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Just what is the Smart Pill?

The Smart Pill Capsule Study will help your Doctor determine if you have a condition called gatroparesis which is a condition that may delay food from emptying out of your stomach. It allows the Doctors to see how long it takes food to travel through your stomach and intestines. You will swallow a vitamin-sized capsule the will send measurements of ph, temperature throught your GI tract to a data recorder that you will wear for the duration of the test which can last as long as 5 days.

What to expect during the test: You will eat a Smart Bar, they say just like a granola bar but it is gritty and chewy and not easy to eat when you already feel nauseated, suffering from Gerd, esophagitis and unable to eat, now you have to eat this gritty bar, But I used mind over madder in this situation. Then they give you the smart pill, which is the largest size pill I have seen if you bend your head down its easier to swallow. Then fast again for 6 hours, you wear the data recorder during the entire test. The hardest part, you can’t take your normal medications, like the ones that keep you from throwing up, gerd, acid reducer, pain meds, tums ect. This is before and during the test. You should be able to excrete the pill with in 2 days, If not MRI to find out where it is and how they are going to get it out.

My experience has not been easy to say the least, Non stop nausea, fullness, esophagitis, Gerd, a sense of feeling of full from the moment I ate the bar, I am miserable, can’t sleep, can’t eat, barely drink. But only 4 more days. thank god for music and meditation. But I am hoping this test will help the Doctors figure out what’s going on with my tummy so I can eat and start get stronger again.


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Think before you go under the knife!!! 5 common complaints after surgery!

Anesthesia is a medication for surgical patients that produces a temporary, artificial state of consciousness or loss of physical sensation. Anesthesia is helpful during medical procedures like surgery, tooth extraction or other painful medical procedures. It is necessary when people are having an operation, because of the potential for extreme pain and discomfort. People may even die if they undergo major surgery without anesthesia. That is why doctors must administer anesthesia for many medical procedures.

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What are the Types of Anesthesia?
The medical specialist who administers anesthesia is called an anesthesiologist. There are three main types of anesthesia, including:
Local: This is local numbing of a small area.
Regional: This causes half of the body to become numb and paralyzed for a certain amount of time.
General: This creates a complete loss of consciousness.
What type of anesthesia a doctor decides on depends on what the issue is and what procedure the patient will have. Anesthesia is given to a patient via inhalation or intravenously.
When people have a severe accident and parts of their bodies are badly damaged, anesthesia is helpful. Medical personnel oftentimes administer it before they can deliver treatment for any other issues because it diminishes pain instantly and it makes your body relax more.

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Another use for anesthesia is for mothers who have difficulty delivering their baby. The doctor may resort to performing a cesarean section where they surgically remove the baby from the womb. Often in these situations, anesthesia numbs the lower half of the mother’s body, so she can’t feel any pain whatsoever or move her legs. However, she is still conscious and aware of everything that is happening.
Before the anesthesiologist administers anesthesia, they talk to the patient and studies their medical history, such as allergies. Patients have to sign a form of consent before the process even begins. For people who are minors, their parent or guardian needs to sign the consent form. An adult also has to be present during the procedure, just in case there is an emergency. After surgery, patients receive medication to help their body deal with the side effects of anesthesia.
As helpful as it is, there are some common side effects of anesthesia you should know about. Read on to learn more about them, as well as how to avoid them.

Nausea and Vomiting
Depending on the type of surgery, nausea and vomiting can occur. This side effect usually clears up after 24 hours. Vomiting and nausea can also occur after a patient endures an uncomfortable position for a long time. Medical experts call this postoperative nausea and vomiting. This feeling might continue for a couple of days, depending on the way your body reacts to the anesthesia drugs.
This process of nausea and vomiting is uncomfortable. A patient can lose weight and become dehydrated in the process. If you experience this, you need to drink lots of fluids. You should try to eat foods rich in vitamins and minerals to ensure your body stays strong. Having anesthesia is like consuming drugs and alcohol. It causes your body to produce more acids, which causes your blood to adapt to the situation. When the anesthesia stops, your body becomes confused and off-balance, which leads to nausea and vomiting.
People who often experience minor motion sickness may not experience this type of side effect for long because their body is accustomed to feeling nauseated. So, any nausea they may experience is usually short-lived because their bodies know how to adjust to the feeling. This can also apply to the women who have had morning sickness during their pregnancy.
Recent research studies suggest the people who experienced the most nausea and vomiting were female or those who have a severe problem with motion sickness. They also discovered that younger people are more affected, as well as non-smokers. Unfortunately, you can’t always avoid nausea and vomiting. However, by consuming the proper foods and liquids to stay hydrated and well-nourished, you can fight it and can get back to your normal self quickly.

During this period, the medical staff will provide you with energy-giving fluids like glucose to encourage your body to recover more quickly. However, you will not be able to take in any solid foods or excessive amounts of food because this could result in constipation.
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The process is medically known as hypothermia. Chills and shivering are also side effects that most people endure after coming out of surgery. The shivering process can cause a lot of discomfort for patients recovering from anesthesia. This is a normal process of your body when it is trying to be more comfortable and generate more heat. Patients must be careful because the movement of the shivering process can lead to damage to the freshly-sewn wound.
The post effects of anesthesia tend to hinder your body from generating heat. Vasodilatation or the opening of blood vessels decreases blood pressure. Vasodilatation for prolonged periods of time also tends to hinder your body’s ability to generate heat. After surgery, patients usually rest in comfortable, warm garments that don’t irritate surgical wounds. As for babies, regulating their movement is often necessary. There should be a guardian constantly at the baby’s side to reduce the risk of the baby injuring themselves from movement.
An Anesthesiology and Pain Medicine report discovered using ketamine and pethidine after a surgical procedure greatly lowers the rate of body shivering. They reported mild hypothermia is more present during this process. This mostly occurs after the body tries to redistribute the energy to stop vasodilatation. This side effect is more common in males than in females, because their skin is more sensitive and generates heat much faster.

