Problem solving: Find solutions for your stressors

Date updated: July 20, 2006
Content provided by MayoClinic.com

Aaaaaaaaaaaargh! Feel better? Maybe you do, but probably not for long. Successful stress management involves more than a quick release. To alleviate a stressful situation for good, you must identify the issues causing it, and then create strategies to make the issues less problematic.

The process of identifying stressors and creating strategies is often called problem solving, and it's a powerful tool to add to your stress management toolbox. Brush up on your problem-solving skills by trying these simple steps:

 Identify. What's the cause of your stress? For a definitive answer, ask:

• In concrete terms, what exactly is the problem? Be specific.
• Is the problem really that big? Would others think so?
• Are you using this problem to avoid dealing with a much bigger one?
• Is there any part of the problem over which you have control?

Use this step to identify problems that deserve the time you'll spend solving them. In other words: Choose your battles. You can't change everything, so look for problems and stressors that have the potential for change. And, since change takes effort, look for problems that give you the biggest bang for your problem-solving buck.

. Clarify. What would make the problem go away?

• What do you want to happen?
• What do you not want to happen?
• Are you attempting to solve the main problem that is causing you stress, or have you lost sight of the real stressor?

Would taking a time management course improve your hectic home life, or would it leave you feeling like you had even less time to spend at home? Do you want to create fewer tasks for yourself at home by doling out some of the responsibility, or do you enjoy some mindless time spent folding laundry?

. Create. Now that you have a well-defined problem, it's time to brainstorm like crazy. Think of all the possible ways in which you might solve your problem. The sky is the limit. Now is not the time to judge whether one possible solution is better than another. Not sure where to begin? Try to:

• Recall past problems that you were able to solve. Could a similar solution work for this problem, too?
• Ask friends, family and people you trust for advice.

Remember, consider everything that pops into your head - even ideas that initially seem silly. Your stress reduction program may include a little silliness. Maybe taking a salsa dancing class after work a few days a week will help you to unwind better than would quiet meditation. Keep an open mind.

. Choose. Of all your creative ideas - silly or serious - which make the most sense? You might want to consider:

• What will likely happen if you choose this specific path?
• How will using this solution make you feel in the end? How will it make others feel?
• What are the possible positive and negative consequences?
• Will you be able to carry it out?
• Do you realistically think it will solve the problem?

After narrowing down your options pick the best one and believe in it.

. Evaluate. Now that you've chosen the best solution, it's time to really think it through. Even the best solution may require fine-tuning. Ponder:

• Will you be less stressed in the end, or will the solution create new problems?
• What might go wrong? Can you correct this part of the plan?
• Do you have the proper resources and, more important, the nerve and will to carry out your plan?
• Is your solution appropriate for the problem at hand?

Remember, this step is just to weed out unlikely solutions, not discourage you. A good long-term solution may temporarily generate new problems. That doesn't mean you should give up the plan, just that you need to be prepared for the new problems with a new set of solutions.

. Implement. Believe in yourself, be brave and try your solution out.

. Reflect. In every outcome there is a lesson.

• Did your solution effectively solve the problem?
• Is it solved well?
• If not, what new plan might work?

Mission accomplished?

Problem-solving techniques can be hard to learn and even harder to use on a practical level. But the truth is, you can't fix a flat tire by willing it repaired, and neither can you diminish stress by ignoring it. Practicing problem-solving skills on stressors ranging from minuscule nuisances to monstrous crises can help you to better cope with stress as it comes at you. Nobody wants stress to get the best of them. So don't let it

How to argue without ruining your relationship

The magic 5:1 make sure your 5 time as much positive feeling between you and your partner as there are negative

    Remove blame from your comments

    Say how you feel

    Listen to your partner

    Do not criticize or try to analyze  your partner’s personality

    Do not insult, mock or use sarcasm

    Be direct and stick to one situation rather dragging to past

    Learn how to calm yourself when floods of emotion block communication

    Discuss how you can take break

    Try to think of your partners good quality, praise  and admire them

    Look at these principle again and again—it take long time to learn new hobbits

(Phi lip Hadson)

Diabetes prevention: 5 tips for taking control

Date updated: October 11, 2006
Content provided by MayoClinic.com

When it comes to type 2 diabetes - the most common type of diabetes - prevention is a big deal.

Consider the statistics. Diabetes affects nearly 21 million people in the United States and 230 million people worldwide, according to the American Diabetes Association and the International Diabetes Federation. And that number is on the rise. In the United States alone, experts at the Centers for Disease Control and Prevention expect diabetes to affect more than 48 million people by 2050.

