD) and neurological pain are among the disorders treated by chiropractors, certain of them directly such as tension headaches, and others indirectly, such as osteoporosis, by addressing the symptoms. However conditions of the blood, heart, lungs and other organs, as well as infectious diseases or injuries, require treatment by medical health care professionals. If you are under the care of a specialist, discuss your interest in chiropractic treatment with your health care team: don't ignore your regular course of treatment: many conditions today are more effectively co-managed by a variety of health care professionals.

Medical and chiropractic physicians have been in the process for many years now of building professional bridges. You should have no difficulty attaining cooperation between a medical and a chiropractic doctor.

Increasing Acceptance

Chiropractic care has been the object of skepticism and even scorn by certain conventional health care professionals. But the practice has gained much respect in recent years, and many health care professionals will refer patients to chiropractors on occasion. A recent report from Washington state points out that fully 57 percent of medical doctors refer their patients with back pain to chiropractors and that two-thirds of them would like to learn more about exactly what it is chiropractors do. Your health plan may even cover chiropractic treatment. Ninety-two percent of preferred provider organizations (PPOs) and 57 percent of health maintenance organizations (HMOs) include chiropractic benefits.

Active duty personnel in the U.S. armed forces now have guaranteed access to a permanent chiropractic benefit. On October 30, 2000, President Bill Clinton signed into law the National Defense Authorization Act for Fiscal Year 2001, requiring access to chiropractic services which includes, at a minimum, care for neuromusculoskeletal conditions typical among military personnel on active duty. The law requires that full implementation of the benefit be phased in over a five-year period, throughout all three service branches of the military. When completed, all active duty personnel stationed in the U.S. and overseas are to have access to chiropractic care.

A similar bill was signed into law in 2002, providing chiropractic care for United States Armed Forces veterans. It should be noted that 20 percent of all medical military discharges are for low back pain.

Respect for chiropractic has increased because of the therapy's track record as an appropriate treatment, particularly for early-stage lower-back pain, which is the second most costly medical problem in America. The Journal of the American Medical Association reported that chiropractic manipulation has been shown to have a "reasonably good degree of efficacy in relieving back pain, headaches and similar musculoskeletal problems."

Several studies indicate that chiropractic patients are more satisfied with their treatment than are those who receive traditional medical care and that they are less likely to seek care elsewhere for the same problem. Chiropractic patients also have the perception that chiropractors spend more face-to-face time with them than do their other health care professionals.

Colon Cancer

Only lung cancer kills more Americans than colorectal cancer. Fear, denial and embarrassment keep many people from being screened for the disease. There is also a misperception that colon cancer mainly strikes men. Yet colorectal cancer is the third most common malignancy in women after breast and lung cancer. Men and women develop colorectal cancer with almost equal frequency. In fact, more women over 75 die of colorectal cancer than of breast cancer.

There are regional differences in the disease's incidence and mortality throughout the country with the highest rates occurring among those in the Northeast, and survival rates lowest among African Americans.

The good news is that the disease is not only highly beatable and treatable, but also highly preventable. Screening for colon cancer can reduce deaths from colon cancer by at least 60 percent by preventing its development in the first place.

About 90 percent of those diagnosed with colon cancer survive five years or longer if the disease is diagnosed at an early stage. Once the cancer has spread to the lymph nodes, however, the five-year survival rate drops to 67 percent. If the cancer has already spread to distant parts of the body such as the liver or lungs, the five-year survival rate goes down to 10 percent.

The large intestine is the last section of the digestive tract and consists of the colon and rectum. The colon is four to six feet long, the last 12 to 15 centimeters or seven to nine inches of which is called the rectum. After food is digested in the stomach and nutrients are absorbed in the small intestine, waste from this process move into the colon, where it solidifies and remains for one or two days until it passes out of the body.

Sometimes the body produces too much tissue, ultimately forming a tumor. These tumors can be benign (not cancerous) or malignant (cancerous). In the large intestine, these tumors are called polyps. Polyps are found in about 30-50 percent of adults.

There are several different types of polyps. Inflammatory polyps, hyperplastic polyps and lymphoid polyps don't typically develop into colorectal cancer. However, researchers find that polyps called "adenomas" may undergo cancerous changes, becoming adenocarcinomas. Overall, about one percent of adenomatous polyps less than one cm in size will undergo this change, 10 percent of adenomatous polyps greater than one cm will become malignant within 10 years and 25 percent of adenomas greater than one cm will become malignant within 20 years. Furthermore, people with polyps in their colon tend to continue to produce new polyps even after existing polyps are removed.

The important fact is that colon cancers develop from adenomatous polyps by growing larger and eventually transforming into cancer; it is believed to take about 5 to 10 years for an adenomatous polyp to grow into cancer. Therefore, if appropriate colorectal cancer screening is performed, most of these polyps can be removed before they turn into cancer, effectively preventing the development of colon cancer.

Besides adenocarcinomas, there are other rare types of cancers of the large intestine, including carcinoid tumors typically found in the appendix and rectum; gastrointestinal stromal tumors found in the connective tissue of the colonic or rectal wall; and lymphomas, which are malignancies of immune cells that can involve the colon, rectum and lymph nodes.

Healthy-Women