Riuh Rendah

Salam...

Terubat rindu dihati....arini ketiga2 anak kesayangan ada kat rumah...rindukan keriuhan dan karenah mereka selama 2 minggu ni...ni pun berkemungkinan balik sekejap jer dalam seminggu,...pastu dorg akan g umah wan/nenek dia org semula. Yang pasti anak sulong dan yg kedua akan ikut, yg bongsu selalunya aku tak bg pegi...tapi tak tau la kalau kali ni wan dia nak ambik jugaj...huhuhuhuu....

2minggu ketiadaan anak2 terasa sunyi sangat...rindukan mereka, keriuhan mereka, kenakalan mereka dan sebagainya...bila ada, ada masa naik tension jugak dok dengar asyik bergaduh jer sesama sendiri...tapi itulah pemanis dan pengubat sebenarnya...sesungguhnya anak2 adalah anugerah yang tak terhingga nilainya...

Si abg, bukan main celotehnya...mcm2 yg nak diceritakan...dalam bbrp jam kalau boleh cerita selama dua minggu nak diceritakan...huhuhhuhu..abg...abg...rindu katanya...mama pun rindu kat abg...

Si kakak, tak de la sebyk abg celotehnya...tapi nampak jelas muka kerinduan...mama love u too kakak...

Lepas ni kalau anak2 mama berjauhan dengan mama..tak tau la mcm mana mama nak hadapi...

Hand Foot Mouth Disease (HFMD)

Kisah ni ada dalam entry bulan July 2012..masa ni akubaru discharge dari hospital dalam seminggu still on MC anak aku demam panas dan kena jangkitan HFMD ni...anak yg bongsu...

nail bintik2 merak kat tangan dan tapak tangan...gatal

Bintik2 dlm mulut dan ulcer (lelangit)

kat bahagian tapak kaki pun ada...

bintik-bintik ni akan bertukar menjadi gelembung berair @ macam melepuh...bagi kes yang teruk. alhamdulillah, bujang kecik aku ni tak la teruk sampai melepuh yg kronik..cuma ulcer dlm mulut tu yg bat dia tak mau mkn dan minum serta demam yg terlampau panas. syukur....!! pada ibu bapa diluar sana, jika ada simptom2 mcm ni cepat2 la bw g jumpa doktor atau pakar kanak2 utk pengesahan...kalau dibiarkan virus ni boleh serang otak...dan boleh membawa kepada kematian...lagipun mudah berjangkit dengan kanak2 lain yg berusia bawah 5 tahun...

CT Scan (Abdomen)

Gambar yg bakal diletakkan ni juga dah di ceritakan kisahnya pada entry July 2012 bertajuk Sesi Bersama Doktor....ini kira pengalaman ngeri aku dlm buat CT Scan...mmg ngeri laa..rasa cam kot boleh elak..nak elak...

Ct SScan ni salah satu kaedah nak lihat organ dalaman kita tak kira la tang mana kot ada masalah...kalau memerlukan dimasukkan contrass (dye) kena la set line (IV Drip)...sb nnti dia akan pam kan dye tu time test tu dibuat..disebabkan set line n pan dye tu la buat aku cm serik yg amat...serius...

haaaa....inilah sebabnya...ini bahana apabila dalam masa bbrp jam dlm sehari tu 8 cucukan dibuat semata2 nak set IV Drip masa nak buat Ct Scan...gambar pertama tu tangan kanan yg paling byk dikerjakan...gambar ketiga tangan kiri...dua2 kat pelipat tu tak berjaya selepas 7kali cucuk...lastly gambar no 2, cucukan yg kelapan, berjaya...tapi dapat urat kecik jer..so masa dia org pam dye dengan high pressure...terasa mcm belon kecik dimasukkan air dengan tekanan yg tinggi dan menggelembung...tu sb jadi lebam...sakit jgn cakap la masa tu...rasa cm nk pecah urat...but no choice kena jugak buat...dia org try pressure paling rendah...if tak boleh jugak, mmg tak boleh teruskan...alhamdulillah...berjaya...lepas azab...

Gambar yg last tu, beberapa hari selepas kejadian, lebam dia dah makin membesar...huhuhuhuhuhu...inilah pengalaman aku dengan test2 kat hospital...sbnrnya ada byk lg..cuma ada yg lupa nak snap gambar...