Scary? Of course. But you don't need to become a statistic. Tweaking your lifestyle could be a big step toward diabetes prevention - and it's never too late to start. Consider the latest diabetes prevention tips from the American Diabetes Association.

Tip 1: Lose extra weight

If you're overweight, diabetes prevention may hinge on weight loss. Every pound you lose can improve your health. And you may be surprised by how much. In one study, overweight adults who lost a modest amount of weight - 5 percent to 10 percent of initial body weight - and exercised regularly reduced the risk of developing diabetes by 58 percent over three years.

To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Involve other family members as well. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

Tip 2: Skip fad diets

Low-carb, high-protein or other fad diets may help you lose weight at first, but they're not likely to help you maintain a healthy weight in the long run. And by excluding or strictly limiting a particular food group, you may be giving up essential nutrients.

Instead, think variety and portion control as part of an overall healthy-eating plan. Choose healthy foods low in fat and calories, including fruits, vegetables and various lean foods from the other major food groups.

Tip 3: Get plenty of fiber

It's rough, it's tough - and it can reduce the risk of diabetes by improving your blood sugar control. And that's not all. Fiber also reduces the risk of heart disease. It can even promote weight loss by helping you feel full longer. Aim for 25 to 50 grams of fiber a day. Foods high in fiber include fruits, vegetables, beans, whole grains, nuts and seeds.

Tip 4: Go for whole grains

Whole grains are another important piece in the diabetes-prevention puzzle. Try to make at least half your grains whole grains. Even if you've been eating white bread and baking with refined flour for years, switching to whole grains might be easier than you think. Many foods made from whole grains come ready to eat, including various breads, pasta products and ready-to-eat cereals. Look for the word "whole" on the package and among the first few items in the ingredient list. Try to choose items with at least 3 grams of fiber per serving.

Tip 5: Get more physical activity

Increasing your physical activity can help you lose weight. But even if it doesn't, it's still important to get off the couch. Whether you lose weight or not, physical activity lowers blood sugar and boosts your sensitivity to insulin - which helps keep your blood sugar within a normal range.

With your doctor's OK, aim for at least 30 minutes of moderate physical activity a day. Take a brisk daily walk. Ride your bike. Swim laps. If you can't fit in a long workout, break it up into smaller sessions spread throughout the day. Even trading the elevator for the stairs and parking farther from your destination are steps in the right direction.

Make it a team effort

The American Diabetes Association recommends blood glucose screening for everyone at age 45. If you're overweight with one or more additional risk factors for type 2 diabetes - such as a sedentary lifestyle or a family history of diabetes - ask your doctor about earlier testing.

Also share your concerns about diabetes prevention. Your doctor will applaud your efforts to keep diabetes at bay, and perhaps offer additional suggestions based on your medical history or other factors.

Diabetes management: How lifestyle, daily

 routine affect blood sugar

Date updated: June 21, 2007
Content provided by MayoClinic.com

When it comes to diabetes management, blood sugar control is often the central theme. After all, keeping your blood sugar level within your target range can help you live a long and healthy life with diabetes. But do you know what makes your blood sugar level rise and fall? The list is sometimes surprising!

Food

Healthy eating is a cornerstone of any diabetes management plan. But it's not just what you eat that affects your blood sugar level. How much you eat and when you eat matters, too.

What to do

• Be consistent. Your blood sugar level is highest an hour or two after you eat, and then begins to fall. But this predictable pattern can work to your advantage. Simply eating about the same amount of food at about the same time every day can help you control your blood sugar level
• Even out your carbs. Carbohydrates have a bigger impact on your blood sugar level than does protein or fat. Eating about the same amount of carbohydrates at each meal or snack will help keep your blood sugar level steady throughout the day.
• Coordinate your meals and medication. Too little food in comparison to your diabetes medications - especially insulin - may result in dangerously low blood sugar (hypoglycemia). Too much food may cause your blood sugar level to climb too high (hyperglycemia). Your diabetes health care team can help you strike a balance.

Exercise

Physical activity is another important part of your diabetes management plan. When you exercise, your muscles use sugar (glucose) for energy. Regular physical activity also improves your body's response to insulin. These factors work together to lower your blood sugar level. The more strenuous your workout, the longer the effect lasts. But even light activities - such as housework, gardening or being on your feet for extended periods - can lower your blood sugar level

What to do

• Get your doctor's OK to exercise. This is especially important if you've been inactive and plan to start exercising regularly.
• Adjust your diabetes treatment plan as needed. If you take insulin, you may need to adjust your insulin dose before exercising or wait a few hours to exercise after injecting insulin. Or your doctor may suggest other changes to your diabetes treatment plan
• Exercise good judgment. Check your blood sugar level before, during and after exercise, especially if you take insulin or medications that can cause low blood sugar. Drink plenty of fluids while you work out. Stop exercising if you experience any warning signs, such as severe shortness of breath, dizziness or chest pain.

