Ovarian cancer is a disease in which malignant cells develop in the ovaries — two small hormone-producing organs on both sides of the uterus. the American Cancer Society estimated that there will be about 22,280 new cases of ovarian cancer and 15,500 deaths from ovarian cancer in 2012.

It has been called the silent killer because of its nearly asymptomatic early stages, but given these statistics, it’s more important than ever to spread awareness and increase early detection. In fact, David Fishman, director of the National Ovarian Cancer Detection program, said, “if you diagnose ovarian cancer in the earliest stage, it’s over 90 percent curable.”

CausesThe exact cause of ovarian cancer currently evades scientists. Healthy cells multiply at a steady rate, with new cells replacing old, dying cells, and so on. Cancer cells, on the other hand, do not die. they continue multiplying until they amass into a tumor. These cancer cells then metastasize, which means they beyond the initial ovarian tumor to corrupt other areas in the body.

The Mayo Clinic reported that cancer that begins on the outside of the ovaries forms an epithelial tumor. when the cancer starts in the egg-producing cells is forms a germ cell tumor. when it beings in the hormone-producing cells, it forms stromal tumors. more Caucasian women develop ovarian cancer than African-American women.

SymptomsSince the ovaries are deep within the abdominal cavity, symptoms during the early stages are difficult to detect, according to the National Ovarian Cancer Coalition(NOCC). Stephen J. Iacoboni, medical director of hematology/oncology at Kennewick General Hospital, said that ovarian cancer often presents itself in the later stages (III-IV) “because this illness is asymptomatic in the early stages and because there is no effective screening method.”

Common symptoms include bloating, pelvic or abdominal pain, trouble eating, feeling full quickly and frequent need to urinate. the NOCC added that fatigue, upset stomach, back pain, pain during intercourse and constipation can also be warning signs, especially if they persist for longer than two weeks.

DiagnosisDoctors may monitor women who are at high risk or demonstrate warning signs with various early detection tests: blood tests, transvaginal ultrasounds and pelvic exams. the Ovarian Cancer National Alliance (OCNA) explained that a high concentration of protein CA-125 exists in cancerous cells. Blood tests can evaluate the prevalence of this protein in women. Transvaginal ultrasounds, which are administered by inserting a probe into a woman’s vagina, can provide computer images of her reproductive organs and bladder. a doctor can assess the size and shape of a woman’s ovaries and uterus by inserting a finger or two into her vagina and placing his other hand over her abdomen, during a pelvic exam.

If these tests reveal a possibility of ovarian cancer, the doctor can proceed to PT or CT scans. the only definitive diagnosis procedure, however, is surgery and biopsy, according to the OCNA.

Beth Karlan, a gynecologic oncologist at Cedars-Sinai Medical Center, recommended seeking treatment from a gynecologic oncologist because they are trained as surgeons and as oncologists. This specialty has the privilege of caring for patients from diagnosis through to follow-up after treatment. she also said there is also data suggesting that ovarian cancer patients have a better chance of survival when treated by gynecologic oncologists.

TreatmentAccording to the department of pathology at John Hopkins, there are three basic forms of ovarian cancer treatment: surgery, chemotherapy and radiation. Robin Cohen, an oncology nurse and co-founder of the Sandy Rollman Ovarian Cancer Foundation, said, “The treatment depends on the staging. For advanced cancer (which is most common), a total hysterectomy and debulking (removal of as much cancer as possible) are performed.”

The goal of surgery is to remove the cancer from the ovaries and surrounding infected areas. This could necessitate removal of the ovaries, fallopian tubes, uterus, omentum and lymph nodes, depending on how far the cancer has spread.

Chemotherapy drugs kill cancer cells and can be given intravenously or directly into the abdominal cavity. These can be administered alone or in combination with other approaches. Smith added, “Chemotherapy is used to shrink ovarian cancer and slow cancer growth. But of course, it comes with potential side effects – the most common are nausea and vomiting.”

In certain circumstances, patients benefit from radiation treatment, which destroys cancer cells with high energy X-rays.