Sore Throat
Sore throats tend to come about due to bacteria, from colds and flu, or even the lack of adequate water supply in the body. After surgery, patients tend to be dehydrated due to the inadequate water supply and blood flow in the body. Patients also experience dry mouth and mild hoarseness in the throat. Communicating can be rather difficult, and if you don’t receive water or any fluids immediately, you could collapse. However, this side effect is not life-threatening if you or your doctor tends to it early.

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Sore throats can also happen after the removal of the tube fixed with in the mouth and windpipe to enable patients to breathe during surgery. The body tends to react from the sudden change and irritation, so one may experience a sore throat and hoarseness. This usually happens in the first four to six hours after surgery. It usually occurs with general anesthesia where the patient becomes completely unconscious. Sore throats are uncomfortable, so seek medical attention if you experience this discomfort for more than a day.
Medical doctors normally talk to patients and describe the symptoms that may arise from anesthesia, such as a sore throat. Sore throats for children who haven’t mastered fluent speaking is also dangerous. They may even end up not being able to pronounce some words for the rest of their lives. A research published in 2013 in the American Association of Nurse Anesthetists journal highlighted all the risk factors that arise after surgery to the throat. The most dangerous of them is the loss of throat function, which can lead to throat surgery.
People over the age of 60 also suffer from sore throats due to weaker bodies. They commonly get medicine to reduce sore throat symptoms. Elderly people who use a throat pack or endotracheal tube need to consider the use of medicines that lessen the pain in the body. However, when having regional surgery, doctors can avoid sore throats by inserting a smaller tube during the surgical procedure.
A headache is the feeling of pain and/or pressure in the head or the brain. Headaches can affect your eyes, ears or nose if the pain is extreme. They tend to make people uncomfortable and unhappy. Continuous headaches can lead to complications like internal bleeding in the brain, amnesia, meningitis and exhaustion. It is normal to encounter headaches and dizziness immediately after surgery. This is because the blood supply to the head needs to get back to normal after the surgical process, because it is lacking an adequate supply of oxygen.

This feeling often occurs shortly after general or regional anesthesia. Headaches often happen when undergoing surgeries like caesarian sections, hip replacements or operations that involve lower parts of the body. These headaches are the result of leaking spinal fluids during the injection process.
It does not lead to any complications, but if the anesthesiologist injects the wrong part of the spinal cord, you could end up not being able to bend again. It could also reduce your back strength. Sometimes, a patient can end up in a coma due to excessive leakage of spinal fluids in the body.
The loss of the spinal fluids leads to internal pressure in the brain. Headaches can occur as a result. Decreased pressure in the fluids that surround the brain and the spinal cord can lead to spinal headaches. Patients often experience this type of a headache 12 to 14 hours after surgery.
Medical personnel will monitor surgical patients to help them avoid the horrible side effects from excess pain, and possibly even brain damage if left untreated.

In 2013, an article in The Caspian Journal of Internal Medicine found 18 percent of people who undergo regional surgery suffer from spinal leakage. Although this is a normal side effect, the results lead to spinal headaches. Postural headaches were also discovered to be a characteristic of spinal puncture headaches. Doctors often prescribe painkillers for patients to reduce the pain, which they can take before surgery to prevent headaches from happening in the first placeConfusion and Cognitive Decline
After a surgical procedure, patients experience a lot of trauma and pain, including headaches, sore throats and sometimes even the temporary loss of sight. This can lead to confusion in bodily functions. The brain the is most affected part in your body following surgery. This is because it is not oxygenated properly during the process. This lack of oxygen can cause patients to feel confused as their heart pumps blood at a greater pace into the brain vessels. This generally is what leads to confusion and disorientation in the body.
People who come out of surgery tend to have impaired judgment, which can lead to making poor decisions. This makes what they do during this period void because it cannot be used against them in a court of law. Ladies who have undergone C-sections may try to kill their child or hurt them due to their impaired judgment. That is why hospital staff monitors them during this period as they might end up doing something they will regret in the future. This process of not thinking clearly is normal for a few days before the brain adapts to its normal routine.

For elderly people, the confusion can last up to four weeks, especially if the person is already suffering from memory loss. A medical study in 2002 revealed that prolonged postoperative memory loss is likely to affect women over the age of 40 who give birth by caesarian section. Men who undergo surgery over the age of 60 are likely to suffer from memory loss. If the body and brain are too weak, they may never recover from the confusion and memory loss. The rate of memory loss increases as the age increases, up to 80. People over the age of 80 could even return to behaving like infants.
For this reason, family members of elderly patients receive instructions and information on the possibility of permanent memory loss before they sign any consent form.

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Blastocystis! Say What?????

Here is a name of a new parasite, actually not new, but one that is not tested, The CDC recognizes it as a Parasite that effects your digestive tracks and causes Unbelievable digestive pain, can’t eat, diarrhea, intestinal pain, extreme fatigue and other symptoms, Now here is what I found was interesting is humans can have this parasite and live with and have no symtoms but for others it can be awful. As you will read in the article you will learn about this parasite. If you have animals you are more likely to get it. It is transferred through the animals feces. This Parasite unfortunately is not tested unless you ask, because our Dr’s don’t learn about it, but in other countries it is a routine test with stomach issues, digestive issues.

Blastocystis is a genus of single-celled heterokont parasites belonging to a group of organisms known as the Stramenopiles (also called Heterokonts) that includes algae, diatoms, and water molds. Blastocystis consists of several species, living in the gastrointestinal tracts of species as diverse as humans, farm animals, birds, rodents, reptiles, amphibians, fish, and cockroaches.[2] Blastocystis exhibits low host specificity, and many different species of Blastocystis can infect humans[3] and by current convention, any of these species would be identified as Blastocystis hominis.
Blastocystis is one of the most common human parasites in the world and has a global distribution.[4][5][6][7] It is the most common parasitic infection in the United States, where it infected approximately 23% of the total population during year 2000.[6][7] In less developed areas, infection rates as high as 100% have been observed.[4][5] High rates of infection are found in individuals in developed countries who work with animals.[5][8] Although the role of Blastocystis hominis in human disease is often referred to as controversial, a systematic survey of research studies conducted by 11 infectious disease specialists from nine countries, found that over 95% of papers published in the 10 years prior identified it as causing illness in immunocompetent individuals.[7] The paper attributed confusion over pathogenicity to the existence of asymptomatic carriers, a phenomenon the study noted is common to all gastrointestinal protozoa.[7]

