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2015 II

Lic. Geraldina Vallejos Torres

Lic. Marita Quispe Cisneros
Lic. Vivian Morales Snchez
Lic. Erika Matsusita Manabe
Lic. Lizbeth Rondoy Hirahoka
Lic. Maritza Glvez Nores


Week 1




Weeks 2 & 3

Osteoporosis, which means "porous bones," causes bones to become weak and brittle
so brittle that even mild stresses like bending over, lifting a vacuum cleaner or coughing
can cause a fracture. In most cases, bones weaken when you have low levels of calcium,
phosphorus and other minerals in your bones.
A common result of osteoporosis is fractures most of them in the spine, hip or wrist.
Although it's often thought of as a women's disease, osteoporosis also affects many men.
And aside from people who have osteoporosis, many more have low bone density.
In the early stages of bone loss, you usually have no pain or other symptoms. But once
bones have been weakened by osteoporosis, you may have osteoporosis symptoms that

Back pain, which can be severe if you have a fractured or collapsed vertebra

Loss of height over time, with an accompanying stooped posture

Fracture of the vertebrae, wrists, hips or other bones

The strength of your bones depends on their size and density; bone density depends in
part on the amount of calcium, phosphorus and other minerals bones contain. When your
bones contain fewer minerals than normal, they're less strong and eventually lose their
internal supporting structure.
Scientists have yet to learn all the reasons why this occurs, but the process involves how
bone is made. Bone is continuously changing new bone is made and old bone is broken
down a process called remodeling, or bone turnover.
A full cycle of bone remodeling takes about two to three months. When you're young, your
body makes new bone faster than it breaks down old bone, and your bone mass increases.
You reach your peak bone mass in your mid-30s. After that, bone remodeling continues,
but you lose slightly more than you gain. At menopause, when estrogen levels drop, bone
loss in women increases dramatically. Although many factors contribute to bone loss, the
leading cause in women is decreased estrogen production during menopause.
Your risk of developing osteoporosis depends on how much bone mass you attained
between ages 25 and 35 (peak bone mass) and how rapidly you lose it later. The higher
your peak bone mass, the more bone you have "in the bank" and the less likely you are to
develop osteoporosis as you age. Not getting enough vitamin D and calcium in your diet
may lead to a lower peak bone mass and accelerated bone loss later.
Three factors that you can influence are essential for keeping your bones healthy
throughout your life:

Regular exercise

Adequate amounts of calcium


Adequate amounts of vitamin D, which is essential for absorbing calcium

A number of factors can increase the likelihood that you'll develop osteoporosis, including:

Your sex. Fractures from osteoporosis are about twice as common in women as they
are in men. That's because women start out with lower bone mass and tend to live
longer. They also experience a sudden drop in estrogen at menopause that
accelerates bone loss. Slender, small-framed women are particularly at risk. Men who
have low levels of the male hormone testosterone also are at increased risk. The risk
of osteoporosis in men is greatest from age 75 on.

Age. The older you get, the higher your risk of osteoporosis. Your bones become
weaker as you age.

Race. You're at greatest risk of osteoporosis if you're white or of Southeast Asian

descent. Black and Hispanic men and women have a lower, but still significant, risk.

Family history. Osteoporosis runs in families. For that reason, having a parent or
sibling with osteoporosis puts you at greater risk, especially if you also have a family
history of fractures.

Frame size. Men and women who are exceptionally thin or have small body frames
tend to have higher risk because they may have less bone mass to draw from as they

Tobacco use. The exact role tobacco plays in osteoporosis isn't clearly understood,
but researchers do know that tobacco use contributes to weak bones.

Lifetime exposure to estrogen. The greater a woman's lifetime exposure to estrogen,

the lower her risk of osteoporosis. For example, you have a lower risk if you have a
late menopause or you began menstruating at an earlier than average age. But your
risk of osteoporosis is increased if your lifetime exposure to estrogen has been
deficient, such as from infrequent menstrual periods or menopause before age 45.

Eating disorders. Women and men with anorexia nervosa or bulimia are at higher risk
of lower bone density in their lower backs and hips.

Corticosteroid medications. Long-term use of corticosteroid medications, such as

prednisone, cortisone, etc., is damaging to bone. These medications are common
treatments for chronic conditions, such as asthma, rheumatoid arthritis and psoriasis. If
you need to take a steroid medication for long periods, your doctor should monitor your
bone density and recommend other drugs to help prevent bone loss.