Mmg mengikut pengalaman dan kata2 nurse yg pernah mengerjakan urat aku sume kata urat halus cam baby..dan susah utk guna jarum besar...tapi alhamdulillah, bila dalam bilik operation..pakar bius yg set line sekali cucuk jer...mmg terror...

Batu Dalam Hempedu (Gallstone)

Salam,

Sebenarnya cerita pasal Gallstone ni dah penah aku update dlm entry sblm ni...dalam bulan Jun 2012...cuma dalam entry tu tak ada gambar...kali ni aku nak masukkan gambar stone yg di keluarkan tu...

ni adalah tangan yang menjadi mangsa cucukan sewaktu masuk wad sebelum pembedahan utk gambar pertama..gambar kedua tu selepas keluar dari dewan bedah...sedar2 dorg dah sorong masuk dalam wad semula..dalam sejam pastu panggil nurse suh off line drip...kan tak ada tali air dah tu...rimas tuuu...nak bergerak pun susah...alasan masa tu kat nurse, nak g toliet tukar uniform...dari baju khas masuk dewan bedah yg seksi tu ke baju sendiri..nnti doktor datang tak de la seksi kan...bijak tak...pastu sampai ke sudah aku tak panggil nurse utk on balik drip tu..hihihihi....

dan inilah hasilnya....batu yg dok berkampung dalam hempedu aku...besar dia lbh kurang size sebiji guli...hurmmm...tak penah rasa sakit atau tanda apa2 masa benda ni dok dlm badan aku...but Alhamdulillah...Allah Maha Besar...dipermudahkan masalah aku...kalau dibiarkan lama2 badan akan memudaratkan...terutama bila batu sudah memasuki saluran lain...

Berdua Bersatu

Penuh makna tersirat lagu ini...suka sangat

Kehilangan

Salam,

Jam 6:55am hari ini, aku terima satu panggilan yang membawa berita pemergian pakcik kepada suami yang kami panggil Ayah Cik...beliau merupakan adik kepada arwah bapa mertua aku. Semoga rohnya dicucuri rahmat dan diterima OlehnYA disana.

Sebelum aku kawin lagi Ayah Cik sudah sakit iaitu kira2 11tahun yang lepas. Pada masa itu beliau dikatakan menghidap kanser kulit dibahagian lehernya. Namun selepas rawatan demi rawatan, alhamdulillah Ayah Cik pulih dan bebas dari kanser...

Beberapa tahun kebelakangan ini, kesihatan beliau mulai merosot. Bila ditanya, Ayah Cik kata dia tak ada masalah kesihatan, cuma yang pelik kenapa dia semakin kurus..sehinggalah pada bulan puasa tahun ini, beliau jatuh sakit dan dimasukkan ke hospital. Dimana beliau tidak boleh menelan dan makan..beliau dirawat di ICU Hospital Takawal. Pada masa itu aku tidak dpt pergi melawat sebab aku sendiri pun pada masa dalam hospital....

Kami melawat Ayah Cik pada hari raya. Sewaktu sampai kat rumah Ayah Cik sedih melihat keadaan beliau...walaupun nampak sihat namun masalah tidak boleh menelan masih seperti itu juga. Beliau hanya boleh minum susu setiap #jam yang disalurkan melalui saluran yang di pasang melalui hidungnya.

Hari ini akhirnya beliau menghadap illahi. Semoga rohnya dicucuri rahmat dan ditempatkan dikalangan org2 yg beriman.

Acute Myocardial Infarction (Heart Attack)

Heart attack facts

• A heart attack results when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle and heart muscle dies.
• The blood clot that causes the heart attack usually forms at the site of rupture of an atherosclerotic, cholesterol plaque on the inner wall of a coronary artery.
• The most common symptom of heart attack is chest pain.
• The most common complications of a heart attack are heart failure and ventricular fibrillation.
• The risk factors for atherosclerosis and heart attack include elevated cholesterol levels, increased blood pressure, tobacco use, diabetes, male gender, and a family history of heart attacks at an early age.
• Heart attacks are diagnosed with electrocardiograms and measurement of cardiac enzymes in blood.
• Early reopening of blocked coronary arteries reduces the amount of damage to the heart and improves the prognosis for a heart attack.
• Medical treatment for heart attacks may include antiplatelet, anticoagulant, and clot dissolving drugs as well as angiotensin converting enzyme (ACE) inhibitors, beta blockers, and oxygen.
• Interventional treatment for heart attacks may include coronary angiography with percutaneous transluminal coronary angioplasty (PTCA), coronary artery stents, and coronary artery bypass grafting (CABG).
• Patients suffering a heart attack are hospitalized for several days to detect heart rhythm disturbances, shortness of breath, and chest pain.
• Further heart attacks can be prevented by aspirin, beta blockers, ACE inhibitors, discontinuing smoking, weight reduction, exercise, good control of blood pressure and diabetes, following a low cholesterol and low saturated fat diet that is high in omega-3-fatty acids, takingmultivitamins with an increased amount of folic acid, decreasing LDL cholesterol, and increasing HDL cholesterol.