1 Classification
2 Signs and symptoms
3 Taxonomy
4 Epidemiology
4.1 Transmission
4.2 Reservoir
5 Morphology
6 Life cycle
7 Obtaining and culturing Blastocystis
8 See also
9 References
10 External links

The appropriate classification of Blastocystis has only recently been resolved. The original description of Blastocystis was as a yeast due to its yeast-like glistening appearance in fresh wet mounts and the absence of pseudopodia and locomotion.[9] This was then contradicted by Zierdt,[10] who reclassified it under subphylum Sporozoa (and later in Sarcodina), based on some distinctive protistan features of the Blastocystis cell, such as the presence of nuclei, smooth and rough endoplasmic reticulum, Golgi complex, and mitochondrion-like organelles. Its sensitivity to antiprotozoal drugs and its inability to grow on fungal media further indicated that it was a protozoan.
However, major revisions were made to its classification. An analysis of gene sequences was performed in 1996, which placed it into the group Stramenopiles.[11][12] Other Stramenopiles include brown algae, mildew, diatoms, the organism that caused the Irish potato famine, and the organism responsible for Sudden oak death disease. However, the position of Blastocystis within the stramenopiles remains enigmatic.[13]
Signs and symptoms
See also: Blastocystosis
Most published studies have reported that between 50% and 80% of individuals mono-infected with Blastocystis will show symptoms.[14][15] Factors influencing presentation of symptoms have been listed as the patient’s age, with younger patients less likely to show symptoms, as well genetic changes that influence the production of cytokines.[16] Some studies have suggested that pathogenicity may be linked to specific subtypes of Blastocystis[17] and experimental infection of animals has reported varying degrees of illness depending on the subtype used.[18] While some subtypes appear to be less likely to result in symptomatic infection, those subtypes are also found in symptomatic individuals who have no other infection found.[16] Symptoms associated with the infection are diarrhea,constipation, nausea, abdominal cramps, bloating, excessive gas, and anal itching.[19] Most cases of the infection appear to become diagnosed as irritable bowel syndrome, according to studies from Denmark,[20] Pakistan, the United Kingdom, and Italy.[7] The timescale of infection with the parasite can range from weeks to years.[21] In the early 2000s, Egyptian physicians identified 84 patients with diarrhea and enteritis apparently caused by Blastocystis hominis. After three days of nitazoxanide treatment, symptoms cleared and no fecal organisms were detectable in 36 (86%) of 42 treated patients and in 16 (38%) of 42 people who received placebo (P < .0001). the investigators concluded that either B hominis is pathogenic and can often be effectively treated with nitazoxanide, or that nitazoxanide (a drug approved by the FDA for the treatment of giardia and cryptosporidia) eradicated an unidentifiable organism.[22] Taxonomy For many years, scientists believed one species of Blastocystis infected humans, while different species of Blastocystis infected other animals. So they called Blastocystis from humans Blastocystis hominis and gave different species names to Blastocystis from other animals, for example Blastocystis ratti from rats. In recent years, various genetic analysis have shown that Blastocystis hominis as a unique entity does not exist, i.e. there is no single species of Blastocystis that infects humans.[3] In fact, a number of distinct genetic types of Blastocystis can infect humans, including those previously called Blastocystis ratti[23] and the differences are so great that they could be considered separate species. Because of this, in 2007 scientists proposed discontinuing the use of the term Blastocystis hominis. Their proposal was to refer to Blastocystis from humans and animals as Blastocystis sp. subtype nn where nn is a number assigned to each group according to the degree of genetic identity of the Blastocystis organisms, based on gene sequences, rather than the host that was infected.[24] At that time nine subtypes were known to infect mammals and birds, all of which had been found in humans. A tenth group was reported in China in 2007,[25] but a full analysis of its relationships has not yet been performed and it is not yet clear whether it is a group within a described subtype or a new subtype. A definite tenth subtype was then found in a variety of other mammals, including primates, but it has not as yet been found in humans.[26] There are now at least 13 genetically distinct small subunit ribosomal RNA lineages.[27] These additional subtypes were found in a variety of mammalian hosts (including elephants and giraffes) and it is very likely that more subtypes will be found as more hosts are surveyed. Epidemiology Blastocystis spp. prevalence in humans often exceeds 5% in industrialized countries.[28] In the United States, it infected approximately 23% of the total population during year 2000.[6][7] In less developed areas, infection rates with one or more subtypes are as high as 100%.[4][5] Transmission Fecal-oral transmission is the most accepted pathway, and recent studies have shown that transmission involves only the cyst form of the parasite.[29] The extent to which human-human, human-animal, and animal-human transmission occurs is still unknown. Genomic studies provide evidence for all three routes, though experimental studies have yet to provide conclusive proof for the existence of either.[30] Reservoir Conclusively stating that Blastocystis has an animal reservoir depends upon unraveling the true nature of its transmission. If, as Noël et al. deem likely based upon their own molecular work and a review of the literature, animal-to-human transmission is possible, then animals such as pigs and dogs could in fact be acting as a large reservoir capable of human infection.[31] Epidemiological studies finding that infection is more common in people living in proximity to farm animals or pets[21] further supports this notion. Morphology Blastocystis has various morphological forms. Four commonly described forms are the vacuolar (otherwise known as central body), granular, amoeboid, and cyst forms. The appearance of the organism is largely dependent upon environmental conditions as it is extremely sensitive to oxygen. Whether all of these forms exist in the host intestine is unclear. Vacuolar form The vacuolar form is the typical cell form of Blastocystis seen in culture and is often used for the identification of the organism. These vacuolar forms vary greatly in size, with diameters ranging between 2 µm and 200 µm. The vacuolar form is otherwise known as central body form because it has a large central vacuole surrounded by a thin band of peripheral cytoplasm which contains other organelles. Flocculent material has been described as being scattered unevenly throughout the vacuole. The function of the vacuole is still unclear, however, it has been suggested that, like for many eukaryotic cells, it is for storage purposes. Other functions, such as cell division during reproduction and the deposition of apoptotic bodies, have been proposed, although more tests need to be done to validate these roles. Four common forms of Blastocystis hominis. Clockwise from top left: vacuolar, granular, amoeboid, and cyst forms. Granular form The granular form is somewhat morphologically similar to the vacuolar forms except that distinct granules are observed in the central vacuole and / or cytoplasm. Within the central vacuole, these granules appear in different forms too. Three types were suggested – metabolic, lipid, and reproductive granules. Metabolic granules play a role in chemical processes that are necessary for the maintenance of life in the organism. It was also put forward that reproductive granules were involved in the development of progeny cells. These hypotheses were made based on microscopy alone, which may be deemed misleading, hence more need to be done before making a definite conclusion. It has also been suggested that the granules may be an indication that the cell is dying. Amoeboid form The other form that exists is the amoeboid form. The amoeboid form of Blastocystis is non-motile and strongly adhesive. A research study has reported that amoeboid forms are produced only in cultures taken from symptomatic individuals, with asymptomatic individuals producing exclusively vacuolar forms. The study suggested this method could be used for diagnosing symptomatic infection. Additionally, it suggested the symptoms could be due to the accumulation of the strongly adhesive amoeboid forms on the host's intestinal wall. A detailed ultra-structural study of amoeboid forms was published in 2007.[32] Cyst form The Blastocystis cyst form is a more recent discovery and has helped in the advancement of understanding the way the infection is transmitted. As compared to the other forms, it is generally smaller in size and has a thick multilayered cyst wall. It lacks a central vacuole and few nuclei, multiple vacuoles and food storage deposits were observed. The cyst form is the most resistant form of this parasite and is able to survive in harsh conditions because of its thick multilayered cyst wall. Experiments have been carried out to show its ability to withstand acidic gastric juices. Besides, the cysts did not lyse when placed in distilled water and could survive well at room temperature for up to 19 days, indicating its strong resistance.[33][34] Life cycle The supposed life cycle begins with ingestion of the cyst form. After ingestion, the cyst develops into other forms which may in turn re-develop into cyst forms. Through human feces, the cyst forms enter the external environment and are transmitted to humans and other animals via the fecal–oral route, repeating the entire cycle. Life cycle of Blastocystis proposed by Tan[35] Obtaining and culturing Blastocystis The ATCC maintains a collection of Blastocystis isolates. Some records show whether the isolates were obtained from symptomatic or asymptomatic carriers. As yet, no publication has identified the subtypes of most of the ATCC isolates, which are mostly axenic. Researchers have reported that patients with Irritable bowel syndrome may provide a reliable source for xenic Blastocystis isolates. Some researchers have reported being able to culture Blastocystis from 46% of IBS patients.[36] Researchers have described different culture mechanisms for growing Blastocystis. Colony growth on solid medium colonies on solid culture medium using a synthetic medium with added supplements have both been described.[37][38] However, most cultivation is performed in liquid media of various types.