Nearly three out of four women will have uterine fibroids at some point, according to the Mayo Clinic. the symptoms and appearance of fibroids can vary widely from one woman to the next. Uterine fibroids are cell growths that can shrink, grow larger or stay the same size over time. These masses may cause extreme pain, or they might not cause  symptoms at all. Fibroids can appear minuscule or they can grow large enough to expand your uterus to your ribcage. the severity of symptoms will usually determine whether or not treatment is required.

OverviewUterine fibroids can also be called fibromyomas, leiomyomas or myomas. While fibroids form due to abnormal cell growth, they are almost always noncancerous. usually, an anomalous cell in the uterus will reproduce, and eventually enough cells will combine to form a firm, rubbery mass. These masses can develop within the uterus cavity or on its outside tissue lining. Uterine fibroids tend to affect women during their childbearing years, but the fibroids rarely prevent pregnancy. in fact, most women will experience no symptoms of uterine fibroids.

SymptomsThe minority of women with uterine fibroids will experience symptoms such as a particularly heavy flow or a prolonged menstrual period, usually considered seven days or more of bleeding. Fibroids may also cause pain in your pelvis. if the masses are pressing down on your bladder, they can cause frequent or difficult urination. Fibroids placing pressure on your rectum may result in constipation or backache. the location of the fibroids typically determines which symptoms appear. Submucosal fibroids grow inside the uterus, and they likely account for heavy and prolonged menstrual periods. These fibroids could affect a woman’s ability to get pregnant. Subserosal fibroids occur outside the uterus, and they usually press on your bladder or rectum, causing problems with urination or bowel movements. These fibroids may likewise compress a spinal nerve, resulting in back aches and pain.

CauseDoctors have yet to determine a definitive cause for fibroids, but genetic mutations may account for the cell abnormalities that cause fibroids. A problem with the hormones estrogen and progesterone may also play a role. Other chemical substances in the body may also factor into fibroid formation.

TreatmentMost uterine fibroids are negligible enough to bypass treatment. However, for fibroids that cause extreme pain or discomfort, a wide variety of treatment options are available. Medications control menstrual bleeding and possibly shrink fibroids. These drugs usually treat symptoms by managing your hormone levels. While medication might make fibroids smaller, only surgery can effectively remove fibroids from your body. A surgical procedure called a myomectomy removes fibroids but does not prevent them from returning. A hysterectomy can result in permanent fibroid removal, but this procedure involves removing your uterus completely. this surgery is a major decision, as women who have a hysterectomy can no longer bear children. Focused ultrasound surgery is one of the least invasive surgical options. with the use of high-energy sound waves directed at your uterus, surgeons can find and destroy the fibroids, which affect each woman differently. A health care professional can help you find the right path to manage and treat your symptoms effectively.

(Credit:CBS/WTVR)

(CBS) the death of a 7-year-old girl at school from a peanut allergy has raised questions about a school’s responsibility in treating kids with food allergies.

PICTURES – Food allergy: 9 dangerous myths

Two days ago, Ammaria Johnson died after suffering an allergic reaction at Hopkins Elementary School in Chesterfield Country, Va., WTVR CBS 6 in Richmond reported. the death is still being investigated, but Johnson’s mother told WTVR she learned from the school principal and a doctor that the allergy was to a peanut product.

Emergency crews were called to the school on Monday, but by the time they arrived, the child was in cardiac arrest, according to a Chesterfield fire Department spokesman Lt. Jason Elmore. Johnson was pronounced dead a short time later at CJW Medical Center in Richmond.

Food allergies affect an estimated 6 to 8 percent of children under age 5, and about 3 to 4 percent of adults, according to the Mayo Clinic. Food allergies can cause a number of symptoms, ranging from digestive problems and hives to a life-threatening reaction called anaphylaxis.

How did the school respond? County school and health officials could not discuss Johnson’s death directly, although they said it is the responsibility of the parent to provide medicine and instructions to doctors for kids with allergies.