Thyroid hormone. Too much thyroid hormone also can cause bone loss. This can
occur either because your thyroid is overactive (hyperthyroidism) or because you take
excess amounts of thyroid hormone medication to treat an underactive thyroid

Selective serotonin reuptake inhibitors (SSRIs). Research published in 2007

showed lower bone mineral density among both men and women currently using
SSRIs compared with study participants not taking these antidepressants. More
research is needed to fully understand the association between SSRI use and low
bone density.

Other medications. Long-term use of the blood-thinning medication heparin, the

cancer treatment drug methotrexate, some anti-seizure medications, diuretics and
aluminum-containing antacids also can cause bone loss.


Breast cancer. Postmenopausal women who have had breast cancer are at increased
risk of osteoporosis, especially if they were treated with chemotherapy or aromatase
inhibitors such as anastrozole and letrozole, which suppress estrogen.
Low calcium intake. A lifelong lack of calcium plays a major role in the development
of osteoporosis. Low calcium intake contributes to poor bone density, early bone loss
and an increased risk of fractures.
Medical conditions and procedures that decrease calcium absorption. Stomach
surgery (gastrectomy) can affect your body's ability to absorb calcium. So can
conditions such as Crohn's disease, celiac disease, vitamin D deficiency, anorexia
nervosa and Cushing's disease a rare disorder in which your adrenal glands
produce excessive corticosteroid hormones.
Sedentary lifestyle. Bone health begins in childhood. Children who are physically
active and consume adequate amounts of calcium-containing foods have the greatest
bone density. Any weight-bearing exercise is beneficial, but jumping and hopping
seem particularly helpful for creating healthy bones. Exercise throughout life is
important, but you can increase your bone density at any age.
Excess soda consumption. The link between osteoporosis and caffeinated sodas
isn't clear, but caffeine may interfere with calcium absorption and its diuretic effect may
increase mineral loss. In addition, the phosphoric acid in soda may contribute to bone
loss by changing the acid balance in your blood. If you do drink caffeinated soda, be
sure to get adequate calcium and vitamin D from other sources in your diet or from
Chronic alcoholism. For men, alcoholism is one of the leading risk factors for
osteoporosis. Excess consumption of alcohol reduces bone formation and interferes
with the body's ability to absorb calcium.
Depression. People who experience serious depression have increased rates of bone

Osteopenia refers to mild bone loss that isn't severe enough to be called osteoporosis, but
that increases your risk of osteoporosis. Doctors can detect osteopenia or early signs of
osteoporosis using a variety of devices to measure bone density.
The best screening test is dual energy X-ray absorptiometry (DEXA). This procedure is
quick, simple and gives accurate results. It measures the density of bones in your spine,
hip and wrist the areas most likely to be affected by osteoporosis and it's used to
accurately follow changes in these bones over time.
Other tests that can accurately measure bone density include:


Quantitative computerized tomography (CT) scanning

If you're a woman, the National Osteoporosis Foundation in USA recommends that you
have a bone density test if you aren't taking estrogen and any of the following conditions
apply to you:

You're older than age 65, regardless of risk factors.


You're postmenopausal and have at least one risk factor for osteoporosis, including
having fractured a bone.
You have a vertebral abnormality.
You use medications, such as prednisone, that can cause osteoporosis.
You have type 1 diabetes, liver disease, kidney disease, thyroid disease or a family
history of osteoporosis.
You experienced early menopause.

Doctors don't generally recommend osteoporosis screening for men because the disease is
less common in men than it is in women.
Fractures are the most frequent and serious complication of osteoporosis. They often occur
in your spine or hips bones that directly support your weight. Hip fractures usually result
from a fall. Although most people do relatively well with modern surgical treatment, hip
fractures can result in disability and even death from postoperative complications,
especially in older adults. Wrist fractures from falls also are common.
In some cases, spinal fractures can occur without any fall or injury simply because the
bones in your back (vertebrae) become so weakened that they b egin to compress.
Compression fractures can cause severe pain and require a long recovery. If you have
many such fractures, you can lose several inches of height as your posture becomes
Getting adequate calcium and vitamin D is an important factor in reducing your risk of
osteoporosis. If you already have osteoporosis, getting adequate calcium and vitamin D, as
well as taking other measures, can help prevent your bones from becoming weaker. In
some cases you may even be able to replace bone you've lost.
The amount of calcium you need to stay healthy changes over your lifetime. Your body's
demand for calcium is greatest during childhood and adolescence, when your skeleton is
growing rapidly, and during pregnancy and breast-feeding. Postmenopausal women and
older men also need to consume more calcium. As you age, your body becomes less
efficient at absorbing calcium, and you're more likely to take medications that interfere with
calcium absorption.
Premenopausal women and postmenopausal women who use HT should consume at least
1,000 milligrams (mg) of elemental calcium and a minimum of 800 international units (IU) of
vitamin D every day. Postmenopausal women not using HT, anyone at risk of steroid induced osteoporosis, and all men and women older than 65 should aim for 1,500 mg of
elemental calcium and at least 800 IU of vitamin D daily.
Getting enough vitamin D is just as important as getting adequate amounts of calcium. Not
only does vitamin D improve bone health by helping calcium absorption, but it also may
improve muscle strength.


