TONSILITIS

What is Tonsillitis?

Tonsillitis (ton-sil-lie-tiss) is an inflammation of the tonsils caused by an infection. In tonsillitis, the tonsils are enlarged, red, and often coated (either partly or entirely) by a substance that is yellow, gray, or white. Tonsillitis usually occurs as part of a pharyngitis (throat infection). Tonsillitis usually begins with sudden sore throat and painful swallowing.

Sometimes, tonsillitis reoccurs, and may cause difficulty breathing. If this occurs, your doctor may recommend taking them out. This procedure of removing tonsils from the throat is called a tonsillectomy.

What are Tonsils?

The tonsils are fleshy clusters of tissue that lie in bands on both sides of the back of the throat, above and behind the tongue. The tonsils' major function is to catch incoming germs before the germs cause infections in the throat, mouth, or sinuses. Tonsils contain infection-fighting cells and antibodies that stop the spread of the germs further into the body.

If the tonsils are taken out, the individual will not suffer from more infections than they did when they had their tonsils. There are other tissues in the body that will produce antibodies to fight infection.

What are the symptoms of Tonsillitis?

Each person with tonsillitis may not experience all of the symptoms. Some of the major symptoms of tonsillitis are:

• fever
• redder-than-normal tonsils
• chills
• a yellow or white coating on the tonsils
• a funny-sounding voice
• swollen glands in the neck
• bad breath

How is Tonsillitis diagnosed?

Tonsillitis can be diagnosed by performing a rapid strep test, also called a throat culture. To perform the throat culture, the doctor will use a long cotton swab to swipe off some of the stuff on the surface of the back of your throat. The doctor will then test the "stuff" on the cotton swab. This test will determine whether you have tonsillitis and whether it is caused by a bacteria or a virus.

Is Tonsillitis Contagious?

Yes. Tonsillitis usually spreads from person to person by contact with the throat or nasal fluids of someone who is already infected.

How Is Tonsillitis Treated?

Treatment for tonsillitis depends on whether it was caused by a virus or bacteria. If the tonsillitis was caused by strep bacteria (streptococci), the doctor will prescribe antibiotics. If the tonsillitis was caused by a virus, your body will fight off the infection on its own.

How long does Tonsillitis Last?

If tonsillitis is caused by bacteria, with antibiotic treatment, the illness is usually cured within 1 week. However, it may take several weeks for the tonsils and swollen glands to return to normal size.

When tonsillitis is caused by viruses, the length of illness depends on which virus is involved. Usually, people are almost completely recovered within 1 week.

ALZHEIMER'S DISEASE

• DEFINITION

Alzheimer's disease is the most common cause of dementia — the loss of intellectual and social abilities severe enough to interfere with daily functioning. In Alzheimer's disease, healthy brain tissue degenerates, causing a steady decline in memory and mental abilities.

Alzheimer's disease is not a part of normal aging, but the risk of the disorder increases with age. About 5 percent of people between the ages of 65 and 74 have Alzheimer's disease, while nearly half the people over the age of 85 have Alzheimer's.

Although there's no cure, treatments may improve the quality of life for people with Alzheimer's disease. Those with Alzheimer's — as well as those who care for them — need support and affection from friends and family to cope.

• SYMPTOM'S

Alzheimer's disease may start with slight memory loss and confusion, but it eventually leads to irreversible mental impairment that destroys a person's ability to remember, reason, learn and imagine.

Memory loss
Everyone has occasional lapses in memory. It's normal to forget where you put your car keys or to blank on the names of people whom you rarely see. But the memory problems associated with Alzheimer's disease persist and worsen. People with Alzheimer's may:

• Repeat things
• Often forget conversations or appointments
• Routinely misplace things, often putting them in illogical locations
• Eventually forget the names of family members and everyday objects

Problems with abstract thinking
People with Alzheimer's may initially have trouble balancing their checkbook, a problem that progresses to trouble recognizing and dealing with numbers.

Difficulty finding the right word
It may be a challenge for those with Alzheimer's to find the right words to express thoughts or even follow conversations. Eventually, reading and writing also are affected.

Disorientation
People with Alzheimer's disease often lose their sense of time and dates, and may find themselves lost in familiar surroundings.