What is a heart attack?

A heart attack (also known as a myocardial infarction or MI) is the death of heart muscle from the sudden blockage of a coronary artery by a blood clot. Coronary arteries are blood vessels that supply the heart muscle with blood and oxygen. Blockage of a coronary artery deprives the heart muscle of blood and oxygen, causing injury to the heart muscle. Injury to the heart muscle causes chest pain and chest pressure sensation. If blood flow is not restored to the heart muscle within 20 to 40 minutes, irreversible death of the heart muscle will begin to occur. Muscle continues to die for six to eight hours at which time the heart attack usually is "complete." The dead heart muscle is eventually replaced by scar tissue.

Approximately one million Americans suffer a heart attack each year. Four hundred thousand of them die as a result of their heart attack.

What causes a heart attack?

Atherosclerosis

Atherosclerosis is a gradual process by which plaques (collections) of cholesterol are deposited in the walls of arteries. Cholesterol plaques cause hardening of the arterial walls and narrowing of the inner channel (lumen) of the artery. Arteries that are narrowed by atherosclerosis cannot deliver enough blood to maintain normal function of the parts of the body they supply. For example, atherosclerosis of the arteries in the legs causes reduced blood flow to the legs. Reduced blood flow to the legs can lead to pain in the legs while walking or exercising, leg ulcers, or a delay in the healing of wounds to the legs. Atherosclerosis of the arteries that furnish blood to the brain can lead to vascular dementia (mental deterioration due to gradual death of brain tissue over many years) or stroke (sudden death of brain tissue).

In many people, atherosclerosis can remain silent (causing no symptoms or health problems) for years or decades. Atherosclerosis can begin as early as the teenage years, but symptoms or health problems usually do not arise until later in adulthood when the arterial narrowing becomes severe. Smoking cigarettes, high blood pressure, elevated cholesterol, and diabetes mellitus can accelerate atherosclerosis and lead to the earlier onset of symptoms and complications, particularly in those people who have a family history of early atherosclerosis.

Coronary atherosclerosis (or coronary artery disease) refers to the atherosclerosis that causes hardening and narrowing of the coronary arteries. Diseases caused by the reduced blood supply to the heart muscle from coronary atherosclerosis are called coronary heart diseases (CHD). Coronary heart diseases include heart attacks, sudden unexpected death, chest pain (angina), abnormal heart rhythms, and heart failure due to weakening of the heart muscle.

Atherosclerosis and angina pectoris

Angina pectoris (also referred to as angina) is chest pain or pressure that occurs when the blood and oxygen supply to the heart muscle cannot keep up with the needs of the muscle. When coronary arteries are narrowed by more than 50 to 70 percent, the arteries may not be able to increase the supply of blood to the heart muscle during exercise or other periods of high demand for oxygen. An insufficient supply of oxygen to the heart muscle causes angina. Angina that occurs with exercise or exertion is calledexertional angina. In some patients, especially diabetics, the progressive decrease in blood flow to the heart may occur without any pain or with just shortness of breath or unusually early fatigue.

Exertional angina usually feels like a pressure, heaviness, squeezing, or aching across the chest. This pain may travel to the neck, jaw, arms, back, or even the teeth, and may be accompanied by shortness of breath,nausea, or a cold sweat. Exertional angina typically lasts from one to 15 minutes and is relieved by rest or by placing a tablet of nitroglycerin under the tongue. Both resting and nitroglycerin decrease the heart muscle's demand for oxygen, thus relieving angina. Exertional angina may be the first warning sign of advanced coronary artery disease. Chest pains that just last a few seconds rarely are due to coronary artery disease.