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A letter to spread the word.

I wrote a letter to the Governor asking for help spreading the word about Vestibular dysfunction and I received a generic letter back. Look what I found in my spam folder. So excited. I am fighting for all of us and this spread the word. Knowledge is power.!!!!! If you would like to see bigger, please click on letter and you should be able to blow it up to bigger font size.


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Diabetes and Neuropathy

About Speaking of Diabetes

Speaking of Diabetes is produced by Joslin Diabetes Center for people with diabetes and those who care for them..

Joslin Diabetes Center, a teaching and research affiliate of Harvard Medical School, is a one-of-a-kind institution on the front lines of the world epidemic of diabetes – leading the battle to conquer diabetes in all forms through cutting-edge research and innovative approaches to clinical care and education.

Gastroparesis and Diabetes: Another Aspect of Neuropathy
Posted on June 26, 2015 by Joslin Communications
This entry was posted in Complications, Diabetes Day2Day and tagged gastroparesis, neuropathy. Bookmark the permalink.

Patients with long standing diabetes usually have some evidence of damage to the nervous system, or neuropathy. If you have neuropathy you may be familiar with pain, tingling, numbness or loss of feeling in the feet or hands (called peripheral neuropathy), but it can affect any organ system, including the stomach and its related organs.

Nerve damage associated within the gastrointestinal tract can result in the motility disorders of gastroparesis and small bowel bacterial overgrowth (SBBO). Gastroparesis is 2 to 3 times more common in type 1 diabetes than type 2 diabetes and may affect as many as 50 percent of those with type 1.

If you eat a low-fat, mixed meal your blood glucose will peak in about 1.5 hours. With normal bowel function, this peak coincides with the peak action of rapid acting insulin.

But damage to the nerves (the vagus nerve) of the gastrointestinal tract causes a loss of stomach and intestinal motor control. This can lead to a mismatch between when you digest food and glucose enters the blood stream and the action time of insulin.

If you have gastroparesis you may experience erratic blood glucose, with a pattern of low glucose readings shortly following the meal and elevated readings hours after eating.

Symptoms include nausea, early satiety, vomiting and in severe cases weight loss. Because of gastric stasis and slower bowel transit times, patients are also prone to constipation.

Gastroparesis is diagnosed by gastric emptying studies. In this test, patients are fed a meal containing a marker isotope and x-ray pictures are taken of the stomach over a 4 hour period.

Severe gastroparesis can lead to malnutrition due to continued vomiting and poor consumption of calories and protein. The goals of nutrition therapy are to prevent muscle loss, provide adequate vitamin and mineral intake, control blood glucose levels and relieve symptoms.

Nutrition recommendations include

1. Eat smaller, more frequent meals;

2. Consume more of your calories with liquids. Liquids pass more quickly than solids through the stomach;

3. Limit dietary fiber especially, for patients prone to bezoars (those are hairball like accumulations of hardened food fibers, and they can lead to obstruction of the passage from the stomach to the intestine)

4. Reduce dietary fats –especially solid fats – as they delay gastric emptying. Fats in liquid form appear better tolerated

5. Consume adequate calories to achieve or maintain a healthy weight

Other recommendations include:

1. Control of blood glucose- high levels (greater than 270 mg/dl) delay GI transit time.

2. Taking insulin after the meal or for patients using an insulin pump, use the extended action bolus.

3. Using a combination of prokinetic (movement stimulating) and antiemetic (anti nausea and vomiting) agents to improve gastric motility and control symptoms of nausea and vomiting.

