I. Human Skeletal System: Skeletal system is the system of bones, associated cartilages and joints of human body.

Together these structures form the human skeleton. Skeleton can be defined as the hard framework of human body around which the entire body is built. Almost all the hard parts of human body are components of human skeletal system. Joints are very important because they make the hard and rigid skeleton allow different types of movements at different locations. If the skeleton were without joints, no movement would have taken place and the significance of human body; no more than a stone. Human Skeleton Components of Human Skeleton: Human skeleton is composed of three main components; Bones, Associated cartilages and Joints. Bones: Bone is a tough and rigid form of connective tissue. It is the weight bearing organ of human body and it is responsible for almost all strength of human skeleton. Cartilages: Cartilage is also a form of connective tissue but is not as tough and rigid as bone. The main difference in the cartilage and bone is the mineralization factor. Bones are highly mineralized with calcium salts while cartilages are not. Joints: Joints are important components of human skeleton because they make the human skeleton mobile. A joint occurs between two or more bones, bone and cartilage and cartilage and cartilage. Divisions of Human Skeleton: Human skeleton can be divided into two divisions. Axial Skeleton: Axial skeleton forms the axis of human body. It consists of Skull, vertebral column and thoracic cage. Skull: Skull is that part of human skeleton that forms the bony framework of the head. It consists of 22 different bones that are divided into two groups: bones of cranium and bones of face. Vertebral Column: It is a flexible column of vertebrae, connecting the trunk of human body to the skull and appendages. It is composed of 33 vertebrae which are divided into 5 regions: Cervical, Thoracic, Lumbar, Sacral, and Coccygeal.

Rib Cage: It is a bony cage enclosing vital human organs formed by the sternum and ribs. There are 12 pairs of ribs that are divided into three groups: True ribs, False ribs, and Floating ribs. Axial Skeleton Appendicular Skeleton: It is the skeleton of appendages of human body. It consists of Shoulder girdle, Skeleton of upper limb, Pelvic girdle and Skeleton of lower limb. Shoulder Girdle: It attaches the upper limb to body trunk and is formed by two bones: clavicle and scapula.Clavicle is a modified long bone and is subcutaneous throughout its position. It is also known as the beauty bone. For more details on clavicle, Scapula is a pear shaped flat bone that contains the glenoid fossa for the formation of shoulder joint. It possesses three important processes: Spine of scapula, Acromion process and Coracoid process. Skeleton of Upper limb: The skeleton of each upper limb consists of 30 bones. These bones are: Humerus, Ulna, Radius, Carpals (8), Metacarpals (5), Phalanges (14). Pelvic Girdle: There are two pelvic girdles (one for each lower limb) but unlike the pectoral girdles, they are jointed with each other at symphysis pubis. Each pelvic girdle is a single bone in adults and is made up of three components: Ileum, Ischium and Pubis. Skeleton of Lower limb: The skeleton of each lower limb consists of 30 bones. These bones are; Femur, Tibia, Patella, Tarsals (7), Metatarsals (5), Phalanges (14). Functions of human skeleton: Human skeleton performs some important functions that are necessary for survival of human beings. STRENGTH, SUPPORT AND SHAPE: It gives strength, support and shape to the body. Without a hard and rigid skeletal system, human body cannot stand upright, and it will become just a bag of soft tissues without any proper shape PROTECTION OF DELICATE ORGANS: In areas like the rib cage and skull, the skeleton protects inner soft but vital organs like heart and brain from external shocks. Any damage to these organs can prove fatal, therefore protective function of skeleton is very important LEVERAGE FOR MOVEMENTS: Bones of the human skeleton in all parts of body provide attachment to the muscles. These muscles provide motor power for producing movements of body parts. In these movements the parts of skeleton acts like levers of different types thus producing movements according to the needs of the human body.

PRODUCTION OF RED BLOOD CELLS: Bones like the sternum, and heads of tibia have hemopoeitic activity (blood cells production). These are the sites of production of new blood cells. Nutrients Needed For a Healthy Bone: Most people only think of calcium when they think of keeping their bones healthy. But research has shown that a spectrum of nutrients is necessary to maintain bone health. Vitamin D, for example, has gained a significant amount of attention for its role in increasing calcium absorption. And while calcium is the primary mineral found in bones, other minerals like magnesium, zinc, phosphorous and boron also play a crucial role in maintaining bone strength and integrity. Recent studies are also bringing to light the importance of nutrients not previously associated with bone health. Certain B vitamins, for example, lower a toxic body chemical known as homocysteine which can greatly increase the risk of fractures in both men and women. And studies have found that vitamin K, a nutrient not found in most multivitamin supplements, may significantly improve bone mineral density. Even phytonutrients, like the isoflavones found in soy, the polyphenols found in green tea and certain antioxidants found in fruits and vegetables, have been found to have a beneficial impact on chemical reactions in the body that affect bone health. Nutrients almost always work best in groups or families, as they are found in whole foods. And even though research and media attention has focused almost solely on calcium as the principle nutrient needed for bone health, in the end we will probably find that it takes the subtle interplay of a wide variety of nutrients to keep bones healthy and strong. Diseases and Disorders Leukemia The cause of most human leukemia is unknown. It is a kind of cancer in which abnormal white blood cells multiply in an uncontrolled manner. they interfere with the production of normal white blood cells. Leukemia affects the production of red blood cells. Bursitis Bursitis is a disorder that causes pain in the body's joints. It most commonly affects the shoulder and hip joints. It is caused by an inflammation of the bursa, small fluidfilled bags that act as lubricating surfaces for muscles to move over bones. This inflammation usually results from overactivity of an arm or leg. Osteoporosis Osteoporosis is a disease resulting in the loss of bone tissue. In osteoporosis, the cancellous bone loses calcium, becomes thinner, and may disappear altogether.

Sprains A sprain is an injury to a ligament or to the tissue that covers a joint. Most sprains result from a sudden wrench that stretches or tears the tissues of the ligaments. A sprain is usually extremely painful. The injured part often swells and turns black and blue. Fractures A fracture is a broken bone. These are some common kinds of fractures:

Spina bifida Spina bifida is a spinal defect that is present at birth. In spina bifida, the spinal cord does not form properly and the vertebrae and skin cannot form around it. Spina bifida results from an error in the development of the embryo that occurs about a month after a woman becomes pregnant. This error may have various causes, including the use of alcohol or certain medications by the pregnant woman or exposure to extreme heat. Genetic factors appear to be very important. Scurvy Scurvy is a disease caused by lack of ascorbic acid (vitamin C) in the diet. If a person does not get enough vitamin C, any wound he or she might have heals poorly. The person also bruises easily. The mouth and gums become sore. The gums bleed, and the teeth may become loose. Patients lose their appetite, their joints become sore, and they become restless. Arthritis There are more than 100 diseases of the joints referred to as arthritis. Victims of arthritis suffer pain, stiffness, and swelling in their joints. Osteoarthritis, also called degenerative joint disease, occurs when a joint wears out.

Many elderly people have osteoarthritis, and the disease may also occur if a joint has been injured many times. The joints most frequently affected are those of the hands, hips, knees, lower back, and neck. Scoliosis Scoliosis is a side-to-side curve of the spine. This condition becomes apparent during adolescence. It is unknown why Scoliosis affects more girls than boys. Talipes equinovarus Talipes equinovarus, often called clubfoot is an abnormal condition of the foot, usually present at birth. The foot is bent downward and inward so that the person can walk only on the toes and on the outside of the foot. Sometimes the foot is bent upward and outward so that the person can use only the heel for walking. Tendinitis Tendinitis is a disorder involving stiffness or pain in the muscles or joints. It is often called rheumatism. Kyphosis Kyphosis, also called hunchback is a forward bending of the spine. Kyphosis is caused by any condition that deforms the bones of the upper part of the spine so that the person is bent forward. Diseases that cause kyphosis include tuberculosis, syphilis, and rheumatoid arthritis. Poliomyelitis Poliomyelitis, also called polio, is a serious infection caused by a virus. A polio virus may attack the nerve cells of the brain and spinal cord, causing paralysis. Some patients show only mild symptoms, such as fever, headache, sore throat, and vomiting. Symptoms may disappear after about a day. Remedies: Specific treatment for a bone disorder will be determined by your physician based on:

Your age, overall health, and medical history Extent of the disease Your tolerance for specific medications, procedures, or therapies Expectations for the course of the disease Your opinion or preference

Treatment may include:

Assistive devices - (i.e., casts or crutches) Core decompression - a surgical procedure in which the inner layer of bone is removed to reduce pressure, allow for increased blood flow, and slow or stop bone and/or joint destruction. Osteotomy - a surgical procedure to reshape the bone and reduce stress on the affected area. Bone graft - a surgical procedure in which healthy bone is transplanted from another part of the patient's body (autograft) or from a donor (allograft) into the affected area. Arthroplasty (total joint replacement) - a surgical procedure to remove and replace an arthritic or damaged joint with an artificial joint (called a prosthesis); may be considered only after other treatment options have failed to provide adequate relief from pain and/or disability. Chemotherapy - when cancer is present, this systemic procedure involves the use of drugs to destroy the cancer cells. Surgery - when cancer is present, surgery may include biopsy to diagnose and stage the cancer, and/or a procedure to remove the cancerous tissue or tumor. Amputation - although limb-sparing surgery normally is the goal, sometimes, the extent of the cancer requires that an entire limb be removed, a surgical procedure called amputation. Radiation therapy - when cancer is present, radiation may be used to kill cancerous cells. This type of treatment may include the following: o External beam radiation - external beam therapy is delivered externally from a machine directed to the cancer inside the patient. Examples of external beam therapy include intensity-modulated radiation therapy (IMRT) and proton beam radiation. The type of machine used will be determined by the radiation oncologist. External beam therapy delivers ionizing radiation to the cancer, destroying cancer cells. Internal radiation - radioactive pellets are implanted in the affected area.

II. Muscular System The muscles of your body are vitally important -- they allow you to sit, stand, walk and perform all other movements. When your muscles are healthy, your body can move freely. Your physician may recommend exercise and a balanced diet with good nutrition to keep your muscles in tip-top shape, but you can also take a variety of vitamins for good muscle health. Nutrients Needed for Healthy Muscles Vitamin C Your muscles need vitamin C to function properly. This vitamin plays a vital role in the formation of elastin and collagen, both of which serve as connective tissues to help develop muscle structure, according to the Health Guidance website. In addition, vitamin C works in combination with magnesium, calcium, potassium and phosphorus to contribute toward muscle regulation. Without vitamin C, your body would lack healthy blood vessels, a part of your body that delivers the oxygen and nutrients to muscles that help keep them working well. Medline Plus recommends that you take in between 75 and 90 mg of vitamin C on a daily basis. While you can get vitamin C in your diet by eating citrus fruits, green peppers, tomatoes and broccoli, you may need a vitamin supplement to make sure that you get enough of this important nutrient for optimal muscle health. Do not take more than 2,000 mg of vitamin C per day. Vitamin E Include vitamin E in your daily diet to improve and maintain the health of your muscles. Vitamin E increases the amount of oxygen in your body, which supplies your muscles with plenty of energy to function correctly, according to the Herbs2000 website. This vitamin, in conjunction with insulin and other vitamins, also helps supply your body with the fuel it needs to move your muscles and keep them healthy by helping to convert carbohydrates and fats into energy. Getting enough vitamin E is especially important if you have fibromylagia, a chronic condition that presents with muscle pain and weakness. Medline Plus recommends getting approximately 15 mg of vitamin E per day. Vitamin E supplements are available, or you may find vitamin E in corn, nuts, seeds and olives. Vitamin B12 All the B vitamins are important to muscle function and coordination, but vitamin B12 in particular is a vitamin you should include in your diet to influence the health of your muscles. Vitamin B12 helps you develop healthy nerve cells and red blood cells, according to the Mayo Clinic. Red blood cells carry oxygen throughout the body, including your muscles, and the Herbs2000 website reports that vitamin B12's impact on the nervous system plays a vital role in regulating the muscles. The Mayo Clinic indicates that if you have a vitamin B12 deficiency you may experience muscle weakness and fatigue as well as shaky-leg syndrome, which results in muscle tremors. The recommended daily intake of vitamin B12 is 2.4 mcg of adults. You can meet these daily nutritional needs by eating seafood, meat or dairy products or taking a vitamin supplement.

The human body has more than 600 muscles. Every movement you make, regardless or how slight or exaggerated, involves a muscle contraction. During exercise, your muscles work in concert to move body parts numerous times. Consuming the proper nutrients will allow you to do this action optimally and help speed recovery. Carbohydrates Carbohydrates are macronutrients that are pivotal for muscles during exercise. When carbs are consumed, they get converted to glucose, which is either used immediately for energy or stored in the muscles as glycogen and used for energy at a later time. If you do not consume enough carbs before a workout, you run the risk of "hitting the wall" or "bonking." This is a point where exhaustion kicks in and your energy levels are tapped. The recommended daily intake of carbs is 130 grams for the average person. Athletes however, should aim for 250 grams or more. Include carb-containing foods in your diet like fruits, sweet potatoes, oatmeal, brown rice, yogurt, whole wheat pasta, whole grain bread and legumes. Potassium and Sodium Potassium and sodium are electrolyte minerals that play critical roles in exercise, especially when it is intense and of a long duration. Excessive sweating causes potassium and sodium levels to become depleted in the body. Your body needs potassium and sodium for fluid balance, nerve signal transmission and muscle contractions. Include foods in your diet that contain both of these minerals. Raisins, salted nuts, peanut butter, apricots, oranges and raisins are examples. Iron Iron is a mineral that aids in the production of the oxygen-carrying proteins hemoglobin and myoglobin. A lack of iron in the diet will cause you to feel tired and weak, and your muscles will not work properly. Animal meats and derivatives such as beef, chicken, turkey, eggs, fish and pork have a high iron content. If you are vegetarian or vegan, include non-meat iron sources in your diet like spinach, lentils, kidney beans and brown rice. Vitamin C helps with the absorption of iron. Pair a vitamin C-rich food with an iron-containing food to help with absorption. Water Water is vitally important for your muscles, especially during long, high-intensity training bouts. A lack of water can lead to muscle fatigue, poor coordination and cramps. Exercising in extreme heat without enough water can elevate your risk of heat stroke. The American Council on Exercise recommends drinking 8 ounces of water before you exercise and 7 to 10 ounces every 10 to 20 minutes during your exercise sessions. Sports drinks, which commonly contain a balance of potassium and sodium, are only necessary if you exceed 45 minutes of high-intensity training. Protein Protein is an important macronutrient often referred to as the building block of muscle. It is composed of amino acids, which are essential or nonessential. Essential amino acids need to be consumed from food because the body does not make them.

Foods that contain all nine of the essential amino acids are called complete proteins. Any animal meat or derivative is a complete protein. The best time to consume protein for muscle growth is immediately following workouts. The National Strength and Conditioning Association recommends consuming a liquid source of protein, which absorbs quickly. Drink milk or prepare a shake made with whey protein powder, which is a fast-absorbing type. Diseases, Disorders & Remedies of Muscles Myopathy This term is generally used to refer to multiple types of skeletal muscle diseases. Symptoms which commonly occur with this disease include: Muscle weakness to such an extent that the affected person becomes unable to do routine tasks Cramping, stiffness, tenderness, and tightness Fibromyalgia Another common muscle disorder is fibromyalgia. It is more common in women than in men. According to medical experts, this disorder interferes with the processing of pain signals by the brain by amplifying painful sensations. The characteristic symptoms of this incurable chronic disease include: Pain at various places in the body such as the upper hips, side of the hips, back of the head, top of the shoulders and inner knees. The upper chest area, the area between the shoulder blades, and front sides of the neck are also affected The above symptoms may be accompanied by fatigue, depression, anxiety for no real reason, headaches, and symptoms of irritable bowel syndrome Chronic Fatigue Syndrome Unlike the normal feeling of fatigue, this condition does not improve with rest or sleep, but only worsens with physical and even mental inactivity. There could be several kinds of symptoms that may show up in this disorder, sometimes making it difficult to be diagnosed. Fatigue, which may be accompanied by memory problems, less concentration, and sleep is not refreshing Sore throat, enlarged lymph nodes, abnormal muscle pain, and pain radiating from one joint to another A headache that is different from what occurs normally Feeling of being washed out extremely, which may last for more than a day after indulging in physical or mental work Chest pain, diarrhea, dry mouth, jaw pain, nausea, chills, dizziness, cough (chronic), bloated feeling, morning stiffness, etc., are some more symptoms that have been reported by patients Polymyositis It is one of the common forms of myopathy. It is characterized by its ill effects on the connective tissues. People between 30s and 50s have been found to be more vulnerable to contract this inflammatory muscle disease.

The disease is more prevalent in women than in men. The polymyositis symptoms to be watched out for include: Tenderness in the affected muscles or in the joints Difficulty in eating and drinking Fatigue, which might be accompanied by shortness of breath Speech problems Chronic Compartment Syndrome One of the common neuromuscular diseases is the chronic compartment syndrome. This is a rare condition that is known to be exercise-induced, and affects the muscles of the limbs. That is why it is more common in athletes who are indulged in sports that involve repetitive movements. Main signs and symptoms include: Pain in the affected limb which may also have a feeling of tightness, and burning sensation There might be weakness in the affected area, which sometimes, may be worsened by swelling It is important to take a note of the fact that the pain caused by this disease begins soon after the person starts exercising, and keeps aggravating if the exercise is continued. The pain usually ceases about 15 - 30 minutes after the person has stopped exercising, but with time it may take a day or two for the pain to subside Isaac's Syndrome One of the rarest kinds of muscle diseases, is the Issac's syndrome. It is a neuromuscular disorder, whose important symptoms are: Contracting or twitching muscles (continuously) Cramping Excessive perspiration Weakened reflexes Delayed muscle relaxation Stiffness in limbs and trunk Speech and breathing problems Rhabdomyolysis Another rare kind of muscle disease which causes the breakdown of muscle cells is what is known as rhabdomyolysis. This process results in the release of muscle fiber contents in the circulation, which gives rise to a number of symptoms such as: Intense pain that radiates throughout the entire body Weakness in the muscles of different parts of the body Urine color may be dark or cola-colored Symptoms of kidney damage Muscular Dystrophy (MD) Here, the muscle fibers in the body, somehow, stay at a high risk of damage. Muscular dystrophy is actually known to be a group of diseases of the muscles that are inherited. The voluntary muscles tend to be the most vulnerable type to get affected by this condition.

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Some types of this group also affect the heart muscles, and other involuntary muscles. The general symptoms are: Loss of balance or coordination Muscle weakness Crippling The major forms of MD are as follows: Becker Congenital Distal Duchenne Emery-Dreifuss Facioscapulohumeral Limb-girdle Myotonic Oculopharyngeal Kennedy's Disease This condition only affects men. It is an inherited condition, and causes a gradual break down of muscles. The common symptoms include: Muscle cramps Tremors Difficulty in swallowing food and drinks Difficulty in speaking Low sperm count, breast development, and impotency Shrunken testicles Numbness that stays localized As it can be inferred from the symptoms, the conditions may severely affect the health of the affected person. So paying heed to the symptoms, and discussing them with a medical expert, can keep things from getting ugly and sometimes, even fatal. III. Nervous System Every moment of the day your nervous system is active. It exchanges millions of signals corresponding with feeling, thoughts and actions. A simple example of how important the nervous system is in your behavior is meeting a friend. First, the visual information of your eyes is sent to your brain by nervous cells. There the information is interpreted and translated into a signal to take action. Finally the brain sends a command to your voice or to another action system like muscles or glands. For example, you may start walking towards him. Your nervous system enables this rapid recognition and action. "The nervous system allows us to perceive, to interpret and to respond to events from the environment."

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The nervous system is the most complex system of the human body. The human brain itself consists of at least 10 billion neurons. Single-cell creatures do not need a nervous system. They are in immediate contact with their environment and do not need communication between cells. Multicelled creatures need the nervous system for the communication between their cells. What is its function? There are three general functions of the nervous system in man and animals: 1. Sensing specific information about external and internal conditions (In the example above, this is seeing your friend). 2. Intergrating that information (This is the understanding of the information coming from the eyes). 3. Issuing commands for a response from the muscles or glands (This is the reaction of walking towards him). The nervous system provides us the ability to perceive, understand and react to environmental events. That is why the nervous system is so extremely important for human behavior. Nutrients Needed Carbohydrates Carbohydrates provide your body with glucose, a simple sugar that provides energy for your body. Glucose is especially important for your brain and nervous system, so it is imperative that you consume adequate amounts of dietary carbohydrates to provide your brain and nervous system with a steady supply of glucose. The Food and Nutrition Board, a subgroup of the Institute of Medicine, recommends that carbohydrates comprise 45 to 65 percent of your daily calorie intake, more than any of the other macronutrients. Thiamin Thiamin, also referred to as vitamin B1, plays a role in the transmission of nerve impulses by ensuring that nerve cells stay healthy and function properly. Thiamin also allows your body to metabolize carbohydrates, giving your nervous system access to glucose. To ensure that the nervous system functions properly, adult men should consume 1.2 mg of thiamin per day, whereas adult women should consume 1.1 mg of thiamin daily. Sources of thiamin include whole grain foods, enriched grains, fortified cereals and pork. Vitamin B6 Vitamin B6 acts as a coenzyme, which is a substance that helps enzymes produce chemical reactions. Vitamin B6 plays a role in the chemical reactions that produce serotonin, dopamine, norepinephrine and gamma-aminobutyric acid, or GABA, neurotransmitters that are vital to proper nervous system functioning.

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Vitamin B6 also helps your body break down glycogen, the storage form of glucose, which provides your brain and nervous system with energy when your carbohydrate intake is insufficient. Adult women should consume between 1.3 and 1.5 mg of vitamin B6 every day. Adult men need 1.3 to 1.7 mg of vitamin B6 daily. A wide range of foods, including meat, fish, poultry, fruits, nuts, legumes, fortified cereals and a variety of vegetables, provide vitamin B6. Vitamin B12 For nerve signals to travel quickly and efficiently, nerve cells must be covered with a fatty layer called the myelin sheath. Vitamin B12 keeps your nerves healthy by supporting the structure of the myelin sheath. Vitamin B12 also plays a role in regenerating nerve cells and the growth of new cells. Both adult men and women should consume 2.4 mcg of vitamin B12 every day. The only foods that provide natural vitamin B12 are meat, fish, poultry and dairy products. Fortified cereals and enriched soy milk also provide vitamin B12. Diseases and Disorders of the Nervous System/ Remedies Bell's Palsy A form of Neuritis that involves paralysis of the facial nerve causing weakness of the muscles of one side of the face and an inability to close the eye. Unknown. (Recovery may occur spontaneously.) Paralysis of the facial nerve; weakness of the muscles of one side of the face; may result in inability to close the eye. (In some cases the patient's hearing may also be affected in such a way that sounds seem to him/her to be abnormally loud. Loss of taste sensation may also occur.) Cerebal Palsy A nonprogressive disorder of movement resulting from damage to the brain before, during, or immediately after birth. Cerebal Palsy is attributed to damage to the brain, generally occuring before, during, or immediately after birth. It is often associated with other neurological and mental problems.There are many causes including birth injury, hypoxia, hypoglycaemia, jaundice and infection. The most common disability is a spastic paralysis. Sensation is often affected, leading to a lack of balance, and intelligence, posture and speech are frequently impaired. Contractures of the limbs may cause fixed abnormalities. Other associated features include epilepsy, visual impairment, squint, reduced hearing, and behavioural problems.

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Motor Neurone Disease A progressive degenerative disease of the motor system occurring in middle age and causing muscle weakness and wasting. Some forms of Motor Neurone Disease are inherited. Motor Neurone disease primarily affects the cells of the anterior horn of the spinal cord, the motor nuclei in the brainstem, and the corticospinal fibres.

Multiple Sclerosis A chronic disease of the nervous system that can affect young and middle-aged adults. The course of this illness usually involves recurrent relapses followed by remissions, but some patients experience a chronic progressive course. The myelin sheaths surrounding nerves in the brain and spinal cord are damaged, which affects the function of the nerves involved. The underlying cause of the nerve damage remains unknown. Multiple Scerosis affects different parts of the brain and spinal cord, resulting in typically scattered symptoms. These can include: Unsteady gait and shaky movement of the limbs (ataxia); Rapid involuntary movements of the eyes (nystagmus); Defects in speech pronunciation (dysarthria); Spastic weakness and retrobulbar neuritis (= inflammation of the optic nerve).

Myalgic Encephalomyelitis (ME) A condition characterized by extreme disabling fatigue that has lasted for at least six months, is made worse by physical or mental exertion, does not resolve with bed rest, and cannot be attributed to other disorders.

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Often occurs as a sequel to such viral infections as glandular fever.

Extreme disabling fatigue that has lasted for at least six months, is made worse by physical or mental exertion, does not resolve with bed rest, and cannot be attributed to other disorders. The fatigue is accompanied by at least some of the following: Muscle pain or weakness; Poor co-ordination; Joint pain; Sore throat; Slight fever; Painful lymph nodes in the neck and armpits; Depression; Inability to concentrate; General malaise.

Neuralgia Maybe due to previous attack of shingles (Postherpetic Neuralgia). A severe burning or stabbing pain often following the course of a nerve.

Neuritis A disease of the peripheral nerves showing the pathological changes of inflammation. (This term may also be less precisely used to refer to any disease of the peripheral nerves, usually causing weakness and numbness.) Inflammation of the nerves, which may be painful.

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Parkinson's Disease Degenerative disease process (associated with aging) that affects the basal ganglia of the brain. Associated with a deficiency of the neurotransmitter dopamine. Also associated with aging. Tremor, rigidity and poverty of spontaneous movements. The commonest symptom is tremor, which often affects one hand, spreading first to the leg on the same side then to the other limbs. It is most profound in resting limbs, interfering with such actions as holding a cup. The patient has an expressionless face, an unmodulated voice, an increasing tendency to stoop, and a shuffling walk. Sciatica A common condition arising from compression of, or damage to, a nerve or nerve root. Usually caused by degeneration of an intervertebral disc, which protrudes laterally to compress a lower lumbar or an upper sacral spinal nerve root.The onset may be sudden, brought on by an awkward lifting or twisting movement. Pain felt down the back and outer side of the thigh, leg, and foot. The back is stiff and painful. There may be numbness and weakness in the leg. Homeopathic remedies for Neurological Diseases Homeopathy has excellent remedies for neurological disorders. This is because homeopathic treatment is centered on a person and his or her pathological condition. Moreover, homeopathic medicines are prescribed after taking into account the patient's constitutional type like the physical, emotional, and psychological makeup and his or her medical history. An experienced homeopath determines all the factors, including miasmatic tendency of the patient before deciding any treatment. Some of the remedies for demyelinating diseases are: Causticum: This is an effective remedy for multiple sclerosis which manifests itself in chronic paralytic affections. The symptoms are tearing, drawing pains and severe weakness. The other indications are the total paralysis of body parts like vocal cords, tongue, eyelids, face, bladder and extremities. The patient experiences impaired vision and dark spots in the centre of the vision and restless legs with weak ankles during nights. Gelsemium: This is the best known curative homeopathic treatment for motor paralysis. It acts on nervous system and acts best when there is dizziness, trembling, drowsiness, and paralysis of throat, larynx, and extremities. It also asks for strong indications of motor nervous problems like muscle cramps, lack of muscle coordination, watery urine, chillness, tremulousness, partial bladder paralysis, heavy eyelids and blurry vision. Oxalic acid: Oxalic acid is an effective medication for multiple cerebral and posterior spinal sclerosis. The indications are lancinating, shooting and jerking pains in different parts of the external body. The other symptoms are muscular prostration, numbness, tingling sensation, and back ache.

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Phosphorus: This is the best curative for atrophy and softening of brain and spinal cord, which cause prostration, trembling, numbness and complete paralysis. The symptoms are locomotor ataxia. Moreover, paralysis of motor sensory nervous may result in paralysis from tips of fingers to toes. The patient experiences vulnerability to light, sound, touch and thunders.

IV. Respiratory System The primary function of the respiratory system is to supply the blood with oxygen in order for the blood to deliver oxygen to all parts of the body. The respiratory system does this through breathing. When we breathe, we inhale oxygen and exhale carbon dioxide. This exchange of gases is the respiratory system's means of getting oxygen to the blood Respiration is achieved through the mouth, nose, trachea, lungs, and diaphragm. Oxygen enters the respiratory system through the mouth and the nose. The oxygen then passes through the larynx (where speech sounds are produced) and the trachea which is a tube that enters the chest cavity. In the chest cavity, the trachea splits into two smaller tubes called the bronchi. Each bronchus then divides again forming the bronchial tubes. The bronchial tubes lead directly into the lungs where they divide into many smaller tubes which connect to tiny sacs called alveoli. The average adult's lungs contain about 600 million of these spongy, air-filled sacs that are surrounded by capillaries. The inhaled oxygen passes into the alveoli and then diffuses through the capillaries into the arterial blood. Meanwhile, the waste-rich blood from the veins releases its carbon dioxide into the alveoli. The carbon dioxide follows the same path out of the lungs when you exhale. The diaphragm's job is to help pump the carbon dioxide out of the lungs and pull the oxygen into the lungs. The diaphragm is a sheet of muscles that lies across the bottom of the chest cavity. As the diaphragm contracts and relaxes, breathing takes place. When the diaphragm contracts, oxygen is pulled into the lungs. When the diaphragm relaxes, carbon dioxide is pumped out of the lungs. Nutrients Needed Energy To operate, all cells depend upon a source of energy, which comes in the form of the macronutrients -- carbohydrates, protein and fat -- explains Dr. Lauralee Sherwood in her book, "Human Physiology." Because your lungs depend upon muscles to operate -- muscles consume large quantities of energy -- and because the cells of the lungs themselves burn energy, some of the calories you consume each day go toward fueling the cells of the respiratory system. Vitamins and Minerals Cells depend upon vitamins and minerals to help them maintain normal function, and the cells of the respiratory system are no exception. For instance, the muscles of the respiratory system and the nerves that serve them require sodium and potassium to contract and transmit information. 17

The B vitamins assist in metabolism of nutrients, which allows for production of energy, while vitamins C and E are antioxidants that help prevent damage from toxins. Specific Requirements Unlike the eyes, for instance, which require vitamin A in particular, there are no nutritional requirements specific to the respiratory system. In an oblique sense, however, iron is critical to respiratory function. Without iron, you can't make red blood cells, which carry oxygen from the lungs to the tissues, explains Dr. Gary Thibodeau in his book, "Anatomy and Physiology." As such, while iron doesn't impact respiratory function directly, it allows respiratory function to benefit the rest of the body cells. Vitamin C An increased intake of vitamin C has been linked to improved cardiopulmonary function, according to Today's Dietitian. Also known as ascorbic acid, vitamin C is a water-soluble vitamin essential for good health. As an antioxidant, vitamin C protects the body from the free radicals found in various toxins, including cigarette smoke. Citrus fruits, berries and melons are good sources of vitamin C. The essential vitamin is also found in tomatoes, dark green vegetables, red and yellow peppers, cauliflower, and broccoli. Vitamin E Vitamin E is another antioxidant that can be beneficial to your respiratory health. A collective name for several fat-soluble compounds, vitamin E helps protect your body from the effects of potentially damaging free radicals. Vitamin E is found naturally in a variety of foods, such as nuts, seeds and oils. Selenium Selenium is a mineral that can also help support better breathing and a stronger respiratory system. Additionally, in asthma patients, it may help prevents attacks and encourage recovery. Cod, mackerel, salmon, shrimp and tuna are the best food sources of selenium. The trace mineral is also found in Brazil nuts, sunflower seeds, lean beef, chicken and various grains. Beta Carotene Vitamin A, as beta carotene, is another important nutrient for better respiratory health. Along with the other antioxidants, beta carotene promotes breathing, prevents asthma attacks, and boosts recovery from respiratory illnesses. A high intake of vitamin A and beta-carotene may decrease the risk of lung cancer. Yellow-orange vegetables, such as carrots and sweet potatoes, supply betacarotene in concentrated amounts. The antioxidant is also abundant in green, leafy vegetables like kale, spinach and turnip greens. Vitamin D Some cardiopulmonary problems result from a vitamin D deficiency, which can also lead to bone loss and osteoporosis. But a lack of this important nutrient can result in a loss of lung functioning as well. Vitamin D may help slow this reduction of lung functioning, not only in people with 18

respiratory disease but also in the aging population. Cod liver oil, salmon, tuna and sardines are good sources of vitamin D. It is also found in egg yolks, fortified milk and cereal, and other foods. Apart from dietary sources, sun exposure triggers the production of vitamin D in the body. Diseases, Disorder and Remedies in the Respiratory System There are many different types of respiratory diseases that interfere with the vital process of breathing. Respiratory obstructions arising from diseases can occur in the nasal area, the regions of the throat and windpipe (upper respiratory system), or in the bronchial tubes and lungs (lower respiratory system). The common cold and allergic reactions to airborne pollens block the nasal passages by creating nasal inflammation (rhinitis). Viral and bacterial infections of the upper respiratory tract inflame various parts of the airways. These infections lead to fever, irritation, coughing, and phlegm, which is mixture of mucus and pus. Inflammations may occur in the throat (pharynx), tonsils, larynx, and bronchial tubes. Damage to these parts of the respiratory system and to the lungs can also result from the inhalation of tobacco smoke, air pollution caused by smog, and industrial waste products. With the mid-twentieth-century discovery and use of antibiotics, the two major respiratory killers of the past, tuberculosis and pneumonia, were brought under control. In place of those diseases, lung cancer began to emerge in the 1940s as an epidemic disease among those who are heavy smokers of cigarettes and those who are exposed to some forms of hazardous environmental pollution. Worksite populations exposed to such materials as asbestos, chromium, and radioactive substances were also found to have a higher incidence of lung cancer.

Colds, like flu and allergies, challenge the breathing process. There are no cures for these conditions, but they are usually not life threatening, unlike many other respiratory diseases. Prescription medicines and over-the-counter medications may provide temporary relief of the discomforts associated with colds, flu, and allergies, while asthma, tuberculosis, and other respiratory diseases require long-range medical attention and supervision.