Angina also can occur at rest. Angina at rest more commonly indicates that a coronary artery has narrowed to such a critical degree that the heart is not receiving enough oxygen even at rest. Angina at rest infrequently may be due to spasm of a coronary artery (a condition called Prinzmetal's or variant angina). Unlike a heart attack, there is no permanent muscle damage with either exertional or rest angina although the angina is a warning sign that there is an increased risk of a heart attack in the future.

Atherosclerosis and heart attack

Occasionally the surface of a cholesterol plaque in a coronary artery may rupture, and a blood clot forms on the surface of the plaque. The clot blocks the flow of blood through the artery and results in a heart attack (see picture below). The cause of rupture that leads to the formation of a clot is largely unknown, but contributing factors may include cigarette smoking or othernicotine exposure, elevated low-density lipoprotein (LDL) cholesterol, elevated levels of blood catecholamines (adrenaline), high blood pressure, and other mechanical and biochemical stimuli.

Unlike exertional or rest angina, heart muscle dies during a heart attack and loss of the muscle is permanent, unless blood flow can be promptly restored, usually within one to six hours.

While heart attacks can occur at any time, more heart attacks occur between 4:00 A.M. and 10:00 A.M. because of the higher blood levels of adrenaline released from the adrenal glands during the morning hours. Increased adrenaline, as previously discussed, may contribute to rupture of cholesterol plaques.

Only approximately 50% of patients who develop heart attacks have warning symptoms such as exertional angina or rest angina prior to their heart attacks, but these symptoms may be mild and ignored as unimportant.

What are the symptoms of a heart attack?

Although chest pain or pressure is the most common symptom of a heart attack, heart attack victims may experience a variety of symptoms including:

• Pain, fullness, and/or squeezing sensation of the chest
• Jaw pain, toothache, headache
• Shortness of breath
• Nausea, vomiting, and/or general epigastric (upper middle abdomen) discomfort
• Sweating
• Heartburn and/or indigestion
• Arm pain (more commonly the left arm, but may be either arm)
• Upper back pain
• General malaise (vague feeling of illness)
• No symptoms (Approximately one quarter of all heart attacks are silent, without chest pain or new symptoms. Silent heart attacks are especially common among patients with diabetes mellitus.)

Even though the symptoms of a heart attack at times can be vague and mild, it is important to remember that heart attacks producing no symptoms or only mild symptoms can be just as serious and life-threatening as heart attacks that cause severe chest pain. Too often patients attribute heart attack symptoms to "indigestion," "fatigue," or "stress," and consequently delay seeking prompt medical attention. One cannot overemphasize the importance of seeking prompt medical attention in the presence of new symptoms that suggest a heart attack. Early diagnosis and treatment saves lives, and delays in reaching medical assistance can be fatal. A delay in treatment can lead to permanently reduced function of the heart due to more extensive damage to the heart muscle. Death also may occur as a result of the sudden onset of arrhythmias such as ventricular fibrillation.

What are the complications of a heart attack?

Heart failure 

When a large amount of heart muscle dies, the ability of the heart to pump blood to the rest of the body is diminished, and this can result in heart failure. The body retains fluid, and organs, for example, the kidneys, begin to fail.

Ventricular fibrillation 

Injury to heart muscle also can lead toventricular fibrillation. Ventricular fibrillation occurs when the normal, regular, electrical activation of heart muscle contraction is replaced by chaotic electrical activity that causes the heart to stop beating and pumping blood to the brain and other parts of the body. Permanent brain damage and death can occur unless the flow of blood to the brain is restored within five minutes.

Most of the deaths from heart attacks are caused by ventricular fibrillation of the heart that occurs before the victim of the heart attack can reach an emergency room. Those who reach the emergency room have an excellent prognosis; survival from a heart attack with modern treatment should exceed 90%. The 1% to 10% of heart attack victims who later die frequently had suffered major damage to the heart muscle initially or additional damage at a later time.

Deaths from ventricular fibrillation can be avoided by cardiopulmonary resuscitation (CPR) started within five minutes of the onset of ventricular fibrillation. CPR requires breathing for the victim and applying external compression to the chest to squeeze the heart and force it to pump blood. In 2008, the American Heart Association modified the mouth-to-mouth instruction of CPR, and recommends that chest compressions alone are effective if a bystander is reluctant to do mouth-to-mouth. When paramedics arrive, medications and/or an electrical shock (cardioversion) can be administered to convert ventricular fibrillation back to a normal heart rhythm and allow the heart to pump blood normally. Therefore, prompt CPR and a rapid response by paramedics can improve the chances of survival from a heart attack. In addition, many public venues now have automatic external defibrillators (AEDs) that provide the electrical shock needed to restore a normal heart rhythm even before the paramedics arrive. This greatly improves the chances of survival.