Medication

Insulin and other diabetes medications are designed to lower your blood sugar level. But the effectiveness of these medications depends on the timing and size of the dose. And any medications you take for conditions other than diabetes can affect your blood sugar level, too.

What to do

• Store insulin properly. Insulin that's improperly stored or past its expiration date may not be effective
• Report problems to your doctor. If your diabetes medications cause your blood sugar level to drop too low, the dosage or timing may need to be adjusted.
• Be cautious with new medications. If you're considering an over-the-counter medication or your doctor prescribes a new drug to treat another condition - such as high blood pressure or high cholesterol - ask your doctor or pharmacist if the medication may affect your blood sugar level. Sometimes an alternate medication may be recommended.

Illness

When you're sick, your body produces hormones to help fight the illness. These hormones raise your blood sugar level by preventing insulin from working effectively. This can help promote healing - and wreak havoc with your diabetes management plan.

What to do

• Plan ahead. Work with your health care team to create a sick-day plan. Include instructions on what medications to take, how often to measure your blood sugar and urine ketone levels, how to adjust your insulin dosage, if you need insulin, and when to call your doctor.
• Stick to your diabetes meal plan. If you can, eating as usual will help you control your blood sugar level.
• Check the sugar content of over-the-counter medications. Many cough syrups and other cold preparations are high in sugar. Ask your doctor or pharmacist for advice.

Alcohol

The liver normally releases stored sugar to counteract falling blood sugar levels. But if your liver is busy metabolizing alcohol, your blood sugar level may not get the boost it needs. If you take insulin or oral diabetes medications, even as little as 2 ounces of alcohol - the equivalent of two drinks - can cause low blood sugar.

What to do

 Get your doctor's OK to drink alcohol. Alcohol can aggravate diabetes complications, such as nerve damage and eye disease. But if your diabetes is under control and your doctor agrees, an occasional alcoholic drink with a meal is fine.

• Choose your drinks carefully. Light beer and dry wines have fewer calories and carbohydrates than do other alcoholic drinks. If you prefer mixed drinks, stick with sugar-free mixers - such as diet soda, diet tonic, club soda or seltzer.
• Tally your calories. Remember to include the calories from any alcohol you drink in your daily calorie count.

Hormone levels

As your hormone levels fluctuate during your menstrual cycle, so can your blood sugar levels - particularly in the week before your period. Menopause may trigger fluctuations in your blood sugar level as well.

What to do

• Look for patterns. Keep careful track of your blood sugar readings from month to month. Soon you may be able to predict fluctuations related to your menstrual cycle.
• Adjust your diabetes treatment plan as needed. Your doctor may recommend changes in your meal plan, activity level or diabetes medications to make up for monthly blood sugar swings.

Stress

If you're stressed, it's easy to abandon your usual diabetes management routine. You might exercise less, eat fewer healthy foods or test your blood sugar less often - and lose control of your blood sugar in the process. The hormones your body may produce in response to prolonged stress may even prevent insulin from working properly, which only makes matters worse.

What to do

• Look for patterns. Log your stress level on a scale of one to 10 each time you log your blood sugar level. A pattern may soon emerge.
• Take control. Once you know how stress affects your blood sugar level, fight back. Learn relaxation techniques. Prioritize your tasks. Set limits. Most importantly, take good care of yourself

The more you know about factors that influence your blood sugar level, the more you can anticipate fluctuations - and plan ahead accordingly.

Back pain

Introduction

Causes

• Bulging or ruptured disks. Disks act as cushions between the vertebrae in your spine. Sometimes, the soft material inside a disk may bulge out of place or rupture and press on a nerve. But many people who have bulging or herniated disks experience no pain from the condition.
• Sciatica. If a bulging or herniated disk presses on the main nerve that travels down your leg, it can cause sciatica — sharp, shooting pain through the buttock and back of the leg.
• Arthritis. The joints most commonly affected by osteoarthritis are the hips, hands, knees and lower back. In some cases arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
• Skeletal irregularities. Back pain can occur if your spine curves in an abnormal way. If the natural curves in your spine become exaggerated, your upper back may look abnormally rounded or your lower back may arch excessively. Scoliosis, a condition in which your spine curves to the side, also may lead to back pain.
• Osteoporosis. Compression fractures of your spine's vertebrae can occur if your bones become porous and brittle.