“For any medication, the school would have to be in possession of that medication to provide it,” Shawn Smith, a spokesman for Chesterfield County Public Schools, told ABC News. “The medication we receive, or should receive, has to be specific to that child, whether it’s over-the-counter or prescription.” 

The girl’s mom, Laura Pendleton, told WTVR she authorized an allergy action plan to give her daughter Benadryl in case of an allergic reaction, but the school didn’t give the girl the medication. Pendleton said she had tried to give an aid an EpiPen for emergencies, but was told to keep it at home. An EpiPen is available with prescription and gives a dose of epinephrine that reverses symptoms of an allergic reaction for enough time to get the person to a hospital.

The girl’s tragic case raises the question: should schools stockpile EpiPens to treat kids in the event of an allergic reaction?

Maria Acebal, head of the Food Allergy and Anaphylaxis Network, told CNN that Ammaria’s death “underscores the need for all teachers to have the basics of food allergy safety as part of their orientation and continuing education.”

Acebal told ABC she’s supporting a bill that would let all schools give EpiPens to any student, regardless of if they have a prescription.

“No one in this country has ever been sued for giving epinephrine, to my knowledge,” Acebal told ABC. “All the lawsuits come about because school officials don’t give it when it’s needed.”

By Medical Edge July 19, 2011 12:00 AM

Dear Mayo Clinic: I have heard that sometimes people have gallstones and don’t even know it, while others have severe pain because of them. am I at greater risk if some of my family members have had them? How will I know if I have gallstones?

Reply: It is true that even if you develop gallstones — a condition in which digestive fluid hardens into pebble-like deposits — you might not even notice. in fact, many are discovered by chance during an abdominal X-ray or ultrasound exam for some other reason. That’s because in most patients, gallstones do not cause symptoms.

In other cases, though, you know all too well something’s wrong. Gallstones can cause attacks of pain, known as gallbladder attacks, in your upper abdomen or chest.

Your gallbladder is a pear-shaped sac that sits beneath your liver. The gallbladder’s main job is to store bile — a thick, greenish-brown liquid that’s produced by the liver. after you eat, your gallbladder contracts, pushing bile through a small tube called the common bile duct into the upper portion of your small intestine.

There, the bile helps your body absorb fats, cholesterol and certain vitamins. Gallstones form when components of bile harden into crystals. Most gallstones are made of cholesterol. It is possible to have just one gallstone or hundreds, ranging in size from a grain of sand to a golf ball.

Gallstones may form because of changes in the composition of bile, such as an increased amount or proportion of cholesterol. in other cases, the gallbladder muscle loses some of its squeezing power, so it doesn’t empty completely. Infection and inflammation also can damage the gallbladder and trigger the development of gallstones.

Factors that may increase your risk of cholesterol gallstones include: Obesity and excess weight, pregnancy, high-fat, high-cholesterol or low-fiber diet, family history of gallstones, diabetes, liver disease, Crohn’s disease, rapid weight loss, certain cholesterol-lowering medications and medications that contain estrogen.

Gallstones usually settle at the bottom of your gallbladder, where they’re unlikely to cause problems. Symptoms may arise if a stone migrates up the neck of the gallbladder and blocks the flow of bile out of the gallbladder or through the bile duct. a blocked gallbladder or bile duct can cause intense pain in your abdomen that may extend to your shoulder blade, chest or arm. The pain is sometimes accompanied by nausea and vomiting.

A gallbladder attack often subsides as the stones move. But if the blockage persists, your gallbladder can become inflamed or infected. This condition is called acute cholecystitis and requires treatment in a hospital where you’ll likely receive fluids, pain relievers and antibiotics intravenously. Treatment also includes surgery to remove the gallbladder (cholecystectomy), usually within 24 to 48 hours.

If you think you’ve had a gallbladder attack, see your doctor. Seek medical attention immediately if the pain is persistent and severe, if you have a fever or chills, or if your skin or the whites of your eyes are yellowish. if your gallstones aren’t causing any symptoms, you do not need treatment. if you have frequent attacks, your doctor will likely recommend that you have your gallbladder removed.