Loss of judgment
Solving everyday problems, such as knowing what to do if food on the stove is burning, becomes increasingly difficult, eventually impossible. Alzheimer's is characterized by greater difficulty in doing things that require planning, decision making and judgment.

Difficulty performing familiar tasks
Once-routine tasks that require sequential steps, such as cooking, become a struggle as the disease progresses. Eventually, people with advanced Alzheimer's may forget how to do even the most basic things.

Personality changes
People with Alzheimer's may exhibit:

• Mood swings
• Distrust in others
• Increased stubbornness
• Social withdrawal
• Depression
• Anxiety
• Aggressiveness

• CAUSES
  

No one factor appears to cause Alzheimer's disease. Instead, scientists believe that it may take a combination of genetic, lifestyle and environmental factors to trigger the onset of symptoms. While the causes of Alzheimer's are poorly understood, its effect on brain tissue is clear. Alzheimer's disease damages and kills brain cells.

Two types of brain cell (neuron) damage are common in people who have Alzheimer's:

• Plaques. Clumps of a normally harmless protein called beta-amyloid may interfere with communication between brain cells. Although the ultimate cause of neuron death in Alzheimer's isn't known, mounting evidence suggests that the abnormal processing of beta-amyloid protein may be the culprit.
• Tangles. The internal support structure for brain cells depends on the normal functioning of a protein called tau. In people with Alzheimer's, threads of tau protein undergo alterations that cause them to become twisted. Many researchers believe this may seriously damage neurons, causing them to die.

• RISK FACTOR'S

Age
Alzheimer's usually affects people older than 65, but can, rarely, affect those younger than 40. Less than 5 percent of people between 65 and 74 have Alzheimer's. For people 85 and older, that number jumps to nearly 50 percent.

Heredity
Your risk of developing Alzheimer's appears to be slightly higher if a first-degree relative — parent, sister or brother — has the disease. Although the genetic mechanisms of Alzheimer's among families remain largely unexplained, researchers have identified several genetic mutations that greatly increase risk in some families.

Sex
Women are more likely than men are to develop the disease, in part because they live longer.

Mild cognitive impairment
People who have mild cognitive impairment have memory problems that are worse than what might be expected for people of their age, yet not bad enough to be classified as dementia. Many of those who have this condition go on to develop Alzheimer's disease.

Lifestyle
The same factors that put you at risk of heart disease may also increase the likelihood that you'll develop Alzheimer's disease. Examples include:

• High blood pressure
• High cholesterol
• Poorly controlled diabetes

And keeping your body fit isn't your only concern — you've got to exercise your mind as well. Some studies have suggested that remaining mentally active throughout your life, especially in your later years, reduces the risk of Alzheimer's disease.

Education levels
Studies have found an association between less education and the risk of Alzheimer's. But the precise reason why this occurs is unknown. Some researchers theorize that the more you use your brain, the more synapses you create, which provides a greater reserve as you age. But it may simply be harder to detect Alzheimer's in people who exercise their minds frequently or who have more education.

• TESTS AND DIAGNOSIS

Doctors can accurately diagnose 90 percent of Alzheimer's cases. Alzheimer's disease can be diagnosed with complete accuracy only after death, when microscopic examination of the brain reveals plaques and tangles.

To help distinguish Alzheimer's disease from other causes of memory loss, doctors typically rely on the following types of tests.

Lab tests
Blood tests may be done to help doctors rule out other potential causes of the dementia, such as thyroid disorders or vitamin deficiencies.

Neuropsychological testing
Sometimes doctors undertake a more extensive assessment of thinking and memory skills. This type of testing, which can take several hours to complete, is especially helpful in trying to detect Alzheimer's and other dementias at an early stage.

Brain scans
By looking at images of the brain, doctors may be able to pinpoint any visible abnormalities — such as clots, bleeding or tumors — that may be causing signs and symptoms. Positron emission tomography (PET) can reveal areas of the brain that may be less active and the density of amyloid plaques.