For patients who do not find relief with the above measures, gastric electric stimulation can be attempted. A small pulse generator is placed under the skin and wires are attached to the stomach. The generator emits a small charge stimulating stomach emptying.

But, as always, talk to your doctor before making any changes to your diet or care.

More information about gastroparesis can be found on the NIH website.

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Let’s talk Vestibular Dysfunction

Dizziness is a general term that describes sensations of imbalance and unsteadiness, such as vertigo, mild turning, imbalance, and near fainting or fainting. Feelings of dizziness stem from the vestibular system, which includes the brain and the parts of the inner ear that sense position and motion, coupled with sensory information from the eyes, skin, and muscle tension.

Because dizziness is a general term for a variety of feelings of instability, it spans a large range of symptoms. These symptoms range from the most dramatic, vertigo, to the least severe, imbalance. Included in these feelings is fainting, which results in a loss of consciousness.

Vertigo is an acute feeling of violent rotation. People with vertigo often feel as if they are tilting or falling through space. Vertigo is most often caused by problems with the vestibular system of the inner ear. Symptoms can be brief, or may last for extended periods of time and may be accompanied by changes in pulse and blood pressure, perspiration, nausea, and a type of rapid eye movement called nystagmus.

Mild turning is a less violent type of vertigo. People with mild turning are still able to function in normal daily routines. However, a feeling of turning may continue for weeks. Mild turning is usually a symptom of inner ear dysfunction. It may also result from transient ischemic attack , or a lack of blood flow to the brain. People who have suffered from strokes may feel mild turning for periods of time. Mild turning may also be associated with multiple sclerosis , AIDS , or head trauma.

Imbalance is a feeling of instability or floating. It is associated with many general medical problems such as the flu or infection. Imbalance can also be associated with arthritis, especially in the neck, or another neurological problem.

Fainting is a sudden loss of consciousness and near fainting is a feeling of extreme light-headedness with a sinking or falling feeling. Vision usually becomes hazy or dimmed and the extremities become weak. Both fainting and near fainting are caused by lack of blood flow to the brain. Anything that causes a rapid drop in blood pressure, such as a heart attack or an insulin reaction in a diabetic, can result in fainting or near fainting. Panic attacks that cause a person to exhale a lot of carbon dioxide can cause fainting or near fainting.
Vestibular system

The vestibular system is the sensory system located in the inner ear that helps the body to maintain balance. Balance in the human body is coordinated by the brainstem, which, with speed and precision, collects information from other parts of the brain and sensory organs throughout the body. It is the brainstem that sends neurological instructions to the muscles and joints. The sensory organs that play critical roles relaying information to the brain-stem include the skin, eyes, muscles and joints, and the vestibular system in the inner ear. Dizziness may result with dysfunction in any of these components or in the nerves that connect them.

The cerebellum , which is responsible for coordination and the cerebral cortex, provides neurological information to the brainstem. For example, the cerebellum is the organ that informs the body how to shift weight when going down a flight of stairs and how to balance on a bicycle. These processes are accomplished without conscious thinking.

In order to maintain balance, the brainstem depends on input from sensory organs including the eyes, muscles, joints, skin and ears. This information is relayed to the brainstem via the spinal cord. The combined neurological receptor system, which involves the brainstem, spinal cord, and sensory organs, is called the proprioceptive system. Proprioceptive dysfunction may result in dizziness, and people with problems with their proprioceptive system may fall often. Additionally, as people age, problems with proprioception become more common.
Sensory organs

Visual information is of particular importance to maintaining balance. The visual systems most involved are the optokinetic and pursuit systems. The optokinetic system is the motor impulse responsible for moving the eyes when the head moves, so that the field of vision remains clear. The pursuit system allows a person to focus on a moving object while the head remains stationary. Both of these systems feed information about the person’s position relative to the surroundings to the brainstem. A specific type of eye movement called nystagmus, which is repetitive jerky movements of the eye, most often in the horizontal direction, may cause dizziness. Nystagmus may indicate that neurologic signals from the optokinetic or pursuit systems are not in agreement with the other balance information received by the brain.

Sensory information from muscles, joints, and skin plays a key role in balance. The muscles and joints of the human body are lined with sensory receptors that send neurological information about the position of the body to the brainstem. For example, receptors in the neck muscles tell the brain which way the head is turned. The skin, in particular the skin of the feet and buttocks, is covered with pressure sensors that relay information to the brain regarding what part of the body is touching the ground.
Peripheral vestibular system

The ear, particularly the inner ear, plays a critical role in maintaining balance. The inner ear contains two major parts: the cochlea, which is mostly used for hearing, and the vestibular apparatus, also known as the peripheral vestibular system, which is important in balance. A set of channels connects the two parts of the ear and therefore any disease that affects hearing may also affect balance, and vice versa.

The peripheral vestibular system consists of a series of canals and chambers, all of which are made of membranes. This membrane system is filled with a fluid called endolymph. The peripheral vestibular system is further embedded in the temporal bone of the skull. In the space between the temporal bone and the membranes of the peripheral vestibular system resides a second fluid called perilymph. Endolymph and perilymph each have a different chemical makeup consisting of varying concentrations of water, potassium, sodium, and other salts. Endolymph flows out of the peripheral vestiubular system into an endolymphatic sac and then diffuses through a membrane into the cerebrospinal fluid that bathes the brain. Peri-lymph flows out of the peripheral vestibular system and directly into the cerebrospinal fluid. When the flow pressures or chemical compositions of the endolymph and perilymph change, feelings of dizziness can occur. These types of changes may be related to Mèniére’s disease.

The vestibular apparatus is made up of two types of sensory organs: otolith organs and semicircular canals. The otolith organs sense the direction of gravity, while the semi-circular canals sense rotation and movement of the head.