After your gallbladder is removed, bile flows directly from your liver into your small intestine. You’ll still be able to digest food. and you’ll be able to get back to your usual activities, with or without a gallbladder. — John Poterucha, M.D., Gastroenterology, Mayo Clinic

Send questions to medicaledge

@mayo.edu.

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Oh, barf. Literally, though: Today, NBCLosAngeles.com reports on children with abdominal migraines, also called cyclic vomiting syndrome, a mysterious disorder that causes bouts of nausea and vomiting — sometimes as often as six times an hour — that can last for hours, or even days. (Days!) 

It’s a condition with no known cause or cure, according to the Mayo Clinic, but it most often occurs in kids ages 3 to 7. Typically, it’s something kids grow out of by the time they’re teenagers, but it can last into adulthood, which is when things get really icky: For adults, symptoms can last as long as a week.  

The National Institutes of Health lists all the possible triggers for an episode of near-constant retching: emotional stress or excitement; anxiety and panic attacks; colds, allergies, sinus problems and the flu; eating too much or eating before bed, hot weather, physical exhaustion, menstruation and motion sickness. (In short: Being alive can trigger symptoms.) Medications are sometimes prescribed to stop all the barfing, but the NIH says most people learn to control their symptoms by staying in bed and sleeping in a dark, quiet room. 

Quoth one small sufferer of cyclic vomiting syndrome: ”I’ll vomit up to about 40 times a day. That’s just terrible, terrible. For being my age especially,” Olivia Brown told NBCLosAngeles.com.

Poor thing. Readers, have you ever heard of cyclic vomiting syndrome? and, just for fun — tell us your grossest vomiting story, won’t you? For Olivia’s sake. 

You can find The Body Odd on Twitter and Facebook, and follow Melissa Dahl @melissadahl.

Dr. Xiang Gao, a Harvard Medical School research scientist, released data this week suggesting that the use of ibuprofen may be associated with a decreased risk of Parkinson's disease. The data were highlighted in the current issue of Neurology.

What is Parkinson's disease?

Parkinson's disease is a progressive neurological disorder which affects the motor functions of the body. according to the National Institute of Neurological Disorders and Stroke, there are four primary symptoms, and these include:

* Tremor of the hands, face, jaw, arms or legs

* Rigid or stiff extremities and torso

* slow movements (also called bradykinesia)

* Lack of balance and coordination of movements

What are the risk factors for Parkinson's disease?

Parkinson's disease affects persons over the age of 50 in most instances, and the risk increases the older one is. Men develop the disease more often than women, and the risk increases for those with close relatives who have Parkinson's disease. The Mayo Clinic reports that those who work continually with pesticides and herbicides are also more prone to this disease.

What causes Parkinson's disease?

According to the Parkinson's Disease Foundation, close to a million people in the United States have Parkinson's disease. although the cause is unknown, research has uncovered changes in the brains of those with the disease. When a specific group of dopamine-producing brain cells die, the symptoms of Parkinson's disease occur. Dopamine is the neurotransmitter which sends messages to the areas of the brain which control movement and coordination. With less dopamine, the speed of the messages is much slower, causing the symptoms described above.

Another change in the brain is damage to the sympathetic nerve endings that release the chemical messenger, norepinephrine, which affects blood pressure. When examined during autopsy, these brains also show the presence of unusual clumps of protein called Lewy bodies, and their function is unclear.

What medications are available for Parkinson's disease?

Physicians prescribe medications to those diagnosed with Parkinson's disease to help alleviate the symptoms, as none of the medications cure Parkinson's disease. There are various classes of drugs used, and these include Carbidopa/Levodopa therapy, Dopamine Agonists, Anticholinergics, MAO-B Inhibitors, and COMT Inhibitors.

Although it was discovered 40 years ago, levodopa remains the most effective medication for Parkinson's disease, with 70 percent to 80 percent of patients taking this medication. Physicians prescribe it in combination with another drug, carbidopa, and the resultant medication is called Sinemet. Levodopa actually is a naturally occurring substance in the body and once it enters the brain can convert into dopamine by an enzyme. it is combined with carbidopa, to prevent the levodopa from converting too soon to dopamine, prior to entering the brain.