• Cauda equina syndrome. This is a serious neurological problem affecting a bundle of nerve roots that serve your lower back and legs. It can cause weakness in the legs, numbness in the "saddle" or groin area, and loss of bowel or bladder control.
• Cancer in the spine. A tumor on the spine can press on a nerve, causing back pain.
• Infection of the spine. If a fever and a tender, warm area accompany back pain, the cause could be an infection.

Risk factors

• Smoking
• Obesity
• Older age
• Female gender
• Physically strenuous work
• Sedentary work
• Stressful job
• Anxiety
• Depression

When to seek medical advice

• Is constant or intense, especially at night or when you lie down
• Spreads down one or both legs, especially if the pain extends below the knee
• Causes weakness, numbness or tingling in one or both legs
• Causes new bowel or bladder problems
• Is associated with pain or pulsation (throbbing) in the abdomen, or fever
• Follows a fall, blow to your back or other injury
• Is accompanied by unexplained weight loss

Screening and diagnosis

• X-ray. These images show the alignment of your bones and whether you have arthritis or broken bones. X-ray images won't directly show problems with your spinal cord, muscles, nerves or disks.
• Magnetic resonance imaging (MRI) or computerized tomography (CT) scans. These scans can generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.
• Bone scan. In rare cases, your doctor may use a bone scan to look for bone tumors or compression fractures caused by osteoporosis. In this procedure, you'll receive an injection of a small amount of a radioactive substance (tracer) into one of your veins. The substance collects in your bones and allows your doctor to detect bone problems using a special camera.
• Nerve studies (electromyography, or EMG). This test measures the electrical impulses produced by the nerves and the responses of your muscles. Studies of your nerve-conduction pathways can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

Treatment

• Fusion. This surgery involves joining two vertebrae to eliminate painful movement. A bone graft is inserted between the two vertebrae, which may then be splinted together with metal plates, screws or cages. A drawback to the procedure is that it increases the chances of arthritis developing in adjoining vertebrae.
• Disk replacement. An alternative to fusion, this surgery inserts an artificial disk as a replacement cushion between two vertebrae.
• Partial removal of disk. If disk material is pressing or squeezing a nerve, your doctor may be able to remove just the portion of the disk that's causing the problem.
• Partial removal of a vertebra. If your spine has developed bony growths that are pinching your spinal cord or nerves, surgeons can remove a small section of the offending vertebra, to open up the passage.

Prevention

• Exercise. Regular low-impact aerobic activities — those that don't strain or jolt your back — can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices. Talk with your doctor about which activities are best for you.
• Build muscle strength and flexibility. Abdominal and back muscle exercises (core-strengthening exercises) help condition these muscles so that they work together like a natural corset for your back. Flexibility in your hips and upper legs aligns your pelvic bones to improve how your back feels.
• Quit smoking. Smokers have diminished oxygen levels in their spinal tissues, which can hinder the healing process.
• Maintain a healthy weight. Being overweight puts strain on your back muscles. If you're overweight, trimming down can prevent back pain.

• Stand smart. Maintain a neutral pelvic position. If you must stand for long periods of time, alternate placing your feet on a low footstool to take some of the load off your lower back.
• Sit smart. Choose a seat with good lower back support, arm rests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level.
• Lift smart. Let your legs do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward.

Complementary and alternative medicine

• Chiropractic care. Back pain is one of the most common reasons that people see a chiropractor. If you're considering chiropractic care, talk to your doctor about the most appropriate specialist for your type of problem. In addition to chiropractors, many osteopathic doctors and some physical therapists have training in spinal manipulation.
• Acupuncture. Some people with low back pain report that acupuncture helps relieve their symptoms. The National Institutes of Health has found that acupuncture can be an effective treatment for some types of chronic pain. In acupuncture, the practitioner inserts sterilized stainless steel needles into the skin at specific points on the body.
• Massage. If your back pain is caused by tense or overworked muscles, massage therapy may help loosen knotted muscles and promote relaxation.

Headache Treatment: Overview

Date effective: December 05, 2006
Content provided by Cleveland Clinic

How are headaches evaluated and diagnosed?
The correct headache diagnosis is needed to begin an effective treatment plan. The most important aspect of the headache evaluation is the headache history, which is obtained from the patient. It is important for you to describe your headache symptoms and characteristics to your doctor as completely as possible so the headache can be properly diagnosed and successfully treated. Your headache can be more accurately diagnosed by knowing:

• When the headache started
• How long you have had the headache
• Whether there is a single type of headache or multiple types of headaches
• How often the headache occurs
• What causes the headache, if known (for example, do certain situations, foods, or medications usually trigger the headache?)
• If physical activity aggravates the headache pain
• What events are associated with the headache
• Who else in your family has headaches
• What symptoms, if any, occur between headaches

Your doctor will also ask additional questions about performance at work, family background, and if there is any history of drug abuse.