Colds The entire tubular system for bringing air into the lungs is coated by a moist mucous membrane that helps to clean the air and fight infection. In the case of a cold, the mucous membrane is fighting any one of over 200 viruses. If the immune system is unsuccessful in warding off such a virus, the nasal passages and other parts of the upper respiratory tract become inflamed, swollen, and congested, thus interfering with the breathing process. The body uses the reflex actions of sneezing and coughing to expel mucus, a thick sticky substance that comes from the mucous membranes and other secretions. These secretions come up from the infected areas as phlegm. Coughing is a reflex action that helps to expel infected mucus or phlegm from the airways of the lungs by causing the diaphragm to contract spasmodically. It is characterized by loud explosive sounds that can often indicate the nature of the discomfort. While coughing is irritating and uncomfortable, losing the ability to cough can be fatal in an illness such as pneumonia, where

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coughing is essential to break up the mucous and other infected secretions produced by the body in its battle against the disease. Antibiotics kill bacteria but not viruses; hence they are not effective against cold viruses. The body has to build up its own defense against them. Since there are so many different types of viruses that can cause a cold, no vaccine to protect against the cold has as yet been developed. Though the common cold by itself is not a serious condition, it poses a threat because of the complications that may arise from it, especially for children, who are much more prone to colds than older people. Colds are usually contracted in the winter months, but there are other seasonal conditions that make individuals receptive to colds. Influenza Other viruses cause different types of influenza, such as swine flu, Asian flu, Hong Kong flu, and Victoria flu. Some of the symptoms of influenza resemble the common cold, but influenza is a more serious condition than a cold. It is a disease of the lungs and is highly contagious. Its symptoms include fever, chills, weakness, and aches. It can be especially dangerous to the elderly, children, and the chronically ill. After World War I, a flu epidemic killed 20 million people throughout the world. Fortunately, there has so far not been a repetition of such a severe strain of flu. Flu vaccines provide only seasonal immunity, and each year new serums have to be developed for the particular strain that appears to be current in that period of time. Allergic rhinitis Every season throughout the world, ragweed and pollens from grasses, plants, and trees produce the reactions of sneezing, runny nose, swollen nasal tissue, headaches, blocked sinuses, fever, and watery, irritated eyes in those who are sensitive to these substances. These are the symptoms of hay fever, which is one of the common allergies. The term hay fever is really a misnomer because the condition is not caused by hay and does not cause fever. Allergic respiratory disturbances may also be provoked by dust particles. Usually, the allergic response is due more to the feces of the dust mite that inhabits the dust particle. The dust mite's feces are small enough to be inhaled and to create an allergic respiratory response. Colds and allergic rhinitis both cause the nasal passages and sinuses to become stuffed and clogged with excess mucous. In the case of a cold, a viral infection is responsible for the production of excess mucus. Inhaling steam with an aromatic oil is recommended for the cold. Decongestants are recommended to avoid infection from the excess mucous of the common cold. In seasonal allergic rhinitis, the symptoms result from an exaggerated immune response to what, in principle, is a harmless substance. Histamines released by the mast cells play a major role in an allergic immune response, and it is these chemicals, for the most part, that are responsible for the allergy symptoms. Additional Topics Respiratory Diseases - Treatments Antihistamines are used to block the body's production of histamines that cause allergy symptoms. Cold medicines usually contain antihistamines, decongestants, and non-narcotic analgesics like aspirin. Though the antihistamines are not effective against the cold viruses, they do cause 20

drowsiness, and that may help to alleviate the sleeplessness that often accompanies a cold. The analgesics Respiratory Diseases - Bronchial Diseases Asthma, chronic bronchitis, and emphysema are complex illnesses for which there is no simple treatment. Treatments depend on the severity of the conditions. All three conditions are characterized by an involuntary smooth muscle constriction in the walls of the bronchial tubes. When nerve signals from the autonomic nervous system contract the bronchial muscles, the openings of the tubes close to th Respiratory Diseases - Bronchodilators Bronchodilators are used in the treatment of asthma, chronic bronchitis, and emphysema. A bronchodilator is a medicine used to relax the muscles of the bronchial tubes. It is usually administered as a mist through an inhaler. Some are given orally as a tablet. Administered with an inhaler, they go straight to the lungs for fast action. Since they do not enter the bloodstream, they have few side ef Respiratory Diseases - Tuberculosis Tuberculosis is an infectious disease of the lungs caused by bacteria called tubercle bacilli. It was one of the major causes of death until the introduction of antibiotics in the 1940s. The bacillus is transmitted by the coughing of an individual who has an advanced case of the disease and infects the lungs of uninfected people who inhale the infected droplets. The disease is also spread through Respiratory Diseases - Pneumonia Pneumonia, another life threatening disease, is an infection or inflammation of the lungs caused by bacteria, viruses, mycoplasma (microorganisms that show similarities to both viruses and bacteria), and fungi, as well as such inorganic agents as inhaled dusts or gases. The irritation to the lung tissues from these sources destroys the alveoli (air sacs) of the lung. Blood cells from lung capillar Respiratory Diseases - Cancer Respiratory Diseases - Miscellaneous Disorders Noncancerous (benign) tumors may occur throughout the respiratory system. Although benign tumors are less serious than malignant ones, they can still cause serious obstructions of the airways and other complications. They may later become malignant. Different types of drugs like heroin can cause edema (lung fluid). Anticancer drugs can cause pulmonary fibrosis (scar tissue).

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V. Cardiovascular System/ Circulatory System The Circulatory System is the main transportation and cooling system for the body. The Red Blood Cells act like billions of little UPS trucks carrying all sorts of packages that are needed by all the cells in the body. Instead of UPS, I'll call them RBC's. RBC's carry oxygen and nutrients to the cells. Every cell in the body requires oxygen to remain alive. Besides RBC's, there are also White Blood Cells moving in the circulatory system traffic. White Blood Cells are the paramedics, police and street cleaners of the circulatory system. Anytime we have a cold, a cut, or an infection the WBC's go to work. The highway system of the Circulatory System consists off a lot of one way streets. The superhighways of the circulatory system are the veins and arteries. Veins are used to carry blood *to* the heart. Arteries carry blood *away* from the heart. Most of the time, blood in the veins is blood where most of the oxygen and nutrients have already been delivered to the cells. This blood is called deoxygenated and is very *dark* red. Most of the time blood in the arteries is loaded with oxygen and nutrients and the color is very *bright* red. There is one artery that carries deoxygenated blood and there are some veins that carry oxygenated blood. To get to the bottom of this little mystery we need to talk about the Heart and Lungs. The Heart This is a subject that is near and dear to my heart. The heart is a two sided, four chambered pump. It is made up mostly of muscle. Heart muscle is very special. Unlike all the other muscles in the body, the heart muscle cannot afford to get tired. Imagine what would happen if every 15 minutes zor so the pump got tired and decided to take a little nap! Not a pretty sight. So, heart muscle is always expanding and contracting, usually at between 60 and 100 beats per minute. The right side of the heart is the low pressure side. Its main job is to push the RBC's, cargo bays mostly empty now, up to the lungs (loading docks and filling stations) so that they can get recharged with oxygen. Blood enters the right heart through a chamber called the Right Atrium. Atrium is another word for an 'entry room.' Since the right atrium is located *above* the Right Ventricle, a combination of gravity and an easy squeeze pushes the blood though the Tricuspid Valve into the right ventricle. The tricuspid valve is a valve made up of three 'leaflets' that allows blood to go from top to bottom in the heart but closes to prevent the blood from backing up into the right atrium when the right ventricle squeezes. After the blood is in the right ventricle, the right ventricle begins its contraction to push the blood out toward the lungs. Remember that this blood is deoxygenated. The blood leaves the right ventricle and enters the *pulmonary artery.* This artery and its two branches are the only arteries in the body to carry deoxygenated blood. Important: Arteries carry blood *away* from the heart. There is nothing in the definition that says blood has to be oxygenated. When the blood leaves the pulmonary arteries it enters *capillaries* in the lungs. Capillaries are very, very small blood vessels that act as the connectors between veins and arteries. The capillaries in the lungs are very special because they are located against the *alveoli* or air sacks. When blood in the capillaries goes past the air sacks, the RBC's pick up oxygen. The alveoli are like the loading docks where trucks pick up their load. Capillaries are so small, in some places, that only *one* RBC at a time can get through!

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When the blood has picked up its oxygen, it enters some blood vessels known as the *cardiac veins.* This is fully oxygenated blood and it is now in veins. Remember: Veins take blood to the heart. The cardiac veins empty into the *left atrium.* The left side of the heart is the high pressure side, its job is to push the blood out to the body. The left atrium sits on top of the *left ventricle* and is separated from it by the *mitral valve*. The mitral valve is named this because it resembles, to some people, a Bishop's Mitered Hat. This valve has the same function as the tricuspid valve, it prevents blood from being pushed from the left ventricle back up to the left atrium. The left ventricle is a very high pressure pump. Its main job is to produce enough pressure to push the blood out of the heart and into the body's circulation. When the blood leaves the left ventricle it enters the Aorta. There are valves located at the opening of the Aorta that prevent the blood from backing up into the ventricle. As soon as the blood is in the aorta, there are arteries called *coronary arteries* that take some of the blood and use it to nourish the heart muscle. Remember: the heart is like James Brown, it's the hardest working muscle in the body (in case you don't know, James Brown says he's the hardest working man in show business). The Aorta and the Arterial System The aorta leaves the heart and heads toward, what else, the head. We have to keep our brains well nourished so we can make good grades in school. The arteries that take the blood to the head are located on something called the *aortic arch.* After the blood passes through the aortic arch it is then distributed to the rest of the body. The *descending aorta* goes behind the heart and down the center of the body. Sometimes, if you are lying flat on your back, you can look down toward your feet and actually see your abdomen pulsate with each heart beat. This pulsation is really the aorta throbbing with each heart beat. Do not be alarmed, this is normal. From the aorta, blood is sent off to many other arteries and arterioles (very small arteries) where it gives oxygen and nutrition to *every* cell in the body. At the end of the arterioles are, guess what, capillaries. The blood gives up its cargo as it passes through the capillaries and enters the venous system. The Venous System The venous system carries the blood back to the heart. The blood flows from the capillaries, to venules (very small veins), to veins. The two largest veins in the body are the *superior* and *inferior* vena cavas. The superior vena cava carries the blood from the upper part of the body to the heart. The inferior vena cava carries the blood from the lower body to the heart. In medical terms, *superior* means above and *inferior* means under. Many people believe that the blood in the veins is *blue*; it is not. Venous blood is really dark red or maroon in color. Veins do have a bluish appearance and this may be why people think venous blood is blue. Both the superior and inferior vena cava end in the right atrium. The superior vena cava enters from the top and the inferior vena cava enters from the bottom.

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Nutrients Needed 1. Vitamins E, C. These are found in fruits and vegetables. These act as antioxidants and help lower the concentrations of triglyceride and cholesterol, the major substances responsible for plaque formation in the heart and blood vessels. 2. Oil coming from fish and vegetables This type of oil has Omega 3 which protects the heart from bad cholesterol (LDL low density cholesterol) and other heart ailments. 3. Minerals Minerals like calcium, magnesium, selenium are found also in fruits and vegetables. These minerals have vital functions in the heart's contraction and pumping process. 4. Green Tea This contains polyphenol and other important ingredients which prevent clot or emboli formation in blood vessels; hence, preventing heart attack or myocardial infarctions. Aside from this, it has been proven to decrease the incidence of cancer and helps in the management of diabetes mellitus. 5. Red wine Red wine can lower levels of triglyceride and bad cholesterol, when taken in moderation. This is because of the phenolic component of red wine which has also an antioxidant property thereby helping in the reduction of lipids in the body. 6. Oat fiber (whole grain food) Oat meals are rich in fiber and low in fat, which is precisely what the heart needs. This type of diet prevents lipid or fat formation in the blood vessels and promotes good circulation as blood vessels' integrity is good. Diseases that are Possible in the Circulatory System/ Cardiopulmonary System and their Remedies Congenital Heart Defects

Congenital heart defects are structural abnormalities of the heart that were present at birth. In some cases, they are hereditary. However, in many cases, there cause is unknown. Congenital heart defects may result in difficulty breathing, problems with blood flow and excessive fatigue. If the problem is not treated, it could result in heart failure. Babies with 24

congenital heart defects almost always require immediate surgery to repair the heart defects. A variety of medications will likely be needed before and after surgery to ensure proper functioning of the circulatory system.

Cardiomyopathy

Cardiomyopathy is a disease of the heart muscle. In dilated cardiomyopathy, the heart's chambers enlarge and weaken. In restrictive cardiomyopathy, the heart muscle becomes stiff and rigid. In hypertrophic cardiomyopathy, the heart muscle becomes thick and will not relax completely. When any of these diseases occur, the heart is unable to pump enough blood to the rest of the body. The most severe cases may even be fatal. Treatment depends on the type of cardiomyopathy present, although a heart transplant is often required. A heart transplant involves surgically replacing the diseased heart with a donor's healthy heart.

Coronary Artery Disease

Coronary Artery Disease occurs when plaque builds up along the inside of the coronary arteries. The coronary arteries wrap around the heart itself, and supply the heart with blood and oxygen. When these arteries become blocked with plaque, it reduces the amount of blood they are able to deliver to the heart. Over time, this lack of blood will damage or weaken the heart. In some cases, the plaque tears and the body attempts to fix the tear by forming a blood clot. This blood clot will typically block all blood flow to the heart, causing a heart attack. Coronary artery disease is the most common type of heart disease. A variety of treatment options are available; treatment often depends on the severity of the disease. Medications often help to lower cholesterol and decrease the work your heart is required to do. Lifestyle changes will need to revolve around eating a healthy diet, losing weight, exercising regularly and quitting smoking. In severe cases, surgery may be required. In this case, a stent will likely need to be placed inside the coronary arteries to open them up and allow for proper blood flow.

Atherosclerosis

Atherosclerosis is a buildup of cholesterol and fatty plaque on the inside walls of the rest of the arteries. This plaque hardens and narrows the arteries, making it difficult for blood to pass through them. Atherosclerosis can affect any artery of the body, but most commonly occurs in the arteries of the heart, brain, kidneys, legs and pelvis. When arteries of the brain become blocked with plaque, it is called carotid artery disease. A blockage of blood to the brain may result in a stroke. When arteries of the arms, legs or pelvis become blocked, it is referred to as peripheral artery disease (PAD). When blood is blocked from flowing to these areas, it may result in numbness, pain and serious infections. The main treatment for atherosclerosis includes significant changes to lifestyle. A person suffering from this circulatory system disease should aim for a nutritious diet and regular exercise to maintain a healthy weight. He should also quit smoking and eliminate any significant sources of stress. Certain medications may also be prescribed to help regulate blood flow. In serious cases, medical procedures may be necessary to re-open the blocked arteries.

Arrhythmia 25

Arrhythmia is an abnormality in the heart's rhythm. An arrhythmia may be the result of a congenital heart defect, or it may be acquired later in life. This disease causes the heart to beat either abnormally fast or abnormally slow. Arrhythmia may lead to a variety of symptoms, some minor and some serious. If left untreated, the disease may result in chest pain, fatigue and shortness of breath. In serious cases, it may even lead to cardiovascular collapse and cardiac arrest. Medications will likely be prescribed to decrease the effects of an arrhythmia; oftentimes, medication will be the only treatment necessary. In some cases, an ablation will need to be done to permanently correct the irregular heart rhythm.

Aortic Aneurysm Aortic aneurysm is bulging in the wall of the aorta, the largest artery of the body. It is caused due to aortic dissection (tear in the aortic wall) or defect in the aortic wall. A rupture of the bulging may cause heavy bleeding or hemorrhage. Aortic aneurysm can be developed as a complication of other diseases such as obesity, atherosclerosis, and high blood pressure.

Angina Angina is pain or discomfort in the chest area, which is caused due to blockage in the blood vessels leading to the heart. The symptoms of angina are observed when there is insufficient supply of oxygen and blood to the heart muscles. Usually, chest pain lasts for about 10 minutes.

Arrhythmia Arrhythmia is a heart problem, characterized by irregularity in the heart rhythm. Symptoms of this system may vary from very slow to fast heart rhythm. Arrhythmia can be a congenital or an acquired problem. In case of acquired arrhythmia, it can occur at any stage of life. Atherosclerosis Atherosclerosis is hardening of the arterial wall (usually medium and large arteries) due to formation of plaque or atheroma. The plaque is composed of cholesterol, calcium, and fatty deposits. Atherosclerosis may hamper the blood circulation or at times, stops the blood flow. A person suffering from this problem experiences sharp pain in the affected area. High Blood Pressure High blood pressure or hypertension is a condition, when the systolic pressure exceeds 140 mmHg and diastolic pressure exceeds 90 mmHg. It is mostly caused due to hereditary reasons or unhealthy lifestyle habits such as heavy drinking and smoking.

Peripheral Vascular Disease Peripheral vascular disease is a disorder in the blood vessels that are not part of the brain and heart. This disease is caused due to fatty acid deposits in the arteries of the leg portion. It can be hereditary or develop as a complication of obesity, high blood pressure, and smoking. In severe cases, heart disease can cause heart attack, heart failure, and several 26

other fatal health problems. One word of advice for people who smoke cigarette and have circulatory problem would be to quit smoking, as it can worsen the existing condition by constricting the blood vessels. Problems and diseases related to the circulatory system may also be caused due to intake of certain drugs like oral contraceptives and diuretics. To avoid such a case, it is always advisable to consult and seek advice from a qualified health practitioner before self ingesting any type of drugs. Atherosclerosis Literally, hardening of the fatty stuff. High fat diets can lead to formation of fatty plaques lining blood vessels. These fatty areas can become calcified and hard leading to arteriosclerosis, hardening of the arteries. When blood vessels become less stretchable, blood pressure rises and can result in heart and kidney damage and strokes. Double cheese bacon burger, anybody? Myocardial infarction (MI) You know we are talking about heart muscle, right, myocardial? An infarction is blockage of blood flow resulting in death of muscle tissue. Laymans language for this is a heart attack. The blockage occurs in one of the arteries of the heart muscle itself, a coronary artery. Depending upon how much tissue dies, a victim of an MI may survive and undergo cardiac rehabilitation, strengthening the remaining heart muscle, or may die if too much muscle tissue is destroyed. Did you exercise at the gym this week? Mitral prolapse, stenosis, regurgitation Blood flows through four chambers in the heart separated by one-way valves. A major valve is the one separating the upper and lower chambers on the left side of the heart. The left side is especially important because freshly oxygenated blood returning from the lungs is circulated out of the heart to the rest of the body. The left valve, called atrioventricular, for the chambers it separates, is also called the mitral valve, because it is shaped like an upside down Bishops hat, a miter. If the flaps of this valve tear away due to disease, the process is called prolapse, a falling forward. This results in leakage and backward flow called regurgitation (get the picture?). Sometimes a valve is abnormally narrow causing partial obstruction constricting flow. Stenosis means a narrowing. Angina pectoris Literally, pain in the chest. But, this is a special kind of pain associated with the heart and is distinctive as crushing, vise-like, and often accompanied by shortness of breath, fatigue and nausea. Anginal pain indicates not enough blood is getting to

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the heart muscle, and the heart is protesting and begging for more. People with a history of angina often take nitroglycerine tablets to relieve the pain by increasing blood flow to the heart muscle. Arrhythmia/dysrhythmia Abnormal heart rates and rhythms all have special names like ventricular tachycardia, fibrillation, but generically are termed arrhythmias or dysrhythmia, meaning no rhythm and abnormal rhythm. There are fine distinctions between the two, but they are often used interchangeably. Ischemia Sometimes the heart muscle is not getting enough blood flow, more importantly, the oxygen the blood carries is insufficient to sustain muscle which has a very high metabolic rate, and oxygen demand. The term loosely means not quite enough blood. Typically, the patient suffers angina pain (see above) and they may think they are having a heart attack. And, they may be! Acute Coronary Syndrome The symptoms of coronary syndrome are unstable angina, non-ST elevation myocardial infarction and ST-elevation myocardial infarction. Nitroglycerin and aspirin are the medications used in the treatment of this syndrome.

Endocarditis Here, the inner layer of heart is inflamed. This disease is of two types i.e. infective and non-infective. Antibiotics are used in the treatment of infective endocarditis. Replacing the heart valve is another treatment measure used for endocarditis.

Conceptual Apraxia The human brain possesses an ability to organize work that involves use of different motor skills. In conceptual apraxia, this ability of organizing tasks is lost. It is hard to say anything about the treatment or recovery of this disease at present. The problem might just get cured without any medical help.

Pulmonary Valve Stenosis In this condition, the pulmonary valve opens only incompletely. The discharge of blood that comes to lungs from the right ventricle is therefore, affected. Surgery of the valve is the treatment used for pulmonary stenosis. Replacement of the valve also is one of the treatment measure being adopted.

Thrombophlebitis 28

It is a condition in which blood clots develop in the veins of arms and especially legs. This condition mostly results from inactivity for a long time. Pain medications are primarily used for the treatment of thrombophlebitis. Preventing the formation of clots is necessary; in order to stop clot formation, anticoagulants are used.

Ventricular Tachycardia In ventricular tachycardia, heartbeat rises above the normal level. The fast rhythm of heat beat responsible for ventricular tachycardia originates from ventricles. The treatment for ventricular tachycardia is given only in emergency. Otherwise, this condition is not a cause of concern. Cardioversion, CPR and antiarrhythmic medications are used for treating emergency situations.

Temporal Arteritis In this disease, blood vessels in the neck region are damaged. Defect in immune response is said to be the cause of temporal arteritis. The exact cause is however, not known. Corticosteroids which mitigate the damage caused to tissues is recommended for treatment of this disease.

V. Lymphatic System Understanding the lymphatic system The lymphatic system consists of organs, ducts, and nodes. It transports a watery clear fluid called lymph. This fluid distributes immune cells and other factors throughout the body. It also interacts with the blood circulatory system to drain fluid from cells and tissues. The lymphatic system contains immune cells called lymphocytes, which protect the body against antigens (viruses, bacteria, etc.) that invade the body. See more on lymphocytes below. It is abnormal cells of this type that cause lymphoma. Main functions of the lymphatic system "to collect and return interstitial fluid, including plasma protein to the blood, and thus help maintain fluid balance, to defend the body against disease by producing lymphocytes, to absorb lipids from the intestine and transport them to the blood." Source jdaross.mcmail.net

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Lymph organs Include the bone marrow, lymph nodes, spleen, and thymus. Precursor cells in the bone marrow produce lymphocytes. B-lymphocytes (B-cells) mature in the bone marrow. T-lymphocytes (T-cells) mature in the thymus gland. Besides providing a home for lymphocytes (B-cells and T-cells), the ducts of the lymphatic system provide transportation for proteins, fats, and other substances in a medium called lymph. Lymph nodes: "Human lymph nodes are bean-shaped and range in size from a few millimeters to about 1-2 cm in their normal state. They may become enlarged due to a tumor or infection. White blood cells are located within honeycomb structures of the lymph nodes. Lymph nodes are enlarged when the body is infected due to enhanced production of some cells and division of activated T and B cells. In some cases they may feel enlarged due to past infections; although one may be healthy, one may still feel them residually enlarged." Wikipedia.org Lymph "Means clear water and it is basically the fluid and protein that has been squeezed out of the blood (i.e. blood plasma). The lymph is drained from the tissue in microscopic blind-ended vessels called lymph capillaries. These lymph capillaries are very permeable, and because they are not pressurized the lymph fluid can drain easily from the tissue into the lymph capillaries. As with the blood network the lymph vessels form a network throughout the body, unlike the blood the lymph system is a one-way street draining lymph from the tissue and returning it to the blood." Source bbc.co.uk "Unlike the cardiovascular system, the lymphatic system is not closed and has no central pump." wikipedia.org "Lymph movement occurs despite low pressure due to peristalsis - smooth muscle and skeletal activity (everyday activity and motion of the body). "Secondary lymphatic tissues control the quality of immune responses. Differences among the various lymphatic tissues significantly affect the form of immunity and relate to how antigens (bacteria, virus, fungus, etc.) are acquired by these organs. - Lymph nodes are filters of lymph - the spleen is a filter of blood - mucosal associated lymphatic tissues acquire antigens by transcytosis to lymphoid tissue from the "external" environment across specialized follicle-associated epithelial cells." Source geocities.com

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"Lymphatics are found in every part of the body except the central nervous system. The major parts of the system are the bone marrow, spleen, thymus gland, lymph nodes, and the tonsils. Other organs, including the heart, lungs, intestines, liver, and skin also contain lymphatic tissue." gorhams.dk Lymphoma Is a disease in which malignant lymphocytes grow too fast or live too long. These cells may then accumulate in the lymph nodes or other areas of the lymphatic system to form tumors. When these cells accumulate in lymph nodes it's often calledadenopathy - the enlargement of the lymph nodes; but adenopathy can have other causes. There are many benign reasons for enlarged lymph nodes: Diagnostic Problems in the Evaluation of Lymphadenopathy, Weinstock, Straus Cancernetwork.com Lymphadenopathy: Differential Diagnosis and Evaluation, Robert Ferrer, M.D., M.P.H. American Family Physician

Normal sized lymph nodes? Swollen lymph nodes By Mayo Clinic staff Reactive Lymph nodes "LYMPH nodes are a combination of burglar alarm and West Point. Like a burglar alarm they are on guard against intrusive antigen. Like West Point, the nodes are in the business of training a militant elite:" pleiad.umdnj.edu What's the deal with Waxing, Waning, and Persistently Enlarged Lymph Nodes? Lymph nodes can increase or decrease in size for many reasons, including response to treatment, progression of lymphoma, spontaneous regression of lymphoma, immune activation against lymphoma, infection or the resolving of infection (reactive, see above), and so on. Therefore, imaging of lymphoma is only an estimate of treatment response and disease direction. Collapsing of necrotic areas in lymph nodes may explain a sudden decrease in a large lymph node. Residual lymphoid masses? Following treatment "a residual mass persisting on CT after treatment poses a common clinical dilemma: it may indicate the presence of viable lymphoma, which requires further treatment, or it can be benign, consisting of onlyfibrotic and necrotic tissues." PMID: 12644887

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For this reason PET or Gallium scans may be used after treatment to help differentiate active disease from scar tissue. Lymphoid tumors are made up of the accumulated abnormal lymphocytes but also supportive tissue of different cell types: epithelial cells and also there is supporting tissue, called connective tissue which is there to support the epithelial cells. These cells are sometimes referred to in shorthand as tumor stromal cells. Our understanding is that the macrophages (immune cells) will eventually gobble up this necrotic material after successful therapy, which explains why the treated tumor continues to shrink well after therapy is done. NOTE: The delayed shrinking of lymphoid tumor can lead to questionable conclusions of the causal effect of subsequent therapy standard, investigational, and alternative, because the tumor in some cases would have resolved with more time. PET scans are used to help distinguish between necrotic and viable tumor following treatment, but this test is not perfect can produce false positives due to inflammation. Reactive lymph nodes - Lymph nodes may enlarge when immune cells react to pathogen such as virus or bacteria. Swollen glands, common to many illnesses is an example of nodes enlarging in response to a pathogen. This might also be called a flare.

What determines how healthy your cells are has to do with one primary source of your body your blood stream. Your blood stream is the environment for every cell in your body to grow and live in, if you maintain that then you will have health, if you dont and you pollute it, then the cells in your body are going to be weak, which means your energy is going to be weak and you will probably end up dying prematurely, possibly painfully. 32

Your breath and the good nutrition you provide your body are the control buttons to the mechanisms that cleanse your circulatory system. Breath is not only the foundation of all life in that it gives oxygen to the cells; things they must have to live, but it also controls the flow of lymph fluid in your body. Good nutrition will provide the materials to prevent extra chemicals and bacteria forming in the blood stream, as well as materials which will support cellular function, digestion and waist elimination. Our lymph fluid also contains white blood cells called lymphocytes which help protect your entire body and cleanse the system. So what exactly is the lymph system? The lymph system can be described as the bodys sewerage system. Every cell in your body is literally surrounded by lymph in fact, you have four times more lymph fluid in your body as you do blood. The lymph system is extremely important, so much so that if it was to totally shut down for only 24hrs, you would be dead as a result of trapped blood proteins and excess fluid throughout your cells. Our blood carries oxygen and nutrients to capillaries where they are then passed onto the fluid around the cells which are called lymph. The bodys cells depend on the lymph system as the only way to drain off the large toxic materials and the excess fluid in our bodies which restricts the amount of oxygen our cells can get. So now that you understand the importance of the lymph system and its function, I will delve into the two things I mentioned above which we need to do to keep our lymph system nice and healthy; deep breathing and nutrition. Deep Breathing For those of us who exercise regularly at a level which requires us to take big deep breaths, we have an added advantage, because the lymph system is activated by deep breathing! If you want to have a healthy blood stream with an effective lymph and immune system, you need to breathe deeply and produce movements that will stimulate that lymph. Unlike the blood stream which has a pump (the heart), the lymph system doesnt, so the only way lymph can move around is by deep breathing and muscular movement. Deep breathing multiplies the pace of which the body eliminates toxins. Deep breathing and exercise can accelerate this cleansing process by as much as 15 times the normal pace. Lack of oxygen seems to play a major roll in causing cells to become malignant or cancerous. To cleanse your body through effective breathing, remember: 1-4-2. 1 = Number of counts while breathing in. 4 = Number of counts to hold your breath. 2 = Number of counts while exhaling. As you become better in being able to hold your breath, add extra seconds by using the 1-4-2 system. Examples; 4-16-8, 6-24-12, 8-32-16. Make sure to breathe deep into the abdomen, like a vacuum. This helps the lymph system, as when 33

you hold your breath your body can fully oxygenate the blood and activate your lymphatic system, and as you slowly exhale your body eliminates the toxins through your lymphatic system. Good Nutrition If you look up how to cleanse and/or detoxify your lymph system, you will notice one main characteristic in all the recommendations; they are high in vegetables, or even consist of solely vegetables. Why? Because our body needs to be able to get rid of toxins with foods which contain high levels of nutrients, these nutrients assist in moving toxins out of the body, as well as keeping your body healthy and functioning properly. Jam on toast, does not fall under this category. The best thing you can do to keep your cells healthy, is to have a diet rich in foods that are from nature; meat, fish, eggs, nuts, seeds, fruits and vegetables. These are the foods our body recognises and has been developed to consume. The foods you want to avoid in order to keep your cells healthy are foods which are no longer close to nature, or foods which have been processed and have added chemicals in the form of flavoring, preserving and colouring; Lollies, cereals, cakes, processed meats (salami, devin, berlina, etc) and tofu, for example. If we eat the foods which are good for us and consist of good nutrients; good solid protein sources (meat, fish, eggs), good low GI carbohydrate sources (vegetables, fruit), good fat sources (Fish oil, nuts, egg yolks, olive oil, coconut oil) and good micronutrient sources (vegetables, fruits, plants), it will leave our cells thriving, and your lymphatic system clean day after day! Diseases of the Lymphatic System Lymphadenopathy Lymphadenopathy is a disease which is characterized by the inflammation of the lymph nodes. This inflammation can be localized to only some nodes or can be generalized. Usually, a localized inflammation of lymph nodes is due to an infection, foreign particles, or other diseases of organs that are situated close to them. Lymph nodes inflamed due to an infection tend to be painful, but those inflamed from cancers are usually painless. The Site of Inflammation Enlarged lymph nodes at a particular site are often associated with certain diseases. Axillary lymph nodes can get affected by infections or cancers of the hand, breast and chest region. Supraclavicular lymph nodes can get affected by diseases of the lungs, esophagus and thorax. Inguinal lymph nodes are connected to the lower abdominal region, external reproductive structures, perineum and lower anal region. Diseases of any of these organs can have an impact on the inguinal lymph nodes. Bilateral hilar lymphadenopathy (BHL) occurs when mediastinal lymph nodes are affected. This is a major feature of the disease, sarcoidosis. Likewise, whichever group of nodes is connected to a particular region, it is affected by diseases of that region. Generalized lymphadenopathy, involving the lymphatic system of the whole body, can occur due to HIV infection, tuberculosis and cancers of the lymphatic system. Causes 34

Many diseases have lymphadenopathy as a secondary complication. Some such factors are: Pathogenic Organisms: Infection by various bacteria, viruses, fungi and other organisms can cause inflammation of the lymph nodes. Bacteria (Staphylococci, Streptococci, Mycobacteria, Brucella, etc.), viruses (HIV, Epstein-Barr virus, etc.), fungi (Histoplasma, Coccidioides, etc.), and other organisms like Toxoplasma gondii and Leishmania, commonly cause infections that affect lymph nodes. Other Causes: Cancers of the lymphoid system or cancers that have originated in a part of the body and metastasized to other locations may cause lymphadenopathy. Other diseases that have lymphadenopathy as a complication are sarcoidosis, rheumatoid arthritis and amyloidosis. Some drugs such as phenytoin can also cause lymph node inflammation. Lymphoma Cancers of the lymphoid tissues are referred to as lymphomas. They are grouped into two broad types, known as Hodgkin's lymphoma and Non-Hodgkin's lymphomas, based on a feature that distinguishes the two from each other. That criterion is the presence of a type of large cell, known as Reed-Sternberg cell, in Hodgkin's lymphoma. This cell is not present in the cancerous tissues of Non-Hodgkin's lymphoma; and therefore, is the basis of their segregation into two classes. Hodgkin's Lymphoma It is a type of cancer that occurs primarily in the lymph nodes. Based on the appearance of the cancerous tissues in a biopsy, it is grouped into two types, nodular lymphocyte predominant Hodgkin's lymphoma (NLPHL) and Classical Hodgkin's lymphoma. The latter is further subdivided into four types, based on the appearance of cells in laboratory findings. Symptoms Like most cancers, a person suffering from Hodgkin's lymphoma may or may not manifest all its symptoms. Some patients remain asymptomatic till the disease has reached an advanced stage. Some of the symptoms are: Painless, rubbery, enlarged lymph nodes Unexplained exhaustion and fever Dry cough and breathing problems Severe itching in the legs or in the entire body Profuse nighttime sweating Weight loss The symptoms of Hodgkin's lymphoma are divided into different stages based on severity of symptoms. The treatment plan of a person suffering from Hodgkin's lymphoma is guided by the stage to which the cancer has progressed. Stage I Hodgkin's lymphoma is defined as that in which 35

the cancer is localized only in a single group of lymph nodes or if only a single organ is affected. In stage II, two or more groups of lymph nodes are affected or a single organ and one or more group of lymph nodes are affected. Stage III lymphoma is one in which the cancer has spread to both sides, above and below the diaphragm. Finally, stage IV cancer is one that has spread to the entire body, and involves many lymph nodes and organs. Additionally, a cluster of symptoms (fever, weight loss and night sweats), called 'B' symptoms are an important criterion for deciding treatment approach. Treatment The treatment depends upon the stage of the disease, and involves chemotherapy and radiation therapy. Although many factors determine which treatment option is to be used, generally stage I and stage II are treated with radiation therapy. Patients with 'B' symptoms, those with advanced stage II, stage III and stage IV, are treated with chemotherapy. Non-Hodgkin's Lymphoma Non-Hodgkin's lymphoma is a cancer of the lymphoid system. It is divided into three types: highgrade, intermediate-grade and low-grade. High-grade NHL progresses fast and can be lifethreatening if left untreated. However, if detected, it is curable. Low-grade NHL, on the other hand, is slow-growing and does not produce symptoms easily. But it is not curable by the methods used for treating cancers. Symptoms Many of the symptoms of NHL are similar to those of Hodgkin's lymphoma, like fatigue, weight loss, fever, itching and night sweats. Swollen and painless lymph nodes develop in the neck region, armpits and inguinal region. Persistent coughing may indicate cancer in the thymus. If the cancer spreads to the brain, symptoms like headache, cognitive problems and seizures may be seen. Many NHL patients have abdominal swelling and pain. Treatment It is based on whether the cancer is high-grade, intermediate-grade or low-grade and several other factors. The treatment options include radiation therapy, chemotherapy, monoclonal antibody therapy and autologous stem cell transplantation. Lymphangitis Lymphangitis is an inflammation of the lymphatics (lymph channels) due to an infection by a microbe or some chemical irritant. It occurs when an infection or inflammation occurs somewhere else and the microbe or the irritant is transported along with lymph fluid through the lymphatics. This leads to a secondary infection and inflammation, distinct from the infection or inflammation at the primary site. The infection affects the lymph vessel walls, which become inflamed. The consistency of the lymph changes and becomes thick. Microbes that cause lymphangitis mostly enter the lymphatics via a skin infection. 36

Causes Bacteria such as Streptococci, Staphylococci and even Neisseria can cause lymphangitis. Nodular lymphangitis, which is another form of this disease in which nodules form below the skin, is caused by microbes like Mycobacteria, Nocardia and Sporothrix, Leishmania, Francisella, etc. Additionally, cancer cells can colonize the lymph vessels and block them. Symptoms Red streaks or lines are visible on the skin, charting the course of the inflammation, which runs along the inflamed lymphatic vessels to the closest lymph node. This is accompanied with fever, pain, swelling and tenderness. Treatment The primary infection due to which lymphangitis has occurred is treated, usually with antibiotics. If not treated, the infection may spread to the blood stream, causing septicemia, which is a lifethreatening condition. If lymphatic fluid is trapped, it may be drained by an incision. A bandage is applied if the lymphangitis has affected an extremity. Lymphangiectasia Dilatation of the lymph vessels is known as lymphangiectasia. It can occur as a primary disorder, wherein the cause of the disorder is a congenital defect, i.e. the lymphatic vessels are joined to each other. This disease can also occur as secondarily, due to an obstruction in the lymph vessel. Such obstruction can occur due to lymphomas or filariasis. Intestinal Lymphangiectasia: It occurs when the intestinal lymphatic vessels are dilated. The disease is characterized by leaking of protein and fat-containing lymph in the small intestine. Other symptoms include swollen peripheral lymphatics and fat-rich stools. This occurs because of an obstructed lymphatic channel, which leads to poor drainage of lymph. Pulmonary Lymphangiectasia: It is a disorder that can occur due to several factors, but is most often due to a congenital defect in the lymphatic vessels of the lungs. Children born with this disorder usually die within a few hours after their birth. Those who survive have breathing difficulties, cough a lot and suffer from frequent bouts of pneumonia. Treatment If lymphangiectasia is caused by secondary factors, treatment is aimed at those underlying causes. Congenital intestinal lymphangiectasia can be managed by modifying the diet. A diet low in fat and having medium-chain fatty acids is recommended for people suffering from this condition. Medicines to control diarrhea can be taken for managing the motility problems, resulting from this disease. Lymphatic Filariasis 37

It is perhaps the most well-known disease of the lymphatic system because of the severe disfigurement of affected body parts that it causes. It occurs when mosquitoes that harbor the larvae of certain nematodes bite a person. The larvae enter the lymphatic system, where they mature into adult worms. These adult worms produce many larvae during their lifetime, that mature into adult worms, continuing the cycle. The nematodes obstruct the lymphatic vessels, leading to enlargement of body parts like legs and scrotum. Causes It is caused by nematodes like Wuchereria bancrofti, Brugia malayi and Brugia timori. These nematodes are transmitted by mosquitoes of the genera Culex, Anopheles and/or Aedes. Symptoms Symptoms include inflammation of the skin and lymph nodes. The damage to the lymphatic system leads to impaired defense against other infections, which is the reason behind the inflammation. Chronic infection causes thickening of tissues and accumulation of lymph. All these cause the massive swelling of organs called elephantiasis. Treatment An oral dose of Albendazole along with Ivermectin and Diethylcarbamazine citrate (DEC) is effective in killing mature nematodes as well as the larvae. Eradication of mosquitoes is ideally the best method as it would prevent people from contracting the disease. Splenomegaly Splenomegaly is a condition in which the spleen becomes enlarged, tender and painful. It can occur due to a number of reasons, ranging from certain infections to cancers. Many people remain asymptomatic while others have symptoms like tiredness, feeling satiated even after eating a small amount of food, and increased susceptibility to infections. Causes Bacterial, viral and parasitic infections, pathological conditions of the liver, hematological diseases, autoimmune disorders and several kinds of cancers can cause splenomegaly. Treatment In theory, treatment of the underlying conditions causing the enlarged spleen, will treat the splenomegaly as well. If this is not possible, radiation therapy, or surgical removal of the spleen are the options available to those suffering from the condition. It is an aphorism in biology that the more complex a system, the greater the price that an organism has to pay for its acquisition. The numerous diseases that the lymphatic system is susceptible to, illustrate it quite clearly.