Margie Miklas is a critical-care nurse with more than 30 years experience. She currently works in south Florida in a cardiovascular ICU with a specialty certification in cardiac surgery.

HelloLife™ Home » Explore Home » Children’s Health » NCBI on Whooping Cough: Risk Factors, Causes, Symptoms

According to the Mayo Clinic, whooping cough (pertussis) is a highly contagious respiratory tract infection. this condition often starts like the common cold, advises the U.S. Centers for Disease Control and Prevention (CDC).

Patients may experience runny nose or congestion and sneezing. after one to two weeks, severe coughing can begin. that coughing can make it hard to breathe, sucking the air out of the lungs until the patient tries to take a breath with a deep “whoop” sound.

Whooping cough is caused by the Bordetella pertussis or Bordetella parapertussis bacteria. According to the University of Wisconsin, this is a rod-shaped bacterium that triggers the body’s immune response. the immune system senses a cytokine reaction, which is toxic to the body. as a result, the body initiates inflammation of the tissues and blood vessels.

The Mayo Clinic explains that in the first half of the 20th century, whooping cough was a leading cause of childhood illness and death in the United States. after the first vaccine was introduced, the number of affected people gradually declined, reaching a low in the mid-1970s. Since that time, however, the incidence of whooping cough has begun to increase, particularly among children too young to have completed the full course of vaccinations. Teenagers and adults with compromised immunity are also at risk.

Two important theories explain the latest rise in whooping cough cases. the vaccine received in childhood eventually wears off, which leaves most teenagers and adults susceptible to the infection during outbreaks, which regularly occur. moreover, children are not fully immune to whooping cough until they receive at least three shots, which leaves those six months and younger at risk of contracting the infection.

According to the National Center for Biotechnology Information (NCBI), when an infected person sneezes or coughs, tiny droplets containing the bacteria move through the air, whereby whooping cough is easily spread among people. Once inside the airways, the bacteria multiply and produce toxins that interfere with the respiratory tract’s ability to sweep away germs. the Mayo Clinic indicates thick mucus accumulates inside the airways, causing uncontrollable coughing. Inflammation caused by the bacteria may also narrow breathing tubes in the lungs, which leaves one gasping for air.

The NCBI states infection often lasts six weeks and may require hospitalization. Initial symptoms often develop about one week after exposure to the bacteria. Severe episodes of coughing may start 10 to 12 days later. the whoop noise heard during breathing is rare in patients under six months of age and in adults. those patients may, instead, have deep fits of coughing. those fits may lead to vomiting or a short loss of consciousness. In infants, choking spells are also common. Patients may also experience a slight fever (102 degrees F or lower) and diarrhea.

Additional symptoms of whooping cough, as provided by the Mayo Clinic, include the following:

• Red, watery eyes
• Dry cough
• Thick phlegm
• Red or blue face that ensues from coughing
• Extreme fatigue

Sources:

ncbi.nlm.nih.gov/pubmedhealth/PMH0002528

mayoclinic.com/health/whooping-cough/DS00445

cdc.gov/Features/Pertussis/

bioweb.uwlax.edu/bio203/s2007/wolf_bri2/

“Heat illness was the third leading cause of death amoung high school athletes in 2004.”

Summer is in full swing and the temperatures are rising. by 7:00a.m. the sun is already out and the thermometer can read 80 degrees, with 70% relative humidity. Workouts in the heat can be challenging and dangerous if you don’t take steps to help your body adjust. You could suffer some form of heat illness that could lead to heat exhaustion or worse, heat stroke. Heat edema, heat cramps, heat syncope, heat exhaustion, and heat stroke are the five common types of heat illness typically associated with strenuous activity in hot, humid weather (Marsh and Jenkins (2002)). Heat exhaustion is a condition whose symptoms may include heavy sweating and a rapid pulse, a result of your body overheating. It’s one of three heat-related syndromes, with heat cramps being the mildest and heatstroke being the most severe (Mayo Clinic). Heatstroke, a result of the escalation of heat cramps and heat exhaustion, is a life-threatening condition that occurs when your body temperature reaches 104 F (40 C) or higher.