Clinical description of headaches
Describe how you feel when you have the headache and what happens when you get the headache, such as:

• Where the pain is located
• What it feels like
• How severe the headache pain is, using a scale from one (mild) to 10 (severe)
• If the headache appears suddenly without warning or with accompanying symptoms
• What time of day the headache usually occurs
• If there is an aura (changes in vision, blind spots, or bright lights) before the headache
• What other symptoms or warning signs occur with the headache (weakness, nausea, sensitivity to light or noise, decreased appetite, changes in attitude or behavior)
• How long the headache lasts

History of headache treatments
You should provide your physician with a history of prior headache treatments. Tell your doctor what medications you have taken in the past and what medications are you currently taking. Don't hesitate to list them, bring in the medication bottles, or ask your pharmacist for a printout.

If any studies or tests were previously performed, bring them with you. This may save time and repetition of tests.

Physical and neurological examinations
After completing the medical history part of the evaluation, your physician will perform physical and neurological examinations. The physician will look for signs and symptoms of an illness that may be causing the headache. These signs and symptoms can include: fever, infection, high blood pressure, muscle weakness, balance problems, or vision problems.

After evaluating the results of your headache history, physical examination, and neurological examination, your physician should be able to determine what type of headache you have, whether or not a serious problem is present, and whether additional tests are needed.

When additional tests may be needed
If the results of the physical exam show signs of a condition within your brain that may be causing the headaches (organic cause), additional laboratory tests may be needed.

An imaging test called a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan may be recommended if a structural disorder of the central nervous system is suspected. Both of these tests produce cross-sectional images of the brain that can reveal problems within the brain.

Skull X-rays are not helpful. An electroencephalogram (EEG) is also unnecessary unless a person has lost consciousness with his or her headaches.

Although additional tests may be important to ensure that the headaches are not the result of a serious medical condition, they do not help in diagnosing migraine, cluster, or tension-type headaches.

How are headaches treated?
The proper treatment will depend on several factors, including the type and frequency of the headache and its cause. Treatment may include education, stress management, biofeedback, and medication and physical therapy education.

Headache education
Education includes learning and recording what triggers the headaches, such as lack of sleep, a poor diet, your environment, or stress. Your health care provider may give you a Headache Diary to record the characteristics of your headaches and can recommend ways of managing headache triggers. Bring the diary with you to all of your doctor appointments; this information will help your health care providers correctly treat your headaches.

Relaxation techniques
Learning relaxation techniques can help you reduce headaches. If you have a headache, you should:

• Lie down and relax
• Stretch and relax the muscles
• Take breaks from activities that trigger or provoke headaches, such as using the computer for long periods of time or exercising strenuously

There are several other methods you can use to relax or reduce stress, including:

• Deep breathing exercises
• Progressive muscle relaxation
• Mental imagery relaxation
• Relaxation to music
• Biofeedback (explained below)
• Counseling, which can help you recognize and release stress

Biofeedback
Biofeedback can help you learn stress-reduction skills by providing information about muscle tension, heart rate, and other vital signs as you try to relax. It is used to gain control over certain bodily functions which cause tension and physical pain.

Biofeedback can be used to help you learn how your body responds in stressful situations. If a headache, such as a migraine, begins slowly, many people can use biofeedback to stop the attack before it becomes full blown.

Medications
Medications may be recommended to manage headache pain. Headache medications can be grouped into three different categories: symptomatic relief, abortive therapy, and preventive therapy. Each type of medication is most effective when used in combination with other medical recommendations, such as dietary and lifestyle changes, exercise, and relaxation therapy.

• Symptomatic relief Used to relieve symptoms associated with headaches, including the pain of a headache or the nausea and vomiting associated with migraine. These may include simple analgesics, ibuprofen or acetaminophen, antiemetics or sedatives. Many of these are available over-the-counter, while others require a prescription.

Important: If symptomatic relief medications are used more than twice a week, you should see your health care provider who can prescribe preventive headache medications. Overuse of these symptomatic medications can actually cause more frequent headaches or worsen headache symptoms.

• Abortive therapy These medications are most effective when used at the first sign of a migraine to stop the process that causes the headache pain. By stopping the headache process, abortive medications help prevent the symptoms of migraines including pain, nausea, light sensitivity, etc. Abortive medications include: ergotamine tartrate and caffeine (Cafergot), dihydro-ergotamine mesylate (DHE-45, Migranal), a combination medication (Midrin), sumatriptan succinate (Imitrex), zolmitriptan (Zomig), and others.
• Preventive therapy Used to treat very frequent tension headaches and migraines, or the combination of both types of headaches. Preventive therapy is aimed at reducing both the frequency and severity of the headaches and includes nonsteroidal anti-inflammatory (NSAID) medications, antidepressants, antihistamines, beta blockers, calcium channel blockers, and anticonvulsant medications as recommended by your doctor. Most of these medications require a prescription.