What are the risk factors for atherosclerosis and heart attack?

Factors that increase the risk of developing atherosclerosis and heart attacks include increased blood cholesterol, high blood pressure, use of tobacco, diabetes mellitus, male gender (although women may still be very much at risk -- see section at end of article), and a family history of coronaryheart disease. While family history and male gender are genetically determined, the other risk factors can be modified through changes in lifestyle and medications.

• High Blood Cholesterol (Hyperlipidemia). A high level of cholesterol in the blood is associated with an increased risk of heart attack because cholesterol is the major component of the plaques deposited in arterial walls. Cholesterol, like oil, cannot dissolve in the blood unless it is combined with special proteins called lipoproteins. (Without combining with lipoproteins, cholesterol in the blood would turn into a solid substance.) The cholesterol in blood is either combined with lipoproteins as very low-density lipoproteins (VLDL), low-density lipoproteins (LDL) or high-density lipoproteins (HDL). The cholesterol that is combined with low-density lipoproteins (LDL cholesterol) is the "bad" cholesterol that deposits cholesterol in arterial plaques. Thus, elevated levels of LDL cholesterol are associated with an increased risk of heart attack. The cholesterol that is combined with HDL (HDL cholesterol) is the "good" cholesterol that removes cholesterol from arterial plaques. Thus, low levels of HDL cholesterol are associated with an increased risk of heart attacks.Measures that lower LDL cholesterol and/or increase HDL cholesterol (losing excess weight, diets low in saturated fats, regular exercise, and medications) have been shown to lower the risk of heart attack. One important class of medications for treating elevated cholesterol levels (the statins) have actions in addition to lowering LDL cholesterol which also protect against heart attack. Most patients at "high risk" for a heart attack should be on a statin no matter what the levels of their cholesterol.
• High Blood Pressure (Hypertension). High blood pressure is a risk factor for developing atherosclerosis and heart attack. Both high systolic pressure (the blood pressure as the heart contracts) and high diastolic pressure (the blood pressure as the heart relaxes) increase the risk of heart attack. It has been shown that controlling hypertension with medications can reduce the risk of heart attack.
• Tobacco Use (Smoking). Tobacco and tobacco smoke contain chemicals that cause damage to blood vessel walls, accelerate the development of atherosclerosis, and increase the risk of heart attack.
• Diabetes (Diabetes Mellitus). Both insulin dependent and noninsulin dependent diabetes mellitus (type 1 and 2, respectively) are associated with accelerated atherosclerosis throughout the body. Therefore, patients with diabetes mellitus are at higher risk for reduced blood flow to the legs, coronary heart disease, erectile dysfunction, and strokes at an earlier age than nondiabetic subjects. Patients with diabetes can lower their risk through rigorous control of their blood sugar levels, regular exercise, weight control, and proper diets.
• Male Gender. Men are more likely to suffer heart attacks than women if they are less than 75 years old. Above age 75, women are as likely as men to have heart attacks.
• Family History of Heart Disease. Individuals with a family history of coronary heart diseases have an increased risk of heart attack. Specifically, the risk is higher if there is a family history of early coronary heart disease, including a heart attack or sudden death before age 55 in the father or other first-degree male relative, or before age 65 in the mother or other female first-degree female relative.

How is a heart attack diagnosed?

When there is severe chest pain, suspicion that a heart attack is occurring usually is high, and tests can be performed quickly that will confirm the heart attack. A problem arises, however, when the symptoms of a heart attack do not include chest pain. A heart attack may not be suspected, and the appropriate tests may not be performed. Therefore, the initial step in diagnosing a heart attack is to be suspicious that one has occurred so that the appropriate tests can be done.

Electrocardiogram. An electrocardiogram(ECG) is a recording of the electrical activity of the heart. Abnormalities in the electrical activity usually occur with heart attacks and can identify the areas of heart muscle that are deprived of oxygen and/or areas of muscle that have died. In a patient with typical symptoms of heart attack (such as crushing chest pain) and characteristic changes of heart attack on the ECG, a secure diagnosis of heart attack can be made quickly in the emergency room and treatment can be started immediately. If a patient's symptoms are vague or atypical and if there are pre-existing ECG abnormalities, for example, from old heart attacks or abnormal electrical patterns that make interpretation of the ECG difficult, the diagnosis of a heart attack may be less secure. In these patients, the diagnosis can be made only hours later through blood tests.

