Health departments in Flathead, Lake, Confederated SalishKootenai Tribe and Missoula counties issued an alert March 8 thatpertusiss, commonly called whooping cough, is continuing to spreadalong the U.S. 93 corridor.

The health departments reported 12 cases in Flathead County, 14 inLake County and four in Missoula County. many cases have been foundin immunized school-aged children.

Although not 100 percent effective, pertussis vaccine remains theprimary means of preventing the illness, according to healthofficials. A highly immunized population increases protection foreach area.

Patients with pertussis should not go to daycare, school, work orpublic gatherings until at least five days after starting aprescribed antibiotic.

To prevent illness, health officials say those in close contactwith someone ill with pertussis should start treatment at the sametime as the ill person. This is particularly important for younginfants and other people at high risk for complications from thedisease.

Health officers urge anyone with a cough lasting more than one weekto consult their health care provider. Symptoms vary greatlydepending on the patient’s age, vaccination status and stage ofpertussis infection.

Anyone with suspicious symptoms is advised to stay home and callhis or her health provider, since early treatment is important.They also urge residents to get vaccinated, especially parents,family members and caregivers of young infants.

For more information, contact the Flathead City-County HealthDepartment at 751-8101.

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Treatment

An early diagnosis of CF and a comprehensive treatment plan can improve both survival and quality of life. Follow-up and monitoring are very important. if possible, patients should be cared for at cycstic fibrosis specialty clinics, which can be found in many communities. When children reach adulthood, they should transfer to a cystic fibrosis specialty center for adults.

Treatment for lung problems includes:

• Antibiotics to prevent and treat lung and sinus infections. They may be taken by mouth, or given in the veins or by breathing treatments. People with cystic fibrosis may take antibiotics only when needed, or all the time. Doses are usually higher than normal.
• Inhaled medicines to help open the airways
• DNAse enzyme replacement therapy to thin mucus and make it easier to cough up
• Flu vaccine and pneumococcal polysaccharide vaccine (PPV) yearly (ask your health care provider)
• Lung transplant is an option in some cases
• Oxygen therapy may be needed as lung disease gets worse

Treatment for bowel and nutritional problems (see: Cystic fibrosis – nutritional considerations) may include:

• A special diet high in protein and calories for older children and adults (see: Cystic fibrosis nutrional considerations)
• Pancreatic enzymes to help absorb fats and protein
• Vitamin supplements, especially vitamins A, D, E, and K
• Your doctor can suggest other treatments if you have very hard stools

Care and monitoring at home should include:

• Avoiding smoke, dust, dirt, fumes, household chemicals, fireplace smoke, and mold or mildew
• Clearing or bringing up mucus or secretions from the airways. this must be done one to fours times each day. Patients, families, and caregivers must learn about doing chest percussion and postural drainage to help keep the airways clear
• Drinking plenty of fluids. this is particularly true for infants, children, in hot weather, when there is diarrhea or loose stools, or during extra physical activity
• Exercising two or three times each week. Swimming, jogging, and cycling are good options. Avoid contact sports, scuba diving, and endurance activities such as marathons

Support Groups

For additional information and resources, see: Cystic fibrosis support group

Prognosis (Expectations)

Most children with cystic fibrosis are fairly healthy until they reach adolescence or adulthood. They are able to participate in most activities and should be able to attend school. many young adults with cystic fibrosis finish college or find employment.

Lung disease eventually worsens to the point where the person is disabled. Today, the average life span for people with CF who live to adulthood is approximately 35 years, a dramatic increase over the last three decades.

Death is usually caused by lung complications.

Complications

The most common complication is chronic respiratory infection.

Calling your Health Care Provider

Call your health care provider if an infant or child has symptoms of cystic fibrosis.

Call your health care provider if a person with cystic fibrosis develops new symptoms or if symptoms get worse, particularly severe breathing difficulty or coughing up blood.

Call your health care provider if you or your child experiences:

• Fever, increased coughing, changes in sputum or blood in sputum, loss of appetite, or other signs of pneumonia
• Increased weight loss
• More frequent bowel movements or stools that are foul-smelling or have more mucus
• Swollen belly or increased bloating

Review Date : 5/11/2009Reviewed by : Daniel Rauch, MD, FAAP. Director, Pediatric Hospitalist Program, Associate Professor of Pediatrics, NYU School of Medicine, new York, NY. Review provided by VeriMed Healthcare Network. also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsements of those other sites. © 1997- 2010 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Tags: cystic fibrosis, Cystic fibrosis Treatment.

Symptoms & Signs

• Bend in the penis with erection
• Narrowing of the penis with erection
• Painful erection
• Problems with penetration or pain during intercourse

Diagnosis & Tests

The health care provider can diagnose curvature of the penis with a physical examination. The hard plaques can be felt with or without an erection.