Two otolith organs in each ear are called the saccule and the utricle. The saccule is oriented in a vertical direction when a person is standing and, best senses vertical motion of the head. The utricle is nearly horizontal when a person is standing, so it best senses horizontal motion of the head. Each organ consists of calcium carbonate crystals embedded in a gel. Special hair-producing cells extend into the gel from below. As the head moves, gravity and inertia cause the crystals to bend the hairs, which are in contact with nerves. Information on the position and motion of the head is thus relayed to the brain. If the hairs or the crystals in the otolith organs are damaged, feelings of dizziness may result.

In each ear, there are also three semicircular canals that lie on planes that are perpendicular to each other. The canals are connected together by a main chamber called a vestibule. The canals and the vestibule are filled with endolymph fluid. Near its connection to the vestibule, one end of each of the canals widens into a region called the ampulla. One side of the ampulla is lined with specialized sensory cells. These cells have hairlike structures that extend into a gelatinous structure called a cupula. As the head moves in a given plane, the endolymph inside the semicircular canal in that plane remains stationary due to inertia. The cupula, however, moves because it is attached to the head. This puts pressure on the cupula, which in turn moves the hairlike structures. The bending of the hairlike structures stimulates nerves, alerting the brain that the head is moving in a particular plane. By integrating information from all three planes in which the semicircular canals lie, the brain reconstructs the three-dimensional movement of the head. If information from one of the semicircular canals does not agree with that of another, or if the information generated by semicircular canals in one ear does not agree with the information produced by the other ear, feelings of dizziness may result.

All of the signals from the peripheral vestibular system travel to the brain along the eighth cranial nerve, also called the vestibular nerve. Damage to this nerve, either through head trauma or the growth of tumors, can also cause feelings of dizziness. Neurological information from the semicircular canals seems be more important to the brain than information from the otolith structures. If the eighth cranial nerve on one side of the head is damaged, but the other side remains intact, the brain learns to compensate over time; however, the mechanics involved in this process are not well understood.

Dizziness is an extremely common symptom occurring in people of all ages, ethnicities, and socioeconomic backgrounds. Balance disorders increase with age, and by age 75, dizziness is one of the most common reasons for visiting a doctor. In the general population, dizziness is the third most common reason that patients visit doctors. According to the National Institutes of Health (NIH), about 42% of the population of the United States will complain of dizziness at some point in their lives. In the United States, the cost of medical care for patients with symptoms of imbalance is estimated to be more than $1 billion per year.
Diseases associated with dizziness

Because it involves so many different parts of the body, the balance system may exhibit signs of dysfunction for a variety of reasons. Dizziness may be caused by problems with the central nervous system , the vestibular system, the sensory organs, including the eyes, muscles and joints, or more systemic disorders such as cardiovascular disease, bacterial and viral diseases, arthritis, blood disorders, medications, or psychological illnesses.
Central nervous system dysfunction

Any problem that affects the nerves leading to the brain from vestibular or sensory organs, the spinal cord, the cerebellum, the cerebral cortex, or the brainstem may result in dizziness. In particular, tumors that affect any of these organs are of concern. In addition, disorders that affect blood supply to the central nervous system, such as transient ischemic attacks, stroke , migraines, epilepsy , or multiple sclerosis, may result in feelings of dizziness.

BRAINTUMORS Although rare, acoustic neuroma is a benign tumor growing on the vestibulo-cochlear nerves, which reach from the inner ear to the brain. It may press as well on blood vessels that flow between the peripheral vestibular system and the brain. Symptoms included ringing in one ear, imbalance, and hearing loss. Distortion of words often becomes increased as the tumor grows and disturbs the nerve. Treatment requires surgical removal of the tumor, which nearly always returns the sense of balance to normal, although some residual hearing loss may occur.

Other brain tumors may also cause feelings of dizziness. These include tumors that originate in the brain tissue, such as meningiomas (benign tumors) and gliomas (malignant tumors). Sometimes tumors from other parts of the body may metastasize in the brain and cause problems with balance.

CEREBRAL ATROPHY Age causes atrophy (deterioration) of brain cells that may result in slight feelings of imbalance. More severe forms of dizziness may result from other neurological disorders.

BLOOD SUPPLY DISORDERS If the blood flow and oxygenation to the cerebellum, cerebral cortex, or brain-stem is not adequate, feelings of dizziness can result. Such symptoms can result from several types of disorders, including anemia, transient ischemic attacks (TIAs), and stroke.

TIAs are temporary loss of blood supply to the brain, often caused by arteriosclerosis (hardening of the arteries). In addition to a brief period of dizziness or vertigo, symptoms include a transient episode of numbness on one side of the body, and slurred speech and/or lack of coordination. If the loss of blood supply to the brain is due to a blockage in one of the arteries in the neck, surgery may correct the problem.

Strokes, or cerebrovascular accidents (CVA), occur in three major ways. A thrombotic stroke occurs when a fatty deposit forms a clot in an artery, blocking blood supply to the brain. An embolic stroke occurs when part of a clot from another part of the body breaks off and obstructs an artery leading to the brain. A hemorrhagic stroke occurs when blood vessels in the brain hemorrhage, leaving a blood clot in the brain.

PERIPHERAL VESTIBULAR SYSTEM DYSFUNCTION When balance problems are brief or intermittent, the peripheral vestibular system is usually the cause. Many different problems may be at the root of vestibular disorder.

BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) Benign paroxysmal positional vertigo occurs following an abrupt change in position of the head. Often, onset of vertigo occurs when patients roll from their back onto the side, and it usually subsides in less than a minute. BPPV can result from head trauma, degeneration of the peripheral vestibular system with age, infection of the respiratory tract, high blood pressure, or other cardiovascular diseases. Those who suffer from an infection of their vestibular system, causing severe vertigo that lasts up to several days, can develop BPPV any time within the next eight years. BPPV is also associated with migraine headaches .

