Drinking and Driving

Drinking and Driving

•     Alcohol affects you in a way that changes your judgement, depth perception as well as vital motor skills required to drive safely. Its easy to think you are driving normally when truly you are not. When the police take notice you could be hit with a DUI/DWI. This is the best case scenario. Getting into an accident your life could be lost as well as any others who too are involved in this accident. According to 2009 drunk driving statistics there were 10,839 traffic fatalities in alcohol-impaired-driving crashes. This is those whose lives were lost not the total number of alcohol related accidents, or the number of individuals arrested for drinking and driving.The sound of a siren, the red flashing lights and a person in uniform knocking at your driver side window.  An officer has pulled you over for suspicious driving. If the officer smells a strong odor of alcohol, you exhibit slurred speech or general incoherence you will be asked to exit your vehicle and move to the side of the road where you will undergo field sobriety testing. If you fail to demonstrate the proper motor skills or judgment to safely operate a motor vehicle during these field tests, the officer can then ask permission to perform a blood alcohol content test, commonly abbreviated BAC. In most states the legal limit of BAC is .10%, however many states have adopted a lower of .08%. Failing these tests will result in a ride in the back of a police car,  A night in jail and charges of a DUI or DWI. You are now facing the legal repercussions of drinking and driving.

Digestion/Excretion Career Gastroenterologist

Gastroenterologist

What is a Gastroenterologist ?

A Gastroenterologist is a physician with dedicated training and unique experience in the management of diseases of the gastrointestinal tract and liver. Gastroenterology is the study of the normal function and diseases of the esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver. It involves a detailed understanding of the normal action (physiology) of the gastrointestinal organs including the movement of material through the stomach and intestine (motility), the digestion and absorption of nutrients into the body, removal of waste from the system, and the function of the liver as a digestive organ. It includes common and important conditions such as colon polyps and cancer, hepatitis, gastroesophageal reflux (heartburn), peptic ulcer disease, colitis, gallbladder and biliary tract disease, nutritional problems, Irritable Bowel Syndrome (IBS), and pancreatitis. In essence, all normal activity and disease of the digestive organs are part of the study of Gastroenterology.

What tools do they use?

Gastroscope	Used to perform esophagogastroduodenoscopy (EGD/OGD)
Duodenoscope	Used to perform ERCP
Enteroscope	Used to perform push enteroscopy
Colonoscope	Used to perform colonoscopy
Flexible sigmoidoscope	Used to perform flexible sigmoidoscopy
Rigid sigmoidoscope	Used to perform rigid sigmoidoscopy
Ultrasound endoscope	Used to perform endoscopic ultrasound (EUS)
Video capsule	Used to perform video capsule enteroscopy
Endoscopy snare	Used to perform polypectomy and endoscopic foreign body removal
Band ligator	Used to perform variceal band ligation
Sengstaken-Blakemore tube	Used in the management of bleeding esophageal varices
Balloon dilator	Used to perform esophageal balloon dilatation, pyloric dilatation or ileocolonic dilatation
Savary-Gilliard dilator	Used to perform esophageal bougie dilatation
Heater probe	Used to perform endoscopic heater probe thermocoagulation of bleeding blood vessels
APC unit	Used to perform endoscopic Argon plasma coagulation
PEG tube	Used to perform percutaneous endoscopic gastrostomy
Menghini needle or Tru-Cut needle	Used to perform percutaneous liver biopsy

What do you need to do to become a gastroenterologists?

Becoming a doctor requires more training than most other jobs. It usually takes at least 11 years to become a doctor: 4 years of college, 4 years of medical school, and 3 years working in a hospital. For some specialties, doctors may have to work in a hospital for up to 8 years before they are fully trained. To become a doctor, you should study biology, chemistry, physics, math, and English. It is not easy to get into medical school. You have to do very well in college and on medical school entrance tests. Students spend most of the first 2 years of medical school in labs and classrooms. They take lots of science courses. They also learn to ask patients the right questions and how to examine them. They learn how to tell what sickness a patient has. In the last 2 years, students work with patients and doctors in hospitals and clinics. After medical school, doctors go to work in a hospital for a few years. They are called residents. To be a resident, you must pass a test.