Blood tests. Cardiac enzymes are proteins that are released into the blood by dying heart muscles. These cardiac enzymes are creatine phosphokinase (CPK), special sub-fractions of CPK (specifically, the MB fraction of CPK), and troponin, and their levels can be measured in blood. These cardiac enzymes typically are elevated in the blood several hours after the onset of a heart attack. A series of blood tests for the enzymes performed over a 24-hour period are useful not only in confirming the diagnosis of heart attack, but the changes in their levels over time also correlates with the amount of heart muscle that has died.

The most important factor in diagnosing and treating a heart attack is prompt medical attention. Rapid evaluation allows early treatment of potentially life-threatening abnormal rhythms such as ventricular fibrillation and allows early reperfusion (return of blood flow to the heart muscle) by procedures that unclog the blocked coronary arteries. The more rapidly blood flow is reestablished, the more heart muscle that is saved. At this time, mechanical reperfusion with angioplasty and/or stenting to increase the flow of blood to the heart is the preferred way to preserve heart muscle if it can be performed within 90 minutes of arrival to the hospital; if there will be a delay, thrombolytic agents (clot busters) are preferred.

Large and active medical centers often have a "chest pain unit" where patients suspected of having heart attacks are rapidly evaluated. If a heart attack is diagnosed, prompt therapy is initiated. If the diagnosis of heart attack is initially unclear, the patient is placed under continuous monitoring until the results of further testing are available.

Type 1 Diabetes (Juvenile Diabetes)

Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to produce energy. Type 2 diabetes, which is far more common, occurs when the body becomes resistant to the effects of insulin or doesn't make enough insulin.

Various factors may contribute to type 1 diabetes, including genetics and exposure to certain viruses. Although type 1 diabetes typically appears during adolescence, it can develop at any age.

Despite active research, type 1 diabetes has no cure, although it can be managed. With proper treatment, people who have type 1 diabetes can expect to live longer, healthier lives than in the past.

Symptoms

By Mayo Clinic staff

Controlling Your Diabetes

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Type 1 diabetes signs and symptoms can come on quickly and may include:

• Increased thirst and frequent urination. As excess sugar builds up in your bloodstream, fluid is pulled from your tissues. This may leave you thirsty. As a result, you may drink — and urinate — more than usual.
• Extreme hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger that may persist even after you eat. Without insulin, the sugar in your food never reaches your energy-starved tissues.
• Weight loss. Despite eating more than usual to relieve hunger, you may lose weight — sometimes rapidly. Without the energy sugar supplies, your muscle tissues and fat stores may simply shrink.
• Fatigue. If your cells are deprived of sugar, you may become tired and irritable.
• Blurred vision. If your blood sugar level is too high, fluid may be pulled from your tissues — including the lenses of your eyes. This may affect your ability to focus clearly.

When to see a doctor

Consult your doctor if you're concerned about diabetes or if you notice any type 1 diabetes signs and symptoms.

Causes

By Mayo Clinic staff

Controlling Your Diabetes

Subscribe to our Controlling Your Diabetes e-newsletter to stay up to date on diabetes topics.

Sign up now

The exact cause of type 1 diabetes is unknown. Scientists do know that in most people with type 1 diabetes, their body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet) cells in the pancreas. Genetics may play a role in this process, and exposure to certain viruses may trigger the disease.

Whatever the cause, once the islet cells are destroyed, you'll produce little or no insulin. Normally, the hormone insulin helps glucose enter your cells to provide energy to your muscles and tissues. Insulin comes from the pancreas, a gland located just behind the stomach. When everything is working properly, once you eat, the pancreas secretes insulin into the bloodstream. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter the body's cells. Insulin lowers the amount of sugar in the bloodstream, and as the blood sugar level drops, so does the secretion of insulin from the pancreas.

The liver acts as a glucose storage and manufacturing center. When insulin levels are low — when you haven't eaten in a while, for example — the liver converts stored glycogen back to glucose to keep your blood glucose level within a normal range.

In type 1 diabetes, none of this occurs because there's no insulin to let glucose into the cells. So instead of being transported into your cells, sugar builds up in your bloodstream, where it can cause life-threatening complications.