Two theories on the cause of BPPV currently exist. One suggests that BPPV will occur when the calcium carbonate crystals in the otolith organs (the saccule and the utiricle) are displaced and become lodged in the cupula of the semicircular canals due to head trauma, infection, or degeneration of the inner ear canals. This displacement will stimulate the nerves from the semicircular canals when the head rotates in a particular position, indicating to the brain that the person is spinning. However, the rest of the sensory organs in the body report that the body is stationary. This conflicting information produces vertigo. The calcium carbonate crystals dissolve after a brief time, and the symptom is rectified. The second theory suggests that cellular debris accumulates into a mass that moves around the semicircular canals, exerting pressure on the cupula and causing vertigo. When the mass dissolves, the symptoms subside.

INNER EAR INFECTIONS Inner ear infection, or vestibular neuronitis, occurs some time after a person has suffered from a viral infection. Onset includes a violent attack of vertigo, including nausea, vomiting, and the inability to stand or walk. Symptoms subside in several days, although feelings of unsteadiness may continue for a week or more. A swelling of the vestibular nerve following a viral infection causes vestibular neuronitis.

Sometimes the inflammation can recur over several years. A viral infection affecting the inner ear, but not the vestibular nerve, is called viral labyrinthitis. Labyrinthitis can cause hearing loss, but all other symptoms are similar to vestibular neuronitis.

Severe bacterial infections can also cause inflammation of the inner ear. These cases include risk of deafness, inflammation of the brain, and meningitis (inflammation of the membranes surrounding the brain and spinal cord). Otitis occurs when fluid accumulates in the middle ear, causing feelings of imbalance, mild turning, or vertigo. When the infection reaches the inner ear, the disease is called acute suppurative labyrinthitis. Treatment for any bacterial infection in the ear is critical to prevent long-term damage to hearing and balance organs.

PERILYMPH FISTULA Perilymph fistulas are openings that occur between the middle ear and the inner ear. This allows a hole through which perilymph can flow, changing the pressure of perilymph flowing into the brain and causing dizziness. Fistulas often form as a result of head trauma or abrupt changes in pressure. Symptoms may also include hearing loss, ringing in the ears, coordination problems, nystagmus, and headaches. Most fistulas heal with time; however, in severe cases, surgical procedures are used to close the hole, using a tissue graft.

MÈNIÉRE’S DISEASE In 1861, French physician Prosper Mèniére described Mèniére’s disease as having four particular symptoms: vertigo lasting for an hour or more, but less than 24 hours; ringing or buzzing sounds in the ear; feeling of pressure or fullness in the ear; and some hearing loss. Some people are affected in both ears; others just one ear. Onset of Mèniére’s may be related to stress, although not in all cases. Nystagmus is usually associated with the attacks.

Mèniére’s disease is thought to be caused by an accumulation of endolymph within the canals of the inner ear, a condition called endolymphatic hydrops. This causes produces a swelling in the canals containing endolymph, which puts pressure on the parts of the canals containing perilymph. The result affects both hearing and balance. In severe cases, it is feared that the endolymphatic compartments may burst, disrupting both the chemical and pressure balances between the two fluids.

The cause of the accumulation of endolymph is unknown, although it can be related to trauma to the head, infection, degeneration of the inner ear, or some other regulatory mechanism. Syphilis is often associated with Mèniére’s disease, as are allergies and leukemia. Some suggest that Mèniére’s disease is an autoimmune dysfunction. There may be a genetic predisposition to Mèniére’s disease.

Mèniére’s disease is usually treated with meclizine (Antivert), antihistamines, and sedatives. Diuretics can be used to rid the body of excess endolymph. Salt-free diets can also help to prevent the accumulation of fluid in the ears.
Systemic disorders

Dizziness may be a symptom of a disorder that affects the whole body, or systems within the body. Dizziness may also be the result of systemic toxicity to substances such as medications and drugs.

POSTURAL HYPOTENSION The major symptom of postural hypotension, also called orthostasis, is low blood pressure. When a person stands up from a prone position, blood vessels in the legs and feet must constrict to force blood to the brain. When blood pressure is low, the blood vessels do not constrict quickly or with enough pressure and the result is a lag before blood reaches the brain, causing dizziness. Postural hypotension can be treated with an increase in fluid intake or with blood pressure medication.

HEART CONDITIONS A variety of heart conditions can cause feelings of dizziness. In particular, arrhythmia, a dysfunction of the heart characterized by an irregular heartbeat, decreases blood supply to the brain in such a way as to cause balance problems. In most cases, symptoms of dizziness associated with arrhythmia result from problems with heart valves, such as narrowing of the aorta and mitral valve prolapse.

INFECTIOUS DISEASES Influenza and flu-like diseases can cause dizziness, especially if accompanied by fever. The virus herpes zoster oticus causes painful blisters and shingles . If the virus attacks the facial nerve, it may result in vertigo. Several bacterial diseases can result in dizziness, including tuberculosis, syphilis, meningitis, or encephalitis. One of the major symptoms of Lyme disease , which is caused by infection of a microorganism resulting from a deer tick bite, is dizziness.

BLOOD DISORDERS A variety of diseases of the blood result in feelings of dizziness. These diseases include anemia, or a depletion of iron in the blood, sickle-cell anemia, leukemia, and polycythemia.

DRUGS AND OTHER SUBSTANCES A variety of substances ingested systemically to prevent disorders of diseases can result in feelings of dizziness. In particular, overdose of aspirin and other anti-inflammatory drugs can cause problems with balance. Antibiotics taken for extended periods of time are also known to cause dizziness. Streptomycin is known to damage the vestibular system, if taken in large doses. Medicines that are used to treat high blood pressure can lower blood pressure so much as to cause feelings of light-headedness. Quinine, which is taken to treat malaria, can cause dizziness, as can antihistamines used to prevent allergy attacks. Chemotherapy drugs are well known to have various side effects, including dizziness. Alcohol, caffeine, and nicotine are also known to cause dizziness, when taken in large doses.

Because maintaining posture integrates so many different parts of the body, diagnosing the actual problem responsible for dizziness often requires a battery of tests. The cardiovascular system, the neurological system, and the vestibular system are all examined.