Salary Range:

The median expected annual pay for a typical Physician - Gastroenterology in the United States is $339,335 so 50% of the people who perform the job of Physician - Gastroenterology in the United Sates are expected to make less than $339,335.

Digestion/Excretion Disease Acid Reflux

Acid Reflux

What is Acid reflux?

At the entrance to your stomach is a valve, which is a ring of muscle called the lower esophageal sphincter (LES). Normally, the LES closes as soon as food passes through it. If the LES doesn't close all the way or if it opens too often, acid produced by your stomach can move up into your esophagus. This can cause symptoms such as a burning chest pain called heartburn. If acid reflux symptoms happen more than twice a week, you have acid reflux disease, also known as gastroesophageal reflux disease (GERD).

Symptoms of Acid Reflux 

• Heartburn: a burning pain or discomfort that may move from your stomach to your abdomen or chest, or even up into your throat
• Regurgitation: a sour or bitter-tasting acid backing up into your throat or mouth

Other symptoms of acid reflux disease include:

• Bloating
• Bloody or black stools or bloody vomiting
• Burping
• Dysphagia -- a narrowing of your esophagus, which creates the sensation of food being stuck in your throat
• Hiccups that don't let up
• Nausea
• Weight loss for no known reason
• Wheezing, dry cough, hoarseness, or chronic sore throat

What causes Acid Reflux disease?

One common cause of acid reflux disease is a stomach abnormality called a hiatal hernia. This occurs when the upper part of the stomach and LES move above the diaphragm, a muscle that separates your stomach from your chest. Normally, the diaphragm helps keep acid in our stomach. But if you have a hiatal hernia, acid can move up into your esophagus and cause symptoms of acid reflux disease.

How's it diagnosed?

• Barium swallow (esophagram) can check for ulcers or a narrowing of the esophagus. You first swallow a solution to help structures show up on an X-ray.
• Esophageal manometry can check the function of the esophagus and lower esophageal sphincter.
• pH monitoring can check for acid in your esophagus. The doctor inserts a device into your esophagus and leaves it in place for 1 to 2 days to measure the amount of acid in your esophagus.
• Endoscopy can check for problems in your esophagus or stomach. This test involves inserting a long, flexible, lighted tube down your throat. First, the doctor will spray the back of your throat with anesthetic and give you a sedative to make you more comfortable.
• A biopsy may be taken during endoscopy to check samples of tissue under a microscope for infection or abnormalities.

NS Disease 3 Dysautonomia

Dysautonomia

What is Dysautonomia?

Dysautonomia is an umbrella term used to describe several different medical conditions that cause a malfunction of the Autonomic Nervous System. The Autonomic Nervous System controls the "automatic" functions of the body that we do not consciously think about, such as heart rate, blood pressure, digestion, dilation and constriction of the pupils of the eye, kidney function, and temperature control. People living with various forms of dysautonomia have trouble regulating these systems, which can result in lightheadedness, fainting, unstable blood pressure, abnormal heart rates, malnutrition, and in severe cases, death.

Dysautonomia is not rare. Over 70 million people worldwide live with various forms of dysautonomia. People of any age, gender or race can be impacted. There is no cure for any form of dysautonomia at this time, but Dysautonomia International is funding research to develop better treatments, and hopefully someday a cure for each form of dysautonomia. Despite the high prevalence of dysautonomia, most patients take years to get diagnosed due to a lack of awareness amongst the public and within the medical profession. 

What are the symptoms of Dysautonomia?