Many people comment that workouts in hot conditions are tougher, they get tired faster, and they can’t last as long. much of this can be attributed to the increased work the body has to go through to cool itself while you workout. These are early symptoms of heat exhaustion. When you exercise, your body temperature rises. To help cool itself down, your body sweats. You will notice in heat, that your body begins to sweat more and sooner than when you exercise in cool weather. To help keep yourself cool, wear lighter fabrics and lighter colors. Also, use a hat, one that has breathable fabric, to keep your head and your face cool.

Your body also looses more water due to the increase in sweating. as a result, you may experience heat cramps. Signs and symptoms of heat cramps usually include heavy sweating, fatigue, thirst and muscle cramps. immediate attention usually prevents heat cramps from progressing to heat exhaustion. be sure to hydrate, drinking 6-8 oz of water or sports drink every 15-20 minutes. (If you are working out for less than 80 minutes, you can just drink water, but it is recommended that you do a mixture of sports drinks and water). You can carry a bottle with you or plan your routes so that you are passing by water fountains frequently. If you will be working out in the same place for extended periods of time, bring a cooler to keep water cold. be aware that even with these precautions you may experience muscle cramps.

Ways to avoid heat illness:

• always wear sunscreen, even underneath clothing and remember to reapply if you will be outside for an extended period of time.
• Wearing sunglasses will help reduce damage to your eyes and keep you from squinting.
• Stay hydrated. Dehydration impedes your ability to sweat.
• Avoid alcohol use. Alcohol can result in dehydration, along with other adverse effects on performance.
• be smart. Reducing the intensity of your workout, or easing into workouts in heat, can also help your body regulate and get used to the higher temperatures. Don’t expect to be able to do the same workout in 85 degrees that you could in 40 degrees.
• Avoid stimulants before workouts. Stimulants often speed metabolism, heart rate, and blood pressure. This increased activity in the body produces extra heat (especially in hot and humid conditions). Under these conditions the blood vessels in the skin constrict, preventing the body from cooling itself efficiently. by making the user feel more energetic and less fatigued, stimulants keep users exercising longer. This can set the stage for heat illness, heat stroke and sudden death in certain situations.

Heat exhaustion and heat stroke are very dangerous conditions. If you start to feel dizzy or nauseated, stop what you are doing and move to a shaded, cool area or head inside. use cool towels and washcloths to cool your skin slowly.

Ultimately, both exercise related heat illness and sunburn are preventable injuries. consequently, it is the responsibility of those caring for athletes, the parents, coaches, trainers, and team doctors, to ensure that athletes are educated in preventative strategies and are properly monitored during training or competition in the heat.

References:
Coris EE, Ramirez AM, Van Durme DJ. Heat illness in
athletes: the dangerous combination of heat, humidity and
exercise. Sports Medicine. 2004; 34(1):9–16.

Wendt D, van Loon LJC, van Marken Lichtenbelt WD.
Thermoregulation during exercise in the heat: strategies
for maintaining health and performance. Sports Medicine.
2007; 37(8):669–682.

Marsh SA, Jenkins DG. Physiological responses to the
menstrual cycle: implications for the development of heat
illness in female athletes. Sports . 2002; 32(10):601–614.

Noakes TD. A modern classifi cation of the exercise-related
heat illnesses. J Science and Medicine in Sport. 2008;
11:33–39.

Forget chasing the no. 1 ranking. Phil Mickelson was moreworried about being able to get out of bed.

Mickelson revealed Tuesday he has psoriatic arthritis, whichcauses his immune system to attack his joints and tendons andproduced such intense pain he couldn’t walk. He noticed the firstsymptoms five days before the U.S. Open, and the pain eventuallygot so bad he made a visit to the Mayo Clinic.

Weekly shots have brought the disease under control, andMickelson said there shouldn’t be any negative impact on his long-or even short-term health.