What happens next?
When your physician starts a treatment program, keep track of the results and how the treatment program is working. Keep your scheduled follow-up appointments with your health care provider so that he or she can monitor your progress and make changes in your treatment program if necessary.

Do adults "outgrow" headaches?
Headaches may improve over time. The headaches may disappear and then return later in life. Migraines can go away as soon as a year after they first appear, even without treatment, or they may remain for life.

Heart disease prevention: 5 strategies keep your heart healthy

 Don't smoke or use tobacco products

 Get active

 Eat a heart-healthy diet

 Maintain a healthy weight

 Get regular health screenings

• Blood pressure. Regular blood pressure screenings start in childhood. Adults should have their blood pressure checked at least every two years. You may need more frequent checks if your numbers aren't optimal or if you have other risk factors for cardiovascular disease. Optimal blood pressure is less than 120/80 millimeters of mercury.
• Cholesterol levels. Adults should have their cholesterol measured at least once every five years. You may need more frequent testing if your numbers aren't optimal or if you have other risk factors for cardiovascular disease. Some children may need their blood cholesterol tested if they have a strong family history of heart disease.

Prevention pays

kidney stones

Introduction

Signs and symptoms

• Pain in the side and back, below the ribs
• Fluctuations in pain intensity, with periods of pain lasting 20 to 60 minutes
• Pain waves radiating from the side and back to the lower abdomen and groin
• Bloody, cloudy or foul-smelling urine
• Pain on urination
• Nausea and vomiting
• Persistent urge to urinate
• Fever and chills if an infection is present

Causes

CLICK TO ENLARGE

Kidney stones

• Calcium stones. Roughly four out of five kidney stones are calcium stones, usually in the form of calcium oxalate. Oxalate is found in some fruits and vegetables, but the liver produces most of the body's oxalate supply. Dietary factors, high doses of vitamin D, intestinal bypass surgery and several different metabolic disorders can increase the concentration of calcium or oxalate in urine.
• Struvite stones. Found more often in women, struvite stones are almost always the result of urinary tract infections. Struvite stones may be large enough to fill most of a kidney's urine-collecting space, forming a characteristic stag's-horn shape.
• Uric acid stones. These stones are formed of uric acid, a byproduct of protein metabolism. You're more likely to develop uric acid stones if you eat a high-protein diet. Gout also leads to uric acid stones. Certain genetic factors and disorders of the blood-producing tissues also may predispose you to the condition.
• Cystine stones. These stones represent only a small percentage of kidney stones. They form in people with a hereditary disorder that causes the kidneys to excrete excessive amounts of certain amino acids (cystinuria) .

Risk factors

• Lack of fluids. If you don't drink enough fluids, especially water, your urine is likely to have higher concentrations of substances that can form stones. That's also why you're more likely to form kidney stones if you live in a hot, dry climate or exercise strenuously without replacing lost fluids.
• Family or personal history. If someone in your family has kidney stones, you're more likely to develop stones too. And if you've already had one or more kidney stones, you're at increased risk of developing another.
• Age and sex. Most people who develop kidney stones are between 20 and 70 years of age. Men are more likely to develop kidney stones than are women.
• Diet. A high-protein, high-sodium and low-calcium diet may increase your risk of some types of kidney stones.
• Limited activity. You're more prone to develop kidney stones if you're bedridden or very sedentary for a long period of time. That's partly because limited activity can cause your bones to release more calcium.
• Obesity. High body mass index (BMI), increased waist size and weight gain have been linked to kidney stones in long-term studies of large populations. The relationship is strongest in women.
• High blood pressure. Having high blood pressure doubles your risk of forming kidney stones.
• Gastric bypass surgery, inflammatory bowel disease or chronic diarrhea. Changes in the digestive process affect your absorption of calcium and increase the levels of stone-forming substances in your urine.