The symptoms of dysautonomia conditions are usually “invisible” to the untrained eye. To the casual observer, the dysautonomia patient can appear to be healthy. The manifestations of the conditions are occurring internally, and although the symptoms are quantifiable and verifiable medically they are not visible on the outside (people cannot see fast heart rates, blood pressure changes, dizziness, migraines, stomach pain etc.). Symptoms of dysautonomia can be unpredictable, may come and go, appear in any combination, and usually vary in severity (wax and wane). Some symptoms seem to occur in intense phases. Patients often become more symptomatic after a stressor or physical activity (which can lead to chronic avoidance of physical activity contributing to additional decline). Symptoms can occasionally be severe enough that patients may require consideration for placement in full or part time home bound teaching programs for health impaired students; others will be able to attend school, often with modifications in their educational plans. The social isolation experienced by not being able to attend school or community activities is one of the hardest things for these children to deal with.  It is essential that school systems make every possible effort to help these students remain in school and to keep home bound students connected to their peers. Since patients afflicted with dysautonomia are usually normal in appearance, it can be a hard condition for laypeople to understand. Even the general physician sometimes misses the clues leading to a proper diagnosis. The symptoms are often difficult for the very young patient to verbalize and the conditions are not always promptly recognized. Traditionally, cardiologists and cardiac electrophysiologists can efficiently diagnose and treat dysautonomia patients. Sometimes neurologists and other specialists get involved as well. Families often find themselves desperately traveling great distances to the few pediatric dysautonomia specialists throughout the country for a proper diagnosis and innovative treatment.

Different types of Dysautonomia

Baroreflex Failure 
The baroreceptor reflex, or baroreflex, is one of the body's homeostatic mechanisms for maintaining blood pressure. If the baroreceptor itself or part of its messaging system fails, this is referred to as Baroreflex Failure. Patients often deal with normal or low resting blood pressure and very high or volatile blood pressure during periods of stress. 

Cerebral Salt Wasting Syndrome 

Cerebral salt-wasting syndrome (CSWS) is a rare condition featuring hyponatremia and dehydration in response to a physical injury or the presence of tumors in or surrounding the brain. The hyponatraemia is due to excessive sodium excretion from the kidney resulting from a centrally mediated process. 

Diabetic Autonomic Neuropathy 
Diabetic Autonomic Neuropathy is a secondary form of autonomic dysfunction, but it is likely the most common form of autonomic dysfunction in the world. An estimated 20% of all diabetics suffer from Diabetic Autonomic Neuropathy, which equates to approximately 69 million people worldwide. Diabetic Autonomic Neuropathy is a serious complication of diabetes. It is associated with an increased risk of cardiovascular mortality. 

When you should see a doctor

• Blood pressure fluctuations
• Difficulty with breathing or swallowing
• Shortness of breath with activity or exercise
• Distension of the abdomen

Why do people contract dysautonomia?

Dysautonomia may be due to inherited or degenerative neurologic diseases (primary dysautonomia) or it may occur due to injury of the autonomic nervous system from an acquired disorder (secondary dysautonomia). Side effects of drugs can cause abnormalities in the function of the autonomic nervous system, producing an iatrogenic form of dysautonomia.

NS Disease 2 Autism Spectrum

Autism Spectrum

What is Autism Spectrum?

Autism is not a single disorder, but a spectrum of closely-related disorders with a shared core of symptoms. Every individual on the autism spectrum has problems to some degree with social skills, empathy, communication, and flexible behavior. But the level of disability and the combination of symptoms varies tremendously from person to person. In fact, two kids with the same diagnosis may look very different when it comes to their behaviors and abilities.

What are the symptoms of this disease?

Social Skills 

• Unusual or inappropriate body language, gestures, and facial expressions (e.g. avoiding eye contact or using facial expressions that don’t match what he or she is saying).
• Lack of interest in other people or in sharing interests or achievements (e.g. showing you a drawing, pointing to a bird).
• Unlikely to approach others or to pursue social interaction; comes across as aloof and detached; prefers to be alone.
• Difficulty understanding other people’s feelings, reactions, and nonverbal cues.
• Resistance to being touched.
• Difficulty or failure to make friends with children the same age. 