The doctor may use injected medications to cause an erection. or you may provide your health care provider with pictures of the erect penis for evaluation.

An ultrasound may show the scar tissue in the penis, but it is not necessary.

Review Date : 4/5/2009Reviewed By : David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, a.D.a.M., inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. a licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsements of those other sites. © 1997- 2010 a.D.a.M., inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Tags: Curvature of the penis, Curvature of the penis Signs, Curvature of the penis Symptoms, Diagnosis Of Coronary Heart Disease.

By Caren Fairweather Published: 2:00 AM – 01/19/11

If you resolved to get fit this year and recently learned you are pregnant, don’t fret! many symptoms of pregnancy may be helped by continuing or beginning an exercise program. Difficulty sleeping, low energy and maintaining a healthy weight and body image improve when pregnant women adopt a safe, moderate exercise program.

Two added bonuses: Physical activity can help you prepare for childbirth by building stamina and strength, and it can also make it easier to get back into shape after the baby is born.

Whether you have been physically active for years or you want to begin a fitness program now that you’re pregnant, adhering to several guidelines will ensure a safe pregnancy and birth.

First, see your health-care provider as soon as you know you are pregnant. Several conditions may make exercise risky during pregnancy, including asthma, high blood pressure, carrying multiples (twins, triplets, etc.) or having delivered prematurely previously. A prenatal physical exam and assessment will help your provider determine the best course of action for you and your baby.

If you get the green light to exercise, consider walking or stationary bicycling, swimming and prenatal yoga with a qualified instructor.

Walking provides aerobic benefits and improves posture. In the second and third trimesters, when you may lose your balance more easily, it is recommended that you walk with a buddy. it is common for a woman’s feet to grow during pregnancy, so invest in a new pair of walking shoes that fit. Your breasts may also be more tender than usual, so get a support exercise bra.

Swimming feels great when you are pregnant, especially in the later months when other forms of movement get uncomfortable. keep the speed down, no diving, and enjoy the feeling of weightlessness as your body grows big with baby. Stay out of hot water, as overheating is dangerous for the fetus.

Prenatal yoga focuses on gentle stretching, strengthening, breathing and learning to relax your body and mind. Some prenatal yoga classes include guided meditations to bond with your unborn child.

Whichever form of exercise you choose, drink at least a cup of water before, during and after exercising. Avoid becoming dehydrated because dehydration can cause contractions. Learn to monitor your heart rate accurately and keep it under 140 beats a minute.

Even if you have been athletic before becoming pregnant, refrain from risky forms of exercise such as contact sports, including volleyball, and activities that require jumping and bouncing. Avoid activities that can lead to falls, including skiing, waterskiing, skating and horseback riding. stop exercising immediately and contact your physician if you experience nausea, dizziness, vaginal bleeding or leaking, a racing heart or swelling in your calves.

Check with your local hospital and fitness centers for safe, effective prenatal exercise programs. It’s a new year, and having a new baby is a great reason keep your fitness resolution.

Caren Fairweather is executive director of Maternal-Infant Services Network Inc. (MISN), a mid-Hudson not-for-profit that promotes family health and wellness. Visit MISN at misn-ny.org.

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By Dr. Christian Pope December 02, 2010 12:00 AM

A 30-year-old woman presents after having three consecutive miscarriages. Before these miscarriages, she had one successful pregnancy. she is a healthy woman with no medical problems.

What’s next?

As with many women’s health issues, there is no one answer or treatment that can prevent or cure miscarriages. It is always difficult and should be fully evaluated by your health care provider.

There are a number of factors and reasons that miscarriages occur, from health complications such as diabetes or uterine malformations to caffeine intake or chromosomal issues. It is important to undergo a full evaluation and provide as much information as you can to your obstetrician. the following is a quick overview of types of miscarriage and the evaluation process.

A miscarriage is the spontaneous loss of a pregnancy before 20 weeks. Miscarriage occurs in 15 percent to 20 percent of pregnancies. A majority of miscarriages that occur before 10 weeks of pregnancy are due to chromosomal problems. the rate of miscarriage increases when maternal age is less than 18 years or greater than 35 years old.

Recurrent miscarriage, defined as the loss of three or more consecutive pregnancies, occurs in approximately 1 percent of couples attempting pregnancy.

Many experts consider two consecutive losses as sufficient for the diagnosis of recurrent miscarriage, because the recurrence rate is similar to that after three losses. this can occur in up to 5 percent of reproductively active couples and occurs in an even higher proportion of women 35 or older. For many couples, the evaluation does not reveal a cause and yet, in some cases, may lead to an unrelated finding and therefore unnecessary treatments with vitamin supplements or blood thinners.