Screening and diagnosis

• Computerized tomography (CT) scan. This imaging test has become the standard of care for evaluating acute kidney stones. It's rapidly performed, can identify stones regardless of composition and doesn't require the use of contrast dye.
• Abdominal X-ray. An abdominal X-ray can visualize most kidney stones and can help to judge changes in the size of a stone over time.
• Ultrasound. Instead of X-rays, this diagnostic technique combines high-frequency radio waves and computer processing to view your internal organs. It's safe, painless and noninvasive, but it may miss small stones, especially if they're located in a ureter or your bladder.
• Intravenous pyelography (excretory urogram). This study can be useful in determining the location of stones in the urinary system and can define the degree of blockage caused by a stone. A contrast dye is injected into a vein in your arm and a series of X-rays is taken as the dye moves through your kidneys, ureters and bladder. This study has largely been replaced by the CT scan but is still useful in limited circumstances.

Complications

Treatment

• Extracorporeal shock wave lithotripsy (ESWL). This is a commonly used procedure for treating kidney stones. It uses shock waves to break the stones into tiny pieces that are then passed in your urine. In some cases, you may be partially submerged in a tub of water during the procedure. In others, you may lie on a soft cushion. You'll generally require sedation or light anesthesia due to moderate pain caused by the shock waves. A loud noise is produced each time a shock wave is generated, and you'll wear earphones to protect your hearing.
  Your doctor will likely use X-rays or ultrasound to help determine the position of the stone as well as to monitor the status of the stone during treatment.
  Complications that may occur with ESWL include blood in the urine, bruising on the back or abdomen, bleeding around the kidney and other adjacent organs, and discomfort as the stone fragments pass through the urinary tract. In addition, if the stone doesn't shatter completely, you may need a second round of ESWL or ureteroscopic stone removal. After treatment, it may take months for all the stone fragments to pass.
• Percutaneous nephrolithotomy. When ESWL isn't effective, or the stone is very large, your surgeon may remove your kidney stone through a small incision in your back using an instrument called a nephroscope.
• Ureteroscopic stone removal. This procedure may be used to remove a stone lodged in a ureter. The stone is snared with a small instrument (ureteroscope) that's passed into the ureter through your bladder. Ultrasound or laser energy also can be directed through the scope to shatter the stone. These methods work especially well on stones in the lower part of the ureter.
• Parathyroid surgery. Some calcium stones are caused by overactive parathyroid glands, which are located on the four corners of your thyroid gland, just below your Adam's apple. When these glands produce too much parathyroid hormone, your body's level of calcium can become too high, resulting in excessive excretion of calcium in your urine. Most often, this is the result of a small benign tumor in one of your four parathyroid glands. A doctor can surgically remove the tumor.

Prevention

• Calcium stones. To help prevent calcium stones from forming, your doctor may prescribe a thiazide diuretic or a phosphate-containin g preparation. If you have calcium stones because of a condition known as renal tubular acidosis, your doctor may suggest taking sodium bicarbonate or potassium bicarbonate.
• Uric acid stones. Your doctor may prescribe allopurinol (Zyloprim, Aloprim) to reduce uric acid levels in your blood and urine and a medicine to keep your urine alkaline. In some cases, allopurinol and an alkalinizing agent may dissolve the uric acid stones.
• Struvite stones. To prevent struvite stones, the first goal is to keep urine free of bacteria that cause infection. Long-term use of antibiotics in small doses may be useful to achieve this goal.
• Cystine stones. Cystine stones are the hardest stones and the most difficult to treat. Your doctor may prescribe certain medications to alkalinize the urine or to bind the cystine in the urine in addition to recommending an extremely high urine output

Chest pain

Causes

Date updated: November 07, 2006
Content provided by MayoClinic.com

Chest pain has many possible causes, all of which deserve medical attention. The causes of chest pain fall into two major categories - cardiac and noncardiac causes.

Cardiac causes

• Heart attack. A heart attack - a blood clot that's blocking blood flow to your heart muscle - can cause pressure, fullness or a crushing pain in your chest that lasts more than a few minutes. The pain may radiate to your back, neck, jaw, shoulders and arms, especially your left arm. Other signs and symptoms may include shortness of breath, sweating, dizziness and nausea. All, some or none of these may accompany your chest pain.
• Angina. Fatty deposits can build up in the arteries that carry blood to your heart, narrowing them and temporarily restricting blood flow to your heart, especially during times of exertion. Restricted blood flow to your heart can cause recurrent episodes of chest pain - angina pectoris, or angina. Angina (an-JI-nuh or AN-juh-nuh) is often described as a pressure or tightness in the chest. It's usually brought on by physical or emotional stress. The pain usually goes away within minutes after you stop the stressful activity.
• Other cardiac causes. Other problems that can cause chest pain include inflammation of the sac surrounding your heart (pericarditis), a short-lived condition often related to a viral infection. Pericarditis causes sharp, piercing and centralized chest pain. You may also have a fever and feel sick. A rare, life-threatening cause of chest pain called aortic dissection involves the main artery leading from your heart - your aorta. If the inner layers of this blood vessel separate, forcing blood flow between them, the result is sudden and tearing chest and back pain. Aortic dissection can result from a sharp blow to your chest or develop as a complication of uncontrolled high blood pressure. Coronary spasm, also known as Prinzmetal's angina, can cause varying degrees of chest discomfort. In coronary spasm, coronary arteries - arteries that supply blood to the heart - go into spasm, temporarily closing down blood flow to the heart. Spasm of the coronary arteries may occur spontaneously or be triggered by a stimulant, such as nicotine or caffeine. Coronary artery spasm, which tends to cause episodes of chest pain, can occur with activity or at rest. A spasm may even wake you from sleep. The condition may coexist with coronary artery disease - a buildup of fatty deposits in the coronary arteries. Other possible heart-related conditions that can cause chest pain are metabolic syndrome and endothelial dysfunction.