Speech and Language 

• Delay in learning how to speak (after the age of 2) or doesn’t talk at all.
• Speaking in an abnormal tone of voice, or with an odd rhythm or pitch.
• Repeating words or phrases over and over without communicative intent.
• Trouble starting a conversation or keeping it going.
• Difficulty communicating needs or desires.
• Doesn’t understand simple statements or questions.
• Taking what is said too literally, missing humor, irony, and sarcasm.

Different Types of Autism Spectrum

• Autism
• Asperger's Syndrome
• Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS)

Childhood disintegrative disorder and Rett Syndrome are the other pervasive developmental disorders. Because both are extremely rare genetic diseases, they are usually considered to be separate medical conditions that don't truly belong on the autism spectrum.

What are the signs to see a doctor?

Problems with social skills, speech and language, and restricted activities and interests. However, there are enormous differences when it comes to the severity of the symptoms, their combinations, and the patterns of behavior.

NS Disease 1 Alzheimer's Disease

Alzheimer's Disease

What is Alzheimer's Disease?

Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually even the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear after age 65. Estimates vary, but experts suggest that as many as 5 million Americans age 65 and older may have Alzheimer’s disease. Alzheimer’s disease is the most common cause of dementia among older people. Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities, to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.

What are some symptoms of Alzheimer's?

Memory problems are typically one of the first warning signs of cognitive loss, possibly due to the development of Alzheimer’s disease. Some people with memory problems have a condition called amnestic mild cognitive impairment (MCI). People with this condition have more memory problems than normal for people their age, but their symptoms are not as severe as those seen in people with Alzheimer’s disease. Other recent studies have found links between some movement difficulties and MCI. Researchers also have seen links between MCI and some problems with the sense of smell. The ability of people with MCI to perform normal daily activities is not significantly impaired. However, more older people with MCI, compared with those without MCI, go on to develop Alzheimer’s. A decline in other aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment, may also signal the very early stages of Alzheimer’s disease. Scientists are looking to see whether brain imaging and biomarker studies, for example, of people with MCI and those with a family history of Alzheimer’s, can detect early changes in the brain like those seen in Alzheimer’s. Initial studies indicate that early detection using biomarkers and imaging may be possible, but findings will need to be confirmed by other studies before these techniques can be used to help with diagnosis in everyday medical practice. These and other studies offer hope that someday we may have tools that could help detect Alzheimer’s early, track the course of the disease, and monitor response to treatments.

The different stages of Alzheimer's

Stage 1 – Mild/Early (lasts 2-4 yrs) – Frequent recent memory loss, particularly of recent conversations and events. Repeated questions, some problems expressing and understanding language. Mild coordination problems: writing and using objects becomes difficult. Depression and apathy can occur, accompanied by mood swings. Need reminders for daily activities, and may have difficulty driving.
Stage 2 – Moderate/Middle (lasts 2-10 yrs) – Can no longer cover up problems. Pervasive and persistent memory loss, including forgetfulness about personal history and inability to recognize friends and family. Rambling speech, unusual reasoning, and confusion about current events, time, and place. More likely to become lost in familiar settings, experience sleep disturbances, and changes in mood and behavior, which can be aggravated by stress and change. May experience delusions, aggression, and uninhibited behavior. Mobility and coordination is affected by slowness, rigidity, and tremors. Need structure, reminders, and assistance with the activities of daily living.
Stage 3 – Severe/Late (lasts 1-3+ yrs) – Confused about past and present. Loss of ability to remember, communicate, or process information. Generally incapacitated with severe to total loss of verbal skills. Unable to care for self. Falls possible and immobility likely. Problems with swallowing, incontinence, and illness. Extreme problems with mood, behavior, hallucinations, and delirium. In this stage, the person will need round the clock intensive support and care.

What are the signs when you should seek medical attention?

For many people, detecting the first signs of memory problems in themselves or a loved one brings an immediate fear of Alzheimer’s disease. However, most people over 65 experience some level of forgetfulness. It is normal for age-related brain shrinkage to produce changes in processing speed, attention, and short term memory, creating so-called "senior moments"