Most women with recurrent miscarriage have recurrent early miscarriage — that is, miscarriage before 10 completed weeks of pregnancy. Signs may be no fetal heart rate seen by ultrasound, the size of the embryo or pregnancy sac measuring considerably less than expected, and/or symptoms of uterine bleeding and/or cramping. A substantial proportion of recurrent early miscarriages are due to the embryo having a chromosomal problem, although it is less common than with sporadic miscarriages.

A smaller proportion of women with recurrent miscarriage have a late miscarriage — after 10 weeks of pregnancy but usually before 16 completed weeks. Recurrent miscarriage at any time is distressing and gives rise to frustration for the couple and their physician.

The nature of previous losses in a women’s obstetrical history is crucial. this history should be carefully obtained. Also, any general medical problems must be presented and evaluated, since many medical concerns may contribute to pregnancy loss, such as uncontrolled diabetes and thyroid disease, autoimmune diseases and clotting problems known as thrombophilias.

Obesity, smoking, excessive alcohol use and moderate-to-heavy caffeine intake may all be associated with sporadic miscarriage, but have not been proven to be a causative risk of recurrent miscarriage.

Uterine malformations, most commonly “arcuate” and “septate uteruses,” which refers to a congenitally misshaped uterine, are detected in 10 percent to 25 percent of women with recurrent miscarriage. Therefore, evaluation of the uterus with different modalities should always be performed.

In 3 percent to 6 percent of the cases of recurrent miscarriage, one partner, usually the woman, has a chromosomal problem. the most common type is called translocation, which may be detected with blood work.

Years ago, intrauterine infection was thought to cause recurrent miscarriage, and physicians commonly performed expensive laboratory testing on many patients to try to discover the causative organisms.

However, after many studies, there is no proven infectious cause of recurrent miscarriage and the testing is no longer recommended.

Similarly, although a deficiency of progesterone has been proposed as a cause as well, it has not proven true and, again, such testing and progesterone supplementation is no longer recommended.

Medical history requires:

• an accurate obstetrical history as to timing and pattern of previous miscarriages, if such information is available.
• Previous pathology of placenta information from previous miscarriage, if available.
• Prior imaging/ultrasounds if available for comparison with current studies to be performed.
• Assessment for other medical conditions such as thyroid disease or diabetes.

Physical examination includes:

• Gynecologic pelvic examination.
• General medical examination.

Recommended tests include:

• Pelvic ultrasound, hysteroscopy and possible hysterosalpingography (HSG) to evaluate uterine cavity; rarely, uterine MRI is performed.
• Labs: lupus anticoagulant, anticardiolipin antibodies, TSH, HgbA1c.
• Chromosomal testing of the mother and father who are trying to conceive.

The prognosis for women with a history of recurrent miscarriage is often favorable, even without any treatment.

Among women with recurrent miscarriage and positive lab testing for a blood-clotting disorder, such as antiphosholipid antibody syndrome, improved pregnancy and live birth rates have been shown with the use of a blood thinner called heparin together with low-dose aspirin.

For women with unexplained recurrent miscarriage, there is no evidence to support the use of aspirin or heparin.

In women with a uterine anatomical anomaly such as a uterine septum, surgical correction is recommended. this is often performed by a technique called hysteroscopy, that uses a small camera inserted through the vagina into the uterus, without any abdominal incisions. this typically is an outpatient procedure.

In couples who have a genetic contribution to their recurrent pregnancy loss, the prognosis varies depending on the underlying cause; however, overall there is up to a 70 percent chance of a live birth without any interventions.

In-vitro fertilization and pre-implantation genetic diagnosis has been used in some patients, as well with successful outcomes.

My recommendations listed above for evaluation and treatment are based on the most recent guidelines issued by the American College of Obstetricians and Gynecologists, and the American Society for Reproductive Medicine. Couples who have suffered multiple miscarriages should undergo the proper evaluation to help uncover any possible contributing causes.

However, they should also be informed that good evidence is lacking to support several commonly used interventions for recurrent miscarriage and that observation balanced with cautious optimism is a reasonable strategy, since without intervention, a subsequent pregnancy will result in a live birth for more than two-thirds of couples.

Have a women’s health topic you would like covered? Dr. Pope is happy to answer your questions or write a column on a topic you choose. Send your women’s health topic requests to Joyce Brennan at .

Dr. Christian S. Pope specializes in obstetrics and gynecology. He has offices in new Bedford and Mattapoisett and practices at St. Luke’s Hospital, the new Bedford site of Southcoast Hospitals Group. He can be reached at 508-999-6245.

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