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Remedies: 1. Symptoms o Lymphatic infections can range from many symptoms. You can experience small bumps under your under arm, or you can experience swelling; especially of the feet, legs, or arms. Fatigue and skin discoloration are all symptoms of an lymphatic infection. In addition to these symptoms, the main symptom of lymphatic infection could be enlarged lymph nodes. Herbs
o

There are a few common herbs you can find at your local health food store to address the infection. Figwort tea cleanses the lymph system and removes toxins. Based on the dosage take the tea daily. Red root also cleanses the lymph glands and nodes and remove wastes and toxins. If possible, purchase red root as a tincture. Black walnut, typically taken as a tincture, is highly effective for lymphatic problems. Black walnut has antiviral, anti-fungal, and antibacterial properties. Black walnut is great for removing parasites from your body and giving your immune system a good boost. A common herb found almost anywhere in stores is Echinacea. This herb stimulates your immune system and it also eases any tension or stress on the lymph system. Echinacea is typically found in tablet form, but you can also take it as a tincture. Calendula can be used to treat inflamed or congested lymph glands. Take 4 grams of dried calendula flower heads and infuse in 1 cup of boiling water for five minutes. The calendula tea should be taken three times a day until symptoms subside.

Immune System
o

Because your immune system is linked to the lymphatic system, you should also use herbs to strengthen the immune system as well. Hypoxis rooperii is an herb that is the extract of the African potato and is used to boost the immune system. Black Walnut and Echinacea are beneficial for your immune and lymphatic system.

Water
o

The importance of water cannot be stressed enough. Drinking plenty of water allows any buildup of toxins to be removed and flushed out the system.

The bowels
o

Based on the foods that we eat, toxic buildup can accumulate in the lower intestines, which can also cause infection. Start a good colon-cleansing program by using an enema to also alleviate infections. It is suggested and advised that you always seek the assistance of a qualified naturopath when undergoing any forms of natural healing therapy.

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VI. Endocrine System

What Is the Endocrine System? Although we rarely think about the endocrine system, it influences almost every cell, organ, and function of our bodies. The endocrine system is instrumental in regulating mood, growth and development, tissue function, metabolism, and sexual function and reproductive processes. In general, the endocrine system is in charge of body processes that happen slowly, such as cell growth. Faster processes like breathing and body movement are controlled by the nervous system. But even though the nervous system and endocrine system are separate systems, they often work together to help the body function properly. The foundations of the endocrine system are the hormones and glands. As the body's chemical messengers, hormones transfer information and instructions from one set of cells to another. Many different hormones move through the bloodstream, but each type of hormone is designed to affect only certain cells. A gland is a group of cells that produces and secretes, or gives off, chemicals. A gland selects and removes materials from the blood, processes them, and secretes the finished chemical product for use somewhere in the body. Some types of glands release their secretions in specific areas. For instance, exocrine (pronounced: ek-suh-krin) glands, such as the sweat and salivary glands, release secretions in the skin or inside the mouth. Endocrine glands, on the other hand, release more than 20 major hormones directly into the bloodstream where they can be transported to cells in other parts of the body. The major glands that make up the human endocrine system include the:

hypothalamus pituitary gland thyroid parathyroids adrenal glands pineal body reproductive glands (which include the ovaries and testes) pancreas

Hypothalamus The hypothalamus (pronounced: hi-po-tha-luh-mus), a collection of specialized cells that is located in the lower central part of the brain, is the main link between the endocrine and nervous 40

systems. Nerve cells in the hypothalamus control the pituitary gland by producing chemicals that either stimulate or suppress hormone secretions from the pituitary. Pituitary Although it is no bigger than a pea, the pituitary (pronounced: puh-too-uh-ter-ee) gland, located at the base of the brain just beneath the hypothalamus, is considered the most important part of the endocrine system. It's often called the "master gland" because it makes hormones that control several other endocrine glands. The production and secretion of pituitary hormones can be influenced by factors such as emotions and changes in the seasons. To accomplish this, the hypothalamus provides information sensed by the brain (such as environmental temperature, light exposure patterns, and feelings) to the pituitary. The tiny pituitary is divided into two parts: the anterior lobe and the posterior lobe. The anterior lobe regulates the activity of the thyroid, adrenals, and reproductive glands. The anterior lobe produces hormones such as:

growth hormone, which stimulates the growth of bone and other body tissues and plays a role in the body's handling of nutrients and minerals prolactin (pronounced: pro-lak-tin), which activates milk production in women who are breastfeeding thyrotropin (pronounced: thy-ruh-tro-pin), which stimulates the thyroid gland to produce thyroid hormones corticotropin (pronounced: kor-tih-ko-tro-pin), which stimulates the adrenal gland to produce certain hormones

The pituitary also secretes endorphins (pronounced: en-dor-fins), chemicals that act on the nervous system and reduce feelings of pain. In addition, the pituitary secretes hormones that signal the reproductive organs to make sex hormones. The pituitary gland also controls ovulation and the menstrual cycle in women. The posterior lobe of the pituitary releases antidiuretic (pronounced: an-ty-dy-uh-reh-tik) hormone, which helps control the balance of water in the body. The posterior lobe also produces oxytocin (pronounced: ahk-see-toe-sin), which triggers the contractions of the uterus in a woman having a baby. hyroid The thyroid (pronounced: thy-royd), located in the front part of the lower neck, is shaped like a bow tie or butterfly and produces the thyroid hormones thyroxine (pronounced: thy-rahk-sin) and triiodothyronine (pronounced: try-eye-oh-doe-thy-ruh-neen). These hormones control the rate at which cells burn fuels from food to produce energy. The production and release of thyroid hormones is controlled by thyrotropin (pronounced: thyruh-tro-pin), which is secreted by the pituitary gland. The more thyroid hormone there is in a person's bloodstream, the faster chemical reactions occur in the body. 41

Why are thyroid hormones so important? There are several reasons for example, they help kids' and teens' bones grow and develop, and they also play a role in the development of the brain and nervous system in kids. Parathyroids Attached to the thyroid are four tiny glands that function together called the parathyroids (pronounced: par-uh-thy-roydz). They release parathyroid hormone, which regulates the level of calcium in the blood with the help of calcitonin (pronounced: kal-suh-toe-nin), which is produced in the thyroid. Adrenal Glands The body also has two triangular adrenal (pronounced: uh-dree-nul) glands, one on top of each kidney. The adrenal glands have two parts, each of which produces a set of hormones and has a different function: 1. The outer part, the adrenal cortex, produces hormones called corticosteroids (pronounced: kor-tih-ko-ster-oydz) that influence or regulate salt and water balance in the body, the body's response to stress, metabolism, the immune system, and sexual development and function. 2. The inner part, the adrenal medulla (pronounced: muh-duh-luh), produces catecholamines (pronounced: kah-tuh-ko-luh-meenz), such as epinephrine (pronounced: eh-puh-neh-frun). Also called adrenaline, epinephrine increases blood pressure and heart rate when the body Pineal The pineal (pronounced: pih-nee-ul) body, also called the pineal gland, is located in the middle of the brain. It secretes melatonin (pronounced: meh-luh-toe-nin), a hormone that may help regulate when you sleep at night and when you wake in the morning. Reproductive Glands The gonads are the main source of sex hormones. Most people don't realize it, but both guys and girls have gonads. In guys the male gonads, or testes (pronounced: tes-teez), are located in the scrotum. They secrete hormones called androgens (pronounced: an-druh-junz), the most important of which is testosterone (pronounced: teh-stass-tuh-rone). These hormones tell a guy's body when it's time to make the changes associated with puberty, like penis and height growth, deepening voice, and growth in facial and pubic hair. Working with hormones from the pituitary gland, testosterone also tells a guy's body when it's time to produce sperm in the testes. A girl's gonads, the ovaries (pronounced: oh-vuh-reez), are located in her pelvis. They produce eggs and secrete the female hormones estrogen (pronounced: es-truh-jen) and progesterone 42

(pronounced: pro-jes-tuh-rone). Estrogen is involved when a girl begins to go through puberty. During puberty, a girl will experience breast growth, will begin to accumulate body fat around the hips and thighs, and will have a growth spurt. Estrogen and progesterone are also involved in the regulation of a girl's menstrual cycle. These hormones also play a role in pregnancy. Although the endocrine glands are the body's main hormone producers, some other organs not in the endocrine system such as the brain, heart, lungs, kidneys, liver, and skin also produce and release hormones. Pancreas The pancreas (pronounced: pan-kree-us) is also part of the body's hormone-secreting system, even though it is also associated with the digestive system because it produces and secretes digestive enzymes. The pancreas produces (in addition to others) two important hormones, insulin (pronounced: in-suh-lin) and glucagon (pronounced: gloo-kuh-gawn). They work together to maintain a steady level of glucose, or sugar, in the blood and to keep the body supplied with fuel to produce and maintain stores of energy. What Does the Endocrine System Do? Once a hormone is secreted, it travels from the endocrine gland that produced it through the bloodstream to the cells designed to receive its message. These cells are called target cells. Along the way to the target cells, special proteins bind to some of the hormones. These proteins act as carriers that control the amount of hormone that is available for the cells to use. The target cells have receptors that latch onto only specific hormones, and each hormone has its own receptor, so that each hormone will communicate only with specific target cells that have receptors for that hormone. When the hormone reaches its target cell, it locks onto the cell's specific receptors and these hormone-receptor combinations transmit chemical instructions to the inner workings of the cell. When hormone levels reach a certain normal amount, the endocrine system helps the body to keep that level of hormone in the blood. For example, if the thyroid gland has secreted the right amount of thyroid hormones into the blood, the pituitary gland senses the normal levels of thyroid hormone in the bloodstream. Then the pituitary gland adjusts its release of thyrotropin, the hormone that stimulates the thyroid gland to produce thyroid hormones. Another example of this process is parathyroid hormone, which increases the level of calcium in the blood. When the blood calcium level rises, the parathyroid glands sense the change and reduce their secretion of parathyroid hormone. This turnoff process is called a negative feedback system. Things That Can Go Wrong With the Endocrine System Too much or too little of any hormone can be harmful to your body. For example, if the pituitary gland produces too much growth hormone, a teen may grow excessively tall. If it produces too little, a teen may be unusually short. Doctors can often treat problems with the endocrine system by controlling the production of hormones or replacing certain hormones with medication.

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Endocrine problems that can affect teens include: Adrenal insufficiency. This condition occurs when the adrenal glands don't produce enough corticosteroids. The symptoms of adrenal insufficiency may include weakness, fatigue, abdominal pain, nausea, dehydration, and skin changes. Doctors treat adrenal insufficiency with medications to replace corticosteroid hormones. Type 1 diabetes. When the pancreas fails to produce enough insulin, type 1 diabetes (previously known as juvenile diabetes) occurs. In kids and teens, type 1 diabetes is usually an autoimmune disorder, which means that some parts of the body's immune system attack and destroy the cells of the pancreas that produce insulin. To control their blood sugar levels and reduce the risk of developing diabetes problems, kids and teens with this condition need regular injections of insulin. Type 2 diabetes. Unlike type 1 diabetes, in which the body can't produce normal amounts of insulin, in type 2 diabetes the body can't respond to insulin normally. Kids and teens with the condition tend to be overweight. Some kids and teens can control their blood sugar level with dietary changes, exercise, and oral medications, but many will need to take insulin injections like people with type 1 diabetes. Growth hormone problems. Too much growth hormone in kids and teens who are still growing will make their bones and other body parts grow excessively. This rare condition (sometimes called gigantism) is usually caused by a pituitary tumor and can be treated by removing the tumor. The opposite can happen when a kid or teen has a pituitary glad that doesn't produce enough growth hormone. Doctors may treat these growth problems with medication. Hyperthyroidism. Hyperthyroidism (pronounced: hy-per-thy-roy-dih-zum) is a condition in which the levels of thyroid hormones in the blood are very high. In kids and teens, the condition is usually caused by Graves' disease, an immune system problem that causes the thyroid gland to become very active. Doctors may treat hyperthyroidism with medications, surgery, or radiation treatments. Hypothyroidism. Hypothyroidism (pronounced: hy-po-thy-roy-dih-zum) is a condition in which the levels of thyroid hormones in the blood are very low. Thyroid hormone deficiency slows body processes and may lead to fatigue, a slow heart rate, dry skin, weight gain, and constipation. Kids and teens with this condition may also grow more slowly and reach puberty at a later age. Hashimoto's thyroiditis is an immune system problem that often causes problems with the thyroid and blocks the production of thyroid hormone. Doctors often treat this problem with medication. Precocious puberty. If the pituitary glands release hormones that stimulate the gonads to produce sex hormones too early, some kids may begin to go through puberty at a very young age. This condition is called precocious puberty. Kids and teens who are affected by precocious puberty can be treated with medication that will help them develop at a normal rate. Nutrients Needed by the Endocrine System: he endocrine system includes a network of organs and glands that produce and secrete chemicals known as "hormones." The term "hormone" describes any chemical produced in one area of the body that triggers a response in another area of the body. Many nutrients, including vitamins and 44

minerals, support a healthy endocrine system, but vitamins A, D and B-6 and selenium play important roles in promoting the production of hormones. Vitamin A Vitamin A includes a group of related compounds including retinol and retinal. Vitamin A supports a healthy immune system, plays a role in normal growth and development and facilitates the formation of healthy red blood cells. One active form of vitamin A, retinoic acid, acts as a hormone and affects the process by which genes convert to specific proteins. Vitamin A also interacts with thyroid hormone receptors to aid in thyroid hormone signaling, therefore supporting thyroid function. Foods rich in vitamin A compounds include milk, the family of orange and red fruits and vegetables like carrots, cantaloupe, pumpkin and sweet potatoes, and leafy green vegetables like broccoli, spinach and kale. Vitamin D Although vitamin D is best known for its role in promoting the absorption of calcium, it also benefits the endocrine system. Research published in the February 2007 issue of Hormone and Metabolic Research details how the hormone activities of vitamin D regulate growth and differentiation of cells that may help in treating certain skin diseases. In addition, the cells in the pancreas that secrete the hormone insulin -- necessary for regulating the sugar level in the blood -contain vitamin D receptors. The binding of vitamin D promotes the secretion of insulin, especially when the insulin demand increases. Few food sources naturally contain vitamin D, but fortified food sources like milk, orange juice and breakfast cereals contribute to your vitamin D levels. Vitamin B-6 Vitamin B-6 is essential for the production of the coenzyme pyridoxal 5'-phosphate, known as PLP. This coenzyme activates enzymes that increase the speed of vital chemical reactions in the body. Vitamin B-6 benefits the endocrine system because PLP binds to steroid hormone receptors and inhibits the binding of the reproductive hormone like estrogen, progesterone or testosterone therefore interfering with their binding and decreasing their effects. In this role, vitamin B-6 may help reduce the risk for steroid hormone-dependent cancers like breast cancer and prostate cancer. Food sources of vitamin B-6 include salmon, turkey, chicken, potatoes, spinach and bananas. Selenium Selenium, classified as a trace mineral because your body only needs it in small amounts, plays a vital role in activating thyroid hormone. Your thyroid gland located in your neck produces a small amount of active thyroid hormone, known as "triiodothyronine" or T3 and a larger amount of the inactive thyroid hormone called "thyroxine" or T4. Because thyroid hormones regulate nearly every bodily function, your body needs plenty of active thyroid hormone. Selenium activates the enzyme called iodothyronine deiodinases that converts T4 into T3 therefore promoting healthy thyroid function. Brazil nuts serve as the best source of selenium, but other foods like fish, shellfish, meat, breads and milk also provide vitamin B-6 to your diet. Phytoestrogens

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Some foods impact your endocrine system due to their phytoestrogen content. Phytoestrogens are plant chemicals with a similar structure to the estrogen in your body. They can behave similarly to estrogen in your body, binding to proteins called estrogen receptors on your cells. The role of phytoestrogens remains unclear -- they might mimic the presence of estrogen in your system, or phytoestrogens might block the function of the estrogen naturally produced by your body. Soy products, broccoli, beans and legumes all contain phytoestrogens. Vitamins, Minerals and Thyroid Hormones Your thyroid is the largest endocrine gland in your body, and secretes the thyroid hormones T3 and T4 into your bloodstream. A healthy thyroid helps control your metabolic rate; an over- or underactive thyroid increases or decreases your metabolic rate, respectively. Vitamins A and D both interact with cells in your thyroid gland to control thyroid hormone production, and the essential mineral selenium actives enzymes required to activate thyroid hormones. Iodine also helps maintain thyroid health. Iodine deficiencies prevent thyroid hormone production and can cause goiter, or abnormal growth of the thyroid gland. Dairy products typically contain added vitamin A and D, eating Brazil nuts can boost your intake of selenium and cod, shrimp and iodized salt provide iodine. B Vitamins and Melatonin Vitamins also help maintain your internal clock, the biological process that helps you wake up in the morning and get to sleep at night. The primary hormone that maintains this clock is melatonin, a chemical produced in your brain. In the dark, your melatonin levels rise and you begin to feel sleepy, and these melatonin levels decrease in response to light so that you feel more alert during the day. Vitamins B-5 and B-6 both help your brain produce melatonin to support your internal clock. Eat meats, dairy products and lentils as sources of both nutrients. Considerations Even though key nutrients play specific roles in maintaining your endocrine system, the best way to keep your endocrine system healthy is to eat a balanced diet customized for your specific needs. Eating too much or too little each day disrupts your endocrine system -- excess fatty tissue secretes abnormally high levels of estrogen, and people with very little fat also face a risk of hormone imbalance. Phytoestrogens should also be consumed in moderation. Since the function of phytoestrogens in humans is not completely understood, eating a diet high in these chemicals might have adverse health effects, especially if you have suffer from estrogen-sensitive cancers such as breast cancer. If you're concerned about how to eat to keep your endocrine system healthy, consult a doctor or other medical professional for help planning a diet to suit your circumstances.

Diseases of the Endocrine System: he endocrine system is composed of a network of organs and glands responsible for producing, storing, and secreting hormones that help to maintain and control vital functions such as growth, reproduction, and energy levels. There are several endocrine system diseases that result from disruptions in this complex system: 46

Diabetes - One of the more prevalent endocrine system diseases, diabetes is a condition in which the pancreas does not produce enough of the hormone insulin or the body does not effectively use the insulin it does produce. Because insulin is instrumental in helping the body convert sugars and starches into necessary energy, there can be serious consequences if diabetes is left undiagnosed and/or untreated. Growth Disorders - Given that the endocrine system regulates growth processes, endocrine system diseases often result in growth disorders. If the body produces too much growth hormone (GH), gigantism or acromegaly (gigantism in adults) can occur; too little growth hormone results a condition called growth hormone deficiency, or GHD, which can cause children to grow more slowly than normal. Osteoporosis - Osteoporosis, which occurs in both women and men (although the former are four times more likely to develop the disease), is a condition in which bones become fragile and more likely to break. This can be the result of many factors including a decrease in the hormone estrogen occurring during menopause in women, or a decrease in testosterone occurring in men as they age. Because osteoporosis often has no obvious symptoms, it is often left undiagnosed until the person affected suffers a broken or fractured bone during a minor fall. Polycystic Ovary Syndrome - Also referred to as PCOS, polycystic ovary syndrome is one of the more common endocrine system diseases, affecting between 7% to 10% of women aged 15 to 45. PCOS is a condition associated with symptoms of infrequent or irregular menstruation, male hormone excess symptoms like hirsutism (increased and unwanted hair growth) and acne and difficulty to conceive. Patients with PCOS can also have multiple egg-containing cysts on the ovaries. They are higher risk for metabolic complications like diabetes and hypertension.

Thyroid Disorders - Thyroid hormones, hormones produced by the thyroid gland, influence nearly all of the body's symptoms. Thyroid problems include hyperthyroidism (too much thyroid hormone), hypothyroidism (too little thyroid hormone), thyroid nodules, thyroid cancer, and more.

This is an incomplete list; there are many more endocrine system diseases. Visit our endocrine system diseases and conditions page to access more detailed information about these and other disorders, their symptoms, and their treatments. In addition to the endocrine system diseases listed above, there are a number of hormone disorders that are far more rare. Cushing's syndrome and Addison's disease are two of these less common diseases. Cushing's Syndrome Cushing's syndrome, less common than the endocrine system diseases discussed above, occurs as the result of too much cortisol in the blood for an extended period of time. Cortisol is a hormone that, in normal amounts, helps the body perform a number of important functions including converting fat into energy, maintaining immune system function, and responding to stress. 47

The two types of Cushing's syndrome, exogenous (from an outside source) and endogenous (from a source within the body), share a common list of symptoms but different causes. Exogenous Cushing's syndrome occurs in patients taking cortisol-like medications, and is temporary, ceasing when the patient has finished the course of medication. The endogenous form of this endocrine system disease is far rarer, and results from a tumor or tumors either on the adrenal glands or the pituitary gland. Cushing's syndrome symptoms include the following:

Weight gain Muscle loss and weakness Easily-bruised, fragile skin Reduced sex drive Depression/inability to think clearly

This is only a partial list of Cushing's syndrome symptoms. For a full list of symptoms click on the Cushing's syndrome link on the rare endocrine system diseases page. Addison's Disease Addison's disease, also among the rare endocrine system diseases, occurs in fewer than 150 people in a million. Also referred to as primary adrenal insufficiency, Addison's disease occurs when the adrenal glands, which are located at the top of each kidney, produce an insufficient amount of steroid hormones despite the presence of an adequate amount of ACTH, the hormone that triggers the adrenal glands to release steroids. The steroid hormones produced by the adrenal glands, and deficient during Addison's disease, hold many important functions including the regulation of blood sugar levels, helping the body fight infection and stress, and maintaining normal sexual drive. Addison's disease symptoms include the following:

Fatigue, weakness, loss of appetite Muscle and joint pain Gastrointestinal problems (nausea, vomiting, etc.) Darkening of the skin on the face, neck, and back of hands Low blood pressure A craving for salt

For a comprehensive description of Addison's disease, including a complete and detailed list of symptoms, please visit our resource page for rare conditions.

The Endocrine System: The Pancreas & Diabetes Several months ago, we explored the anatomy and physiology of the pancreas in terms of its role in the digestive process. But the pancreas is one of a handful of organs in the body that functions in two distinct modes. It is not only an exocrine digestive organ, but it also functions as part of the endocrine system and, to a significant degree, controls the metabolism of sugar in the body and its 48

use as a source of energy for every single cell and organ in the body. In this newsletter, we examine the endocrine functions of the pancreas. As an endocrine organ, the pancreas produces two sugar-regulating hormones: insulin and glucagon. After reviewing the functions of insulin and glucagon and the four cell types that comprise the endocrine pancreas, we'll examine in detail the main disease associated with the pancreas, diabetes mellitus. The pancreas functions in two modes. As mentioned above, the pancreas functions in two distinctly different modes. It is both an exocrine digestive organ that secretes digestive juices and enzymes into the duct of Wirsung that runs down the middle of the pancreas and empties into the duodenum at the head of the pancreas. But the pancreas is also an endocrine organ, producing insulin, glucagon, and somatostatin that flow directly into the bloodstream, eventually reaching virtually every cell in the body. Anatomy review We explored the anatomy and physiology of the pancreas in some detail in our newsletter focused on that topic, but a quick review would be appropriate before discussing the gland's endocrine function. Physically, the pancreas is located in the upper abdominal cavity, towards the back -- in the C curve of the duodenum. It is about 12 inches long and tapers from right to left. (Remember, anatomically speaking, left and right are referenced from behind the body so they are actually reversed in most diagrams that view the body from the front.) The thick part, the head, comprises almost 50% of the mass of the pancreas and lies to the right, nestled in the C-curve of the duodenum. As for the body of the pancreas, it moves up and to the left, tapering into what is known as the tail of the pancreas, which terminates at the junction of the spleen.

As might be suspected for such an important organ, the pancreas is richly supplied with arteries and veins. It is served by branches from the hepatic artery, the gastroduodenal artery, the pancreaticoduodenal artery, the superior mesenteric artery, and the splenic artery. Ninety-nine percent of the pancreas is made of acini, clusters of cells that resemble a many-lobed 49

"berry" (acinus is Latin for berry). The acini produce exocrine digestive juices that flow out of the acini through small ducts that eventually join together and feed into the duodenum through the pancreatic duct. But today, we are not interested in that ninety-nine percent. We are interested in the one percent of the pancreas that is made up of several million cells scattered throughout the pancreas, grouped together in globules known as islets of Langerhans. It is these cells that contain the endocrine functioning of the pancreas. A healthy human pancreas contains about one million such globules, which are distributed throughout the organ like tiny islets in a vast ocean of acini -hence their name. Their combined mass is a mere 1 to 1.5 grams. Physiology of the endocrine pancreas -- four cell types A single islet of Langerhans is actually comprised of four distinct types of cells (alpha, beta, delta, and gamma), two of which are primary: alpha and beta.

Alpha cells Alpha cells constitute 20% of the islet's cells. They secrete the hormone glucagon, a polypeptide of 29 amino acids, which raises blood sugar to maintain normal levels. For the most part, glucagon does not present the same problems as insulin and will not raise blood sugar much above normal - 80-100 mg of sugar per 100 ccs of blood. For obvious reasons (diabetes), we don't want blood sugar to go too high. But for the brain, we don't want it to go too low either (hypoglycemia). The brain does not store sugar and has no reserves. If blood sugar falls too low, the brain is affected in minutes, possibly even seconds. Note: all of the islet cells are serviced by an abundant network of 50

capillaries that carry their "products," including glucagon, out into the bloodstream. The production and release of glucagon in the pancreas is regulated by chemoreceptors throughout the body that constantly measure the amount of sugar in the blood. Whenever blood sugar gets too low, the chemoreceptors signal the alpha cells in the pancreas to release more glucagon. Glucagon in turn travels through the bloodstream to the liver, where it acts on hepatocytes (cells in the liver) to break down glycogen (the stored form of glucose) into glucose through a process called glycogenolysis. Also, if required, the body can convert amino acids and/or fat into intermediate metabolites that are ultimately converted into glucose through a process called gluconeogenesis. In either case, the glucose makes its way into the bloodstream where it is available to be used by cells for energy. Correspondingly, higher-than-normal blood sugar turns off the release of glucagon. It should also be noted that stimulation of the sympathetic nervous system in preparation for stress, or flight (or in response to fright) also affects glucagon release; it increases it. This is accomplished through both neural and hormonal signals coming down into the pancreas. Hormonally, we're talking about epinephrine and norepinephrine, which stimulate the release of glucagon, thus raising blood sugar levels. And finally, glucagon secretion is inhibited by amylin, a peptide of 37 amino acids, which is secreted by the beta cells of the pancreas. Injections of glucagon are sometimes given to diabetics suffering from an insulin reaction in order to speed the return of normal levels of blood sugar. All of glucagon's actions tend to counter those of insulin, which works to reduce the level of glucose in the blood. Incidentally, glucagon, like insulin, is readily available thanks to genetically engineered bacteria and recombinant DNA technology. This is done by inserting the human gene for insulin into E. coli bacteria, which then "grow" genuine, bio-identical, human insulin in culture tanks. For those squeamish about E. coli, this process is also done by some manufacturers using yeast instead of bacteria. Beta cells Beta cells constitute approximately 80% of islet cells. They secrete insulin, which lowers blood sugar -- also in response to chemoreceptors. Higher-thannormal blood sugar stimulates beta cells to release insulin. Sustained high blood sugar is bad not only for the blood but also for organs and cells. Beta cells have channels in their plasma membrane that serve as glucose detectors. Beta cells secrete insulin in response to a rising level of circulating glucose (i.e. "blood sugar"). Insulin Insulin is a small protein that affects virtually every single cell in the body and most organs -- primarily by regulating how every cell in the body utilizes glucose. Seventy-five percent of that glucose is 51

ultimately used by the body to sustain brain function. The remaining 25% is divided between muscle function, red blood cell production, and powering every single cell in the body. Actually, glucose does not power those cells directly, but rather, through a process known as glycolysis, it is used in the creation of pyruvate, which is then turned into adenosine triphosphate (ATP), the actual energy source within the cell. Again, insulin is a primary regulator of sugar in the body. For example, it stimulates skeletal muscle fibers to take up glucose and convert it into glycogen, which is the storage form of glucose and is utilized in muscle tissue to produce ATP by the muscle itself. Insulin also works inside muscle tissue to extract amino acids from the blood and stimulate their conversion into protein, thereby causing the muscles to "grow." Insulin also acts on liver cells, stimulating them to take up glucose from the blood and convert it into glycogen while inhibiting production of the enzymes involved in breaking glycogen back down into glucose and inhibiting the conversion of fats and proteins into glucose. In this way, insulin helps regulate the body's energy storage system. It should be noted that when the dietary intake of high glycemic carbohydrates is excessive, this leads to an excess of stored fat in the liver, which ultimately compromises liver function. This is further compounded by the fact that insulin acts on fat cells to stimulate their uptake of glucose and the synthesis of fat. In each case, insulin triggers these effects by binding to the insulin receptor -- a transmembrane protein embedded in the plasma membrane of the responding cells. Taken together, all of these insulin actions result in the storage of the soluble nutrients absorbed from the intestine into insoluble, energy-rich products (glycogen, protein, fat) and a drop in the level of blood sugar. Specifically, insulin is glucagon's opposite and acts on the cells of the body to:

Increase the speed and ability of glucose to diffuse into cells -- especially the skeletal muscles and heart muscles for the restoration and recovery of those muscles. Accelerate the conversion of glucose into its storage form, glycogen. Increase the synthesis of proteins from amino acids. Increase the synthesis of fatty acids -- especially in the liver. This is the mechanism animals in the wild use to store energy for hibernation or just to survive harsh winters. Unfortunately, it causes problems for modern man as we no longer face such extreme conditions -- thus leading to an excess of fat storage. It decreases the rate of glycogenolysis (breakdown of glycogen into glucose) and gluconeogenesis (conversion of fats and proteins into glucose). The net effect is to lower glucose levels.

