Diabetic neuropathy (nerve damage). This makes it hard for your nerves to send messages to your brain and other parts of the body. You may lose feeling in parts of your body or have a painful, tingling, or burning feeling. Neuropathy most often affects the feet and legs. If you have neuropathy, you may not be able to feel a sore on your foot. The sore can become infected. In serious cases, the foot may have to be amputated (removed). People who have neuropathy may continue walking on a foot that has damaged joints or bones. This can lead to a condition called Charcot foot. Charcot foot causes swelling and instability in the injured foot. It can also cause the foot to become deformed. However, this problem can often be avoided. Check your feet every day. See your doctor immediately if you see swelling, redness, and feel warmth in your foot. These can be signs of Charcot foot. Your doctor should also check your feet frequently. Neuropathy also can cause erectile dysfunction in men and vaginal dryness in women.
As a first step, rest, heat/cold applications, and topical pain creams can be helpful. For osteoarthritis, the over-the-counter food supplements glucosamine and chondroitin have been helpful for some, though their benefits are still controversial according to national research studies. These supplements are available in pharmacies and health-food stores without a prescription. If patients do not benefit after a three-month trial, I tell them that they may discontinue these supplements. The manufacturers sometimes make claims that these supplements "rebuild" cartilage. This claim has not been adequately verified by scientific studies to date.
Some forms of arthritis are more of an annoyance than a serious medical problem. However, millions of people suffer daily with pain and disability from arthritis or its complications. Moreover, many of the forms of arthritis, because they are rheumatic diseases, can cause symptoms affecting various organs of the body that do not directly involve the joints.
Arthritis that is characterized by a misdirected, overactive immune system (such as rheumatoid arthritis or ankylosing spondylitis) frequently requires medications that suppress the immune system. Medications such as methotrexate (Rheumatrex, Trexall) and sulfasalazine (Azulfidine) are examples. Newer medications that target specific areas of immune activation are referred to as biologics (or biological response modifiers). Sometimes combinations of medications are used. All of these medications require diligent, regular dosing and monitoring.
Studies in type 1 patients have shown that in intensively treated patients, diabetic eye disease decreased by 76%, kidney disease decreased by 54%, and nerve disease decreased by 60%. More recently the EDIC trial has shown that type 1 diabetes is also associated with increased heart disease, similar to type 2 diabetes. However, the price for aggressive blood sugar control is a two to three fold increase in the incidence of abnormally low blood sugar levels (caused by the diabetes medications). For this reason, tight control of diabetes to achieve glucose levels between 70 to120 mg/dl is not recommended for children under 13 years of age, patients with severe recurrent hypoglycemia, patients unaware of their hypoglycemia, and patients with far advanced diabetes complications. To achieve optimal glucose control without an undue risk of abnormally lowering blood sugar levels, patients with type 1 diabetes must monitor their blood glucose at least four times a day and administer insulin at least three times per day. In patients with type 2 diabetes, aggressive blood sugar control has similar beneficial effects on the eyes, kidneys, nerves and blood vessels.
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Cancer is the uncontrolled growth of abnormal cells anywhere in a body. These abnormal cells are termed cancer cells, malignant cells, or tumor cells. These cells can infiltrate normal body tissues. Many cancers and the abnormal cells that compose the cancer tissue are further identified by the name of the tissue that the abnormal cells originated from (for example, breast cancer, lung cancer, colorectal cancer). Cancer is not confined to humans; animals and other living organisms can get cancer. Below is a schematic that shows normal cell division and how when a cell is damaged or altered without repair to its system, the cell usually dies. Also shown is what occurs when such damaged or unrepaired cells do not die and become cancer cells and show uncontrolled division and growth -- a mass of cancer cells develop. Frequently, cancer cells can break away from this original mass of cells, travel through the blood and lymph systems, and lodge in other organs where they can again repeat the uncontrolled growth cycle. This process of cancer cells leaving an area and growing in another body area is termed metastatic spread or metastasis. For example, if breast cancer cells spread to a bone, it means that the individual has metastatic breast cancer to bone. This is not the same as "bone cancer," which would mean the cancer had started in the bone.
Large-scale mutations involve the deletion or gain of a portion of a chromosome. Genomic amplification occurs when a cell gains copies (often 20 or more) of a small chromosomal locus, usually containing one or more oncogenes and adjacent genetic material. Translocation occurs when two separate chromosomal regions become abnormally fused, often at a characteristic location. A well-known example of this is the Philadelphia chromosome, or translocation of chromosomes 9 and 22, which occurs in chronic myelogenous leukemia and results in production of the BCR-abl fusion protein, an oncogenic tyrosine kinase.
Based on history cannabis is believed to have originated from Central Asia. Cannabis is one of the oldest plant medicines known to man. It is difficult to trace the beginnings of cannabis use use by humans because it was cultivated and consumed long before the appearance of writing. According to archeological discoveries, cannabis has been known in China since the Neolithic period, around 4000 BC.
Rheumatologists have particular skills in the evaluation of the over 100 forms of arthritis and have special interests in inflammatory arthritis such as rheumatoid arthritis, seronegative arthritis, spondylitis, psoriatic arthritis, systemic lupus erythematosus, antiphospholipid syndrome, Still's disease, dermatomyositis, Sjögren's syndrome, vasculitis, scleroderma, mixed connective tissue disease, sarcoidosis, Lyme disease, osteomyelitis, osteoarthritis, back pain, gout, pseudogout, relapsing polychondritis, Henoch-Schönlein purpura, serum sickness, reactive arthritis, Kawasaki disease, fibromyalgia, erythromelalgia, Raynaud's disease, growing pains, iritis, osteoporosis, reflex sympathetic dystrophy, and others.
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