The cause of type 1 diabetes is different from the cause of the more familiar type 2 diabetes. In type 2 diabetes, the islet cells are still functioning, but the body becomes resistant to insulin or the pancreas doesn't produce enough insulin or both.

Chronic Kidney Disease (CKD)

Illustration of the kidneys, urinary tract, and bladder.

Illustration of kidney and surrounding anatomy.

Chronic kidney disease

Chronic kidney disease occurs when one suffers from gradual and usually permanent loss of kidney function over time. This happens gradually, usually over months to years. Chronic kidney disease is divided into five stages of increasing severity (see Table 1 below). The term "renal" refers to the kidney, so another name for kidney failure is "renal failure." Mild kidney disease is often called renal insufficiency.

With loss of kidney function, there is an accumulation of water, waste, and toxic substances in the body that are normally excreted by the kidney. Loss of kidney function also causes other problems such as anemia,high blood pressure, acidosis (excessive acidity of body fluids), disorders of cholesterol and fatty acids, and bone disease.

Stage 5 chronic kidney disease is also referred to as kidney failure, end-stage kidney disease, or end-stage renal disease, wherein there is total or near-total loss of kidney function. There is dangerous accumulation of water, waste, and toxic substances, and most individuals in this stage of kidney disease need dialysis or transplantation to stay alive.

Unlike chronic kidney disease, acute kidney failure develops rapidly, over days or weeks.

• Acute kidney failure usually develops in response to a disorder that directly affects the kidney, its blood supply, or urine flow from it.
• Acute kidney failure is often reversible, with complete recovery of kidney function.
• Some patients are left with residual damage and can have a progressive decline in kidney function in the future.
• Others may develop irreversible kidney failure after an acute injury and remain dialysis-dependent.

Table 1. Stages of Chronic Kidney Disease

Stage	Description	GFR* mL/min/1.73 m2
1	Slight kidney damage with normal or increased filtration	More than 90
2	Mild decrease in kidney function	60 to 89
3	Moderate decrease in kidney function	30 to 59
4	Severe decrease in kidney function	15 to 29
5	Kidney failure	Less than 15 (or dialysis)
*GFR is glomerular filtration rate, a measure of the kidney's function.

Chronic Kidney Disease Causes

Although chronic kidney disease sometimes results from primary diseases of the kidneys themselves, the major causes are diabetes and high blood pressure.

• Type 1 and type 2 diabetes mellitus cause a condition called diabetic nephropathy, which is the leading cause of kidney disease in the United States.
• High blood pressure (hypertension), if not controlled, can damage the kidneys over time.
• Glomerulonephritis is the inflammation and damage of the filtration system of the kidneys, which can cause kidney failure. Postinfectious conditions and lupus are among the many causes of glomerulonephritis.
• Polycystic kidney disease is a hereditary cause of chronic kidney disease wherein both kidneys have multiple cysts.
• Use of analgesics such as acetaminophen(Tylenol) and ibuprofen (Motrin, Advil) regularly over long durations of time can cause analgesic nephropathy, another cause of kidney disease. Certain other medications can also damage the kidneys.
• Clogging and hardening of the arteries (atherosclerosis) leading to the kidneys causes a condition called ischemic nephropathy, which is another cause of progressive kidney damage.
• Obstruction of the flow of urine by stones, an enlarged prostate, strictures (narrowings), or cancers may also cause kidney disease.
• Other causes of chronic kidney disease include HIV infection, sickle cell disease, heroin abuse, amyloidosis, kidney stones, chronic kidney infections, and certain cancers.

If one has any of the following conditions, they are at higher-than-normal risk of developing chronic kidney disease. One's kidney function may need to be monitored regularly.

• Diabetes mellitus type 1 or type 2
• High blood pressure
• High cholesterol
• Heart disease
• Liver disease
• Amyloidosis
• Sickle cell disease
• Systemic lupus erythematosus
• Vascular diseases such as arteritis, vasculitis, or fibromuscular dysplasia
• Vesicoureteral reflux (a urinary tract problem in which urine travels from the bladder the wrong way back toward the kidney)
• Require regular use of anti-inflammatory medications
• A family history of kidney disease

Chronic Kidney Disease Symptoms and When to Seek Medical Care

The kidneys are remarkable in their ability to compensate for problems in their function. That is why chronic kidney disease may progress without symptoms for a long time until only very minimal kidney function is left.

Because the kidneys perform so many functions for the body, kidney disease can affect the body in a large number of different ways. Symptoms vary greatly. Several different body systems may be affected. Notably, most patients have no decrease in urine output even with very advanced chronic kidney disease.