Lower-than-normal blood glucose turns off the output of insulin. But there are other factors that also affect insulin release. The parasympathetic nervous system can stimulate insulin release to aid in recovery and rest. Glucagon itself causes insulin release to balance its effect in a negative feedback loop. And finally, gastric inhibitory peptide (GIP) from the enteroendocrine cells of the small intestine responds to glucose in the lumen of the gut, thereby signaling the "preparatory" release of glucose-dependent insulin from pancreatic beta cells. It should be noted that the effect of GIP on the pancreas is diminished by Type 2 diabetes. And finally, beta cells also produce insulin-like growth factors (specifically, IGF-2), which is found in many body tissues at concentrations far higher than insulin itself. It shares the molecular 52

structure and shape of insulin and is involved in growth. As a side note, IGF-1 (produced in the liver) and IGF-2 are used by cancer cells to stimulate growth. Delta cells Delta cells constitute less than 1% of pancreatic islets. They secrete somatostatin, the same growth-hormone-inhibiting hormone secreted by the hypothalamus. This hormone inhibits insulin release and slows absorption of nutrients from the GI tract. Gamma cells (F cells) Gamma cells also constitute less than 1% of pancreatic islets. They secrete a pancreatic polypeptide that inhibits the release of somatostatin. In other words, Delta cells and Gamma cells work to regulate each other. Diabetes mellitus ("sweet urine") Diabetes mellitus is actually not one disease, but a group of disorders in which glucose levels are elevated in the blood. It is called a protean (widespread) disease because it affects every system in the body. (For more on this concept, check out Diabetes -- The Echo Effect -- highly recommended.) By itself, it ranks somewhere between fourth and sixth as a leading cause of death in the US -- and climbing the charts throughout the rest of the world. But when considered as a major factor in cardiovascular disease and kidney failure, its true impact is probably much higher. Its name, sweet urine, comes from the fact that it was originally diagnosed by tasting (not testing) the patient's urine. The word "mellitus" is Latin for honey-sweet. Elevated glucose levels make the urine sweet. Back then, doctors truly earned their fees. Doctors often refer to the clinical manifestations of diabetes as the "three polys":

Polyuria: copious amounts of urine. Polydipsia: excessive thirst and drinking of water -- caused by the polyuria. Polyphagia: excessive eating. Patients with diabetes are actually starving because they're not getting sugar into their cells where it is needed -- so they are driven to eat excessively, in an attempt to compensate.

There are two main types of diabetes. Type I is insulin-dependent diabetes mellitus and Type II is non-insulin-dependent diabetes, formerly known as maturity-onset or adult onset diabetes. There is also a third, less common, type of diabetes that results from mutant genes inherited from one or both parents. We will discuss all three types. Type I diabetes Type I represents about 10-20% of all diabetes cases. It is suspected that it is an autoimmune disease in which the body becomes allergic to its own beta cells and destroys them. What 53

triggers this attack is still unknown, although a prior viral infection may be the culprit. In any case, the net result is that there are simply too few beta cells left to make enough insulin to fulfill the body's needs, and the patient ends up with an absolute deficiency in the quantity of insulin available. Type I diabetes is also known as juvenile-onset diabetes because it often appears in childhood. Standard "medical" treatment is daily insulin injections to give patients the insulin their bodies are not providing. Unfortunately, because insulin demands fluctuate so frequently during the day, it is very hard to regulate "external" insulin in a way that keeps sugar and insulin levels consistently balanced in the body. For example, injections after vigorous exercise or long after a meal may drive the blood sugar level down to a dangerously low value causing an insulin reaction. The patient becomes irritable, fatigued, and may lose consciousness. In response, doctors have developed experimental treatments such as inhalable insulin, pancreatic transplants, islet cell transplants, immune suppression, and insulin pumps. To this point, none of these alternatives is without significant problems. On the other hand, although it cannot be controlled with diet and exercise, there are indeed alternative options that can prove helpful. We'll talk about those a little later. In addition to the immediate problems associated with excess blood sugar, diabetes also presents other problems. For example, patients are in a chronic state of starvation, unable to use nutrients without injections of insulin. In addition, cataracts of the lens of the eye and diabetic retinopathy are related to high blood sugar. The excess sugar diffuses into the eye and forms a cloudy glycoprotein with the lens. Another problem associated with diabetes is if the body is unable to utilize blood sugar as energy for the cells of the body, it will try and convert as much of the excess glucose as possible into fat to store the energy. This not only leads to fatty livers, but to an excess of fat in the blood. High levels of fat in the blood, over long periods, leads to atherosclerosis. Other physical problems related to high blood lipids and blood vessel damage (also caused by blood sugar) include strokes, heart attacks, kidney failure, peripheral vascular disease, and increased rates of infection -- not to mention, a high rate of amputation. (Again, check out Diabetes -- The Echo Effect.) There is another problem associated with Type I diabetes. Since diabetics cannot use glucose for energy effectively, their bodies shift to using fatty acids to produce cellular energy. This results in an excess of fatty acid wastes called ketones. Ketones are very, very acidic, and they cause a shift to acidity in the blood. This condition is called ketoacidosis. You can smell acetone on the breath of a diabetic suffering from ketoacidosis. Uncorrected, ketoacidosis is rapidly fatal. It's probably worth mentioning that low-carb diets work by turning dieters into "controlled" diabetics so that their bodies can shift from sugar burning to fat burning. Effectively, low-carb diets interrupt the Krebs cycle by denying the body the 100 grams of glucose it needs to prime the pump for sugar burning. As I mentioned, this process essentially turns dieters into controlled lowlevel diabetics and produces a mild form of ketoacidosis. As a side note, if a dieter eats protein and fat, then triggers the Krebs cycle, all excess material will be turned into fat anyway -- so ultimately, little is gained unless one chooses to remain permanently a low level diabetic. For more on low-carb diets, check out my series of newsletters on the subject, Low Carb Craziness. Type II diabetes

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At one time, Type II diabetes was known as adult onset diabetes because almost all its victims tended to be over 40 years of age. But those days are long gone, and now, thanks to catastrophic dietary changes in the developed world (and with developing countries struggling to imitate us) Type II diabetes is now appearing in many children. So it has been renamed. It is now called non-insulin-dependent diabetes and accounts for some 90% of all diabetes cases. In fact, children now account for 20% of all newlydiagnosed cases of Type II diabetes and, like their adult counterparts, are usually overweight. Sadly, it is almost always a self-inflicted disease -- most often triggered by high glycemic diets and excessive weight. Fortunately, because it is self-inflicted, it is usually much milder than Type I diabetes (at least if caught in the early stages) and is much easier to control. In fact, many patients have normal insulin levels. The problem is that because the body has had to pump out so much insulin over time to combat the high glycemic foods dominating so many diets, the cells of the body have become progressively less sensitive to the action of insulin. They have, to use the common term, become insulin resistant. Although virtually every single cell in the body survives by converting glucose to energy, skeletal muscle is the major "sink" for removing excess glucose from the blood and converting it into glycogen). But in a Type II diabetic, the ability of skeletal muscle to remove glucose from the blood and convert it into glycogen may be only 20% of normal. This, again, is called insulin resistance. Fortunately, vigorous exercise increases the ability of skeletal muscle to transport glucose across its cellular membrane, thus reducing the effect of insulin resistance. Or to put it another way, people who lead sedentary lives are more likely to develop Type II diabetes. Symptoms of Type II diabetes are similar to that found in Type I and include the three polys mentioned above. Treatment options include:

For most patients -- diet, weight loss, and exercise. For some patients -- pharmaceutical drugs. For a few patients -- insulin injections.

On the other hand, if patients are lax and do not control their disease early on, symptoms become more severe over time. It is as though after years of pumping out insulin in an effort to overcome the patient's insulin resistance, the beta cells become exhausted. Note: there is a close relative of Type II diabetes called gestational diabetes. It usually results from transient elevations in blood glucose during pregnancy. It causes the same problems as Type II diabetes for the fetus. Inherited Forms of Diabetes Mellitus

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A very small number of cases of diabetes result from mutant genes inherited from one or both parents. These genes can cause diabetes in several different ways.

Some mutant genes prevent the body from actually manufacturing insulin. Other genes cause insulin receptor sites on cells to malfunction. Still another mutation prevents the body from manufacturing glucokinase, an enzyme essential for glycolysis, the first step in converting glucose into ATP, which energizes every single cell in the body. And yet another mutation messes up the sodium-potassium pump mechanism (used to transport large molecules into and out of cells) in the beta cells of the pancreas so that the insulin they create can never leave the cell and make its way into the bloodstream. In other words, the insulin is there, but unusable.

While the symptoms of inherited diabetes usually appear in childhood or adolescence, patients with inherited diabetes differ from most children with Type 2 diabetes in that their families have a history of similar problems and they are not necessarily obese. But again, inherited diabetes represents only a small percentage of diabetic patients. Natural treatments for diabetes Ultimately, Type I and Type II diabetics end up at the same place even though they arrive there through very different means. In Type I diabetes, you end up with high blood sugar because your body can't produce enough insulin to drive the sugar into cells where it can be used for energy production. In Type II diabetes, your body can produce more than enough insulin (at least in the beginning), but because cells become resistant to the effects of that insulin, sugar stays in the blood because it can't get transported into the cells of the body. Thus, the alternative methods for dealing with both types of diabetes are similar -- with a couple of additions for Type I diabetes to deal with the autoimmune factor. Natural protocol for dealing with diabetes Beyond modifying your diet and exercising, you might want to inhibit absorption of high glycemic foods, without creating unwelcome responses in the intestinal tract, such as those experienced using metformin. This drastically reduces the amount of insulin your body requires and minimizes the chances of having both sugar and insulin spikes. It can be accomplished with the following herbs:

Nopal cactus Gymnema sylvestre

Naturally reverse insulin resistance so less insulin is required. Again, the benefits for both Type I and Type II diabetes are obvious:

Konjac mannan Cinnulin PF Chromium GTF Omega-3 fatty acids 56

Repair beta cells in the islets of Langerhans in the pancreas to optimize insulin production reserves as opposed to forcing the cells to dramatically overproduce as with glyburide, which leads to inevitable burn out. This is a "sine qua non" for Type I diabetes and is essential if you want to prevent prolonged Type II diabetes from "burning out" the beta cells through forced overproduction of insulin.

Gymnema sylvestre Alpha lipoic acid or R lipoic acid

Lower blood sugar levels through proper diet and herbal supplementation:

Fenugreek extract Momordica charantia Corosolic acid Mulberry

Reduce stress. Remember, adrenaline suppresses the release of insulin. Specific for Type I diabetes Since it is strongly suspected that Type I diabetes results from an out of control immune system that attacks and destroys the beta cells in the islets of Langerhans, it is essential that you try and modulate your immune system to minimize, or even eliminate, this factor. Immunomodulators Natural immunomodulators retrain your immune system to not overreact -- and without deadly side effects.

L-carnosine Cetylmyristoleate (CMO) Transfer Factor found in bovine colostrums Ginseng

Taking on viruses There is steadily mounting evidence that a virus may be responsible for triggering the autoimmune response that causes Type I diabetes. If so, then you will want to use antipathogens to help reduce or eliminate that viral load.

Garlic Olive leaf Zinc Grapefruit seed extract Wild mountain oil of oregano

Additional steps If you clicked the link to Diabetes: the Echo Effect, you know that diabetes potentially affects almost every organ in the body -- many of which, as they degrade, can exacerbate the original 57

diabetic problem. Therefore, anyone suffering from diabetes will want to do whatever is necessary to protect those organs. Protect organs and proteins from damage caused by higher than normal levels of sugar through a mixture of antioxidants and nutraceuticals such as:

L-Carnosine Acetyl-l-carnitine DMAE CoQ10 Alpha lipoic acid or R lipoic acid Benfotiamine

Protect organs from damage caused by higher than normal insulin levels by cleaning the blood by using:

A blood cleansing formula Proteolytic enzymes Omega-3 fatty acids

And that concludes our exploration of the endocrine functions of the pancreas. In our next newsletter, we will conclude our exploration of the endocrine system by examining the adrenal glands. Phosphorus Phosphorus, also known as white phosporus, is made from calcium phosphate found in North African volcanoes. Phosphorus is extremely toxic, but---as with all homeopathic remedies---a minute amount is dissolved in alcohol to form a mother tincture, which is then successively diluted. Homeopaths often prescribe phosphorus for problems that result from a disordered endocrine system; Hpathy.com recommends phosphorus in particular for diabetic patients, especially if they have muscle pain, boils, extreme thirst, and pale urine. Homeopaths may also prescribe phosphorus to treat the tingling sensations caused by diabetic neuropathy, as well as general exhaustion and craving for sweets. Homeopaths often target remedies to the patient's personality; if the afflicted patient is also affectionate, artistic, and ambitious, this serves as even more of an indication for the use of phosphorus. Beneforce.com notes that symptoms that are worsened by windy weather, thunderstorms, overeating, and stress--but are improved by fresh air, sleep, and massage--are also indicative of the need for phosphorus remedy. Blue Shield Complementary and Alternative Health notes that homeopathic treatment is not considered appropriate for major illnesses such as cancer, heart disease and major infections, and states that homeopathic remedies should not replace conventional medical treatments. Natrum Muriaticum Natrum muriaticum is made from sodium chloride, or table salt, and mined from rock salt deposits. Country Herbalist advises it for the treatment of symptoms of abnormal thyroid function. Natrum muriaticum is also the gold standard in homeopathy for treating irregular menstrual 58

cycles, fatigue, headaches and water retention during menstruation. According to Beneforce.com. homeopaths are more likely to advise it for sensitive people who tend towards irritability or depression, and become moody when criticized. If symptoms are worsened by heat, poor air circulation, overeating and stress, but improved by fresh air, cool showers, fasting, and lying down, it is even more likely that a homeopath will advise natrum muriaticum. Check with your doctor before using natrum muriaticum for menstrual problems. Lycopodium clavatum Lycopodium clavatum is made from the spores of club moss, also known as lamb's tail and wolf's claw, a trailing evergreen plant. It has a long history of use in herbal medicine for treating kidney stones, impotence, and prostate disorders; Country Herbalist recommends it for treating conditions of the kidney, liver and pancreas. According to Beneforce.com, the personality type that could most benefit from lycopodium is someone who tends to be anxious and fearful, but hides their emotions behind false confidence. If symptoms are worsened by hot weather and tight clothes but better for cool air, light exercise, and hot food and drink, it is more likely that a homeopath will recommend lycopodium. Before taking lycopodium for kidney, pancreas or liver problems, get the OK from your health care practitioner

VII. Digestive System The Structure and Function of the Digestive System Your digestive system is uniquely constructed to perform its specialized function of turning food into the energy you need to survive and packaging the residue for waste disposal. To help you understand how the many parts of the digestive system work together, here is an overview of the structure and function of this complex system. Mouth The mouth is the beginning of the digestive tract; and, in fact, digestion starts here when taking the first bite of food. Chewing breaks the food into pieces that are more easily digested, while saliva mixes with food to begin the process of breaking it down into a form your body can absorb and use. Esophagus Located in your throat near your trachea (windpipe), the esophagus receives food from your mouth when you swallow. By means of a series of muscular contractions called peristalsis, the esophagus delivers food to your stomach. Stomach The stomach is a hollow organ, or "container," that holds food while it is being mixed with enzymes that continue the process of breaking down food into a usable form. Cells in the lining of the stomach secrete a strong acid and powerful enzymes that are responsible for the breakdown process. When the contents of the stomach are sufficiently processed, they are released into the small intestine. 59

Small intestine Made up of three segments the duodenum, jejunum, and ileum the small intestine is a 22foot long muscular tube that breaks down food using enzymes released by the pancreas and bile from the liver. Peristalsis also is at work in this organ, moving food through and mixing it with digestive secretions from the pancreas and liver. The duodenum is largely responsible for the continuous breaking-down process, with the jejunum and ileum mainly responsible for absorption of nutrients into the bloodstream. Contents of the small intestine start out semi-solid, and end in a liquid form after passing through the organ. Water, bile, enzymes, and mucous contribute to the change in consistency. Once the nutrients have been absorbed and the leftover-food residue liquid has passed through the small intestine, it then moves on to the large intestine, or colon. Pancreas The pancreas secretes digestive enzymes into the duodenum, the first segment of the small intestine. These enzymes break down protein, fats, and carbohydrates. The pancreas also makes insulin, secreting it directly into the bloodstream. Insulin is the chief hormone for metabolizing sugar. Liver The liver has multiple functions, but its main function within the digestive system is to process the nutrients absorbed from the small intestine. Bile from the liver secreted into the small intestine also plays an important role in digesting fat. In addition, the liver is the bodys chemical "factory." It takes the raw materials absorbed by the intestine and makes all the various chemicals the body needs to function. The liver also detoxifies potentially harmful chemicals. It breaks down and secretes many drugs. Gallbladder The gallbladder stores and concentrates bile, and then releases it into the duodenum to help absorb and digest fats. Colon (large intestine) The colon is a 6-foot long muscular tube that connects the small intestine to the rectum. The large intestine is made up of the cecum, the ascending (right) colon, the transverse (across) colon, the descending (left) colon, and the sigmoid colon, which connects to the rectum. The appendix is a small tube attached to the cecum. The large intestine is a highly specialized organ that is responsible for processing waste so that emptying the bowels is easy and convenient. Stool, or waste left over from the digestive process, is passed through the colon by means of peristalsis, first in a liquid state and ultimately in a solid form. As stool passes through the colon, water is removed. Stool is stored in the sigmoid (S-shaped) colon until a "mass movement" empties it into the rectum once or twice a day. It normally takes about 36 hours for stool to get through the colon. The stool itself is mostly food debris and bacteria. These bacteria perform several useful functions, such as synthesizing various vitamins, processing waste products and food particles, and protecting against harmful bacteria. When the descending colon becomes full of stool, or feces, it empties its contents into the rectum to begin the process of elimination. Rectum The rectum (Latin for "straight") is an 8-inch chamber that connects the colon to the anus. It is the 60

rectum's job to receive stool from the colon, to let the person know that there is stool to be evacuated, and to hold the stool until evacuation happens. When anything (gas or stool) comes into the rectum, sensors send a message to the brain. The brain then decides if the rectal contents can be released or not. If they can, the sphincters relax and the rectum contracts, disposing its contents. If the contents cannot be disposed, the sphincter contracts and the rectum accommodates so that the sensation temporarily goes away. Anus The anus is the last part of the digestive tract. It is a 2-inch long canal consisting of the pelvic floor muscles and the two anal sphincters (internal and external). The lining of the upper anus is specialized to detect rectal contents. It lets you know whether the contents are liquid, gas, or solid. The anus is surrounded by sphincter muscles that are important in allowing control of stool. The pelvic floor muscle creates an angle between the rectum and the anus that stops stool from coming out when it is not supposed to. The internal sphincter is always tight, except when stool enters the rectum. It keeps us continent when we are asleep or otherwise unaware of the presence of stool. When we get an urge to go to the bathroom, we rely on our external sphincter to hold the stool until reaching a toilet, where it then relaxes to release the contents. Nutrients Needed: Carbohydrates: An average American adult eats about half a pound of carbohydrate each day. Some of our most common foods contain mostly carbohydrates. Examples are bread, potatoes, pastries, candy, rice, spaghetti, fruits, and vegetables. Many of these foods contain both starch, which can be digested, and fiber, which the body cannot digest. The digestible carbohydrates are broken into simpler molecules by enzymes in the saliva, in juice produced by the pancreas, and in the lining of the small intestine. Starch is digested in two steps: First, an enzyme in the saliva and pancreatic juice breaks the starch into molecules called maltose; then an enzyme in the lining of the small intestine (maltase) splits the maltose into glucose molecules that can be absorbed into the blood. Glucose is carried through the bloodstream to the liver, where it is stored or used to provide energy for the work of the body. Table sugar is another carbohydrate that must be digested to be useful. An enzyme in the lining of the small intestine digests table sugar into glucose and fructose, each of which can be absorbed from the intestinal cavity into the blood. Milk contains yet another type of sugar, lactose, which is changed into absorbable molecules by an enzyme called lactase, also found in the intestinal lining. Protein: Foods such as meat, eggs, and beans consist of giant molecules of protein that must be digested by enzymes before they can be used to build and repair body tissues. An enzyme in the juice of the stomach starts the digestion of swallowed protein. Further digestion of the protein is completed in the small intestine. Here, several enzymes from the pancreatic juice and the lining of the intestine carry out the breakdown of huge protein molecules into small molecules called amino acids. These small molecules can be absorbed from the hollow of the small intestine into the blood and then be carried to all parts of the body to build 61

the walls and other parts of cells. Fats: Fat molecules are a rich source of energy for the body. The first step in digestion of a fat such as butter is to dissolve it into the watery content of the intestinal cavity. The bile acids produced by the liver act as natural detergents to dissolve fat in water and allow the enzymes to break the large fat molecules into smaller molecules, some of which are fatty acids and cholesterol. The bile acids combine with the fatty acids and cholesterol and help these molecules to move into the cells of the mucosa. In these cells the small molecules are formed back into large molecules, most of which pass into vessels (called lymphatics) near the intestine. These small vessels carry the reformed fat to the veins of the chest, and the blood carries the fat to storage depots in different parts of the body. Vitamins: The large, hollow organs of the digestive system contain muscle that enables their walls to move. The movement of organ walls can propel food and liquid and also can mix the contents within each organ. Typical movement of the esophagus, stomach, and intestine is called peristalsis. The action of peristalsis looks like an ocean wave moving through the muscle. The muscle of the organ produces a narrowing and then propels the narrowed portion slowly down the length of the organ. These waves of narrowing push the food and fluid in front of them through each hollow organ. Water and Salt: Most of the material absorbed from the cavity of the small intestine is water in which salt is dissolved. The salt and water come from the food and liquid we swallow and the juices secreted by the many digestive glands. In a healthy adult, more than a gallon of water containing over an ounce of salt is absorbed from the intestine every 24 hours.

Diseases in the Digestive System: Digestive system diseases

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Gastroesophageal Reflux Disease (GERD) -Severe heartburn in laymens language. Weakness of the valve between the esophagus and stomach may allow stomach acid to reflux (regurgitate, backup) into the esophagus and irritate and inflame the lining. This results in chest pain which can mimic that of angina (pain of cardiac ischemia or an MI). Jaundice - Literally means yellow in French. Yellowing of the skin and whites of the eyes from a backup of bile metabolic by-products from the blood into body tissues. May result from blockage of the ducts draining bile from the liver into the intestines or excessive breakdown of red blood cells. Hemoglobin from destroyed RBCs is broken down, and in part, ends up in bile secretions. Diverticulosis/diverticulitis Small pouches may form along the walls of the large intestine called diverticuli which if symptomatic, causing discomfort to the patient, is called diverticulosis. These abnormal outpocketings may collect and not be able to empty fecal material which can lead to inflammation, diverticulitis. Cirrhosis - Literally, orange-yellow in Greek. A degenerative disease of the liver that often develops in chronic alcoholics, but can have other causes. The name refers to the gross appearance of the organ. Portal hypertension A potential complication of chronic alcoholism resulting in liver damage and obstruction of venous blood flow through the liver. The rising blood pressure in the veins between the gastrointestinal tract and liver causes engorgement of veins around the umbilicus (navel). The characteristic radiating pattern of veins is called a caput medusae (head of Medusa). Medusa was the snake-haired lady in Greek mythology. Esophageal varices bulging, engorged veins in the walls of the esophagus are often a complication of chronic alcoholism (see portal hypertension). The thin-walled, swollen veins are at risk of tearing resulting in severe, possibly fatal, bleeding. Dysphagia - Difficulty swallowing. May be related to GERD (see above), esophageal tumor or other causes. Crohns Disease - a chronic inflammatory disease primarily of the bowel. Typical symptoms are abdominal pain, weight loss, diarrhea. There may also be rectal bleeding that can lead to anemia. Special X-rays and tests are needed to differentiate Crohns from other diseases with similar symptoms. Peritonitis - Inflammation of the lining of the abdominal cavity. Before antibiotics, people would die from peritonitis if an inflamed appendix burst. Indications of peritonitis are called peritoneal signs: tender abdomen, rebound pain (pain when manual pressure released from examining abdomen), board-like rigidity of abdominal muscles, no bowel sounds (gurgles). The peritoneal membrane is very sensitive to exposure to foreign substances. Contact with blood, bile, urine, pus will cause peritoneal signs. Remedies for Digestive Disorders: Digestive system procedures/specialists

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Gastroenterologist a physician specializing in diseases of the digestive system including esophagus, stomach and intestines. These specialists do not do surgery. Patients needing surgery are referred to a general surgeon. Proctologist a physician specializing in diseases of the rectum and anus. Proctology is a surgical subspecialty. Guaiac test (Hemoccult, Fecult) - a special chemical test to identify blood in the stool (feces). Blood in the stool may have many causes including cancer and hemorrhoids.

Upper GI series - a series of X-rays of the esophagus and stomach and small intestines having the patient swallow a milkshake of barium. The element barium is opaque, i.e. blocks , X-rays. This procedure may be used to identify problems with swallowing, stomach ulcers, twisting of the small intestines. Lower GI series a series of X-rays using a barium enema to show the large intestine and rectum. This procedure can be used to identify problems such as diverticulitis/diverticulosis, and tumors. Endoscopy - use of a flexible fiberoptic instrument attached to a video camera that can be used to directly visualize the esophagus, stomach and large bowel. Special names may be used for each area explored such as colonoscopy. Ultrasonography (ultrasound) - a procedure using high frequency sound waves to visualize internal organs. Primarily used to visualize abdominal and pelvic organs, such as the pregnant uterus. Tea Many known teas can help calm and soothe the stomach. Ginger is often referred to as the stomach tonic and can help with bowels, stomach cramps, nausea and other digestive disorders. Chamomile tea can relax and help with gas, bloating, cramping, diarrhea and constipation as well as the symptoms associated with IBS. Peppermint tea can control gas and heartburn and tame an upset stomach. Any of these teas can be purchased at many grocery or local health food stores. 64

Aloe Vera More people who have digestive disorders are starting to use aloe vera juice. The many vitamins, minerals and other nutrients found in aloe vera juice can assist in healing digestive disorders. It can soothe the stomach and help relieve constipation, diarrhea and gastrointestinal problems. Because aloe vera forms a protective barrier in the lining of the esophagus, it can help relieve acid reflux and heartburn. Aloe vera is also known to help with peptic ulcers. Drinking a glass of the juice when you wake and before bed each day can help keep stomach issues at bay. Probiotics Probiotics are live microbial organisms that are naturally found in the digestive tract and are often called "friendly bacteria." Probiotics can help people regain good digestive health while helping with conditions such as gas, IBS, diarrhea, colitis, and constipation. Yogurts and kefir often have probiotics in them, or people can take supplements; however, other foods also contain probiotics, such as sauerkraut, aged cheese, cottage cheese, miso and green foods like chlorella, wheat grass and spirulina. Papaya or Pineapple Fruit Enzymes Papaya aids in digestion and intestinal health. Papaya contains the enzymes papain and chymonpapain, and both of these are digestive aids. These enzymes aid in cleansing the digestive tract, which can help reduce bloating, nausea, flatulence and cramps. Pineapple contains the enzyme bromelaine, which helps break down the proteins in foods and generally aids in digestion. Both of these fruit enzymes can be helpful when eaten, used as juices or purchased as tasty chewable tablets that can act as an antacid. Digestive Disorders Digestive disorders from bloating to gas to indigestion, chronic gastrointestinal conditions are pervasive health issues for many people, especially those who are already coping with another ailment. Orthodox medicine tends to isolate digestive disorders as issues of a single system as opposed to challenges to your overall health. And if gastroscopies or colonoscopies do not reveal anything anatomically irregular (for example, a tumor or visible inflammation), the problems are often dismissed, referred to as irritable bowel syndrome (IBS), declared a psychosomatic problem and ultimately left untreated. By contrast, Biological Medicine views the gut as the root of all diseases and attributes the intestinal system to a myriad of biological processes. It is considered the bodys most important regulatory force, a crucial detox organ and central to both the immune system as well as the unconscious nerve system, especially the parasympathetic system. Biological Medicine traces numerous chronic diseases such as autoimmune disorders and allergies to disturbances in the intestinal system. At Paracelsus, doctors first examine intestinal bacteria, as the intestines are the cell-richest organ in the human body. Intestinal bacteria are responsible for absorbing heavy metals, organic and lipophilic toxins and are often in deficit for cancer patients and patients with Fibromyalgia or MCS (multiple chemical sensitivity). They also bind with bile toxins and are important for liver detoxification.

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Secondly, intestinal mucous membranes are examined as they are the site of histamine and serotonin production, which interfere not only with allergies but also mood, concentration, sleep, etc. They are also where Peyers patches are located, home to 80-90 % of the bodys TLymphocytes (immune cells). When the intestinal mucous membranes are leaky, the wrong type of bacteria can begin affecting the body. Conventional methods do not commonly detect these phenomena, but tests administered at Paracelsus such as Regulation thermography (CRT), Darkfield microscopy, comprehensive stool analysis, HRI (heart rate variability), blood test for food allergies and blood and urine tests for histamine, zinc, heavy metals, serotonin and other neurotransmitters provide a concise picture of the intestinal function and also gives Biological Medicine doctors the basis for intensive treatments. This allows the patient to heal from diseases which have lasted for years, like allergies and auto immune diseases and is particularly helpful adjunct therapy for cancer patients. The basic intestinal treatment centers around diet, avoiding major food allergens while adding nutrient dense foods that provide the optimal combination of essential amino acids, lactic acids and minerals to rebuild the intestinal membrane and provide a good foundation for good intestinal bacteria. Probiotics are then administered for a short term along with specific algaes and essential fatty acids. Additional therapies vary depending on the patients condition and can include any of the following: lymphatic stimulation and cleansing, increasing the parasympathetic intestinal nerve system, hydro-colonic therapies and reflorastation of the intestinal bacteria, supplements and other natural medications, Dr. Raus neural therapy, pulsed magnetic field and local hyperthermia (Indiba). For the long term, diet continues to be crucial as well as immune support. VIII. Urinary System How does the urinary system work? The body takes nutrients from food and converts them to energy. After the body has taken the food that it needs, waste products are left behind in the bowel and in the blood. The urinary system keeps chemicals, such as potassium and sodium, and water in balance, and removes a type of waste called urea from the blood. Urea is produced when protein, found in meat products, is broken down in the body. Urea is carried in the bloodstream to the kidneys, where it is removed. Other important functions of the kidneys include blood pressure regulation and the production of erythropoietin, which controls red blood cell production in the bone marrow. Urinary system parts and their functions:

two kidneys - a pair of purplish-brown organs located below the ribs toward the middle of the back. Their function is to: o remove liquid waste from the blood in the form of urine. o keep a stable balance of salts and other substances in the blood. o produce erythropoietin, a hormone that aids the formation of red blood cells. The kidneys remove urea from the blood through tiny filtering units called nephrons. Each 66

nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule. Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney.

two ureters - narrow tubes that carry urine from the kidneys to the bladder. Muscles in the ureter walls continually tighten and relax forcing urine downward, away from the kidneys. If urine backs up, or is allowed to stand still, a kidney infection can develop. About every 10 to 15 seconds, small amounts of urine are emptied into the bladder from the ureters. bladder - a triangle-shaped, hollow organ located in the lower abdomen. It is held in place by ligaments that are attached to other organs and the pelvic bones. The bladder's walls relax and expand to store urine, and contract and flatten to empty urine through the urethra. two sphincter muscles - circular muscles that help keep urine from leaking by closing tightly like a rubber band around the opening of the bladder. nerves in the bladder - alert a person when it is time to urinate, or empty the bladder. urethra - the tube that allows urine to pass outside the body. The brain signals the bladder muscles to tighten, which squeezes urine out of the bladder. At the same time, the brain signals the sphincter muscles to relax to let urine exit the bladder through the urethra. When all the signals occur in the correct order, normal urination occurs.

Facts about urine:

Adults pass about a quart and a half of urine each day, depending on the fluids and foods consumed. The volume of urine formed at night is about half that formed in the daytime. Normal urine is sterile. It contains fluids, salts and waste products, but it is free of bacteria, viruses and fungi. The tissues of the bladder are isolated from urine and toxic substances by a coating that discourages bacteria from attaching and growing on the bladder wall. KIDNEY/BLADDER

The urinary system is responsible for filtering toxins from the blood. If your kidneys are not working properly, the waste products from cell metabolism can collect in your blood and rise to toxic levels. The kidneys maintain the chemical balance of all body fluids, and help to keep the level of nutrients in the blood in a healthy range, by removing excess nutrients. Another important function of the kidneys is to regulate the amount of salt in the body and therefore help control blood pressure. Low intake of nutrients like vitamin A and vitamin E is believed to leave the urinary system susceptible to weakness. However, high doses of certain nutrients can also put undue stress on the kidneys, as does low water intake or a diet high in animal protein. Excess toxins in the body stress the kidneys and bladder. Nutritional screening, careful nutritional supplementation and avoiding high intake of animal products (especially red meat), tobacco, alcohol, caffeine and drugs can help rejuvenate a stressed bladder and kidneys. However, if you suspect you have a disorder of the urinary system, you should see a doctor. 67

Urinary System Recommendations: The quiz is designed to look for signs of overworked kidneys and bladder, and not to diagnose disease. If you think you may have a kidney problem, talk to your doctor about your symptoms, especially if you're being treated for high blood pressure. You can give your kidneys and bladder support and nourishment by:

correcting any nutritional deficiencies; following a diet that is low in animal protein and high in vegetables (especially leafy greens), fruits and whole grains; keeping your salt intake low; making sure you get plenty of vegetable fibre in your diet daily; cutting back your intake of coffee, sugar, alcohol, salt, white flour, meat and cheese; eating more foods with a high magnesium/calcium ratio, such as buckwheat, corn, oats, brown rice, bananas, lima beans, potatoes and soy products like tofu; drinking 8 to 10 glasses of water every day (dehydration causes severe kidney stress); drinking 2 teaspoons of lemon juice or pure cider vinegar in a glass of water first thing every morning; drinking more fresh vegetable juices and/or one of the green drinks available at your health food store; taking a multivitamin/mineral tablet daily (with a meal); exercising regularly and getting enough rest.

These recommendations will also help to keep your immune system strong -- your best defense against any infections. Women are more vulnerable to urinary tract infections than men. Cranberry juice or unsweetened cranberry tincture that you dilute in water is sometimes effective in reducing the occurrence of urinary infections. Cranberries contain a substance that appears to make it more difficult for bacteria to stick to the bladder wall. For many people, an acidophilius supplement with meals also helps increase resistance to urinary infections. There are some very effective, safe herbal compounds which can help keep your urinary tract healthy and prevent urinary tract infections, but they should be prescribed by a naturopath, or holistic doctor. Urinary system diseases

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Nephrosis a noninflammatory disease of kidneys. Nephrolith a kidney stone. Urethritis - inflammation of the urethra, the final pathway for urine in both sexes, and the common pathway for urine and semen in the male. Nocturia frequently getting up and urinating during the night. Enuresis - involuntary release of urine, most often in reference to bedwetting. Urinary Tract Infection Bacteria that enter the urinary tract may cause urinary tract infections (UTIs), which can affect the urethra, bladder or even the kidneys. The NKUDIC reports that UTIs are more common in women; however, they can occur in men as well. A UTI in the bladder may also be called cystitis, and a UTI in the kidneys may be called pyelonephritis. UTIs are usually managed well with antibiotics. Interstitial Cystitis Interstitial cystitis (IC) is a bit of a medical mystery. Its cause is not known; however, IC is a chronic bladder condition. It can cause bladder scarring, and can make the bladder less elastic. This often means the bladder won't hold as much urine. IC can cause pelvic pain, pain during intercourse and increased urinary frequency. New York Presbyterian Hospital reports that IC may also be called painful bladder syndrome, or frequency-urgency-dysuria syndrome. Prostatitis Prostatitis is a urinary system disorder distinct to men. Prostatitis is swelling of the prostate gland. It has a number of different potential causes but often has the same symptoms. These include urinary urgency and frequency, pelvic pain, and pain during urination. Benign prostatic hyperplasia (BPH) has similar symptoms to prostatitis but is often caused by advanced age. New York Presbyterian Hospital reports that BPH results in constriction of the urethra, which, in addition to urinary frequency and urgency, can result in urinary incontinence or urinary retention.