Noncardiac causes
Many conditions unrelated to your heart can cause chest pain. These include:

• Heartburn. Stomach acid that washes up from your stomach into the tube (esophagus) that runs from your mouth to your stomach can cause heartburn - a painful, burning sensation behind your breastbone (sternum). Often this feeling is accompanied by a sour taste and the sensation of food re-entering your mouth (regurgitation). Heartburn-related chest pain usually follows a meal and may last for hours. Signs and symptoms occur more frequently when you bend forward at the waist or lie down.
• Panic attack. If you experience periods of intense fear accompanied by chest pain, rapid heartbeat, rapid breathing (hyperventilation), profuse sweating and shortness of breath, you may be experiencing a panic attack - a form of anxiety.
• Pleurisy. Sharp, localized chest pain that's made worse when you inhale or cough may be caused by pleurisy. This condition occurs when the membrane that lines your chest cavity and covers your lungs becomes inflamed. Pleurisy may result from a wide variety of underlying conditions, including pneumonia and, rarely, autoimmune conditions such as lupus. An autoimmune disease is one in which your body's immune system mistakenly attacks healthy tissue.
• Costochondritis. In this condition - also known as Tietze's syndrome - the cartilage of your rib cage, particularly the cartilage that joins your ribs to your breastbone, becomes inflamed. The pain from costochondritis (kos-toe-KHON-dri-tis) may occur suddenly and be intense, leading you to assume you're having a heart attack. Yet the location of the pain is different. Costochondritis causes your chest to hurt when you push on your sternum or on the ribs near your sternum. Heart attack pain is usually more widespread, and the chest wall usually isn't tender.
• Pulmonary embolism. This condition occurs when a blood clot becomes lodged in a lung artery, blocking blood flow to lung tissue. Symptoms of this life-threatening condition can include sudden, sharp chest pain that begins or worsens with a deep breath or cough. Other signs and symptoms can include shortness of breath, rapid heartbeat, anxiety and faintness. It's rare for pulmonary embolism to occur without preceding risk factors, such as recent surgery or immobilization.
• Other lung conditions. A collapsed lung (pneumothorax), high blood pressure in the arteries carrying blood to the lungs (pulmonary hypertension) and asthma also can produce chest pain.
• Sore muscles. Muscle-related chest pain tends to come on when you twist side to side or when you raise your arms. Chronic pain syndromes, such as fibromyalgia, can produce persistent muscle-related chest pain.
• Injured ribs or pinched nerves. A bruised or broken rib, as well as a pinched nerve, can cause chest pain that tends to be localized and sharp.
• Swallowing disorders. Several disorders of the esophagus, the tube that runs from your mouth to your stomach, can make swallowing difficult and even painful. One type is esophageal spasm, a condition that affects a small group of people with chest pain. When people with this condition swallow, the muscles that normally move food down the esophagus are uncoordinated. This results in painful muscle spasms. Because esophageal spasms can be calmed with the medication nitroglycerin - which also rapidly relieves some heart-related pain - this condition is sometimes mistaken for a heart problem. Another swallowing disorder, which also affects a small group of people with chest pain, is achalasia (ak-uh-LA-zhuh). In this condition, the valve in the lower esophagus doesn't open properly to allow food to enter your stomach. Instead, food backs up into the esophagus, causing pain. Pain with swallowing also can accompany heartburn.
• Shingles. This infection of nerves caused by the chickenpox virus can produce pain and a band of blisters on your back around to your chest wall. This sharp, burning pain may begin several hours to a day or so before blisters appear.
• Gallbladder or pancreas problems. Gallstones or inflammation of your gallbladder (cholecystitis) or pancreas can cause acute abdominal pain that radiates to your chest.
• Cancer. Rarely, cancer involving the chest or cancer that has spread from another part of the body can cause chest pain.