• Magnetic resonance imaging (MRI). An MRI machine uses radio waves and a strong magnetic field to produce detailed images of your brain. You lie on a narrow table that slides into the tube-shaped MRI machine, which makes loud banging noises during scans. The entire procedure can take an hour or more. MRIs are painless, but some people feel claustrophobic in the machine.
• Computerized tomography (CT). For a CT scan, you lie on a narrow table that slides into a small chamber. X-rays pass through your body from various angles, and a computer uses this information to create cross-sectional images, or slices, of your brain. The test is painless and takes about 20 minutes.
• Positron emission tomography (PET). During a PET scan, you'll be injected with a low-level radioactive material, which binds to chemicals that travel to the brain. You lie on a table while an overhead scanner tracks the radioactive material. This helps show which parts of your brain aren't functioning properly. The test is painless and can be particularly useful in distinguishing between different types of dementia.

• TREATMENT'S

Currently, there's no cure for Alzheimer's disease. Doctors sometimes prescribe drugs to improve signs and symptoms that often accompany Alzheimer's, including sleeplessness, wandering, anxiety, agitation and depression. But only two varieties of medications have been proved to slow the cognitive decline associated with Alzheimer's.

Cholinesterase inhibitors
This group of medications — which includes donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) — works by improving the levels of neurotransmitters in the brain. But cholinesterase inhibitors don't work for everyone. As many as half the people who take these drugs show no improvement. Other people may choose to stop taking the drugs because of the side effects, which include diarrhea, nausea and vomiting.

Memantine (Namenda)
The first drug approved to treat moderate to severe stages of Alzheimer's, memantine protects brain cells from damage caused by the chemical messenger glutamate. It sometimes is used in combination with a cholinesterase inhibitor. Memantine's most common side effect is dizziness, although it also appears to increase agitation and delusional behavior in some people.

• COMPLICATION'S

In advanced Alzheimer's disease, people may lose all ability to care for themselves. This can make them more prone to additional health problems such as:

• Pneumonia. Difficulty swallowing food and liquids may cause people with Alzheimer's to inhale (aspirate) some of what they eat and drink into their airways and lungs, which can lead to pneumonia.
• Infections. Urinary incontinence may require the placement of a urinary catheter, which increases the risk of urinary tract infections. Untreated urinary tract infections can lead to more-serious, life-threatening infections.
• Injuries from falls. People with Alzheimer's may become disoriented, increasing their risk of falls. Falls can lead to fractures. In addition, falls are a common cause of serious head injuries, such as bleeding in the brain.

PARKINSON'S DISEASE

• DEFINITION

Parkinson's disease develops gradually, often starting with a barely noticeable tremor in just one hand. But while tremor may be the most well-known sign of Parkinson's disease, the disorder also commonly causes a slowing or freezing of movement.

Friends and family may notice that your face shows little or no expression and your arms don't swing when you walk. Speech often becomes soft and mumbling. Parkinson's symptoms tend to worsen as the disease progresses.

While there is no cure for Parkinson's disease, many different types of medicines can treat its symptoms. In some cases, your doctor may suggest surgery.

• CAUSES

Many symptoms of Parkinson's disease result from the lack of a chemical messenger, called dopamine, in the brain. This occurs when the specific brain cells that produce dopamine die or become impaired. But researchers still aren't certain about what sets this chain of events in motion. Some theorize that genetic mutations or environmental toxins may play a role in Parkinson's disease.

• RISK FACTOR'S

Risk factors for Parkinson's disease include:

• Age. Young adults very rarely experience Parkinson's disease. It ordinarily begins in middle or late life, and the risk continues to increase with age.
• Heredity. Having one or more close relatives with Parkinson's increases the chances that you'll also develop the disease, although your risk is still less than 5 percent. Recent evidence suggests a crucial role for small contributions from many different genes that program brain architecture.
• Sex. Men are more likely to develop Parkinson's disease than women are.
• Exposure to toxins. Ongoing exposure to herbicides and pesticides puts you at slightly increased risk of Parkinson's.