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Kidney Stones Kidney stones are small pieces of material that may be present anywhere in the urinary tract. Medline plus reports that small stones often pass easily; however, larger ones (up to the size of a pearl) may get stuck and require medical attention. Kidney stones can cause pain in the back and sides, as well as blood in the urine. The NKUDIC reports that they are more common in men than women. Kidney Failure Also called renal failure, kidney failure may be acute (often temporary) or can become a chronic condition. The NKUDIC reports that kidney failure occurs when the kidneys are unable to filter waste from the blood for any reason. Acute cases may be caused by trauma or other damage, and may recover over time with treatment. However, renal disease may lead to chronic kidney failure, which may require dialysis treatments or even a kidney transplant. Bladder Cancer According to Medline Plus, bladder cancer is the sixth most common type of cancer in the U.S. Its symptoms are often similar to those of a UTI. Bladder cancer can cause back or pelvic pain, pain during urination and urinary frequency and urgency. It may also cause blood to appear in the urine. New York Presbyterian Hospital reports that recovery from bladder cancer depends largely on the size of the tumor, and the stage at which it is diagnosed. Congenital Kidney Disorders Since the urinary tract includes the kidneys, a congenital kidney disorder fits under the heading of congenital urinary disorders. The kidneys undergo many changes from their embryonic form to a mature form. The cells and tissues organize into tubes called nephrons. In addition the kidneys ascend from lower in the pelvis to the back of the abdomen. There are many different types of congenital kidney disorders. One type, horseshoe kidney, is a caused by fusion of the right and left kidneys. This happens when the connection between the kidneys is caught on a vein in the abdomen as they ascend. This condition is generally asymptomatic but can cause an increased incidence of kidney stones and urinary tract infections. Congenital Ureteral Disorders The ureters transmit urine from the kidneys down to the bladder. They are also subject to many different anomalies. For example, there are normally two ureters--one per kidney. Ureteral duplication refers to the creation of two ureters draining one kidney. This problem can cause fluid filled kidneys in newborns, increased incidence of urinary tract infections and incontinence. Congenital Bladder Disorders The bladder stores urine to be expelled from the body. Two examples of congenital bladder conditions are bladder exstrophy and bladder diverticulula. Bladder exstrophy refers to part of the bladder being found protruding outside the abdominal wall. The condition requires surgical treatment, and persons born with the condition can experience sexual dysfunction, incontinence and urinary tract infections. Bladder diverticula refers to an outpouching of bladder tissue. This 70

condition may also cause increased rates of infection or incontinence, or it may cause no symptoms. Congenital Urethral Disorders The urethra transfers urine from the bladder to outside the body. In males, hypospadias is a condition in which the opening of the urethra is located on the underside of the penis. Epispadias refers to the opening of the urethra being on the top of the penis. Males or females can also have posterior urethral valves. Posterior urethral valves prevent the flow of urine and can lead to kidney damage. Kidney Stones Kidney stones are hard masses that form in the urinary tract from crystals that have separated from the urine. The most common type of kidney stone is formed from calcium, but other types include a struvite stone or uric acid stone, according to the National Kidney and Urologic Diseases Information Clearinghouse. The exact cause of kidney stones is unknown, but those with certain genetic disorders, kidney disorders and recurrent urinary tract infections are more likely to develop kidney stones. Symptoms of kidney stones include extreme pain, cramping in the back and lower abdomen, nausea and vomiting. Most kidney stones can be passed by increasing daily fluid intake to two to three quarts of water per day. If stones are too large to pass with an increase in water consumption, surgery may be needed to break the stones. Urethritis Urethritis is an inflammation of the urethra caused by a bacterial or viral infection. The infection can be caused by the same microbes that cause urinary tract infections, gonorrhea, chlamydia and herpes simplex. Symptoms of urethritis vary between the sexes. Symptoms in men include blood in the urine or semen, burning during urination, discharge, frequent urination, pain and swelling of the penis and pain during ejaculation. Symptoms in women include abdominal pain, pain during urination, fever, chills, frequent urination, pain in the pelvis and vaginal discharge, according to Medline Plus. Treatment for urethritis includes antibiotics or anti-viral medication. Pain medications may also be prescribed to reduce symptoms associated with urethritis. During treatment, sexual intercourse should be avoided. Pyelonephritis Pyelonephritis is a type of urinary tract infection that travels to the kidneys from the urethra or bladder. The infection occurs when bacteria enter the body through the urinary tract. Symptoms of pyelonephritis include fever, pain in the groin, abdominal pain, frequent urination, persistent urge to urinate, burning during urination and blood in the urine, according to MayoClinic.com. Treatment for pyelonephritis usually consists of oral antibiotics. If the infection is severe, antibiotics may be need to be administered intravenously during a hospital stay. If left untreated, pyelonephritis can lead to permanent kidney damage or infections of the blood.

Remedies:

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The kidneys remove waste matter and regulate the blood pressure and salt balance. When the kidneys don't function properly, symptoms such as swelling, excess urination, shortness of breath and cardiovascular difficulties arise. If these problems are ignored, renal failure may set in leading to heart disease or even death. Along with the many treatments available to fight kidney disease, you can be proactive and follow a renal diet, eating certain foods that support healthy kidney function. Natural Diuretics Various foods have diuretic properties, which promote healthy urination and reduce swelling that may be the result of kidney disease. Use parsley, celery watermelon, tomatoes, grapes, cucumber, dandelion greens and fennel to relieve swelling throughout the body. When there is less swelling, your blood pressure may also be lowered. Before consuming large amounts of diuretic foods, contact a health practitioner, especially if you take diuretics or medication for high blood pressure. Pineapple Pineapple is high in the natural enzyme, bromelain, which is reputed to fight inflammation. In the case of kidney disease, bromelain may help to reduce amyloid deposits in the kidneys, although there's scant evidence of this claim, says the University of Maryland Medical Center in a 2008 report on amyloidosis. Amyloid is a type of protein that develops throughout the body as one ages and leads to amyloidosis, an incurable condition. Bromelain is often taken in conjunction with turneric, a spice with anti-inflammatory properties, which boosts the action of both supplements, adds UMMC. Bromelain and turmeric can thin the blood, so don't use them if you take bloodthinning medicines unless under the supervision of a health practitioner. Cranberries Cranberries and cranberry juice have long been used in the treatment of urinary tract infections. Cranberries are high in vitamin C, anthocyanins, a potent anti-inflammatory compound, and potassium, sodium, and phosphorus. These minerals are all critical for proper kidney function and to balance the blood pressure, one of the kidney's main functions. Additionally, cranberries and cranberry juice can prevent and dissolve kidney stones, according to a study on the matter published in the British Journal of Urology in 2003. If you drink cranberry juice, use only unsweetened concentrate and dilute it with 1 part concentrate to 3 parts water to equal 1 qt. total, the study advises. Drink this amount daily throughout the day. Cranberries are considered safe for use in acute urinary tract infections but may cause unseen side effects for those with renal disease. Don't use cranberries or cranberry juice medicinally if you have active kidney disease without first consulting your health practitioner. Berries Blueberries, raspberries and strawberries are all foods to include on a renal diet. They all contain anthocyanins, the compound that gives the berries their reddish-purple color. Anthocyanins are high in nutrients that reduce inflammation in the tissues. All three types of berries are high in vitamin C, phosphorus, potassium, sodium, and manganese. Raspberries are also high in antioxidants as well as fiber and folate. They're reputed to slow the growth of cancerous tumors. Most berries are high in essential minerals, which are required for healthy kidney function; however, they may cause problems in certain types of kidney disease where mineral consumption 72

must be reduced. Consult your health practitioner before using berries in large quantities for medicinal purposes. Kidney Disease and Health Decreased kidney function, notes MayoClinic.com, may not be observed until your kidneys experience significant dysfunction. Some of the most commonly experienced signs and symptoms of kidney disease, or dysfunction, include reduced urine volume, reduced appetite, nausea and vomiting, weakness and fatigue, muscle twitches and cramps, swelling in your lower extremities, and reduced mental alertness. There are several risk factors associated with this condition, including hypertension, diabetes, obesity and long-term smoking. Common Herbal Remedies Certain herbal remedies have long been used in treating kidney problems and other problems associated with the urinary tract. In his book "Therapeutic Herb Manual," naturalist and herbal medicine expert Ed Smith notes that the following herbs may be particularly helpful in treating infection or inflammation of your kidneys, bladder and urinary ducts: goldenrod flowering tops, corn silk, horsetail, uva ursi leaf and juniper berries. Few herbs used in treating kidney problems may have been subjected to rigorous studies using current scientific testing procedures. Featured Remedy Buchu is an herbal remedy that is commonly used in treating kidney disease and various conditions of your urinary tract. Buchu, notes certified nutritional consultant and nutrition researcher Phyllis A. Balch, author of "Prescription for Nutritional Healing," has historically been used in controlling kidney problems and may be helpful in treating water retention, cystitis and prostate inflammation. This herb -- the leaves of the plant, specifically -- may be particularly helpful in treating kidney disease when taken in tea form, notes Balch. Considerations Kidney disease, or kidney failure, may lead to numerous health complications if left untreated, including cardiovascular disease, impotence and permanent kidney damage. If you are diagnosed with kidney disease, discuss the long-term health implications of this condition with your doctor or specialist and what you can do to mitigate its damaging health effects. Talk with your doctor about natural treatment approaches, including the use of herbs, and what role these therapies might play in your care.

IX. Integumentary System ntegumentary System Functions The integumentary system protects the delicate inner issues and organs by acting as a barrier against dust and pathogenic microbes. It also plays a major role in homeostasis. The structures comprising this system and their respective functions have been explained in the current article. Integumentary system is the largest organ system of our body and consists of skin, hair, nails, oil 73

and sweat glands as well as nerves. All these organs collectively play a variety of roles in maintaining the normal body functions. Skin, the largest organ of our body, plays a protective role, and prevents the entry of foreign bodies like dust particles, bacteria, viruses and other pathogens. It is the site for synthesis of vitamin D in our body. Sensory receptors for touch, pain, pressure and heat are present in skin. These sensory structures are involved in the detection of stimuli and communicating the changes in stimuli to the effector organs of the body. Hair and the associated glands are involved regulating the body temperature (thermoregulation), and in maintaining the water balance of our body. The sweat glands are involved in excretion of electrolytes as well as inhibiting the colonization and growth of harmful bacteria on the skin surface. Nails confer protection to the fingertips and also aid in gripping objects with more precision. Thus, the integumentary system is essential for protection of the internal tissues and maintaining the internal integrity and equilibrium of the body. The structures comprising the integumentary system and their corresponding functions have been detailed below. Diagram of Integumentary System Organ ~ Skin Integumentary System ~ Skin Parts of the Integumentary System Skin The skin is the most important organ of the body, as it protects the delicate organs of the body. The skin is divided into three separate layers as follows: Epidermis: This is the outermost layer of the skin that contains four separate layers of epithelial tissue. The outer most layer is the stratum corneum that is about 2 to 30 cells thick. These are keratinized and dead cells that make the skin waterproof! The second and third layer consists of the stratum granulosum and stratum lucidum, which contain cells that are not keratinised as yet. As these skin grows, the cells are pushed outward and come towards the surface. The last and the deepest layer of the epidermis is the stratum germinativum. These cells are active mitotically and have the ability to reproduce, as these cells are living, thus, making them the manufacturing center for growing skin. Dermis: The dermis lies immediately after the epidermis. The dermis consists of its own blood supply and thus contains many complex structures. The sweat glands are present in this layer that collect waters and waste products from the blood stream. This waste is excreted from the pores in the epidermis along with the water in form of sweat. The hair roots are also present in this layer that help in the growth of hair. When the hair reaches outside the epidermis, the cells are dead. The connective tissue made of collagen fibers are also found in the dermis that help give the skin elasticity and strength. Subcutaneous Layer: The last layer of the skin containing the adipose tissues, cushions the delicate organs beneath the skin. The body temperature is also maintained within this layer by insulating the body to the temperature fluctuations. 74

Functions of the Skin Thermoregulation: The thermoregulation of the skin is carried out with the help of evaporation of the sweat and regulation of the blood flow to the dermis. Sensations: The cutaneous sensations like touch, pressure, vibration, pain, cold, hot, etc, are felt by the skin. Protection: The protective barrier of the skin helps prevent diseases, infections, dehydration, etc. Production of Vitamin D: The precursor present in the skin and UV rays, helps in the production of vitamin D, an important nutrient of the body. Healing: When the epidermis breaks away due to a minor cut or burn, the cells on the lower layers of the skin migrate upwards as a sheet. When two ends of the sheet meet, the cells stop growing due to a process called 'contact inhibition'. Thus, the epidermis is sealed and the skin returns to normal. Hair Hair, feathers, scales, etc. are all derived from the skin. In case of humans, the hair extends to the surface from the hair roots or hair bulbs present in the dermis. The functions of the hair include protection and sensation to touch. Hair is made up of dead, keratinized cells that are bound together with the extracellular proteins. Each hair is divided into hair shaft that is the superficial layer and the root that is in the dermis. Hair follicle is the structure that surrounds the hair root. The oil glands present around the hair follicles help keep the hair and the surrounding skin moist. It also acts as a protective organ involved in temperature regulation. Arrector Pili Muscles These are smooth muscle cells that extend from the hair follicle till the papillary layer of the dermis. These arrector pili muscles cause the hair to become erect and give the feeling of 'goose bumps'. Hair can trap more warm air when they are erect. Hence, during extreme cold environment, these muscles contract leading to erect hair. Under conditions of high temperature, the arrector pili muscles relax so that the hair lie flat on the skin and thus aid in the escape of heat. Nails Nails, claws and horns are structures that are derived from the skin. The nail is a highly keratinized structure of modified epidermal cells. The nail bed gives rise to nails, that is thickened to form a lunula. The moon shaped structure that you observe at the base of your nails is called the lunula. The function of nails is to help in grasping and holding things. The nails act as counter force and help increase the sensitivity of the fingertip. They also protect the fingertips and underlying tissues from damage. Sebaceous Glands and Nerves Sebaceous glands secrete the oil coating for the hair shaft. When these sebaceous glands become clogged with dirt and microorganisms, they become infected and cause pimples or acne. The complex network of the nerves present all over the skin helps send and receive important 75

impulses to and from the brain, thus playing a vital role in sense of touch. Sweat Glands Sweat glands have an opening through the skin pores, and they help in excretion of water and electrolytes. Eccrine sweat glands are found all over the body whereas apocrine sweat glands are present in armpits and groin. Eccrine glands are involved in the cooling mechanism of thermoregulation whereas, apocrine glands are involved in the secretion of chemicals and pheromones. The integumentary system interacts with the various other human body systems and is involved in the physiological processes responsible for maintaining the internal equilibrium of the body. The integumentary system is the scientific name for your skin and its accessories, including hair and nails. Your integumentary system provides a physical barrier to injury and infection, it helps you maintain your body temperature and it senses your environment. You need certain nutrients to maintain your integumentary system. Epidermis Of all the components of your integumentary system, the most complex is the skin. Skin consists of several layers, the outermost of which are the epidermal layers. You have five layers of epidermal cells, or skin cells -- the lower layer reproduces itself and generates new cells that then migrate progressively outward. The outermost layer continually sloughs off, or sheds, which is why constant production of new skin cells is so important to maintaining the epidermis. Living Cells While the lower layer of the epidermis is a layer of living cells, and while the dermis, which lies below the epidermis and contains blood vessels and nerves, is living, many components of the integumentary system aren't alive. For instance, the portion of your hair that you can touch, the portion of the nails that lies above the surface of the skin and the surface of the skin itself all consist of "dead" cells, meaning cells that have lost all metabolic function. Nutritional Consideration While the integumentary system cells need nutrients, since the portions of the system that you can touch aren't living, you can't nourish your skin, nails or hair by rubbing nutrients on them. These cells have no mechanism for absorbing energy or vitamins. Some cells, including outer skin cells, benefit from moisture, which is why you use lotion, but the cells don't actually derive nutrition from topically applied rubs or creams. Energy Like all cells, the living cells of the integumentary system -- including those of the dermis and lower epidermis, the nail beds, and the hair follicles -- need energy-providing nutrients. The energy-providing nutrients include carbohydrates, proteins and fats. When you eat, some of the nutrient molecules from your food travel through the bloodstream to provide for the needs of the 76

living integumentary system cells. Vitamins Specific vitamins help to support the integumentary system. For instance, you use vitamin C to generate collagen, which is an elastic protein that helps keep the skin and connective tissue flexible. Without sufficient vitamin C in your diet, your skin can become brittle or weak. Your skin actually helps in the production of one important vitamin -- vitamin D. In sunlight, the skin transforms cholesterol in your blood into vitamin D for the rest of your body cells. Steps on how to keep Integumentary System Healthy: Step 1 Bathe every day and wash your hands regularly. Keep your skin and nails clean to prevent infections. Avoid using harsh soaps, hair treatments and other irritating chemicals, as they will cause excessive dryness. Water that's too hot will have the same effect, so use warm water in the shower or bath. Cut your fingernails and toenails straight across after bathing to avoid hangnails. Step 2 Apply sunscreen before you spend time outdoors. Choose a formula that protects against both UVA and UVB radiation and has an SPF of 15 or higher. Over time, too much sun exposure contributes to wrinkles, skin cancer, freckles, aging and dilated blood vessels. Avoid using tanning beds because they are also damaging to your skin. Step 3 Eat a healthy well-balanced diet. Foods that are rich in antioxidants are good for your skin, according to Georgia Health Info, but consuming a lot of meat can contribute to wrinkles. Eat a variety of fruits, vegetables, nuts and fish. Remember to stay hydrated by drinking plenty of water. Step 4 Examine your entire body on a regular basis. Check for abnormal growths, signs of skin cancer, and anything else that looks out of the ordinary in your skin. See a dermatologist right away if you have an unusual sore that isn't healing properly. You should also consult a doctor about a mole that is larger than 1/4 of an inch across or has an irregular border, uneven coloring or a rough surface. Step 5 Avoid wearing things that are too tight on your body. Pick shoes that fit your feet properly, because a tight fit can cause ingrown toenails that become painful and infected. Clothes and jewelry that are too constricting may interfere with blood circulation. Don't put rubber bands in your hair too tightly, or they will break individual strands of hair. Step 6 77

Don't smoke cigarettes. Smoking causes wrinkles and ages your skin. It constricts blood vessels, which prevents your integumentary system from getting the nutrients it needs in order to be healthy.

Diseases and Disorders of Integumentary System: The integumentary system is the medical term for skin. Skin serves as a protective covering that supports the fluid and organs in your body. Sometimes, your skin cells grow at a rapid and abnormal rate. In some cases, your skin can appear dramatically different. Skin Cancer Skin cancer is a potentially fatal condition in which skin cells overgrow and form cancerous moles. The Mayo Clinic says skin cancer is typically found in such sun-exposed areas as your face, neck, ears, arms, hands and legs. Sometimes, this cancer is also found on the palms of your hands and soles of your feet. Many types of skin cancers exist. The Mayo Clinic says basal cell carcinoma is the most common type of skin cancer. A pearl-like bump on your face, neck or ears characterizes this cancer. Squamous cell carcinoma is more likely to spread than basal cell carcinoma. This cancer either consists of a firm red mass on your lips, hands, face or arms or a flat, crusted lesion. The Mayo Clinic indicates that melanoma is the most severe form of skin cancer. A mole that is irregular in shape, color, texture and size can be melanoma. Treatment for skin cancer involves freezing or using laser therapy on the questionable skin region. Sometimes, your doctor may want to surgically remove the problematic skin site. Also, radiation and chemotherapy are available skin cancer treatment options to destroy cancerous skin cells. Dermatographia The Mayo Clinic says dermatographia is a medical problem in which mild trauma to your skin (such as scratching) can lead to red, raised lines. Dermatographia can also cause skin swelling, inflammation, welts and itching. The Mayo Clinic says changes in temperature, sunlight and certain emotions can trigger dermatographia. In fact, dermatographia's symptoms may last for 30 minutes to greater than an hour. Typically, dermatographia resolves on its own. Antihistamine medications can be taken if symptoms don't subside. Ichthyosis Vulgaris Ichthyosis vulgaris is a skin disorder in which skin takes on the appearance of fish scales. The 78

Mayo Clinic says ichthyosis vulgaris typically presents itself in childhood but can be present at birth. Specific symptoms include dry skin, a flaky scalp, tile-like scales on the skin and painful cracks in the palms of the hands and soles of the feet. Melanoma Melanoma is the most lethal form of skin cancer, says MedlinePlus. In fact, it states that it is the leading cause of death from skin disease. MedlinePlus says that signs of melanoma include having a sore, lump or growth on the skin. Usually, these moles are not symmetrical and have irregular borders. Sometimes, changes in color occur from brown or black to tan. In some cases, the lesion may be larger than 6mm. Risk factors for developing melanoma include living in sunny climates or high altitudes or having blistering sunburns. Treating melanoma involves chemotherapy and radiation. Also, surgery is another method to remove affected tissues or lymph nodes. Rosacea Rosacea refers to a serious skin condition that affects the nose, cheeks, forehead and eyelids. Sometimes, these regions can turn red and swollen because blood vessels actually swell underneath the skin. The University of Maryland Medical Center says that symptoms of rosacea involve blushing easily and having a red, bulbous nose. Other symptoms involve bloodshot eyes and a burning or stinging sensation of the face. Risk factors for developing rosacea involve being fair-skinned and blushing easily. Other risk factors for rosacea involve being a woman between the ages of 30 and 50. Unfortunately, rosacea has no exact treatment. However, it is important to avoid sun exposure and reduce stress. Limiting spicy foods, alcohol and hot beverages can also help decrease rosacea. Sometimes, antibiotic medications like tetracycline, minocycline or doxycycline can be taken to manage rosacea. Laser surgery can also be used to reduce the redness. Intertrigo Intertrigo refers to a rash that is found in between the skin. FamilyDoctor.org from the American Academy of Family Physicians says that intertrigo is common in people who have diabetes or who are overweight. In fact, signs of intertrigo include a red or brown rash in folds of the toes, groin and armpits. It can also form underneath the breasts, belly and neck or in between the buttocks. It indicates that people with braces, splints and artificial limbs can develop this rash. Fortunately, this rash cannot spread between people. Treating intertrigo involves keeping the air dry and exposed to air. Sometimes, a physician prescribes a topical (applied directly on to the skin) steroidal cream. In some cases, he may prescribe an antifungal cream or an antibiotic medication. Athlete's Foot Athletes foot, or tinea pedis, is an infection of the feet caused by fungi. Certain fungi live on the body normally, but athletes foot occurs when these fungi multiply rapidly and lead to infection. Increased multiplication occurs when the foot remains moist and warm for extended periods of time, such as when sweat builds up on the feet in closed shoes, according to MedlinePlus. Although rare, the infection can occur on the hands as well.

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Symptoms of athletes foot include cracked, peeling skin between the toes that is red and itchy. Blisters, burning and stinging may also occur. Athletes foot is contagious so those with the infection should avoid direct contact and sharing shoes with others. Treatment for athletes foot involves the use of anti-fungal medications that should be administered for one to two weeks, according to MedlinePlus. During this time, the feet should be kept dry and cleaned at least twice per day. Warts Warts are small bumps that appear on the skin due to an infection by a variant of the human papillomavirus. Certain types of the human papillomavirus cause warts on the hands, fingers and inside of the mouth, while other types cause warts on the genitals and rectum, according to the American Academy of Family Physicians. Some people are more susceptible than others to the virus and the eventual development of warts. Warts are not usually accompanied by any other symptoms. Warts on the skin, especially genital warts, are contagious so direct contact should be avoided. Some warts may go away on their own but for those that dont, treatment consists of over-the-counter creams or freezing or burning off of the wart by a doctor. Alopecia Areata Alopecia areata is an autoimmune disease in which the body attacks its hair follicles. This results in hair loss that usually occurs in small, round patches, according to the American Academy of Dermatology. Hair loss most frequently occurs on the scalp, but can also involve eyebrows, eyelashes and facial hair. Hair loss that occurs only on the scalp is called alopecia totalis and hair loss that occurs on the scalp and other parts of the body is called alopecia universalis. Lost hair usually grows back, but there is a high chance that the hair will fall out again. The hair loss is usually not accompanied by any other symptoms, but itching may occur when new hair grows into a bare patch. Treatment for alopecia areata is not necessary, but antiinflammatory drugs are occasionally given in an attempt to suppress the immune system and stop the disease. Medications that promote hair growth may also be given. Dermatitis Dermatitis describes a variety of conditions that cause inflammation of the skin. Merck.com, an online medical library, says seborrheic dermatitis is a chronic inflammation that appears in infants and elderly people. Symptoms of seborrheic dermatitis present as yellow, greasy scales on the scalp that creates a crusted scalp rash known as cradle cap. Atopic dermatitis presents as chronic inflammation that itches and develops into red, crusted rashes. Impetigo Impetigo is a bacterial skin infection caused by group A streptococcus or staphylococcus aureus. An infection occurs when the skin barrier is broken and bacteria get into the skin. Skin that's irritated from conditions such as poison ivy and eczema provide a favorable breeding environment for the bacteria. Blisters appear first, followed by oozing and crusting. Impetigo is highly contagious and spreads easily to other parts of the body or to another person. 80

Shingles Shingles is a skin rash caused by the varicella-zoster virus, the same virus that causes chickenpox. Anyone who has had chicken pox has the varicella-zoster virus resident in the body. It may remain dormant indefinitely, or it may reactivate. The National Institute of Neurological Disorders and Stroke says that upon reactivation, the virus moves to the nerve fibers supplying the skin. Symptoms include itching, numbness or burning pain. About a week after the initial symptoms, the shingles rash appears as fluid-filled blisters. Rosacea Rosacea is a chronic skin disorder that primarily affects the facial skin. The National Rosacea Society says facial flushing is an early sign of rosacea. The redness is intermittent. Other symptoms of rosacea include a persistent redness that appears like permanent sunburn, small red pimples that burn and small visible blood vessels. Secondary symptoms include dry facial skin, skin thickening--especially on the nose--facial swelling and raised red patches. Psoriasis Psoriasis, a chronic autoimmune disease, is not contagious. Of the five types of psoriasis--plaque, guttate, inverse, pustular and erythrodermic--the most common is plaque psoriases. Symptoms include raised red lesions covered with dead skin cells. The most common age for onset of psoriasis is between 15 and 35. Pityriasis Rosea The American Academy of Dermatology (AAD) says that pityriasis rosea is a skin condition in which scaly pink patches form on either the chest or back. They say that this type of rash is called a "herald patch," and it occurs commonly in people between the ages 10 and 35. Within the next fourteen days, this rash can form on the legs, arms and neck and takes on a Christmas tree distribution pattern. The AAD says that itchiness characterizes this disease in 50 percent of patients. Fatigue and aching are other physical symptoms of pityriasis rosea. The AAD says that pityriasis rosea typically needs no treatment because it disappears within six to eight weeks. However, hot baths, anti-itch lotions and ultraviolet light treatments may help manage its manifestations. Intertrigo Intertrigo is a rash that occurs in the folds of the skin. According to FamilyDoctor.org, bacteria, yeast and fungus cause this particular rash. They indicate that overweight people, diabetic patients and people utilizing braces, splints and synthetic extremities are more likely to develop intertrigo. Specifically, FamilyDoctor.org says that the rash is red and brown in color. Intertrigo usually occurs in the armpit regions, groin, underneath the stomach and breasts or in the skin folds of the neck. Sometimes, the skin may itch, bleed and exude a foul smell. Treatment involves keeping the affected skin fold regions dry. Doctors may prescribe a topical steroid, antibiotic or fungal cream to get rid of intertrigo. Lichen Planus 81

FamilyDoctor.org indicates that lichen planus is a skin disease in which red and purple bumps develop on the wrists, ankles and forearms. These bumps are flat and typically contain white scales or flakes. FamilyDoctor.org says that lichen planus can affect the scalp and cause hair loss (alopecia). It can affect the nails and cause them to be weak and brittle. Lichen planus may also affect the mouth or genitals and cause a burning sensation. Typically, lichen planus will resolve by itself within a year. Physicians prescribe corticosteroids, light therapy and retinoid medications to treat it. Acne (AK-nee): Disorder in which hair follicles of the skin become clogged and infected. Athlete's foot: Common fungus infection in which the skin between the toes becomes itchy and sore, cracking and peeling away. Basal cell carcinoma (BAY-sal CELL car-si-NO-ma): Skin cancer that affects the basal cells in the epidermis. Carcinoma (car-si-NO-ma): Cancerous tumor of the skin, mucous membrane, or similar tissue of the body. Dermatitis (der-ma-TIE-tis): Any inflammation of the skin. Malignant melanoma (ma-LIG-nant mel-ah-NO-ma): Cancer of melanocytes; the most serious type of skin cancer. Psoriasis (so-RYE-ah-sis): Chronic skin disease characterized by reddened lesions covered with dry, silvery scales. Seborrheic dermatitis (seh-beh-REE-ik der-ma-TIE-tis): Commonly called seborrhea, a disease of the skin characterized by scaly lesions usually on the scalp, hairline, and face. Squamous cell carcinoma (SKWA-mus CELL carsi-NO-ma): Skin cancer affecting the cells of the second deepest layer of the epidermis. Vitiligo (vit-i-LIE-go): Skin disorder in which the loss of melanocytes results in patches of smooth, milky white skin. Warts: Small growths caused by a viral infection of the skin or mucous membrane. The following are just a few of the many ailments that can target the integumentary system. Acne Acne is a skin disease marked by pimples on the face, chest, and back. The most common skin disease, acne affects an estimated 17 to 28 million people in the United States. Although it can strike people at any age, acne usually begins at puberty and worsens during adolescence. At puberty, increased levels of androgens (male hormones) cause the sebaceous glands to secrete an excessive amount of sebum into hair follicles. The excess sebum combines with dead, sticky 82

skin cells to form a hard plug that blocks the follicle. Bacteria that normally lives on the skin then invades the blocked follicle. Weakened, the follicle bursts open, releasing the sebum, bacteria, skin cells, and white blood cells into the surrounding tissues. A pimple then forms. Treatment for acne depends on whether the condition is mild, moderate, or severe. The goal is to reduce sebum production, remove dead skin cells, and kill skin bacteria. In very mild cases, keeping the skin clean by washing with a mild soap is recommended. In other cases, medications applied directly to the skin or taken orally may be prescribed in combination with gentle cleansing. Athlete's foot Athlete's foot is a common fungus infection in which the skin between the toes becomes itchy and sore, cracking and peeling away. Properly known as tinea pedis, the infection received its common name because the infectioncausing fungi grow well in warm, damp areas such as in and around swimming pools, showers, and locker rooms (areas commonly used by athletes). The fungi that cause athlete's foot are unusual in that they live exclusively on dead body tissue (hair, the outer layer of skin, and nails). Researchers do not know exactly why some people develop the condition and others do not. It is known that sweaty feet, tight shoes, and the failure to dry feet well after swimming or bathing all contribute to the growth of the fungus. Symptoms of athlete's foot include itchy, sore skin on the toes, with scaling, cracking, inflammation, and blisters. If the blisters break, raw patches of tissue may be exposed. If the infection spreads, itching and burning may increase. Athlete's foot usually responds well to treatment. Simple cases are treated with antifungal creams or sprays. In more severe cases, an oral antifungal medication may be prescribed. Burns There are few threats more serious to the skin than burns. Burns are injuries to tissues caused by intense heat, electricity, UV radiation (sunburn), or certain chemicals (such as acids). When skin is burned and cells

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A young woman with acne. (Photograph by Biophoto Associates . Reproduced by permission of Photo Researchers, Inc. ) are destroyed, the body readily loses its precious supply of fluids. Dehydration can follow, leading to a shutdown of the kidneys, a life-threatening condition. Infection of the dead tissue by bacteria and viruses occurs one to two days after skin has been burned. Infection is the leading cause of death in burn victims. Burns are classified according to their severity or depth: first-, second-, or third-degree burns. First-degree burns occur when only the epidermis is damaged. The burned area is painful, the outer skin is reddened, and slight swelling may be present. Sunburns are usually first-degree burns. Although they may cause discomfort, these minor burns are usually not serious and heal within a few days. Second-degree burns occur when the epidermis and the upper region of the dermis are damaged. The burned area is red, painful, and may have a wet, shiny appearance because of exposed tissue. Blisters may form. These moderate burns take longer to heal. If the blisters are not broken and care is taken to prevent infection, the burned skin may regenerate or regrow without permanent scars. 84

Third-degree burns occur when the entire depth of skin is destroyed. Because nerve endings have been destroyed, the burned area has no sensitivity. The area may be blackened or gray-white in color. Muscle tissue and bone underneath may be damaged. In these serious to critical burns, regeneration of the skin is not possible. Skin graftingtaking a piece of skin from an unburned portion of the burn victim's body and transplanting it to the

Burns are classified by degreefirst, second, or thirdaccording to their severity and skin depth. (Illustration by Electronic Illustrators Group .) burned areamust be done to cover the exposed tissues. Third-degree burns take weeks to heal and will leave permanent scarring. Dermatitis Dermatitis is any inflammation of the skin. There are many types of dermatitis and most are characterized by a pink or red rash that itches. Two common types are contact dermatitis and seborrheic dermatitis. Contact dermatitis is an allergic reaction to something that irritates the skin. It usually appears within forty-eight hours after touching or brushing against a substance to which the skin is sensitive. The resin in poison ivy, poison oak, and poison sumac is the most common source of contact dermatitis. The skin of some people may also be irritated by certain flowers, herbs, and vegetables. Chemical irritants that can cause contact dermatitis include chlorine, cleaners, detergents and soaps, fabric softeners, perfumes, glues, and topical medications (those applied on the skin). Contact dermatitis can be treated with medicated creams or ointments and oral antihistamines and antibiotics. 85

Artificial skin, the synthetic or manmade equivalent of human skin, was first developed in the 1970s. Since then, the lives of many severely burned people have been saved through the use of artificial skin. In the 1970s, John F. Burke, chief of trauma services at Massachusetts General Hospital in Boston, and Ioannis V. Yannas, chemistry professor at Massachusetts Institute of Technology in Cambridge, teamed up to develop some type of human skin replacement. In their research, the two men found that collagen fibers (protein found in human skin) and a long sugar molecule (called a polymer) could be combined to form a porous material that resembles skin. They then created a kind of artificial skin using polymers from shark cartilage and collagen from cowhide. Burke and Yannas soon discovered that artificial skin acts like a framework onto which new skin tissue and blood vessels grow. As the new skin grows, the cowhide and shark substances from the artificial skin are broken down and absorbed by the body. In 1979, Burke and Yannas used their artificial skin on their first patient, a woman who had suffered burns over half her body. After peeling away her burned skin, Burke applied a layer of artificial skin and, where possible, grafted or added on some of her own unburned skin. Three weeks later, the woman's new skin, the same color as her unburned skin, was growing at an amazingly healthy rate. With continued research and development, synthetic skin may become a more common treatment for burns and other serious skin disorders. Seborrheic dermatitis, known commonly as seborrhea, appears as red, inflamed skin covered by greasy or dry scales that may be white, yellow, or gray. These scaly lesions appear usually on the scalp, hairline, and face. Dandruff is a mild form of seborrheic dermatitis. Medical researchers do not know the exact cause of this skin disease. They believe that a high-fat diet, alcohol, stress, oily skin, infrequent shampooing, and weather extremes (hot or cold) may play some role. The disease may be treated with special shampoos that help soften and remove the scaly lesions. In more severe cases, medicated creams or shampoos containing coal tar may be prescribed. Psoriasis Psoriasis is a chronic (long-term) skin disease characterized by inflamed lesions with silverywhite scabs of dead skin. The disease affects roughly four million people in the United States, women slightly more than men. It is most common in fair-skinned people. Normal skin cells mature and replace dead skin cells every twenty-eight to thirty days. Psoriasis causes skin cells to mature in less than a week. Because

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Various types of skin lesions. Skin ailments such as dermatitis, psoriasis, and acne are characterized by the size, shape, and texture of lesions present at outbreak. (Illustration by Electronic Illustrators Group .) the body cannot shed old skin as rapidly as new cells are rising to the surface, raised patches of dead skin develop. These patches are seen on the arms, back, chest, elbows, legs, folds between the buttocks, and scalp. The cause of psoriasis is unknown. In some cases, it may be hereditary or inherited. Attacks of psoriasis can be triggered by injury or infection, stress, hormonal changes, exposure to cold temperature, or steroids and other medications. The treatment for psoriasis depends on its severity. Steroid creams and ointments are commonly used to treat mild or moderate psoriasis. If the case is more severe, these medications may be used in conjunction with ultraviolet light B (UVB) treatments. Strong medications are reserved for those individuals suffering from extreme cases of psoriasis. Skin cancer Skin cancer is the growth of abnormal skin cells capable of invading and destroying other cells. Skin cancer is the single most common type of cancer in humans. The cause of most skin cancers or carcinomas is unknown, but overexposure to ultraviolet radiation in sunlight is a risk factor.