“I’m surprised at how quickly it’s gone away, and how quicklyit’s been able to be managed and controlled,” he said. “I feel 100percent, like I say. but when I’m laying there on the couch and Ican’t move, you know, yeah, I had some concerns. but I feel a lotbetter now.”

As if that bombshell wasn’t enough for the day, Lefty droppedanother one: the burger connoisseur is now a vegetarian.

“I know, I know,” he said as reporters laughed. “As long as Ibelieve that there’s a possibility that it will help me overall,yeah, I’ll continue to do that. If it will somehow keep this inremission or stop it from coming back, yeah, I’ll be able to do it.but I haven’t been put it to the real test. The real test isdriving by a five Guys and not stopping.”

Mickelson has been threatening to replace Tiger Woods as worldNo. 1 since The Players Championship in early May, only to stumbleat each opportunity. That’s led many to wonder what’s ailing him,particularly after his lackluster round Sunday at Firestone, wherehe made seven bogeys and a double-bogey _ and just one birdie _ onhis way to a 78.

Turns out, the ranking was the least of his worries.

Mickelson, who turned 40 in June, said he woke up five daysbefore the U.S. Open with “intense pain” in his tendons and jointsthat left him unable to move and his joints feeling sprained.Stretching, walking and anti-inflammatories alleviated the pain,and he went ahead and played Pebble Beach, where he shot 66 onFriday to put himself in contention. He wound up tied forfourth.

But the condition got progressively worse during the U.S. Openand a family vacation to Hawaii afterward, spreading to his knees,hips and elbows.

“That’s when I got concerned,” he said. “I certainly had thegamut of thoughts. … I would just lay down and I couldn’t rollover. I was concerned about being able to swing a club and soforth.”

After the British Open, Mickelson made a trip to the Mayo Clinicin Rochester, Minn., where doctors confirmed the diagnosis ofpsoriatic arthritis. according to the Mayo Clinic website, thecondition causes joint pain, stiffness and swelling. while it canbe linked to psoriasis, the arthritis can appear without thepresence of skin lesions.

There is no cure for the condition, according to the Mayo Clinicwebsite, but the disease is treatable. Weekly shots of Enbrel lowerhis immune system, and Mickelson said the difference was noticeablealmost immediately.

“I feel great now and things have been much, much better,” hesaid. “I’ll probably take this drug for about a year, and feel 100percent. I’ll stop it and see if it goes into remission and it maynever come back. It may be gone forever.”

“It’s not that it’s cured, but it may never come back,” headded. “Or if it does come back, I’ll start the treatment again andshould be able to live a normal life without having any adverseeffects. So I’m not very concerned about it.”

The arthritis is the latest health scare for Mickelson’s family.his wife, Amy, and mother are both battling breast cancer; thelong-term prognosis for both is good.

While Mickelson said the arthritis didn’t affect his play atPebble Beach or St. Andrews, where he was never a factor, he onlyresumed his regular practice routine last week. Revealing hiscondition earlier might have lessened some of the criticism of hisgame these last few weeks.

But that’s not Lefty’s style.

“First of all, I don’t want excuses. And second, I don’t want todiscuss something when I don’t know what the outcome is going tobe,” Mickelson said. “For five or six weeks, I was a little unsureof how this was going to affect me long term, career, what haveyou. now that I feel confident it’s not going to affect not onlythe rest of my career or the rest of my life, but even in the shortterm it shouldn’t have an effect, I feel a lot better about it andI’m a lot more at ease to discuss it.”

Mickelson certainly looked at ease Tuesday during his practiceround at Whistling Straits. He joked and laughed often with playingpartners Dustin Johnson, Jeff Overton and Steve Marino, and it wasclear there was more riding on the round than simple practice.

When Mickelson drained a 10-footer on 18, he gave a hearty fistpump.

“I’m probably not as sharp as I would like to be,” the four-timemajor champion said. “I didn’t play well at the British, obviously.I didn’t play well last week, on the weekend, but I’m able to workon it. I had a good session with Butch and I believe that thegame’s coming around. I’m not sure where I’ll be on Thursday, buthopefully I’ll be ready.”