• SYMPTOMS

The symptoms of Parkinson's disease vary from person to person. Early signs may be subtle and can go unnoticed for months or years. Symptoms typically begin on one side of the body and usually remain worse on that side. Parkinson's signs and symptoms may include:

• Tremor. The characteristic shaking associated with Parkinson's disease often begins in a hand. A back-and-forth rubbing of your thumb and forefinger, known as pill-rolling, is common. However, many people with Parkinson's disease do not experience substantial tremor.
• Slowed motion (bradykinesia). Over time, Parkinson's disease may reduce your ability to initiate voluntary movement. This may make even the simplest tasks difficult and time-consuming. When you walk, your steps may become short and shuffling. Or your feet may freeze to the floor, making it hard to take the first step.
• Rigid muscles. Muscle stiffness often occurs in your limbs and neck. Sometimes the stiffness can be so severe that it limits the range of your movements and causes pain.
• Impaired posture and balance. Your posture may become stooped as a result of Parkinson's disease. Imbalance also is common, although this is usually mild until the later stages of the disease.
• Loss of automatic movements. Blinking, smiling and swinging your arms when you walk are all unconscious acts that are a normal part of being human. In Parkinson's disease, these acts tend to be diminished and even lost. Some people may develop a fixed staring expression and unblinking eyes. Others may no longer gesture or seem animated when they speak.
• Speech changes. Many people with Parkinson's disease have problems with speech. You may speak more softly, rapidly or in a monotone, sometimes slurring or repeating words, or hesitating before speaking.
• Dementia. In the later stages of Parkinson's disease, some people develop problems with memory and mental clarity. Alzheimer's drugs appear to alleviate some of these symptoms to a mild degree.

• TEST'S & DIAGNOSIS

No definitive tests exist for Parkinson's disease, so it can be difficult to diagnose, especially in the early stages. And parkinsonism — the symptoms of Parkinson's disease — can be caused by many other types of problems. Examples include:

• Other neurological disorders. Essential tremor, dementia with Lewy bodies, multiple system atrophy and progressive supranuclear palsy each feature some symptoms common to Parkinson's disease.
• Drugs. Antipsychotic medications — such as chlorpromazine (Thorazine) and haloperidol (Haldol) — block dopamine, as do anti-nausea drugs like prochlorperazine (Compazine) or metoclopramide (Reglan). If you take any of these drugs, you may develop parkinsonism, although it is reversible when the drug is stopped.
• Toxins. Exposure to carbon monoxide, cyanide or certain other toxins can produce symptoms similar to Parkinson's disease.
• Head trauma. Both solitary head injuries and the repetitive variety of head trauma common in boxing have been linked to parkinsonism, although risks are small.
• Structural problems. Strokes or fluid buildup in the brain (hydrocephalus) may occasionally mimic Parkinson's disease.

A diagnosis of Parkinson's disease is based on your medical history and a neurological examination. As part of your medical history, your doctor will want to know about any medications you take and whether you have a family history of Parkinson's. The neurological examination includes an evaluation of your walking and coordination, as well as some simple hand tasks.

A diagnosis of Parkinson's is most likely if you have:

• At least two of the three cardinal Parkinson's symptoms — tremor, slowing of motion and muscle rigidity
• Onset of symptoms on only one side of the body
• Tremor more pronounced at rest, for example, when your hands are resting in your lap
• Strong response to levodopa, a Parkinson's drug

• TREATMENT'S

Your initial response to Parkinson's treatment can be dramatic. Over time, however, the benefits of drugs frequently diminish or become less consistent, although symptoms can usually still be fairly well controlled. Your doctor may recommend lifestyle changes, such as physical therapy, a healthy diet and exercise, in addition to medications. In some cases, surgery may be helpful.

Medications
Medications can help manage problems with walking, movement and tremor by increasing the brain's supply of dopamine. Taking dopamine itself is not helpful, because it is unable to enter your brain.

• Levodopa. The most effective Parkinson's drug is levodopa, which is a natural substance that we all have in our body. When taken by mouth in pill form, it passes into the brain and is converted to dopamine. Levodopa is combined with carbidopa to create the combination drug Sinemet. The carbidopa protects levodopa from premature conversion to dopamine outside the brain; in doing that, it also prevents nausea. In Europe, levodopa is combined with a similar substance, benserazide, and is marketed as Madopar.