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Skin for graftingthe transplantation of healthy skin to a burn or non-healing woundcan be taken from other areas of a patient's body. (Illustration by Electronic Illustrators Group .) Basal cell carcinoma is the most common form of skin cancer, accounting for about 75 percent of cases. It is also the least malignant or cancerous (tending to grow and spread throughout the body). In this form of skin cancer, basal cells in the epidermis are altered so they no longer produce keratin. They also spread, invading the dermis and subcutaneous layer. Shiny, domeshaped lesions develop most often on sunexposed areas of the face. The next most common areas affected are the ears, the backs of the hands, the shoulders, and the arms. When the lesion is removed surgically, 99 percent of patients recover fully. Squamous cell carcinoma affects the cells of the second deepest layer of the epidermis. Like basal cell carcinoma, this type of skin cancer also involves skin exposed to the sun: face, ears, hands, and arms. The cancer presents itself as a small, scaling, raised bump on the skin with a crusting center. It grows rapidly and spreads to adjacent lymph nodes if not removed. If the lesion is caught early and removed surgically or through radiation, the patient has a good chance of recovering completely. Malignant melanoma accounts for about 5 percent of all skin cancers, but it is the most serious type. It is a cancer of the melanocytes, cells in the lower epidermis that produce melanin. In their early stages, melanomas resemble moles. Soon, they appear as an expanding brown to black patch. In addition to invading surrounding tissues, the cancer spreads aggressively to other parts of the body, especially the lungs and liver. Overexposure to the Sun may be a cause of melanomas, but the greatest risk factor seems to be genetic. Early discovery of the melanoma is key to survival. The primary treatment for this skin cancer is the surgical removal of the tumor or diseased area of skin. When the melanoma has spread to other parts of the body, it is generally considered incurable. Vitiligo 88

Vitiligo is a skin disorder in which the loss of melanocytes (cells that produce the color pigment melanin) results in patches of smooth, milky white skin. This often inherited disorder affects about 1 to 2 percent of the world's population. Although it is more easily observed in people with darker skin, it affects all races. It can begin at any age, but in 50 percent of the cases it starts before the age of twenty. Medical researchers do not know the exact cause of the disorder. Some theorize that nerve endings in the skin may release a chemical that destroys melanocytes. Others believe that the melanocytes simply self-destruct. Still others think that vitiligo is a type of autoimmune disease, in which the body targets and destroys its own cells and tissues.

Melanoma cells. Malignant melanoma is the most serious type of skin cancer. (Reproduced by permission of Photo Researchers, Inc. ) Vitiligo cannot be cured, but it can be managed. Cosmetics can be applied to blend the white areas with the surrounding normal skin. Sunscreens are useful to prevent the burning of affected areas and to prevent normal skin around the patches from becoming darker.

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Warts Warts are small growths caused by a viral infection of the skin or mucous membrane. The virus infects the surface layer. Warts are contagious. They can easily pass from person to person. They can also pass from one area of the body to another on the same person. Affecting about 7 to 10 percent of the population, warts are particularly common among children, young adults, and women. Common warts include hand warts, foot warts, and flat warts. Hand warts grow around the nails, on the fingers, and on the backs of the hands. They appear mostly in areas where the skin is broken. Foot warts (also called plantar warts) usually appear on the ball of the foot, the heel, or the flat part of the toes. Foot warts do not stick up above the surface like hand warts. If left untreated, they can grow in size and spread into clusters of several warts. If located on a pressure point of the foot, these warts can be painful. Flat warts are smaller and smoother than other warts. They grow in great numbers and can erupt anywhere on the body. In children, they appear especially on the face. Many nonprescription wart remedies are available that will remove simple warts from hands and fingers. Physicians use stronger chemical medications to treat warts that are larger or do not respond to over-the-counter treatments. Freezing warts with liquid nitrogen or burning them with an electric needle are advanced treatment methods.

Tattoos are relatively permanent marks or designs made on the skin. Tattoo comes from the Tahitian word tattau , meaning "to mark." The process of tattooing is accomplished by injecting colored pigment into small deep holes made in the skin. The modern method of tattooing employs an electric needle to inject the pigment. People have been decorating their bodies with pictures of animals, flowers, supernatural creatures, and various designs for thousands of years. Egyptian mummies dating from 3035 B.C. have been discovered with ornate designs of flowers tattooed on their skin. Many ancient cultures believed that a tattoo of an animal could capture the mystical spirit of that animal and magically link the wearer to the animal depicted. While many cultures have revered tattoos, many others have considered them vulgar and offensive. For as long as people have applied tattoos to their skin, they have sought ways to remove them. In modern times, tattoos can be removed medically through one of four ways. If the tattoo is small, it can be surgically cut off and the skin sewn back together. In a method called dermabrasion, the tattoo is "sanded" with a rotary abrasive instrument until the layers of skin peel. Another method that uses abrasion is called salabrasion. In this procedure, which is centuries old, salt water is applied to the tattoo and then it is vigorously rubbed with some sort of sanding device until the tattoo pigments are dispersed. All three of these methods leave some sort of scarring, but the last method, laser surgery, does not. Pulses of light from a laser are directed onto the tattoo, breaking up its pigments. The pigments are then removed over the next few weeks by the body's defense 90

cells. Remedies: Acne Although most often associated with teenage hormones, acne can strike at any age and can be caused by more than hormones. Poor nutrition can contribute to poor complexion, so stay away from sugary, fatty foods that can provide fuel for acne bacteria or contribute to skin inflammation. As the skin is a major detox organ, a buildup of toxins in the body can contribute to clogged pores and unsightly blemishes. Try a natural cleanse, and give your liver and other detox organs the support they need. For spot treatment, many natural topical remedies will work. Try a drop or two of diluted tea tree oil, or use facial products containing tea tree oil. (I personally have found Purple Prairie Organics Orange & Tea Tree bar to work wonders!) Witch hazel can tighten and minimize pores and reduce inflammation, without overdrying the skin. Chamomile is also anti-inflammatory and anti-septic, making it a great natural treatment. Make a cup of chamomile tea, let it cool to room temperature, then spritz on your face. Warts Unsightly and sometimes painful, warts are caused by a strain of the human papillomavirus (HPV) and are passed on like an infection through skin that is broken or weakened (from either moisture or injury). Although most warts will disappear with time, you can speed up the process by trying various natural remedies. Garlic, oregano and tea tree oil all have antiviral properties that can help fight off the virus and make your wart disappear faster. Apply a few drops of the oils to the wart and cover with a bandage. Tea tree oil is powerful stuff, so unless youre using it on the bottom of your foot, dilute it first before using. If you dont have garlic oil, a freshly cut piece of garlic also works. An old wives tale (that many have reported to work!) is to secure a piece of banana peel, pulp side down, over the wart. Dandruff Although dandruff is generally thought of as a hair problem, those little white flakes actually come from the skin on your head. Dandruff can be caused by both overly oily and overly dry skin, as well as poor hygiene and even a yeast-like fungus that feeds on hair oils. Massaging jojoba and coconut oil into the scalp can help balance out issues of dryness or even oiliness. Rinsing with vinegar can help kill bacteria causing dandruff, as can adding 10 drops of tea tree oil to your shampoo. Age Spots Age spots arent necessarily a sign of unhealthy skinjust of aging skinbut if you want to reduce the appearance of yours, there are a few steps you can take. The natural bleaching powers of lemon can help lighten age spots, as can the lactic acid in yogurt. Try rubbing freshly squeezed lemon juice onto age spots twice daily (watch out for cuts!), or applying a paste of yogurt to affected areas for 20 to 30 minutes once daily. Aloe Vera Several controlled scientific studies have shown statistically significant antibacterial benefits of aloe vera. Other studies have shown statistically significant improvement in skin symptoms when 91

aloe vera has been used in the treatment of radiation ulcers, burns, and frostbite injuries in animals. In 1953, Drs. C.C. Lushbaugh and D.S. Hale found that treatment with aloe vera sped up the repair of skin ulcers caused by radiation in rabbits. It took less than half the time for the aloe-treated ulcers to heal as compared with the untreated group. Drs. S. Goff and I. Levenstein in 1964 found that aloe vera helps surgical wounds in mice to heal more quickly for the first two weeks after surgery. In a related study in 1994, Dr. EM. Strickland and colleagues at the Department of Immunology of the University of Texas and the M.D. Anderson Cancer Center in Houston, Texas, found that aloe vera gel extract spread on the skin of mice exposed to ultraviolet (UV) radiation lessened the degree of UV-induced immune suppression. In 1964, Dr. L.J. Lorenzetti and others found that aloe juice significantly inhibited the growth of four strains of virulent bacteria in the lab. Similarly, in 1982, Dr. M.C. Robson and others found that aloe vera extract killed two strains of clinically important bacteria. In 1982, Dr. Robson and Dr. J.P. Heggers found that aloe vera increases the blood supply to the second layer of skin, the dermis. This speeds healing by bringing in vital nutrients and removing dangerous toxins. The researchers also found that aloe vera decreases tissue destruction after a burn, and that it can increase survival in white rabbits with frostbite injuries by a statistically significant amount. In seven independent studies done from 1968 to 1982, four pharmacologically active ingredients were identified in aloe vera that together reduce the pain, itching, and inflammation of a rash. Thus, aloe vera has been proven to be an important antibacterial and anti-inflammatory agent that speeds the healing of all kinds of wounds, burns, and ulcers. Aloe vera gel is one of the most common botanical additions to first-aid creams, moisturizers, and shampoos. Calaguala Fern and Pine Tar Products Calaguala fern, known to the Mayan people since 350 BC for its use in dry, itchy skin and scalp problems, has been combined with pine tar, a European remedy with similar uses. Skin creams, bath products, soaps, shampoos, and conditioners have been made from this combination and are very helpful for dry, itchy skin and scalp problems. Calendula Calendula (or pot marigold), with its deep yellow and orange flowers, is one of the best all-around skin remedies, good for minor cuts and burns, insect bites, dry skin, and acne. Calendula blossoms have antibacterial and antiviral properties, soothe inflammation, and speed wound healing. Therefore, it is simultaneously potent and gentle, which makes it very useful for all skin types. Calendula tea can be used as an astringent facial rinse two or three times a day for acne. More convenient preparations are available over the counter as salves, creams, oils, and lotions. Chamomile Chamomile is an anti-inflammatory agent that soothes the skin when used topically and soothes the bowels when taken internally. It also has a gentle tranquilizing effect on the central nervous system, and soothes nervous tension and irritability. It is often used for eczema and psoriasis. Generally, it is best taken three times a day as a great-tasting apple-scented herbal tea made from its flowers. Or a clean cloth can be soaked in the chamomile tea and applied to the areas of inflamed skin for fifteen minutes four to six times a day. Chamomile also forms the base for many 92

moisturizers, under-eye therapies for puffiness and dark circles, and many soap and shampoo combinations. Comfrey The leaves and roots of comfrey have been used for centuries to treat cuts, burns, and other wounds. Comfrey contains allantoin, a compound that is quickly absorbed through the skin to stimulate healthy cell growth. It also has astringent and soothing actions. Comfrey is a very common ingredient in over-the-counter and prescription skin-healing salves and ointments. Comfrey poultices, made from powdered comfrey root and hot water mixed to make a thin paste that is spread on a cloth, can be applied on a surface wound. If left on overnight, there is very fast healing by morning. However, since some of the alkaloid compounds comfrey contains can cause serious liver damage if the plant is ingested, comfrey should never be taken by mouth. Also, you should not use comfrey on deep wounds, as an abscess may form if surface healing occurs faster than the deep tissue healing. Emu Oil Advertisers are using the Internet to sing the praises of emu oil. Not only do they say that it's great for cuts, bites, burns, and the itch of poison ivy, but they also claim that it promotes hair growth by rejuvenating skin and hair cells. It has been combined with other ingredients to make cleansers, masques, shampoos, conditioners, shaving creams, body lotions, and lip balms. Flaxseed Flaxseed comes from the herb flax and contains those omega-3 essential fatty acids necessary for the proper synthesis of immune and anti-inflammatory compounds. It is useful in the management of skin disorders such as eczema and psoriasis, which are associated with inflammatory processes. One to two tablespoons of cold-pressed flaxseed oil should be taken daily, preferably with other foods. Herbal remedies have existed for centuries and have been used to treat many illnesses ranging from mild stomach upset to cancer. Recent research supports the use of herbs in the treatment of various medical problems. However, many people believing that "natural" is better have tried unproven and uncontrolled treatments, sometimes with disappointing or even dangerous results. There exist some herbal treatments that may be helpful in treating common skin conditions that do not always require going to the doctor's office. Dr. Doris Day, a Manhattan dermatologist and clinical assistant professor of dermatology at NYU Medical Center recommends that "If I had to choose only one herbal remedy for the treatment of skin problems, aloe vera would be my number one choice. It has been widely recognized as a plant with special healing capabilities." Aloe Vera is used in its pure form as a skin softener and moisturizer. The gel, which is the fluid within the leaves, has been used for centuries to accelerate wound healing. It not only improves healing but also serves as a topical pain reliever. Dr. Day adds "unfortunately many of the products in the stores that contain aloe vera do not have adequate concentration of the substance in them to make them effective." Some reliable studies have demonstrated aloe vera to be very effective in the treatment of psoriasis, a relatively common condition that leads to itchy, red scaly patches on the skin and scalp. Topical preparations of Arnica flower are especially helpful for wound healing. It is effective as an analgesic (pain reliever), antiseptic and anti-inflammatory cream. Dr. Day further comments that "this treatment is recommended for bruises and swelling due to trauma or surgery." It is also 93

helpful in speeding the healing of simple skin abrasions, insect bites and for soothing joint pain. The German government has approved the use of arnica for wound healing therapy. Also known as the common marigold, Calendula flower has a long history of effectiveness in the treatment of burns, bruises, skin infections, cuts and rashes. The German health authorities have approved its use for topical treatment of wounds that are healing poorly and for certain types of skin ulcers. Compresses made with calendula tea are also useful. The tea can be used as a mouth rinse to treat painful lesions in the mouth. Both the roots and leaves of comfrey have been used for centuries to improve healing of cuts and bruises. It has also been useful as an anti-inflammatory for treatment of rashes. It is thought to promote healing of closed fractures when applied on the skin over the site of injury. Dr. Day warns that "although topical use of the roots or leaves is safe, application over broken skin can lead to toxicity and so should not be applied more than three days in a row." Tea made from the comfrey leaf is also useful but should not exceed three cups per day. The tea tree is a tall evergreen found in Australia and Asia. The leaves have been used for centuries as an antiseptic and were used in World War I as a disinfectant. More recently the oil from the leaves has been harvested to treat cuts, insect bites and other common skin problems. The oil has been shown to kill both fungus and bacteria. The oil is available in stores, without a prescription, and can be diluted as necessary for various conditions. Tea tree oil may be toxic and should never be taken by mouth. Chamomile has been used for thousands of years for treatment of various medical problems. Dried and fresh flowers made into a tea have been used for minor stomach upset, as an oral rinse to treat gingivitis and painful mouth lesions, and topically to improve wound healing and treat mild skin problems, such as itchy lesions, hives and sunburn. Commonly known as cayenne, this spicy red pepper has been used for a multitude of medical problems such as high blood pressure, stomach ulcers, poor circulation, lung and skin infections. There are many formulas that combine capsaicin with other herbal products to maximize antibacterial and anti-inflammatory effects. Capsaicin has been shown to deplete substance-P from nerve endings, which makes it an effective pain reliever according to Dr. Day. Initially the pain may be increased or there may be a burning sensation due to the release of substance-P, which is usually temporary. There are many herbal remedies that are useful in treating common skin conditions. Dr. Day maintains that certain herbal remedies may produce adverse reactions if the person using them is sensitive to any of the active ingredients. It is recommended to see your doctor if a skin condition persists or symptoms become worse.

X. Male Reproductive System The purpose of the organs of the male reproductive system is to perform the following functions:

To produce, maintain, and transport sperm (the male reproductive cells) and protective fluid (semen) 94

To discharge sperm within the female reproductive tract during sex To produce and secrete male sex hormones responsible for maintaining the male reproductive system

Unlike the female reproductive system, most of the male reproductive system is located outside of the body. These external structures include the penis, scrotum, and testicles.

Penis: This is the male organ used in sexual intercourse. It has three parts: the root, which attaches to the wall of the abdomen; the body, or shaft; and the glans, which is the coneshaped part at the end of the penis. The glans, also called the head of the penis, is covered with a loose layer of skin called foreskin. This skin is sometimes removed in a procedure called circumcision. The opening of the urethra, the tube that transports semen and urine, is at the tip of the penis. The penis also contains a number of sensitive nerve endings. The body of the penis is cylindrical in shape and consists of three circular shaped chambers. These chambers are made up of special, sponge-like tissue. This tissue contains thousands of large spaces that fill with blood when the man is sexually aroused. As the penis fills with blood, it becomes rigid and erect, which allows for penetration during sexual intercourse. The skin of the penis is loose and elastic to accommodate changes in penis size during an erection. Semen, which contains sperm (reproductive cells), is expelled (ejaculated) through the end of the penis when the man reaches sexual climax (orgasm). When the penis is erect, the flow of urine is blocked from the urethra, allowing only semen to be ejaculated at orgasm.

Scrotum: This is the loose pouch-like sac of skin that hangs behind and below the penis. It contains the testicles (also called testes), as well as many nerves and blood vessels. The scrotum acts as a "climate control system" for the testes. For normal sperm development, the testes must be at a temperature slightly cooler than body temperature. Special muscles in the wall of the scrotum allow it to contract and relax, moving the testicles closer to the body for warmth or farther away from the body to cool the temperature.

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Testicles (testes): These are oval organs about the size of large olives that lie in the scrotum, secured at either end by a structure called the spermatic cord. Most men have two testes. The testes are responsible for making testosterone, the primary male sex hormone, and for generating sperm. Within the testes are coiled masses of tubes called seminiferous tubules. These tubes are responsible for producing sperm cells.

The male reproductive system depends upon the action of many different hormones or chemicals, produced by various body glands and enter systemic circulation. Some of these hormones, called "tropic" hormones, cause other hormones to release. Other hormones have direct effects upon organs or body systems, emotions and production of semen. Unlike women, men don't experience cyclic hormone fluctuation throughout the month--instead, their hormone levels stay relatively constant throughout their reproductive years. Gonadotropin-Releasing Hormone Something of a "master" hormone, according to the textbook "Human Physiology," GonadotropinReleasing Hormone (GnRH) is a tropic hormone produced by a part of the brain called the hypothalamus. While GnRH isn't directly responsible for male sexual behavior or characteristics, it nevertheless proves incredibly important, because it causes the release of two other hormones of the male reproductive system. Follicle-Stimulating Hormone Produced in a part of the brain called the anterior pituitary, follicle-stimulating hormone (FSH) proves active in both male and female reproductive systems. The name comes from the hormone's action in females---males don't produce follicles---but the same hormone responsible for development of a mature egg in women stimulates the production of sperm in the testes of men. FSH is released in response to the stimulation of the anterior pituitary by GnRH. Luteinizing Hormone Like FSH, luteinizing hormone (LH) is released by the anterior pituitary in response to the action of GnRH. Also like FSH, LH is produced by women as well and named for its action in the female reproductive cycle---men don't experience luteinization, which is the release of a mature egg from the ovary during ovulation. In men, LH causes the interstitial cells of the testes to produce the hormone testosterone. Testosterone Made in the testes, testosterone enters systemic circulation in relatively constant concentrations in a healthy, reproductive-age male. This hormone produces and maintains the secondary sexual characteristics of the male---enhanced musculature, facial and body hair, thickened larynx and deepened voice and enlargement of the genitals. It's also responsible for the sex drive and works with FSH to stimulate the production of sperm. The Cleveland Clinic notes that while low testosterone levels in aging men contribute to loss of sex drive and some secondary sexual characteristics, hormone replacement leads to increased risk of prostate cancer and atherosclerosis. Inhibin 96

The hormone inhibin is produced by cells in the testes that are responsible for monitoring the health and maturation of sperm. If sperm levels are high, making nutrients for the developing sperm scarce, the testes release inhibin. The inhibin travels through the bloodstream to the brain, where it prevents the secretion of GnRH. In the absence of GnRH, FSH and LH levels fall and sperm production slows. This is one of the major mechanisms whereby male hormones are maintained at relatively constant concentration. Nutrients Needed by Male Reproductive System: The male reproductive system depends upon the action of many different hormones or chemicals, produced by various body glands and enter systemic circulation. Some of these hormones, called "tropic" hormones, cause other hormones to release. Other hormones have direct effects upon organs or body systems, emotions and production of semen. Unlike women, men don't experience cyclic hormone fluctuation throughout the month--instead, their hormone levels stay relatively constant throughout their reproductive years. Gonadotropin-Releasing Hormone Something of a "master" hormone, according to the textbook "Human Physiology," GonadotropinReleasing Hormone (GnRH) is a tropic hormone produced by a part of the brain called the hypothalamus. While GnRH isn't directly responsible for male sexual behavior or characteristics, it nevertheless proves incredibly important, because it causes the release of two other hormones of the male reproductive system. Follicle-Stimulating Hormone Produced in a part of the brain called the anterior pituitary, follicle-stimulating hormone (FSH) proves active in both male and female reproductive systems. The name comes from the hormone's action in females---males don't produce follicles---but the same hormone responsible for development of a mature egg in women stimulates the production of sperm in the testes of men. FSH is released in response to the stimulation of the anterior pituitary by GnRH. Luteinizing Hormone Like FSH, luteinizing hormone (LH) is released by the anterior pituitary in response to the action of GnRH. Also like FSH, LH is produced by women as well and named for its action in the female reproductive cycle---men don't experience luteinization, which is the release of a mature egg from the ovary during ovulation. In men, LH causes the interstitial cells of the testes to produce the hormone testosterone. Testosterone Made in the testes, testosterone enters systemic circulation in relatively constant concentrations in a healthy, reproductive-age male. This hormone produces and maintains the secondary sexual characteristics of the male---enhanced musculature, facial and body hair, thickened larynx and deepened voice and enlargement of the genitals. It's also responsible for the sex drive and works with FSH to stimulate the production of sperm. The Cleveland Clinic notes that while low testosterone levels in aging men contribute to loss of sex drive and some secondary sexual characteristics, hormone replacement leads to increased risk of prostate cancer and 97

atherosclerosis. Inhibin The hormone inhibin is produced by cells in the testes that are responsible for monitoring the health and maturation of sperm. If sperm levels are high, making nutrients for the developing sperm scarce, the testes release inhibin. The inhibin travels through the bloodstream to the brain, where it prevents the secretion of GnRH. In the absence of GnRH, FSH and LH levels fall and sperm production slows. This is one of the major mechanisms whereby male hormones are maintained at relatively constant concentration. Zinc is a vitamin that is required in the proper development of the reproductive organs. Zinc also regulates a male's hormones, sperm production and prostate. The production of sex hormones can be maintained through the consumption of manganese. Folic acid is needed to help prevent serious birth defects. B vitamins help produce red blood cells, which deliver nourishment to the fetus during a woman's pregnancy. Male reproductive system diseases Hypospadias - literally below the fleshy spike. A condition in which the external urinary meatus (opening) opens anywhere below the tip of the penis rather than at the tip. Hydrocele - a fluid filled sac partially surrounding the testis. Manifests itself as a swelling on the side of the scrotum. May cause discomfort. Can be surgically corrected. And, who would most likely be doing the surgery? A urologist! Varicocele - dilated and twisted veins of the testis, sort of hemorrhoids of the scrotum! Manifests itself as a swelling on the side of the scrotum which may look and feel like a bag of worms. May be surgically corrected if causing discomfort. This condition may also cause reduced sperm count and male sterility due to sluggish blood flow elevating testicular temperature. Cryptorchidism - literally hidden testicle. A condition of lack of descent of one or both testes into the scrotum. If not corrected, usually by surgery, before puberty, can lead to sterility and increased risk of testicular cancer. Benign prostatic hypertrophy (BPH) - swelling of the prostate gland which surrounds the base of the male bladder and urethra causing difficulty urinating, dribbling, and nocturia (remember that word? See urinary system). The bane of old men! BPH becomes more common as men age. Transurethral resection of the prostate (TURP) - the surgical cure for BPH. An instrument inserted through the penile urethra is used to partially cut away the prostate to relieve obstruction of the urinary tract. Prostate Specific Antigen (PSA) PSA is a marker protein for prostate cell secretions which can be detected with a lab test. A rising PSA may be an early sign of prostate cancer, although there may be other causes including false positive tests. How often should men get a PSA test? Testicular Cancer 98

MedlinePlus indicates that testicular cancer is a type of potentially life-threatening condition that begins in the testes, the region where sperm is produced. It says that symptoms of testicular cancer include a lump or swelling in either testicle, a dull ache in the lower part of the stomach or back, an enlarged testicle and testicular pain or heaviness. Also, enlargement of the breast tissue can also be a sign of testicular cancer. MedlinePlus states that testicular cancer typically strikes men between 15 and 35 years of age. Treating testicular cancer involves surgical removing the cancerous tumor and using high dose radiation energy to kill the testicular cancer cells. Chemotherapy medications such as cisplatin and bleomycin may also be used to manage testicular cancer. Unfortunately, the exact cause for testicular cancer is not known. Risk factors for developing testicular cancer involve abnormal testicular development and having a history of testicular cancer and an undescended testicle. Also, having Klinefelter's syndrome (an inherited developmental delay disorder) can also increase an individual's risk for testicular cancer. Penile Cancer Penile cancer is a type of cancer that starts at the penis. MedlinePlus indicates that specific symptoms of penile cancer include a painless sore on the penis, genital lesions and pain or bleeding from the penis. At this time, the cause for penile cancer is unknown. Risk factors for developing penile cancer include smegma, a foul and cheese-like substance found below the penis' foreskin. Treating penile cancer also involves chemotherapy, radiation and surgery to eliminate the penile cancer cells. Priapism Priapism refers to a painful and prolonged erection, says the Mayo Clinic. It states that priapism is common in boys between five and 10 years old and in men between 20 and 50 years old. Priapism may be due to such diseases as sickle cell anemia and leukemia. It may also be due to such prescription medications as sildenafil, fluoxetine, diazepam and warfarin. Blood clots, spinal cord injury and cocaine are some other causes of priapism. Treating priapism involves draining the penis with a needle (aspiration) and taking medications such as phenylephrine. Surgery may be necessary to place a shunt into the penis. Testicular Cancer MedlinePlus indicates that testicular cancer is a type of potentially life-threatening condition that begins in the testes, the region where sperm is produced. It says that symptoms of testicular cancer include a lump or swelling in either testicle, a dull ache in the lower part of the stomach or back, an enlarged testicle and testicular pain or heaviness. Also, enlargement of the breast tissue can also be a sign of testicular cancer.

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MedlinePlus states that testicular cancer typically strikes men between 15 and 35 years of age. Treating testicular cancer involves surgical removing the cancerous tumor and using high dose radiation energy to kill the testicular cancer cells. Chemotherapy medications such as cisplatin and bleomycin may also be used to manage testicular cancer. Unfortunately, the exact cause for testicular cancer is not known. Risk factors for developing testicular cancer involve abnormal testicular development and having a history of testicular cancer and an undescended testicle. Also, having Klinefelter's syndrome (an inherited developmental delay disorder) can also increase an individual's risk for testicular cancer. Penile Cancer Penile cancer is a type of cancer that starts at the penis. MedlinePlus indicates that specific symptoms of penile cancer include a painless sore on the penis, genital lesions and pain or bleeding from the penis. At this time, the cause for penile cancer is unknown. Risk factors for developing penile cancer include smegma, a foul and cheese-like substance found below the penis' foreskin. Treating penile cancer also involves chemotherapy, radiation and surgery to eliminate the penile cancer cells. Priapism Priapism refers to a painful and prolonged erection, says the Mayo Clinic. It states that priapism is common in boys between five and 10 years old and in men between 20 and 50 years old. Priapism may be due to such diseases as sickle cell anemia and leukemia. It may also be due to such prescription medications as sildenafil, fluoxetine, diazepam and warfarin. Blood clots, spinal cord injury and cocaine are some other causes of priapism. Treating priapism involves draining the penis with a needle (aspiration) and taking medications such as phenylephrine. Surgery may be necessary to place a shunt into the penis. Treatment Treatment depends on the:

Type of testicular tumor Stage of the tumor

Once cancer is found, the first step is to determine the type of cancer cell by examining it under a microscope. The cells can be seminoma, nonseminoma, or both. The next step is to determine how far the cancer has spread to other parts of the body. This is called "staging."

Stage I cancer has not spread beyond the testicle. 100

Stage II cancer has spread to lymph nodes in the abdomen. Stage III cancer has spread beyond the lymph nodes (it could be as far as the liver, lungs, or brain).

Three types of treatment can be used.

Surgical treatment removes the testicle (orchiectomy) and may also remove nearby lymph nodes (lymphadenectomy). This is usually performed in the case of both seminoma and nonseminomas. Radiation therapy using high-dose x-rays or other high-energy rays may be used after surgery to prevent the tumor from returning. Radiation therapy is usually only used for treating seminomas. Chemotherapy uses drugs such as cisplatin, bleomycin, and etoposide to kill cancer cells. This treatment has greatly improved survival for patients with both seminomas and nonseminomas.

XI. Female Reproductive System What is the female reproductive system? The organs and structures of the female reproductive system give women the ability to produce ova (an ovum is one egg, ova means multiple eggs) to be fertilised by sperm. They also provide a place for the fetus (baby) to grow and develop. Other structures such as the breasts give the mother the ability to feed and nourish a baby after birth. Where is the female reproductive system found?

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The organs of the female reproductive system are found both internally, in the pelvis, and externally (outside the main body cavity). The organs found inside the body include:

Vagina - the vagina is a canal that joins the cervix (the lower part of uterus) to the outside of the body. The vagina receives the penis during sexual intercourse and is a passageway for childbirth. Uterus (womb) - the uterus is a hollow, pear-shaped organ that is the home to a developing fetus. The uterus is divided into two parts: the cervix, which is the lower part that opens into the vagina, and the main body of the uterus, called the corpus (or body). The corpus can easily expand to hold a developing baby. A channel through the cervix allows sperm to enter and menstrual blood to exit. Ovaries - the ovaries are small, oval-shaped glands that are located on either side of the uterus. The ovaries produce eggs (ova). They also produce the main female sex hormones which are released into the bloodstream. Uterine (Fallopian) tubes - these are narrow tubes that are attached to the upper part of the uterus. They serve as tunnels for the ova to travel from the ovaries to the uterus. Conception, the fertilisation of an egg by a sperm, normally occurs in the uterine tubes. The fertilised egg then moves to the uterus, where it implants into the lining of the uterine wall.

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The external structures of the female reproductive system include parts of the vagina, and the breasts. The labia, the clitoris and a number of glands are all parts of the vagina found externally. Together these organs are known as the vulva.

What does the female reproductive system do? Its main function is to give women the ability to produce ova to be fertilised, and the space and conditions to allow a fetus to develop. In order for this to happen, the female reproductive system also has the structures necessary to allow sperm from a man to meet the ova of a woman. To do all this the female reproductive system makes its own hormones that help to control a woman's monthly cycle. These hormones cause the development and release of ova so that they can be 103

fertilised. This process is called ovulation. They also prevent ovulation during pregnancy. Help for Female Reproductive System Disorders More natural approaches have also proven useful in maintaining and supporting the female reproductive system as well treating their symptoms. Treatments such as herbal and homeopathic remedies are gentle on the bodys system without any harsh side effects. A powerful Chinese tonic herb, Angelica Sinesis maintains balanced hormone levels during menstruation and menopause while Foeniculum vulgare (Sweet Fennel), Pulsatilla vulgaris (Pasque Flower) and Melissa officinale (Lemon Balm) helps to maintain a stable mood before and during menstruation. In addition, Vitex agnus-castus castus (Chasteberry), Cimicifuga racemosa (Black Cohosh) and Eleutherococcus senticosis (Siberian Ginseng) promotes fertility and reproductive functioning.

How does the female reproductive system work? The activity of the female reproductive system is controlled by hormones released both by the brain, and the ovaries. The combination of all these hormones gives women their reproductive cycle.