Blood pressure is one of the most important cardiovascular measurements made to determine the cause of imbalance. Usually the physician will measure blood pressure and heart rate with the patient lying down, and then again after the patient stands up. If blood pressure drops significantly and the heart rate increases more than five beats per minute, this signals the existence of postural hypotension. Dizziness in people suffering from diabetes or on blood pressure medicine may be caused by postural hypotension.
Neurological tests

Because the central nervous system is integral to maintaining balance, neurological tests are often performed on patients with symptoms of dizziness. A test of mental status is often performed to ascertain that mental function is healthy. Physicians may test tendon reflexes to determine the status of peripheral and motor nerves, as well as spinal cord function. Nerves in different parts of the body may also be evaluated. In addition, physicians may test muscle strength and tone, coordination, and gait.

Neurologists may also perform a variety of computerized scans that determine if tumors or acoustic neuromas are present. These tests include magnetic resonance imaging (MRI) , computerized tomography (CT ), and electroencephalogram (EEG).
Tests of the vestibular system

Most often performed by a otolaryngologist, the battery of tests performed to determine the health of the vestibular system include the Dix-Halpike test, electrostagmography, hearing tests, rotation tests, and posturography.

DIX-HALPIKE TEST The Dix-Halpike test, also called the Halpike test, is performed to determine if a patient suffers from benign paroxysmal positional vertigo (BPPV). The patient is seated and positioned so that his or her head hangs off the edge of the table when lying down. The patient’s head is moved 45 degrees in one direction. The patient is then asked to lie down, without moving his or her head. The same procedure will be repeated on the other side. If feelings of vertigo result from this movement, BPPV is usually diagnosed.

ELECTRONYSTAGMOGRAPHY (ENG) Considered one of the most telling diagnostic tests to determine the cause of dizziness, electronystagmography consists of a series of evaluations that test the interactions between the vestibular organs and the eyes, also called the vestibulo-ocular reflex. Results from this test can inform the physician whether problems are caused by the vestibular system or by the central nervous system.

The most common diagnostic feature observed during ENG is nystagmus, an involuntary movement of the pupils that allows a person to maintain balance. In healthy persons, nystagmus consists of a slow movement in one direction in response to a change in the visual field and quick corrective movement in the other direction. In persons with disorders of the vestibular organs, nystagmus will produce quick movements in the horizontal direction. People with neurologic disorders will show signs of nystagmus in the vertical direction or even in a circular pattern.

In most of the ENG tests, electrodes taped to the patient’s head record nystagmus as the patient is exposed to a variety of moving lights or patterns of stripes that stimulate the vestibular system. The patient may be asked to stand and lie in various positions for the tests. Also, included in the ENG is a caloric test in which warm water and cool water are circulated through the outer ear. This causes a slight expansion or contraction of the endolymph in the inner ear and simulates movement cues to the brain.

HEARING TESTS Because the cochlea and the vestibular organs are adjacent to one another, hearing dysfunction can often be related to problems with dizziness. Audiograms include tests for both hearing and interpreting sounds, and can determine whether or not problems exist in the middle ear, the inner ear, or the auditory nerve.

ROTATION TESTS Rotation tests evaluate the vestibulo-ocular reflex and provide important information when the dysfunction is common to both ears. Electrodes are usually taped to the face to monitor eye movement, and the patient is placed in a chair. The chair rotates at different speeds through different arcs of a circle. The audiologist may also ask the patient to focus on different objects as the chair is rotated.

POSTUROGRAPHY During posturography tests, a patient stands on a platform that measures how weight is distributed. During the test, the patient will close and open his or her eyes or look into a box with different visual stimuli. The platform is computer controlled so that it can gently tip forward or backward or from side to side. Posturography measures how much the patient sways or moves in response to the stimuli. This provides information on the function of the proprioceptive system, as well as the vestibular system.

If symptoms of dizziness are found to be associated with systemic diseases such as diabetes, hypotension, or other infectious diseases, or with neurological disorders, treatment for the dizziness is usually successful.

In many patients, dizziness caused by vestibular dysfunction tends to dissipate with time and with little treatment. However, available and common treatments for vestibular problems include physical therapies, medications, and surgeries. In addition, low-salt diets, relaxation techniques, and psychological counseling may be used as treatment.
Exercises and therapy

The physical therapies to decrease dizziness fall into two major groups. Compensation therapies help train the patient’s brain to rely on the sensory information it receives to maintain balance, and to ignore information from damaged organs. Exercises in a compensation program are designed to focus on the movements that cause dizziness so that the brain can adapt to these behaviors. In addition, exercises that teach the patient how to keep the eye movements separate from head movements and to practice balancing in various positions are used.

Specific exercises aimed at relieving benign paroxysmal positional vertigo (BPPV), called canalith repositioning procedures, have recently been developed. By turning the head to one side and moving from a sitting to lying position in a certain sequence, BPPV can be quickly relieved. The movements in the canalith repositioning procedures are intended to move calcium carbonate crystals from the semicircular canals back to the utricle. The success rate with these exercises can be up to 90%.

A variety of medications are used to treat vertigo. These include vestibular suppressants, which seem to work by decreasing the rate of firing of nerve cells. Common vestibular suppressants are meclizine (Antivert, Bonine, and Vetrol). Also prescribed are anti-nausea medications such as promethazane (Phenergan) and anti-histamines (Benadryl, Dramamine). For dizziness brought on by anxiety attacks, anti-anxiety drugs such as diazepam (Valium) and lorazepam (Ativan) may be used. These drugs all have side effects and are seldom prescribed for long periods of time.

Surgery is usually the last step in the treatment of dizziness, only used after therapy and medications have failed. One of the more common surgical procedures for treating vestibular disorders is patching perilymph fistulas, or tears, at the tops of the semicircular canals. Surgery may also be used to drain excess fluid from the endolymphatic canals to relieve endolymphatic hydrops. Cutting the vestibular nerve just before it joins with the auditory nerve to form the eighth cranial nerve can also be performed to alleviate severe problems with dizziness. Finally, the entire labyrinth can be destroyed in a procedure called a labyrinthectomy, although this is usually only performed when hearing has been completely lost as well.

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Vestibular Disorders Association. P.O. Box 4467, Portland, OR 97208. (503) 229-7705 or (800) 837-8428. .

Juli M. Berwald, PhD

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