Effects and symptoms of chronic kidney disease include:

• need to urinate frequently, especially at night (nocturia);
• swelling of the legs and puffiness around the eyes (fluid retention);
• high blood pressure;
• fatigue and weakness (from anemia or accumulation of waste products in the body);
• loss of appetite, nausea and vomiting;
• itching, easy bruising, and pale skin (from anemia);
• shortness of breath from fluid accumulation in the lungs;
• headaches, numbness in the feet or hands (peripheral neuropathy), disturbed sleep, altered mental status (encephalopathy from the accumulation of waste products or uremic poisons), and restless legs syndrome;
• chest pain due to pericarditis (inflammation around the heart);
• bleeding (due to poor blood clotting);
• bone pain and fractures; and
• decreased sexual interest and erectile dysfunction.

When to Seek Medical Care

Several signs and symptoms may suggest complications of chronic kidney disease. One should call a health care professional if they notice any of the following symptoms:

• change in energy level or strength;
• increased water retention (puffiness or swelling) in the legs, around the eyes, or in other parts of the body;
• shortness of breath or change from normal breathing;
• nausea or vomiting;
• lightheadedness;
• bone or joint pain;
• easy bruising; or
• itching.

If a woman has known kidney problems, she should see a health care professional right away if she knows or suspects that she is pregnant.

See a health care practitioner as recommended for monitoring and treatment of chronic conditions such as diabetes, high blood pressure, and high cholesterol.

The following signs and symptoms represent the possibility of a severe complication of chronic kidney disease and warrant a visit to the nearest hospital emergency department.

• Change in level of consciousness -- extreme sleepiness or difficult to awaken
• Severe fatigue
• Chest pain
• Difficulty breathing
• Severe nausea and vomiting
• Severe bleeding (from any source)
• Muscle weakness

Coronary Artery Disease

Definition

By Mayo Clinic staff

Coronary artery disease develops when your coronary arteries — the major blood vessels that supply your heart with blood, oxygen and nutrients — become damaged or diseased. Cholesterol-containing deposits (plaque) on your arteries are usually to blame for coronary artery disease.

When plaques build up, they narrow your coronary arteries, causing your heart to receive less blood. Eventually, the decreased blood flow may cause chest pain (angina), shortness of breath, or other coronary artery disease signs and symptoms. A complete blockage can cause a heart attack.

Because coronary artery disease often develops over decades, it can go virtually unnoticed until you have a heart attack. But there's plenty you can do to prevent and treat coronary artery disease. Start by committing to a healthy lifestyle.

Symptoms

By Mayo Clinic staff

If your coronary arteries become narrowed, they can't supply enough oxygen-rich blood to your heart — especially when it's beating hard, such as during exercise. At first, the decreased blood flow may not cause any coronary artery disease symptoms. As the plaques continue to build up in your coronary arteries, however, you may develop coronary artery disease symptoms, including:

• Chest pain (angina). You may feel pressure or tightness in your chest, as if someone were standing on your chest. The pain, referred to as angina, is usually triggered by physical or emotional stress. It typically goes away within minutes after stopping the stressful activity. In some people, especially women, this pain may be fleeting or sharp and noticed in the abdomen, back or arm.
• Shortness of breath. If your heart can't pump enough blood to meet your body's needs, you may develop shortness of breath or extreme fatigue with exertion.
• Heart attack. If a coronary artery becomes completely blocked, you may have a heart attack. The classic signs and symptoms of a heart attack include crushing pressure in your chest and pain in your shoulder or arm, sometimes with shortness of breath and sweating. Women are somewhat more likely than men are to experience less typical signs and symptoms of a heart attack, including nausea and back or jaw pain. Sometimes a heart attack occurs without any apparent signs or symptoms.

Causes

By Mayo Clinic staff

Development of atherosclerosis

Coronary artery disease is thought to begin with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by various factors, including:

• Smoking
• High blood pressure
• High cholesterol
• Diabetes
• Radiation therapy to the chest, as used for certain types of cancer

Once the inner wall of an artery is damaged, fatty deposits (plaques) made of cholesterol and other cellular waste products tend to accumulate at the site of injury in a process called atherosclerosis. If the surface of these plaques breaks or ruptures, blood cells called platelets will clump at the site to try to repair the artery. This clump can block the artery, leading to a heart attack.