The length of the reproductive (or menstrual) cycle is usually between 24-35 days. During this time an ova is developed and matured, and the lining of the uterus is prepared to receive a fertilised egg. If a fertilised egg is not implanted into the uterus, the lining of the uterus is shed and is expelled from the body. This is the bleeding known as menstruation (period). Traditionally, the first day of bleeding is known as day one of the reproductive cycle. The key event in the cycle is ovulation, the release of a mature ovum (egg) from the ovaries. This usually takes place around 104

the 14th day of a 28-day cycle. The first part of the cycle is concerned with developing an ovum. What happens in the second part of the cycle depends on whether the ovum is fertilised. There are five main hormones that control the reproductive cycle. Three are produced in the brain, while the other two are made in the ovaries.

Gonadotrophin-releasing hormone (GnRH) is made by a part of the brain called the hypothalamus. GnRH travels to another part of the brain where it controls the release of follicle-stimulating hormone (FSH) and luteinising hormone (LH). FSH is released by a part of the brain called the anterior pituitary. FSH is carried by the bloodstream to the ovaries. Here it stimulates the immature ova to start growing. LH is also released by the anterior pituitary and travels to the ovaries. LH triggers ovulation and encourages the formation of a special group of cells called the corpus luteum. Oestrogen is produced by the growing ova and by the corpus luteum. In moderate amounts oestrogen helps to control the levels of GnRH, FSH and LH. This helps to prevent the development of too many ova. Oestrogen also helps to develop and maintain many of the female reproductive structures. Progesterone is mainly released by the corpus luteum. It works with oestrogen to prepare the lining of the uterus for the implantation of a fertilised ovum. It also helps to prepare the breasts for releasing milk. High levels of progesterone control the levels of GnRH, FSH and LH.

During the last few days of the cycle, around 20 small immature ova begin to develop in the ovaries. This continues throughout the menstrual cycle. FSH and LH encourage the growth of these ova. As they grow, the ova also start to release increasing amounts of oestrogen. The amount of oestrogen produced reduces the amount of FSH released. This helps to prevent too many ova growing at the same time. Eventually one ovum outgrows the rest. While this is happening in the ovaries, the oestrogen produced also stimulates the repair of the lining of the uterus. The next stage in the cycle is the release of the mature ovum from the ovaries into the pelvis. By this point in the cycle, levels of oestrogen are high. Previously, medium levels of oestrogen reduced the amount of FSH and LH released. Now this high level of oestrogen is the signal for more FSH and LH to be released. LH causes the ovum to burst through the outer layer of the ovary. Usually the ovum is then swept into the uterine tubes. Next the cells remaining when the ovum leaves the ovary become the corpus luteum. This special group of cells is capable of producing several different hormones, including progesterone and oestrogen. These hormones encourage the growth and maturation of the lining of the uterus. What happens next depends on whether the ovum is fertilised by sperm. If the ovum is fertilised, the corpus luteum continues to produce hormones. Another hormone called human chorionic gonadotrophin (hCG) stops the corpus luteum from breaking down. The cells covering the embryo produce hCG. It is the hormone detected in pregnancy tests. If the ovum is not fertilised, the corpus luteum can only live for a further two weeks. As it begins to break down, it releases fewer of its hormones. As the levels of progesterone and oestrogen go down, they no longer control the levels of GnRH, FSH and LH. So, these hormones increase and 105

new ova begin to develop - the start of a new cycle. In the uterus the decrease in progesterone stimulates the release of chemicals that eventually cause the lining of the uterus to die off. This is the blood flow experienced during menstruation. Female Reproductive System Needs We address various topics here related to this system. They include:

infertility, menstrual problems, premenstrual syndrome (PMS), pregnancy related problems, menopause, and vaginal thrush.

Infertility Infertility or the inability to conceive is a problem for many women. The most common cause of the problem in women is the failure to ovulate (release an egg). This is usually due to hormonal irregularities. Other common causes include damage to the ovaries or fallopian tubes or structural problems with the uterus (such as fibroids or endometriosis). What you can do to help You and your partner should eat plenty of whole foods rich in vitamins and minerals. This will ensure that the:

sperm and the egg are healthy, woman's body has the nutrients for a growing embryo, and chances for conception are increased.

Increase intake of essential fatty acids (EFAs) which can stimulate the production of sex hormones. The EFAs are found in:

oily fish, seeds, nuts, beans, refined vegetable oils, and evening primrose oil.

Vitamin C supplement of 500 mg twice daily and zinc at 15 mg daily. If you have previously taken the contraceptive pill follow the recovery from the Pill diet. (see...) Also see our recommendations for preconception care.

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Menstrual problems Common menstrual problems include:

Dysmenorrhea (painful periods), characterized by cramps in the abdominal region cause by uterine cramps. Menorrhagia (excessive menstrual flow) which is often associated with abdominal pain and may be so severe as to interfere with normal life. Amenorrhea (scanty or absent periods) common in the pubescent and menopausal years but is also associated with weight loss, stress, nutritional deficiencies and hormonal imbalances.

What you can do to help Vitamin B6 taken twice daily can help to prevent period pains. Also take one 50 mg vitamin B complex tablet daily. Magnesium will help with period pains and should be taken at 200 mg daily. Evening primrose oil and fish oils both at 500 mg per day can reduce period problems including heavy periods, pain and cramping. Take iron at 5 mg daily (more if you tend to loose a lot of blood). Take zinc at 15 mg to help in cases of heavy periods. Take vitamin A (as beta-carotene) and vitamin B6 for heavy periods. Bioflavonoids can help to balance the hormone levels and regulate the menstrual cycle. Take as part of a good vitamin C with bioflavonoids supplement. Deficiencies of zinc and vitamin B6 can result in the absence of periods. Premenstrual syndrome Premenstrual syndrome (PMS) relates to a range of physical and emotional symptoms and signs that occur between ovulation and menstruation. The physical symptoms include:

fluid retention, tender breasts, poor skin, and headaches.

The emotional symptoms and signs can include being weepy, depressed, irritable, having mood swings and craving for sweets. PMS is thought to be primarily caused by hormonal imbalances and is often also associated with stress. What you can do to help 107

Evening primrose oil has been effective in alleviating premenstrual breast tenderness, edema and skin problems. Take six to eight 500 mg capsules per day for at least four months. It is best to combine this with a multivitamin and mineral supplement. Vitamin B complex will help with stress and nervous tension and should be taken at 50 to 100 mg per day. Take vitamin C 500-1000 mg or more daily. Magnesium taken twice per day at 500 mg will help with insomnia, palpitations and period pains. Zinc should be taken at 15 mg daily throughout your cycle. Chromium will help if the symptoms are related to blood sugar levels. Limit the intake of sugar, salt, red meat and alcohol. Eat fish, chicken, whole grains and legumes as the main source of protein. If you smoke try to quit. (see.. for tips) Reduce the intake of fats, particularly animal fats, fried foods, and hydrogenated margarines. Increase your intake of fiber in the form of fresh fruit and vegetables (particularly leafy green vegetables). If you experience sugar or food craving, eat small amounts regularly, with high quality protein snacks, such as, nuts, seeds, peas and beans, as well as, animal protein, such as, eggs and fish. Take regular outdoor exercise such as walking and swimming. Work on managing your stress levels. Pregnancy related problems Many women experience a variety of problems during pregnancy. These discomforts are largely related to hormonal changes in the body or because the body is under additional strain during pregnancy. Common complaints and findings include:

anemia, constipation, cramps, varicose veins, vaginal thrush, stretch marks, and nausea and vomiting.

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What you can do to help Ensure that you get plenty of iron to prevent and treat anemia (see your health professional for dosages). Take vitamin C (500 mg per day) with the iron to aid absorption. Folic acid (at lest 400 mcg per day) is necessary during pregnancy for the healthy development of the fetus. Increase your fiber intake to help prevent constipation. Eat plenty of foods rich in calcium and magnesium to help prevent cramps. Vitamin A is linked to growth and it is now recommended that all pregnant and breast feeding women take supplements of vitamin A (as beta-carotene) (no more than 10,000 IUs per day) as well as vitamins D and C. Zinc deficiencies during pregnancy are related to low birth weight babies and it is recommended that you take 15 mg per day. Vitamins C and E and bioflavonoids, zinc and brewer's yeast will help to heal damaged vessels causing varicose veins. Take acidophilus for thrush or eat plenty of fresh natural yoghurt. Vitamins E, C and the minerals zinc and silica will help to prevent stretch marks. Nausea and vomiting during pregnancy will usually respond to iron (5 mg daily), zinc (10 mg daily), magnesium (100 mg daily) and folic acid (200 mcg daily). Menopause problems The menopause marks the end of a woman's reproductive years and may be accompanied by many uncomfortable emotional and physical symptoms. Hormonal changes (a decrease in estrogen and progesterone) primarily cause the symptoms and signs which include:

hot flushes, headaches, skin problems, difficulty sleeping, night sweats, heavy periods, constipation, lack of energy and fatigue, tender and lumpy breasts, irritability and mood swings, and pain during intercourse (mostly due to vaginal dryness).

What you can do to help 109

Evening primrose oil, linseed oil and vitamin B complex (50 mg daily) and zinc (15 mg daily) will assist with skin problems. Magnesium is helpful for insomnia and other sleep problems. Take 200 mg daily. Take magnesium and vitamin B complex for anxiety and irritability. Vitamin E, linseed oil, acidophilus and vitamin B complex will help with lumpy and tender breasts. Vitamin C 500 to 1,000 mg per day can be useful for constipation. Coenzyme Q10 will be useful for the lack of energy and fatigue (check that you are not anemic if you are lacking in energy). Vitamins C and E will assist with headaches and migraines associated with menopause. Vitamin C will help regulate heavy periods, when combined with bioflavonoids. Vitamin A (about 1,000 IUs) zinc, iron and vitamin B complex will also help with heavy menstrual bleeding. Selenium, as part of a good antioxidant, may help to reduce the hot flushes and night sweats, as will vitamin C which is more effective than HRT (hormone replacement therapy) in dealing with these symptoms. Zinc, vitamin C (500 g per day) vitamin E (200 IUs per day) and magnesium will help with painful menstrual periods. Vaginal thrush Vaginal thrush is caused by an infection of the yeast like organism Candida Albicans. Candida occurs naturally in warm moist parts of the body and only becomes a problem when it becomes too prolific. Thrush commonly occurs after a course of antibiotics. These drugs kill off the intestinal bacteria that act to keep Candida Albicans under control. The symptoms and signs of vaginal thrush include:

dry, red and itchy vulva and a white discharge.

What you can do to help About a week after any course of antibiotics take acidophilus to restore the healthy balance of bacteria in the intestines. This will prevent the Candida from proliferating and thus prevent the vaginal thrush. Take yeast free multivitamin and mineral supplements particularly if you have recurrent vaginal infection.

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A zinc supplement at 20 mg per day can help with the healing. Other things that you can do include: Hygiene

Wash regularly but use unperfumed soap or bubble baths to reduce irritation to the vagina. Keep the area clean, so that the organisms don't have suitable growing conditions. Dry your genital area thoroughly after a shower or bath. Always wipe from the front to the back after going to the toilet. Don't use perfumed toilet paper. Don't douche or use feminine hygiene sprays or tampons (one with live natural yoghurt on it, inserted for an hour or so to sooth is ok).

Clothes

Wear cotton or other natural fiber undergarments and not clothes made from synthetic fibers. Avoid tight fitting clothing that will stop the movement of air in the area and will provide an environment that encourages the growth of the organism. Change straight out of your gym wear. Avoid sitting in damp swim wear.

Food

Try to avoid sugary, processed and refined foods. Eat plenty of fresh fruit and vegetables and drink plenty of filtered water. Eat live natural yoghurt or take acidophilus. Drink unsweetened cranberry juice to help acidify your system. If you have diabetes, maintain control of blood sugar levels.

Some disorders of the female reproductive system Atrophic Vaginitis (Vaginal Dryness) Some women may notice changes in their vagina and genital area after the menopause. These changes may include dryness and discomfort during sex. There may also be bladder symptoms. These can all usually be improved with treatment. Treatment options include hormone replacement therapy (HRT), oestrogen cream or pessaries and lubricating gels. On this page

What is atrophic vaginitis and what causes it? How common is atrophic vaginitis? What symptoms can occur? What are the treatments for atrophic vaginitis? References 111

What is atrophic vaginitis and what causes it? Before the menopause (often called the change of life) the skin and tissues around the vagina are kept supple and moist by fluids and mucus. These are made by glands at the neck of the womb. Oestrogen (the female hormone) affects these glands. Oestrogen also affects the tissues in and around the vagina, causing the lining of the vagina to be thicker and more elastic. Oestrogen also stimulates the cells that line the vagina to produce glycogen, a compound which encourages the presence of helpful bacteria which protect the vagina from infection. After the menopause the ovaries make less oestrogen. The lack of oestrogen leads to thinning of the tissues around the vagina and a reduction in the number of glands that make mucus. You also lose some fat tissue from around the genital area. This may make the area also look slightly different than before the menopause. In summary, the hormonal changes make the vagina shorter, less elastic and drier. The genital skin also looks paler. These changes usually take months or years to develop after the menopause and vary from woman to woman. Atrophic vaginitis is the medical term for the condition when these changes produce troublesome symptoms. How common is atrophic vaginitis? After the menopause about half of women have some symptoms related to atrophic vaginitis. You are also more likely to experience symptoms as more years pass after your menopause. What symptoms can occur? The changes described above can occur without causing any symptoms or discomfort. However, some of the following symptoms may develop in some women. Atrophic vaginitis is a common (and usually treatable) cause of the following problems. However, these problems can also be caused by other medical conditions.

Pain when you have sex. This may occur because the vagina is smaller, drier and less likely to become lubricated during sex than before the menopause. Also, the skin around the vagina is more fragile, and this can make the problem worse. Discomfort - if the vulva or vagina is sore and red. Vaginal discharge. There may be a white or yellow discharge. Sometimes this is due to an infection. Infection is more likely if the discharge is smelly and unpleasant. Itch. The skin around the vagina is more sensitive and more likely to itch. This can make you prone to scratching, which then makes the skin more likely to itch, and so on. This is called an itch/scratch cycle which can become difficult to break, and can be distressing. Urinary problems. Atrophic vaginitis may contribute to various urinary problems. This is because of thinning and weakening of the tissues around the neck of the bladder, or around the urethra (opening for urine). For example, urinary symptoms that may occur include an urgency to get to the toilet, and recurring urinary infections.

What are the treatments for atrophic vaginitis? Not all women have all of the above symptoms. Treatment may depend on which symptoms are the most troublesome. Because the problem is mainly due to a lack of oestrogen, it can be helped 112

by replacing the oestrogen in the tissues. Hormone replacement therapy (HRT) This means taking oestrogen in the form of a tablet, gel, implant or patches. This may be the best treatment for relieving the symptoms, but some women don't like the idea of taking HRT. There are advantages and disadvantages of using HRT. See separate leaflet called 'Menopause and HRT' for more detail. Oestrogen creams Sometimes a cream, pessary or vaginal ring containing oestrogen is prescribed. This restores oestrogen to the vagina and surrounding tissues without giving oestrogen to the whole body. Usually the treatment is used every day for about two weeks, and then twice a week for a further three months. After this the effect of the treatment may be assessed by your doctor. This treatment usually works well but the symptoms may recur some time after stopping the treatment. Repeated courses of treatment are often necessary. It is important to follow the instructions about the amount of cream to use. Lubricating gels If vaginal dryness is the only problem, or hormone creams are not recommended because of other medical problems, lubricating gels may help. There are two gels which are available in the UK that are specifically designed to help the problem of vaginal dryness. They replace moisture. They are Replens and Sylk. You can buy these from the pharmacy and your pharmacist should be able to advise you. Bartholin's Cyst and Abscess The two Bartholin's glands lie next to the entrance to the vagina. They make a small amount of mucus-like fluid. A cyst (a fluid filled swelling) sometimes develops from a blocked duct that drains the fluid from a Bartholin's gland. Sometimes a gland gets infected, which may then develop into an abscess. Antibiotics may cure an infection or abscess. A small operation is a common treatment for a Bartholin's cyst or abscess. What are Bartholin's glands and what do they do? Bartholin's glands are a pair of small glands that are just next to the lower part of the entrance to the vagina. Each gland is about the size of a pea. Unless diseased or infected, you cannot normally see or feel these glands as they are within the soft tissues (labia) next to the entrance to the vagina.

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Each gland makes a small amount of mucus-like fluid. The fluid from each gland drains down a short duct (tube) called the Bartholin's gland duct. Each duct is about 2 cm long and comes out towards the lower part of the entrance to the vagina. The fluid helps to keep the entrance to the vagina moist. Bartholin's glands are named after Thomas Bartholin, the doctor who first described them in the 18th century. Bartholin's glands are sometimes called vestibular glands. What problems can arise from Bartholin's glands? Bartholin's cyst If the duct that drains the fluid becomes blocked then a fluid-filled swelling develops (a cyst). The size of a cyst can vary from small and pea-like to the size of a golf ball, or even bigger in some cases. The cyst may remain the same size or may slowly become bigger. The reason why a Bartholin's duct may become blocked and lead to a cyst is not clear. Bartholin's abscess An abscess is a collection of pus (a thick fluid) that can occur with an infection. An abscess can occur in any part of the body, and sometimes occurs in a Bartholin's gland. Sometimes an abscess develops from a Bartholin's cyst that becomes infected. Sometimes the gland itself becomes infected which gets worse and forms into an abscess. Within a few days, the abscess can become the size of a hen's egg, sometimes larger, and is usually very painful. Many types of bacteria (germs) can infect a Bartholin's cyst or gland to cause an abscess. Most are the common germs that cause skin or urine infections such as Staphylococcus and E. coli. So, any woman can develop a Bartholin's abscess. Some cases are due to sexually transmitted germs such as gonorrhoea or chlamydia. Bartholin's gland cancer

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This is a very rare cancer (about 1 in a million chance of a woman having it) and is very unlikely in women under 40. However, if there is any doubt about the cause of the swelling, a biopsy (small sample) can be checked. Who gets Bartholin's cysts and abscesses? About 1 in 50 women will develop a Bartholin's cyst or abscess at some point in their life. So, they are a common problem. Most cases occur 'out of the blue' in women aged between 20 and 30. However, they can occur in older or younger women. What are the symptoms of Bartholin's cysts and abscesses? A Bartholin's cyst or abscess typically only develops on one of the two glands. If a cyst remains small and does not become infected, then you may have no symptoms. You may just feel a small lump to one side at the lower end of the entrance to the vagina which may cause no problems. However, a larger cyst may cause some discomfort, in particular, when walking, sitting, or having sex. Very large cysts can become quite painful. With an abscess, a lump develops and quickly gets bigger, typically over a few hours or days. It is likely to become very painful. You may feel unwell and have a high temperature, and the skin over the abscess tends to become red, hot and very tender. How is it diagnosed? An examination by a doctor can usually diagnose the problem. A Bartholin's cyst and abscess have a typical appearance. No test is usually needed to make the diagnosis. What is the treatment for Bartholin's cysts and abscesses? Treatment is not always needed If you have a small cyst that causes no symptoms, and does not become infected, then it may be best simply to leave it alone. However, always report a 'lump' in the area around your vagina (your vulva) to your doctor. Do not just assume a small lump is a Bartholin's cyst. It is best for a doctor to examine you to confirm the diagnosis and to rule out other causes of lumps in the vulva. If a cyst causes symptoms, then it can be treated. A Bartholin's abscess will almost always need treatment as it can be very painful. However, if an abscess is left long enough it is likely to burst and then may resolve without treatment. This is not recommended though as it will be very painful and you could become quite ill. Antibiotics for an infection or abscess A course of antibiotics has a good chance of curing an infected gland or abscess. However, as a rule, the more pus that forms, the larger the abscess, and the less chance that antibiotics alone will be sufficient to clear the abscess without also needing to drain the pus. 115

A small operation is needed in many cases The main aim of the operation is to drain any fluid or pus. This relieves symptoms. But also, another aim is to minimise the chance of the problem recurring. Marsupialisation A small operation called marsupialisation is the traditional treatment used to treat a Bartholin's cyst or abscess. It may be done under general anaesthetic. However, it can also be done under local anaesthetic when the overlying skin is numbed with an injection of local anaesthetic. A small cut (incision) is made into the cyst or abscess just inside the entrance to the vagina. Any fluid or pus drains out. The cut is widened to about 1 cm. A few stitches are then used to to stitch the inside lining of the cyst to the overlying skin. This then creates a small new permanent opening for fluid to drain out of the gland. Initially, the opening that is left is like a pouch - hence the name of the operation. However, the opening gradually becomes smaller and soon the opening becomes tiny and not noticeable. But this new opening is, in effect, like a new duct which allows any fluid that is made by the gland to drain. A course of antibiotics may be prescribed if pus is drained from an abscess. However, antibiotics are not always needed once the pus has been drained. Marsupialisation is usually successful. In only a few cases does the problem recur if this procedure is done. If a simple cut is made to drain the fluid or pus without then doing a marsupialisation, there is a higher chance that the problem will recur at some point. As with all operations there is a small chance of problems. For example, infection of the wound occurs in a small number of cases following marsupialisation. Other types of operation In recent years, various other procedures have been introduced which are sometimes used instead of marsupialisation. For example:

A variation of the traditional operation where the fluid or pus is drained, but then the cyst or cavity wall is stitched together. Insertion of a Word catheter. This is a small, thin rubber tube. The head of the catheter is inserted through a small cut made into the cyst or abscess. The tip of the catheter has a tiny balloon which is blown up to keep the catheter in place for 2-6 weeks. Whilst the catheter is in place you can go about your normal activities. The aim is to keep the opening from closing up. As the tissues heal, it allows the cells to form a new 'duct' over the catheter. Insertion of a Jacobi ring. This too is a thin catheter that is passed into the cyst or abscess through one small cut and out from a separate cut. The two ends of the catheter are tied together with a silk thread that goes through the middle of the catheter. As with a Word catheter, this is left in place for a few weeks to allow a new 'duct' to form.

The operation chosen depends on factors such as the size of the cyst or abscess, and the preference and expertise of the surgeon. They all seem to work well with a low rate of recurrence. Other techniques

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Some people recommend that sitting in a warm bath for 10-20 minutes, three or four times a day, may encourage a Bartholin's cyst to burst naturally. It is not clear how well this may work. However, it is always best to see a doctor if you think an abscess is developing. Other less commonly used procedures include application of silver nitrate to an abscess cavity, and use of a carbon dioxide laser. Sometimes the entire gland is removed by a surgical operation. This is considered a 'last resort' but may be advised if you have several recurrences of a Bartholin's cyst or abscess. Will it happen again? In most cases, a Bartholin's cyst of abscess does not recur after treatment with one of the operations described above, or if antibiotics alone cured the problem. However, they do recur in some cases when treatment needs to be repeated. Cases due to sexually transmitted infections If you have a Bartholin's gland infection or abscess, a swab of the area or a sample of pus is usually sent to the lab to identify which germ caused the infection. If a sexually transmitted germ is the cause of the infection, then further screening for other sexually transmitted infections for yourself and your partner will usually be advised. Can Bartholin's cysts or abscesses be prevented? Not usually. Most occur 'out of the blue' for no apparent reason. Some Bartholin's abscesses are due to sexually transmitted infections, and so using a condom when having sex may prevent some cases. As mentioned, some people say that, if a cyst develops, then sitting in warm baths may possibly help it to burst and prevent a possible abscess from developing. Cervical Cancer The common early symptom of cervical cancer (cancer of the cervix) is abnormal vaginal bleeding. Most cases develop in women in their 30s or 40s. If cervical cancer is diagnosed at an early stage, there is a good chance of a cure. Regular cervical screening tests can detect pre-cancer which can be treated before cancer develops. On this page

What is the cervix? What is cancer? What is cervical cancer? Who gets cervical cancer? What is the cervical screening test? What causes cervical cancer? What are the symptoms of cervical cancer? How is cervical cancer diagnosed and assessed? 117

What are the treatment options for cervical cancer? What is the outlook (prognosis)? Further help and information References

What is the cervix? The cervix is the lower part of the womb (uterus) which extends slightly into the top of the vagina. The cervix is often called the neck of the womb.

A narrow passage called the cervical canal (or endocervical canal) goes from the vagina to the inside of the womb. This is normally kept tightly shut, but allows blood to flow out from the uterus during a period, and sperm to travel inside when you have sex. It opens very wide during labour when you have a baby. The surface of the cervix is covered with skin-like cells. There are also some tiny glands in the lining of cervical canal which make mucus. What is cancer? Cancer is a disease of the cells in the body. The body is made up of millions of tiny cells. There are many different types of cell in the body, and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and multiply out of control. A malignant tumour is a lump or growth of tissue made up from cancer cells which continue to 118

multiply. Malignant tumours invade into nearby tissues and organs, which can cause damage. Malignant tumours may also spread to other parts of the body. This happens if some cells break off from the first (primary) tumour and are carried in the bloodstream or lymph channels to other parts of the body. These small groups of cells may then multiply to form secondary tumours (metastases) in one or more parts of the body. These secondary tumours may then grow, invade and damage nearby tissues, and spread again. Some cancers are more serious than others. Some are more easily treated than others (particularly if diagnosed at an early stage). Some have a better outlook (prognosis) than others. So, cancer is not just one condition. In each case it is important to know exactly what type of cancer has developed, how large it has become, and whether it has spread. This will enable you to get reliable information on treatment options and outlook. See separate leaflet called Cancer - What are Cancer and Tumours for more information about cancer in general. What is cervical cancer? There are two main types of cervical cancer:

Squamous cell cervical cancer is the most common. This develops from a skin-like cell (a squamous cell) that covers the cervix which becomes cancerous. Adenocarcinoma cervical cancer is less common. This develops from a glandular cell (a cell that makes mucus) within the cervical canal which becomes cancerous.

Both types are diagnosed and treated in a similar way. Who gets cervical cancer? Most cases develop in women aged in their 30s or 40s. Some cases develop in older and younger women. It is rare in women aged under 25 years. Cervical cancer is the twelfth most common type of cancer in women in the UK. Around 950 women in the UK die from this cancer every year. However, the number of cases diagnosed each year has fallen over recent years. This is because cervical cancer can be prevented by regular cervical screening tests. What is the cervical screening test? Women in the UK are offered regular cervical screening tests. During each test some cells are taken from the surface of the cervix. These cells are sent to the laboratory to be looked at under a microscope. In most tests the cells seen are normal. Abnormal (dyskaryotic) cells are seen in some cases. Cervical dyskaryosis is not cervical cancer. Cervical dyskaryosis means that some cells of the cervix are abnormal, but are not cancerous. The abnormal cells are sometimes called precancerous cells or dysplastic cells. Depending on the degree of the abnormality of the cells, cervical dyskaryosis is classed as:

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Mild dyskaryosis. This is when there are only slight cell changes. This is sometimes called CIN 1. CIN stands for cervical intraepithelial neoplasia. Moderate dyskaryosis (or CIN 2). Severe dyskaryosis (or CIN 3). This is when the cells are very abnormal, but are still not cancerous.

In many cases the abnormal (dyskaryotic) cells do not progress to become cancerous. In some cases, they revert back to normal. However, in some cases, often years later, the abnormal cells turn cancerous. If you have just borderline changes, you may simply be offered another test after a few months. In many cases, slightly abnormal cells revert back to normal within a few months. Treatment may be offered if the abnormality persists. For women with moderate or severe abnormal changes, treatment can clear the cervix of the abnormal cells before they develop into cancer. See separate leaflet called Cervical Screening Test for more details. But the take-home message is ... you are very unlikely to develop cervical cancer, IF... you have regular cervical screening tests at the times advised by your doctor, AND ... you have treatment when advised if abnormal cells are detected. What causes cervical cancer? A cancerous tumour starts from one cell. It is thought that something damages or alters certain genes in the cell. This makes the cell very abnormal and multiply out of control. (See separate leaflet called What Causes Cancer for more details.) In the case of cervical cancer, the cancer develops from a cell which is already abnormal - see above. In most cases, abnormal cells are present for years before one of the abnormal cells becomes cancerous and starts to multiply out of control into a cancerous tumour. The initial precancerous abnormality of cervical cells is usually caused by a prior infection with the human papillomavirus (HPV). Human papillomavirus (HPV) and cervical cancer There are many strains of HPV. Two types, HPV 16 and 18, are involved in the development of most cases of cervical cancer. (Note: some other strains of HPV cause common warts and verrucas. These strains of HPV are not associated with cervical cancer.) The strains of HPV associated with cervical cancer are nearly always passed on by having sex with an infected person. An infection with one of these strains of HPV does not usually cause symptoms. So, you cannot tell if you or the person you have sex with are infected with one of these strains of HPV. In some women, the strains of HPV that are associated with cervical cancer affect the cells of the cervix. This makes them more likely to become abnormal which may later (usually years later) turn into cancerous cells. Note: within two years, 9 out of 10 infections with HPV will clear completely from the body. This means that most women who are infected with these strains of HPV do not develop cancer. 120

The HPV vaccine has recently been introduced for girls from the age of 12 in the UK. Studies have shown that the HPV vaccine is very effective at stopping cancer of the cervix from developing. The vaccine has been shown to work better for people who are given the vaccine when they are younger, before they are sexually active, compared to when it is given to adults. However, even if you have had the HPV vaccine, you must attend for cervical screening. This is because the vaccine does not guarantee complete protection against cervical cancer. See separate leaflet called HPV Immunisation for more detail. Other factors Other factors that increase the risk of developing cervical cancer include the following:

Smoking. Chemicals from cigarettes are carried in the bloodstream and can affect cells in the body. Smokers are 2 x more likely than non-smokers to develop cervical cancer. In particular, if you smoke and have HPV infection, the risk is greater. A poor immune system. For example, people with AIDS or people taking immunosuppressant medication have an increased risk. (If your immune system is not working fully then you are less able to deal with HPV infection and abnormal cells and you are more at risk of developing cervical cancer.) There is a possible link between the combined oral contraceptive pill (COCP) - also known as the pill - and a slightly increased risk of cervical cancer if the pill is taken for more than eight years.

What are the symptoms of cervical cancer? You may have no symptoms at first when the tumour is small. As the tumour becomes larger, in most cases the first symptom to develop is abnormal vaginal bleeding such as:

Bleeding between normal periods (intermenstrual bleeding). Bleeding after having sex (postcoital bleeding). Any vaginal bleeding in women past the menopause.

An early symptom in some cases is a vaginal discharge that smells unpleasant, or discomfort or pain during sex. All of the above symptoms can be caused by various other common conditions. But if you develop any of these symptoms, you should have it checked by a doctor. In time, if the cancer spreads to other parts of the body, various other symptoms can develop. How is cervical cancer diagnosed and assessed? To confirm the diagnosis A doctor will usually do a vaginal examination if you have symptoms which may possibly be cervical cancer. He or she may feel an abnormal cervix. If cervical cancer is suspected, you will usually be referred for colposcopy. 121

Colposcopy is a more detailed examination of the cervix. For this test, a speculum is gently put into the vagina so the cervix can be seen. The doctor uses a magnifier (colposcope) to look at the cervix in more detail. The test takes about 15 minutes. During colposcopy it is usual to take a small piece of tissue from the cervix (biopsy). The biopsy sample is then examined under a microscope to look for cancer cells. See separate leaflet called Colposcopy for more details. Assessing the extent and spread If you are found to have cervical cancer then further tests may be advised to assess if the cancer has spread. For example, a CT scan, an MRI scan, a chest X-ray, an ultrasound scan, blood tests or other tests. This assessment is called staging of the cancer. The aim of staging is to find out:

How much the tumour has grown, and whether it has grown to other nearby structures such as the bladder or rectum. Whether the cancer has spread to local lymph glands (nodes). Whether the cancer has spread to other areas of the body (metastasised).

Exactly what tests are needed depends on the initial assessment and the results of the biopsy. For example, the biopsy may show that the cancer is at a very early stage and remains just in the surface cells of the cervix. This is unlikely to have spread (metastasised) and you may not need many other tests. However, if the cancer appears to be more advanced and likely to have spread then a range of tests may be needed. Finding out the stage of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis). See separate leaflet called Staging and Grading Cancer for details. What are the treatment options for cervical cancer? Treatment options which may be considered include surgery, radiotherapy, chemotherapy, or a combination of these treatments. The treatment advised for each case depends on various factors. For example, the stage of the cancer (how large the primary cancer tumour is and whether it has spread), and your general health. You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the various possible treatment options for your type and stage of cancer. You should also discuss with your specialist the aims of treatment. For example:

In some cases, treatment aims to cure the cancer. Some cervical cancers can be cured, particularly if they are treated in the early stages of the disease. (Doctors tend to use the word remission rather than the word cured. Remission means there is no evidence of cancer following treatment. If you are in remission, you may be cured. However, in some cases, a cancer returns months or years later. This is why doctors are sometimes reluctant to use the word cured.) 122

In some cases, treatment aims to control the cancer. If a cure is not realistic, with treatment it is often possible to limit the growth or spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time. In some cases, treatment aims to ease symptoms. For example, if a cancer is advanced then you may require treatments such as painkillers or other treatments to help keep you free of pain or other symptoms. Some treatments may be used to reduce the size of a cancer, which may ease symptoms such as pain.

Surgery An operation to remove the cervix and uterus (hysterectomy) is a common treatment. If the cancer is at an early stage and has not spread then surgery alone can be curative. In some cases, where the cancer is at a very early stage, it may be possible to just remove the part of the cervix affected by the cancer without removing the entire uterus. This would mean that you could still have children. If the cancer has spread to other parts of the body, surgery may still be advised, often in addition to other treatments. For example, in some cases where the cancer has spread to other nearby structures, extensive surgery may be an option. This may be to remove not only the cervix and uterus but also nearby structures which may have become affected such as the bladder and/or bowel. Even if the cancer is advanced and a cure is not possible, some surgical techniques may still have a place to ease symptoms. For example, to relieve a blockage of the bowel or urinary tract which has been caused by the spread of the cancer. Radiotherapy Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. (See separate leaflet called Radiotherapy for details.) Radiotherapy alone can be curative for early-stage cervical cancer and may be an alternative to surgery. For more advanced cancers, radiotherapy may be advised in addition to other treatments. Two types of radiotherapy are used for cervical cancer - external and internal. In many cases both types are used:

External radiotherapy. This is where radiation is targeted on the cancer from a machine. (This is the common type of radiotherapy used for many types of cancer.) Internal radiotherapy (brachytherapy). This treatment involves placing a small radioactive implant next to the cancerous tumour (in the vagina) for a short time.