  As the disease progresses, the benefit from levodopa may become less stable, with a tendency to wax and wane ("wearing off"). This then requires medication adjustments. Levodopa side effects include confusion, delusions and hallucinations, as well as involuntary movements called dyskinesia. These resolve with dose reduction, but sometimes at the expense of reduced parkinsonism control.

• Dopamine agonists. Unlike levodopa, these drugs aren't changed into dopamine. Instead, they mimic the effects of dopamine in the brain and cause neurons to react as though dopamine is present. They are not nearly as effective in treating the symptoms of Parkinson's disease. However, they last longer and are often used to smooth the sometimes off-and-on effect of levodopa.

  This class includes pill forms of dopamine agonists, pramipexole (Mirapex) and ropinirole (Requip), as well as a patch form, rotigotine (Neupro). Pergolide (Permax) has been withdrawn from the market because of its association with heart valve problems. A short-acting injectable dopamine agonist, apomorphine (Apokyn), is used for quick relief.

  The side effects of dopamine agonists include those of carbidopa-levodopa, although they're less likely to cause involuntary movements. However, they are substantially more likely to cause hallucinations, sleepiness or swelling. These medications may also increase your risk of compulsive behaviors such as hypersexuality, compulsive gambling and compulsive overeating. If you are taking these medications and start behaving in a way that's out of character for you, talk to your doctor.

• MAO B inhibitors. These types of drugs, including selegiline (Eldepryl) and rasagiline (Azilect), help prevent the breakdown of both naturally occurring dopamine and dopamine formed from levodopa. They do this by inhibiting the activity of the enzyme monoamine oxidase B (MAO B) — the enzyme that metabolizes dopamine in the brain. Side effects are rare but can include serious interactions with other medications, including drugs to treat depression and certain narcotics.
• Catechol O-methyltransferase (COMT) inhibitors. These drugs prolong the effect of carbidopa-levodopa therapy by blocking an enzyme that breaks down levodopa. Tolcapone (Tasmar) has been linked to liver damage and liver failure, so it's normally used only in people who aren't responding to other therapies. Entacapone (Comtan) doesn't cause liver problems and is now combined with carbidopa and levodopa in a medication called Stalevo.
• Anticholinergics. These drugs have been used for many years to help control the tremor associated with Parkinson's disease. A number of anticholinergic drugs, such as trihexyphenidyl and benztropine (Cogentin), are available. However, their modest benefits may be offset by side effects such as confusion and hallucinations, particularly in people over the age of 70. Other side effects include dry mouth, nausea, urine retention — especially in men with an enlarged prostate — and severe constipation.
• Antivirals. Doctors may prescribe amantadine (Symmetrel) alone to provide short-term relief of mild, early-stage Parkinson's disease. It also may be added to carbidopa-levodopa therapy for people in the later stages of Parkinson's disease, especially if they have problems with involuntary movements (dyskinesia) induced by carbidopa-levodopa. Side effects include swollen ankles and a purple mottling of the skin.

Physical therapy
Exercise is important for general health, but especially for maintaining function in Parkinson's disease. Physical therapy may be advisable and can help improve mobility, range of motion and muscle tone. Although specific exercises can't stop the progress of the disease, improving muscle strength can help you feel more confident and capable. A physical therapist can also work with you to improve your gait and balance. A speech therapist or speech pathologist can improve problems with speaking and swallowing.

Surgery
Deep brain stimulation is the most common surgical procedure to treat Parkinson's disease. It involves implanting an electrode deep within the parts of your brain that control movement. The amount of stimulation delivered by the electrode is controlled by a pacemaker-like device placed under the skin in your upper chest. A wire that travels under your skin connects the device, called a pulse generator, to the electrode.

Deep brain stimulation is most often used for people who have advanced Parkinson's disease who have unstable medication (levodopa) responses. It can stabilize medication fluctuations and reduce or eliminate involuntary movements (dyskinesias). Tremor is especially responsive to this therapy. Deep brain stimulation doesn't help dementia and may make that worse.

Like any other brain surgery, this procedure has risks — such as brain hemorrhage or stroke-like problems. Infection also may occur, requiring parts of the device to be replaced. In addition, the unit's battery beneath the skin of the chest wall must be surgically replaced every few years. Deep brain stimulation isn't beneficial for people who don't respond to carbidopa-levodopa.