Even if the cancer is advanced and a cure is not possible, radiotherapy may still have a place to ease symptoms. For example, radiotherapy may be used to shrink secondary tumours which have developed in other parts of the body and are causing pain. Chemotherapy This is a treatment using anti-cancer drugs which kill cancer cells, or stop them from multiplying. 123

See leaflet called Chemotherapy with Cytotoxic Medicines for details. Chemotherapy may be given in addition to radiotherapy or surgery in certain situations. What is the outlook (prognosis)? The outlook is best in those who are diagnosed when the cancer is confined to the cervix and has not spread. Treatment in this situation gives a good chance of cure for 8-9 women out of 10. For women who are diagnosed when the cancer has already spread, a cure is less likely but still possible. Even if a cure is not possible, treatment can often slow down the progression of the cancer. The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment. Ovarian Cancer Most cases of ovarian cancer (cancer of the ovary) develop in women over the age of 50. The cause is not clear. Some ovarian cancers can be cured. In general, the more advanced the cancer (the more it has grown and spread), the less chance that treatment will be curative. However, treatment can often slow the progress of the cancer. Some women with a strong family history of ovarian cancer may benefit from regular screening. On this page

What are the ovaries? What is cancer? What is ovarian cancer and how common is it? What causes (epithelial) ovarian cancer? What are the symptoms of (epithelial) ovarian cancer? How is (epithelial) ovarian cancer diagnosed and assessed? What are the treatment options for (epithelial) ovarian cancer? What is the prognosis (outlook)? Is there a screening test for ovarian cancer? Further help and information References

What are the ovaries? Women have two ovaries, one on either side of the uterus (womb) in the lower abdomen. Ovaries are small and round, each about the size of a walnut. The ovaries make eggs. In fertile women, each month an egg (ovum) is released from one of the ovaries. The egg passes down the Fallopian tube into the uterus where it may be fertilised by a sperm.

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The ovaries also make hormones including the main female hormones - oestrogen and progesterone. These hormones pass into the bloodstream and have various effects on other parts of the body, including regulating the menstrual cycle and periods. What is cancer? Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cell in the body,and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and multiply 'out of control'. A malignant tumour is a lump or growth of tissue made up from cancer cells which continue to multiply. Malignant tumours invade into nearby tissues and organs, which can cause damage. Malignant tumours may also spread to other parts of the body. This happens if some cells break off from the first (primary) tumour and are carried in the bloodstream or lymph channels to other parts of the body. These small groups of cells may then multiply to form 'secondary' tumours (metastases) in one or more parts of the body. These secondary tumours may then grow, invade and damage nearby tissues and can spread again. Some cancers are more serious than others, some are more easily treated than others (particularly if diagnosed at an early stage), some have a better outlook (prognosis) than others. So, cancer is not just one condition. In each case it is important to know exactly what type of cancer has developed, how large it has become and whether it has spread. This will enable you to get reliable information on treatment options and outlook. 125

See separate leaflet called 'Cancer - What are Cancer and Tumours' for further details about cancer in general. What is ovarian cancer and how common is it? Ovarian cancer is the fifth most common cancer in the UK. It is more common than cervical cancer (cancer of the cervix). About 7,000 women are diagnosed with it every year in the UK. The majority of cases are in women aged over 50 years, although it can occur in younger women. There are various types of ovarian cancer. They are classified by the type of cell from which the cancer originates:

Epithelial ovarian cancer is the most common type (about 9 in 10 cases). This type of cancer develops from one of the cells that surrounds the outside of each ovary. This outer layer of cells is called the germinal epithelium of the ovary. Epithelial ovarian cancer mainly affects women who have had their menopause - usually women aged over 50. It is rare in younger women. There are various subtypes depending on the exact look of the cells causing the cancer (which can be seen under the microscope). Germ cell ovarian cancer develops from germ cells (the cells that make the eggs). About 1 in 10 cases of ovarian cancer are germ cell cancers. They typically develop in younger women. Again, there are various subtypes depending on the exact look of the cells causing the cancer. Most cases of germ cell ovarian cancer are curable, even if diagnosed at a late stage, as it usually responds well to treatment. Stromal ovarian cancer develops from connective tissue cells (the cells that fill the ovary and produce hormones). This type of cancer is rare.

The treatments and prognosis (outlook) are different for each type of ovarian cancer. The rest of this article is only about epithelial ovarian cancer. What causes (epithelial) ovarian cancer? A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply out of control. (See separate leaflet called 'Cancer - What Causes Cancer' for more details.) In most cases, the reason why an ovarian cancer develops is not known. However, there are factors which are known to alter the risk of ovarian cancer developing. These include:

Age. Most cases occur in women over the age of 50 years. Ovulation factors. Factors that reduce the number of times a woman will ovulate slightly lower the risk. For example, taking the combined oral contraceptive pill (COCP), having children and breast-feeding. In contrast, not having children and having a late menopause slightly increases the risk. Being overweight or obese increases the risk. Taking hormone replacement therapy (HRT) may slightly increase the risk. Sterilisation or hysterectomy (removal of the uterus) appears to reduce the risk slightly. Taking the COCP provides some protection from ovarian cancer. This protection seems to 126

continue for many years after stopping the pill. Genetic factors - see below.

Family history and genetic testing Most cases of ovarian cancer are not due to genetic or hereditary factors. Around one in twenty cases is due to faulty genes which increase the risk of cancer of the breast and ovary. Some women are referred for genetic testing if a faulty gene is suspected on the basis of a strong family history of cancer. The most common genes are BRCA1 and BRCA2. For example, if you have two or more close relatives who have had ovarian or breast cancer at a young age (or certain other cancers), you may benefit from genetic testing. If this applies to you then it is advised that you see your GP to talk it through to establish if you should be referred for genetic testing. In addition, if you are eligible for enhanced breast screening due to a family history of breast cancer, you should be aware of the early symptoms of ovarian cancer (see below). See a doctor promptly if you develop any of these symptoms. What are the symptoms of (epithelial) ovarian cancer? In many cases, no symptoms develop for quite some time after the cancer first develops. Symptoms may only be noticed when the cancerous tumour has become quite large. As the tumour grows, the most common early symptoms include one or more of the following:

Constant pain or a feeling of pressure in the lower abdomen (pelvic area). Bloating in the abdomen that does not go away (not bloating that comes and goes). There may also be an actual increase in size of your abdomen. Difficulty eating, and feeling full quickly.

Other symptoms that may develop include:

Loss of appetite. Weight loss. Pain in the lower abdomen when having sex. Passing urine frequently (as the bladder is irritated by the nearby tumour). Change in bowel habit such as constipation or diarrhoea. A more marked swelling of the abdomen. This is caused by ascites, which is a collection of fluid in the abdomen. It is caused by the growth and spread of the cancer to the inside of the abdomen which causes fluid to accumulate.

All of the above symptoms can be caused by various other conditions. Also, when symptoms first start they are often vague for some time, such as mild discomfort in the lower abdomen. These symptoms may be thought to be due to other conditions. The possibility of ovarian cancer may not be considered for some time until the symptoms get worse. In particular, one condition that is often mistaken for ovarian cancer is irritable bowel syndrome (IBS). But, it is uncommon for IBS to first develop in women over the age of 50. (IBS typically first develops at a younger age - but may persist into later life). So, if you have not had IBS type symptoms in the past but then develop them aged over 50, then ovarian cancer should be considered and ruled out (usually by tests) before making a diagnosis of IBS. 127

If the cancer spreads to other parts of the body, various other symptoms can develop. How is (epithelial) ovarian cancer diagnosed and assessed? Initial tests Initial tests to diagnose ovarian cancer may include:

An examination by a doctor. He or she may feel an enlarged ovary or another suspicious abnormality. An ultrasound scan. This is a painless test which uses sound waves to create images of structures inside your body. The probe of the scanner may be placed on your abdomen to scan the ovaries. A small probe is also commonly placed inside the vagina to scan the ovaries from this angle in order to obtain more detailed pictures. A blood test. A sample of blood can detect a protein called CA-125. The level of CA-125 is high in more than 8 in 10 women with advanced ovarian cancer and in about half of women with early ovarian cancer. Other non-cancerous conditions can also cause a high level. This means that this test does not conclusively diagnose or rule out ovarian cancer but it can be a helpful test. This test is also often used to monitor the effects of treatment for ovarian cancer.

Further tests You may be advised to have further tests depending on the symptoms that you have and the results of the initial tests. These tests can help to confirm the diagnosis and to stage the disease. The aim of staging is to find out:

How much the cancer has grown and whether it has grown to other nearby structures, such as the uterus, bladder or rectum. Whether the cancer has spread to local lymph glands (nodes). Whether the cancer has spread to other areas of the body (metastasised).

The stages of ovarian cancer are as follows: Stage 1 - just involving the ovaries. Stage 2 - the cancer has spread outside the ovaries but not outside the pelvis. Stage 3 - the cancer has spread outside the pelvis but not involved other areas of the body. Stage 4 - the cancer has spread to other parts of the body such as the liver and lungs. Tests that are used may include one or more of the following:

Computed tomography (CT) scan of the lower abdomen. This can provide detail of the structure of the internal organs. (See separate leaflet called 'CT Scan' for details.) A chest x-ray to check if the cancer has spread to your lungs. Blood tests to assess your general health and to check if the cancer has affected the function of your liver or kidneys. If you are aged under 40 you may have other tests to check for the rarer types of ovarian cancer. Scans of the bowel or urinary tract. For example, colonoscopy or CT scan. (See separate leaflet called 'Colonoscopy' for more details.) These tests are more likely to be needed if 128

you have symptoms such as constipation or urinary frequency which may indicate the cancer has spread to these areas. Aspiration of fluid. If your abdomen has swollen with fluid leading to ascites then a sample can be taken. This is done by numbing a small area of skin on the abdomen, using local anaesthetic. A fine needle is then inserted through the abdominal wall and some fluid is removed. This fluid can then be looked at under the microscope to look for cancer cells. Even if you do not have fluid in the abdomen, cells may still be obtained by passing a needle through the skin into the abdomen under X-ray control (percutaneous imageguided biopsy). Laparoscopy. This is a procedure to look inside your abdomen by using a laparoscope. A laparoscope is like a thin telescope with a light source. It is used to light up and magnify the structures inside the abdomen. A laparoscope is passed into the abdomen through a small incision (cut) in the skin. The ovaries and other internal organs can be seen. Also, biopsies (small samples) can be taken to be looked at under the microscope to detect and confirm cancer cells.

Even with the above tests, the exact stage (extent of spread) may not be known until after an operation to treat the cancer. Grading of the cancer cells If a biopsy of the cancer is taken, or cancer cells are found in aspirated fluid, the cells can be assessed. By looking at certain features of the cells under the microscope the cancer can be graded.

Grade 1 (a low grade) - the cells look reasonably similar to normal ovarian cells. The cancer cells are said to be well-differentiated. The cancer cells tend to grow and multiply quite slowly and are not so aggressive. Grade 2 - is a middle grade. Grade 3 - the cells look very abnormal and are said to be poorly differentiated. The cancer cells tend to grow and multiply quite quickly and are more aggressive.

Finding out the stage and grade of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of prognosis (outlook). See separate leaflet called 'Cancer - Staging and Grading Cancer' for details. What are the treatment options for (epithelial) ovarian cancer? Treatment options may include surgery, chemotherapy and sometimes radiotherapy. The treatment advised in each case depends on various factors such as the stage and grade of the cancer and your general health. A specialist will be able to give the pros and cons, likely success rate, possible side-effects and other details about the various possible treatment options for your type and stage of cancer. You should also discuss with your specialist the aims of treatment. For example:

In some cases, treatment aims to cure the cancer. (Doctors tend to use the word remission rather than the word cured. Remission means there is no sign of cancer following treatment. If you are in remission, you may be cured. However, in some cases a cancer 129

returns months or years later. This is why doctors are sometimes reluctant to use the word cured.) In some cases, treatment aims to control the cancer. If a cure is not realistic, with treatment it is often possible to limit the growth or spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time. In some cases, treatment aims to ease symptoms. For example, if a cancer is advanced then you may require treatments such as painkillers or other treatments to help keep you free of pain or other symptoms. Some treatments may be used to reduce the size of a cancer, which may ease symptoms such as pain.

Surgery An operation is advised in most cases. If the cancer is at a very early stage (just confined to the ovary and not spread), then an operation to remove the affected ovary and associated Fallopian tube may be all the treatment required. However, in many cases the cancer has grown into other nearby structures or has spread. Therefore, a more extensive operation is often needed. For example, the operation may involve removing the affected ovary, plus the uterus, the other ovary and also other affected areas in the lower abdomen. During the operation the surgeon may take small biopsy samples from structures in the abdomen and from structures lining the abdomen, such as the diaphragm or lymph glands (nodes). The samples are looked at under the microscope to see if any cancer cells have spread to these structures. This helps to give an accurate staging and helps to decide on further treatment. Chemotherapy Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells or stop them from multiplying. See separate leaflet called 'Chemotherapy' for details. In most cases, cells taken during surgery or at biopsy will be looked at under microscope to check the risk of the cancer returning. If the risk is high, you will be offered chemotherapy. Occasionally, chemotherapy is given before surgery to reduce the size of the cancer. This may make surgery easier and more likely to be successful. A second operation is sometimes advised after a course of chemotherapy. This aims to inspect inside the abdomen, assess how well chemotherapy has worked and to remove any cancer which could not have been removed in the first operation but which will have shrunk following chemotherapy. Radiotherapy Radiotherapy is a treatment that uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells or stops cancer cells from multiplying. (See separate leaflet called 'Radiotherapy' for details.) Radiotherapy is not often used for ovarian cancer. It is sometimes used following surgery, to kill cancer cells which may have been left behind after the operation. Radiotherapy may also be used to shrink secondary tumours that have developed in other parts of the body and are causing pain or other symptoms. What is the prognosis (outlook)? 130

There is a good chance of a cure if ovarian cancer is diagnosed and treated when the disease is at an early stage (confined to the ovary and has not spread). Unfortunately, most ovarian cancers are not diagnosed at an early stage. This is because symptoms often do not occur until after the cancer has grown quite large or has spread. In this situation, a cure is less likely but still possible. In general, the later the stage and the higher the grade of the cancer, the poorer the outlook. Even if a cure is not possible, treatment can often slow down the progression of the cancer. The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information about outlook given above is very general. The specialist who knows your case can give more accurate information about your particular outlook and how well your stage and grade of cancer is likely to respond to treatment. Is there a screening test for ovarian cancer? Currently there is no ovarian cancer screening test that is offered to all women in the UK . However, research is underway to see if a screening test will detect ovarian cancer early (when treatment is most likely to be curative). Screening tests being studied are the CA-125 blood test and regular ultrasound scan of the ovary. Two large studies are currently underway which will provide more answers about ovarian cancer screening. Preliminary results of one of these studies - UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) - are encouraging. In this study, many ovarian cancers were detected in women with no symptoms and nearly half of the cancers were detected at an early stage. However, many women who had an abnormal screening test had unnecessary surgery, as they were found to not have ovarian cancer. So, the pros and cons of possible ovarian screening tests are yet to be clarified. Full results will not be available until 2015. After this time a decision can be made as to whether a screening test is appropriate and might lead to a fall in deaths from ovarian cancer. Some people are currently offered screening if they have a strong family history of ovarian cancer. If you have two or more first-degree relatives (sister, mother, aunt) who have had ovarian cancer or have members in the family who have had breast cancer at a young age then you should talk with your doctor to see if you would benefit from screening. Uterine (Endometrial) Cancer Most cases of uterine cancer (cancer of the uterus or womb) arise from the inside lining of the uterus (the endometrium). This is called endometrial cancer. The most common early symptom is abnormal vaginal bleeding. Most cases develop in women aged in their 50s or 60s. If endometrial cancer is diagnosed at an early stage, there is a good chance of a cure. On this page

What is the uterus? What is cancer? What is uterine cancer? Endometrial cancer What causes endometrial cancer? 131

What are the symptoms of endometrial cancer? How is endometrial cancer diagnosed and assessed? What are the treatment options for endometrial cancer? What is the outlook (prognosis)? Further help and information References

What is the uterus? The uterus (womb) is in the lower abdomen behind the bladder. The inside of the uterus is where a baby grows if you become pregnant. The inside lining of the uterus is called the endometrium. This builds up and is then shed each month as a period in women who have not yet gone through the menopause. The thick body of the uterus is called the myometrium and is made of specialised muscle tissue.

The lowest part of the uterus is called the cervix (the neck of the womb) which pushes just into the top part of the vagina. At the top of the womb are the right and left Fallopian tubes which carry the eggs (released from the ovaries) to inside the womb. What is cancer? Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cell in the body, and there are many different types of cancer which 132

arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and multiply out of control. A malignant tumour is a lump or growth of tissue made up from cancer cells which continue to multiply. Malignant tumours invade into nearby tissues and organs which can cause damage. Malignant tumours may also spread to other parts of the body. This happens if some cells break off from the first (primary) tumour and are carried in the bloodstream or lymph channels to other parts of the body. These small groups of cells may then multiply to form secondary tumours (metastases) in one or more parts of the body. These secondary tumours may then grow, invade and damage nearby tissues, and spread again. Some cancers are more serious than others. Some are more easily treated than others (particularly if diagnosed at an early stage). Some have a better outlook (prognosis) than others. In each case it is important to know exactly what type of cancer has developed, how large it has become, and whether it has spread. This will enable you to get reliable information on treatment options and outlook. See separate leaflet called Cancer - what are cancer and tumours? for more details about cancer in general. What is uterine cancer? Most uterine cancers develop from cells in the endometrium (endometrial cancer). Cancer developing from muscle cells in the myometrium (uterine sarcomas) are rare and are not dealt with further in this leaflet. Cervical cancer (cancer of the cervix) is quite different to uterine cancer and is dealt with in a separate leaflet. The rest of this leaflet deals only with endometrial cancer of the uterus. Endometrial cancer About 7,400 women in the UK develop endometrial cancer each year. Most cases develop in women aged in their 50s and 60s. It rarely develops in women under the age of 50. Type and grade of endometrial cancer Most cases of endometrial cancer are called endometrioid adenocarcinomas. These arise from cells which form the glandular tissue in the lining of the endometrium. A sample of cancer tissue can be looked at under the microscope. By looking at certain features of the cells the cancer can be graded.

Grade 1 (low grade) - the cells look reasonably similar to normal endometrial cells. The cancer cells are said to be well differentiated. The cancer cells tend to grow and multiply quite slowly and are not so aggressive. Grade 2 - is a middle grade. Grade 3 - the cells look very abnormal and are said to be poorly differentiated. The cancer cells tend to grow and multiply quite quickly and are more aggressive.

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There are also some rarer types of endometrial cancer. What causes endometrial cancer? A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply out of control. See separate leaflet called What causes cancer? for more details. There are risk factors which are known to increase the risk of endometrial cancer developing. These include the following:

Increased exposure to oestrogen. Oestrogen is the main female hormone. Before the menopause the changing level of oestrogen together with another hormone, progesterone, cause the endometrium to build up each month and then be shed as a period. It is thought that factors which lead to prolonged higher than usual levels of oestrogen, or increased levels of oestrogen not being balanced by progesterone, may somehow increase the risk of endometrial cells becoming cancerous. These include: o If you have never had a baby. This is because your womb has never had a rest from the rise of oestrogen that happens in the course of a normal monthly cycle. o If you are overweight or obese. This is because fat cells make a certain amount of oestrogen. o If you have certain rare oestrogen-producing tumours. o If you have a late menopause (after the age of 52) or started periods at a young age. This is because you will have more monthly menstrual cycles. Endometrial hyperplasia. This is a benign (non-cancerous) condition where the endometrium builds up more than usual. It can cause heavy periods or irregular bleeding after the menopause. Most women with this condition do not develop cancer, but the risk is slightly increased. Tamoxifen. This is a drug which is used in the treatment of breast cancer. The risk of developing endometrial cancer from tamoxifen is very small - about 1 in 500. However, the benefits of taking tamoxifen usually outweigh the risks. Diabetes. There is a small increased risk in women with diabetes. Polycystic ovary syndrome. There is a very slight increased risk in women with this condition. Diet. There are much fewer cases of endometrial cancer in certain eastern countries and dietary factors may be the reason. A western diet high in fat may be a contributing factor. Genetic factors. Most cases are not due to genetic or hereditary factors. However, in a small number of cases, a faulty gene (which can be inherited) may trigger the disease. This disorder is called hereditary nonpolyposis colon cancer (HNPCC).

Women who take the combined oral contraceptive pill have a lower risk of developing endometrial cancer. What are the symptoms of endometrial cancer? In most cases the first symptom to develop is abnormal vaginal bleeding such as:

Vaginal bleeding past the menopause. This can range from spotting to more heavy bleeds. 134

This is the most common symptom of endometrial cancer. Bleeding after having sex (postcoital bleeding). Bleeding between normal periods (intermenstrual bleeding) in women who have not gone through the menopause.

Early symptoms that occur in some cases are: pain during or after having sex, vaginal discharge, and pain in the lower abdomen. All of the above symptoms can be caused by various other common conditions. However, if you develop any of these symptoms, you should see your doctor. Note: a cervical screening test does not screen for endometrial cancer. In time, if the cancer spreads to other parts of the body, various other symptoms can develop. How is endometrial cancer diagnosed and assessed? To confirm the diagnosis A doctor will usually do a vaginal examination if you have symptoms which may be due to endometrial cancer. He or she may feel an enlarged uterus. It is likely you will need to have a further test to confirm the diagnosis - usually one of the following:

Ultrasound scan of the uterus. This is usually the first test that is done. An ultrasound scan is a safe and painless test which uses sound waves to create images of organs and structures inside your body. It is most commonly used in pregnant women. The probe of the scanner may be placed on your abdomen to scan the womb. Sometimes a small probe is also placed inside the vagina to scan the uterus from this angle. Endometrial sampling. This is where a thin tube is passed into the uterus. By using very gentle suction, small samples of the endometrium can often be obtained. This is done in the outpatient clinic, without an anaesthetic. The biopsy (sample) is looked at under the microscope to look for any abnormal cancer cells. Hysteroscopy. This is where a doctor uses a hysteroscope, which is a thin telescope that is passed through the cervix into the uterus. The doctor can see the lining of the uterus and take biopsies (samples) of abnormal-looking areas. This can also be done without an anaesthetic.

Assessing the extent and spread If endometrial cancer is confirmed then further tests may be advised to assess if the cancer has spread. For example, a CT scan, an MRI scan, a chest X-ray, blood tests, an examination under anaesthetic of the uterus, bladder or rectum, or other tests. (See separate leaflets which describe most of these tests in more detail.) This assessment is called staging of the cancer. The aim of staging is to find out:

How much the tumour has grown, and whether it has grown to other nearby structures such as the cervix, bladder or rectum. Whether the cancer has spread to local lymph glands (nodes). Whether the cancer has spread to other areas of the body (metastasised). 135

Finding out the stage of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis). See separate leaflet called Staging and grading cancer for details. What are the treatment options for endometrial cancer? Surgery is the main treatment for endometrial cancer. Radiotherapy or chemotherapy are also used in some circumstances. The treatment advised for each case depends on various factors such as the stage of the cancer (how large the cancer is and whether it has spread) and your general health. You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects and other details about the various possible treatment options for your type of cancer. You should also discuss with your specialist the aims of treatment. For example:

In some cases, treatment aims to cure the cancer. Most cases of endometrial cancer are diagnosed at an early stage. There is a good chance of a cure if it is treated in the early stages. (Doctors tend to use the word remission rather than the word cured. Remission means there is no evidence of cancer following treatment. If you are in remission, you may be cured. However, in some cases a cancer returns months or years later. This is why doctors are sometimes reluctant to use the word cured.) In some cases, treatment aims to control the cancer. If a cure is not realistic, with treatment it is often possible to limit the growth or spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time. In some cases, treatment aims to ease symptoms. For example, if a cancer is advanced then you may require treatments such as painkillers or other treatments to help keep you free of pain or other symptoms. Some treatments may be used to reduce the size of a cancer, which may ease symptoms such as pain.

Surgery An operation to remove the uterus (hysterectomy) and ovaries is a common treatment. It is common for the Fallopian tubes and both ovaries to be removed as well. Many operations are now performed laparoscopically (key-hole). If the cancer is at an early stage and has not spread, then surgery alone can be curative. If the cancer has spread to other parts of the body, surgery may still be advised, often in addition to other treatments. Even if the cancer is advanced and a cure is not possible, some surgical techniques may still have a place to ease symptoms - for example, to relieve a blockage of the bowel or urinary tract which has been caused by the spread of the cancer. Radiotherapy Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells or stops cancer cells from multiplying. (See separate leaflet called Radiotherapy for more details.) Radiotherapy alone can be curative for early-stage endometrial cancer and may be an alternative to surgery. In some cases radiotherapy may be 136

advised in addition to surgery. Even if the cancer is advanced and a cure is not possible, radiotherapy may still have a place to ease symptoms. For example, radiotherapy may be used to shrink secondary tumours which have developed in other parts of the body and are causing pain. Chemotherapy Chemotherapy is a treatment of cancer using anti-cancer drugs. They kill cancer cells, or stop them from multiplying. See separate leaflet called Chemotherapy with cytotoxic medicines for more details. Chemotherapy is not a standard treatment for endometrial cancer but may be given in certain situations (usually in addition to radiotherapy or surgery). Hormonal treatments Treatment with progesterone is used in some types of endometrial cancer. It is generally not used in the initial treatments, but may be considered if the cancer spreads or comes back after those treatments. What is the outlook (prognosis)? There is a good chance of a cure if endometrial cancer is diagnosed and treated when the disease is at an early stage. This is when the cancer is confined to the uterus and has not spread. Many cases are diagnosed at an early stage because abnormal vaginal bleeding often develops at an early stage of the disease and alerts women (and their doctors) to the possibility of cancer. For women who are diagnosed when the cancer has already spread, a cure is less likely but still possible. Even if a cure is not possible, treatment can often slow down the progression of the cancer. The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer are likely to respond to treatment. Vulval Cancer Vulval cancer (cancer of the vulva) is an uncommon cancer. It usually affects women aged over 55, although it can also affect younger women. The most common symptoms are a persistent itch or pain in the vulval area. Some vulval cancers start as a sore or lump in the vulva. Vulval cancer is usually treated by an operation to remove the cancer. Most vulval cancers can be cured. The outlook is good in women who have small cancers that have not spread. On this page

What is the vulva? What is cancer? What is vulval cancer? What causes vulval cancer? 137

What are the symptoms of vulval cancer? How is vulval cancer diagnosed and assessed? What are the treatment options for vulval cancer? What is the prognosis (outlook)? Further help and information References

What is the vulva?

The vulva is the external sex organs of a woman. It is made up of two pairs of 'lips'. The outer pair, called the labia majora, is covered in pubic hair. The inner pair is called the labia minora, which are thinner and more delicate. There are two openings between these lips. One is the vagina which leads to the womb (uterus). The other is the urethra, which is the short tube that carries urine from the bladder. At the front of the vulva is the small organ called the clitoris. What is cancer? Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cell in the body, and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and multiply 'out of control'. A malignant tumour is a 'lump' or 'growth' of tissue made up from cancer cells which continue to multiply. Malignant tumours invade into nearby tissues and organs which can cause damage. Malignant tumours may also spread to other parts of the body. This happens if some cells break off from the first (primary) tumour and are carried in the bloodstream or lymph channels to other parts of the body.

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These small groups of cells may then multiply to form 'secondary' tumours (metastases) in one or more parts of the body. These secondary tumours may then grow, invade and damage nearby tissues, and spread again. Some cancers are more serious than others, some are more easily treated than others (particularly if diagnosed at an early stage), some have a better outlook (prognosis) than others. So, cancer is not just one condition. In each case it is important to know exactly what type of cancer has developed, how large it has become, and whether it has spread. This will enable you to get reliable information on treatment options and outlook. See separate leaflet called Cancer - What are Cancer and Tumours? for further details about cancer in general. What is vulval cancer? Vulval cancer can occur on any part of the vulva. It most commonly develops on the inner edges of the labia majora and the labia minora. It can also sometimes affect the clitoris or Bartholin's glands (small glands on each side of the vagina). It can also occasionally start on the perineum (the skin between the vulva and the anus). Most vulval cancers are squamous cell cancers. This means they have developed from the skin cells in the outer layer of the vulva. Around 4 in 100 cases of vulval cancers are due to a melanoma which develops from cells in the skin that cause pigmentation. What causes vulval cancer? A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply 'out of control'. Vulval cancer is an uncommon cancer. There are just over 1,000 new cases each year in the UK. It usually affects women over the age of 55, but is most common in those who are 85 or over. The numbers of younger women with vulval cancer have increased, but are still small. In many cases, the reason why a vulval cancer develops is not known. However, there are factors which are known to alter the risk of vulval cancer developing. These include:

Age. Most cases develop in people over the age of 55. A condition called vulval intra-epithelial neoplasia (VIN) can occur in the skin of the vulva. The most common symptom of VIN is a persistent itch. Areas of skin affected by VIN can look thickened and swollen, with red, white or dark coloured patches. Around one third of vulval cancers develop in women who have VIN. Human papillomavirus (HPV). This is an infection which is passed between people during sex. Some types of HPV, including types 16, 18 and 31 can lead to VIN developing. However, more than half of all vulval cancers are not related to HPV infection. Lichen sclerosus and lichen planus. These are two conditions that cause long-term inflammation of the skin in the vaginal area. Although almost two thirds of vulval cancers occur in women who have lichen sclerosus, only between 1 and 2 in 100 women who have lichen sclerosus will develop vulval cancer.

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Genital herpes. Infection with the genital herpes virus type 2 increases the risk of vulval cancer. However, most women who have genital herpes do not develop vulval cancer. Smoking. Smoking increases the risk of developing both VIN and vulval cancer.

Note: vulval cancer is not an inherited condition and does not usually run in families. What are the symptoms of vulval cancer? The symptoms of vulval cancer can vary between women. They may include:

A persistent itch. Pain or soreness in the vulval area. Thickened, raised, red, white or dark patches on the skin of the vulva. An open sore or growth that does not improve. Burning pain when you pass urine. Vaginal discharge or bleeding. A lump or swelling in the vulva. A mole on the vulva that changes shape or colour.

Note: all these symptoms can be caused by other conditions which are not cancer. If you have any of these symptoms then you should see your doctor. Vulval cancer can take many years to develop, as it usually grows slowly. As with other cancers, it is easier to treat and cure if it is diagnosed at an early stage. How is vulval cancer diagnosed and assessed? Anyone who has an abnormal growth or sore on their vulva will have a thorough examination by their doctor. This may include feeling for any enlarged lymph glands in the groin. You will then be referred to see a specialist in the hospital. It is likely that further tests in the hospital will be arranged. These may include:

A biopsy. This is where a small sample of tissue is removed from the affected area of your vulva. The tissue is then looked at under a microscope and can help to show whether you have VIN or vulval cancer. If you do have vulval cancer, the biopsy will show which type of vulval cancer you have. Results of a biopsy can take two weeks. Other tests. These may include one or more of: a CT scan or MRI scan of the abdomen and chest, a chest X-ray, blood tests, and sometimes other tests.

This assessment is called 'staging' of the cancer. The aim of staging is to find out:

Whether the cancer has spread to local lymph glands (nodes). Whether the cancer has spread to other areas of the body (metastasised).

Finding out the stage of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis). 140

See separate leaflet called Staging and Grading Cancer for details. What are the treatment options for vulval cancer? Treatment options which may be considered include surgery, radiotherapy and chemotherapy. The treatment advised for each case depends on various factors such as the stage of the cancer (how large the cancer is and whether it has spread), the exact subtype or 'grade' of the cancer, and your general health. You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the various possible treatment options for your type of cancer. You should also discuss with your specialist the aims of treatment; for example:

In some cases, the treatment aims to cure the cancer. Some vulval cancers can be cured, particularly if they are treated in the early stages of the disease. (Doctors tend to use the word 'remission' rather than the word 'cured'. Remission means there is no evidence of cancer following treatment. If you are 'in remission', you may be cured. However, in some cases a cancer returns months or years later. This is why doctors are sometimes reluctant to use the word cured.) In some cases, the treatment aims to control the cancer. If a cure is not realistic, with treatment it is often possible to limit the growth or spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time. In some cases, treatment aims to ease symptoms. For example, if a cancer is advanced then you may require treatments such as painkillers or other treatments to help keep you free of pain or other symptoms. Some treatments may be used to reduce the size of a cancer, which may ease symptoms such as pain.

Surgery Surgery is the main treatment for vulval cancer. The operation performed depends on the size and position of the cancer. If the cancer is small, then the cancer and a small amount of surrounding normal tissue can be removed. For larger cancers, an operation called a vulvectomy (removal of the vulva) may be performed. This may be a partial vulvectomy in which only part of the vulva is removed. Alternatively, this may be a radical vulvectomy in which the entire vulva including the inner and outer labia and the clitoris are removed, usually with the surrounding lymph nodes. If a large amount of skin is removed in the operation then you may need to have a skin graft or skin flaps. Your surgeon will be able to talk to you about this in more detail. Generally surgeons will try to perform surgery that will give the best possible result for the least scarring procedure. Radiotherapy Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. (See separate 141

leaflet called Radiotherapy for more details.) Radiotherapy may be advised in addition to surgery which aims to kill any cancerous cells which may have been left behind following an operation. 140 Radiotherapy is sometimes given before an operation, to shrink the cancer so a smaller operation can then be performed. Chemotherapy Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells or stop them from multiplying. (See separate leaflet called Chemotherapy with Cytotoxic Medicines for more details.) Chemotherapy may be used in three different ways: before an operation, to shrink a large tumour, to give a better chance of the operation being successful; after the operation to give a better chance of cure; if a cancer recurs. There are many different types of chemotherapy. Which type depends on many factors, including your age, general health and your particular stage of cancer. Your specialist can discuss this with you, if you wish. What is the prognosis (outlook)? The outlook is best in those who are diagnosed when the vulval cancer is at an early stage. Surgical removal of a small vulval cancer gives a good chance of cure. The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.

Other Diseases in the Female Reproductive System Dysmenorrhea Menorrhagia Oligomenorrhea Amenorrhea Urinary tract infection Yeast infection Cystitis Sexually transmitted diseases Toxic shock syndrome Vulvovaginitis Endometriosis Pelvic prolapse PCOS Pelvic inflammatory disease Uterine fibroids Ectopic pregnancy Ovarian cysts Ovarian tumors Cervical cancer 142

Uterine or ovarian cancer

Ectopic pregnancy Endometriosis Fibroids Genitourinary (GU) prolapse Heavy periods (menorrhagia) Infertility Lichen sclerosus Menopause Ovarian cyst Period pain Polycystic ovary syndrome Pruritus vulvae (itchy vulva) Sexually transmitted infections Vaginal thrush Help for Female Reproductive System Disorders More natural approaches have also proven useful in maintaining and supporting the female reproductive system as well treating their symptoms. Treatments such as herbal and homeopathic remedies are gentle on the bodys system without any harsh side effects. A powerful Chinese tonic herb, Angelica Sinesis maintains balanced hormone levels during menstruation and menopause while Foeniculum vulgare (Sweet Fennel), Pulsatilla vulgaris (Pasque Flower) and Melissa officinale (Lemon Balm) helps to maintain a stable mood before and during menstruation. In addition, Vitex agnus-castus castus (Chasteberry), Cimicifuga racemosa (Black Cohosh) and Eleutherococcus senticosis (Siberian Ginseng) promotes fertility and reproductive functioning.

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Conclusion

At the end of my research, I found out the different systems that controls our body and helps us to do well in our activities everyday. During my research, I spend a lot of time just to get the best information that I could get from the internet. So these are the results of my research and I realized that our body needs special care especially our internal organs because the result of pure and clean internal organs is shown in our physical appearance.

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