These measures also may help you prevent bone loss:

Exercise. Exercise can help you build strong bones and slow bone loss. Exercise will
benefit your bones no matter when you start, but you'll gain the most benefits if you
start exercising regularly when you're young and continue to exercise throughout your
life. Combine strength training exercises with weight-bearing exercises. Strength
training helps strengthen muscles and bones in your arms and upper spine, and
weight-bearing exercises such as walking, jogging, running, stair climbing, skipping
rope, skiing and impact-producing sports mainly affect the bones in your legs, hips
and lower spine.

Add soy to your diet. The plant estrogens found in soy help maintain bone density
and may reduce the risk of fractures.

Don't smoke. Smoking increases bone loss, perhaps by decreasing the amount of
estrogen a woman's body makes and by reducing the absorption of calcium in your

Consider hormone therapy. Hormone therapy can reduce a woman's risk of

osteoporosis during and after menopause. But because of the risk of side effects,
discuss the options with your doctor and decide what's best for you. Testosterone
replacement therapy works only for men with osteoporosis caused by low testosterone
levels. Taking it when you have normal testosterone levels won't increase bone mass.

Avoid excessive alcohol. Consuming more than two alcoholic drinks a day may
decrease bone formation and reduce your body's ability to absorb calcium. There's no
clear link between moderate alcohol intake and osteoporosis.

Limit caffeine. Moderate caffeine consumption about two to three cups of coffee a
day won't harm you as long as your diet contains adequate calcium.





Week 4

Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your
gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath
your liver. The gallbladder holds a digestive fluid called bile that's released into your small
Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some
people develop just one gallstone, while others develop many gallstones at the same time.
People who experience symptoms from their gallstones usually require gallbladder removal
surgery. Gallstones that don't cause any signs and symptoms typically don't need
treatment. If a gallstone lodges in a duct and causes a blockage, signs and symptoms may
result, such as:
Sudden and rapidly intensifying pain in the upper right portion of your abdomen
Sudden and rapidly intensifying pain in the center of your abdomen, just below your
Back pain between your shoulder blades
Pain in your right shoulder
Yellowing of your skin and the whites of your eyes
It's not clear what causes gallstones to form. Doctors think gallstones may result when:
Your bile contains too much cholesterol. Normally, your bile contains enough
chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes
more cholesterol than your bile can dissolve, the excess cholesterol may form into
crystals and eventually into stones.
Your bile contains too much bilirubin. Bilirubin is a chemical that's produced when
your body breaks down red blood cells. Certain conditions cause your liver to make too
much bilirubin, including liver cirrhosis, biliary tract infections and certain blood
disorders. The excess bilirubin contributes to gallstone formation.
Your gallbladder doesn't empty correctly. If your gallbladder doesn't empty
completely or often enough, bile may become very concentrated and this contributes to
the formation of gallstones.



Types of gallstones that can form in the gallbladder include:

Cholesterol gallstones. They are the most common type of gallstone which often
appear yellow in color. These gallstones are composed mainly of undissolved
cholesterol, but may contain other components.
Pigment gallstones. These dark brown or black stones form when your bile contains
too much bilirubin.
Complications of gallstones may include:
Inflammation of the gallbladder. A gallstone that becomes lodged in the neck of the
gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can
cause severe pain and fever.
Blockage of the common bile duct. Gallstones can block the tubes (ducts) through
which bile flows from your gallbladder or liver to your small intestine. Jaundice and bile
duct infection can result.
Blockage of the pancreatic duct. The pancreatic duct is a tube that runs from the
pancreas to the common bile duct. Pancreatic juices, which aid in digestion, flow
through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct,
which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes
intense, constant abdominal pain and usually requires hospitalization.
Gallbladder cancer. People with a history of gallstones have an increased risk of
gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of
cancer is elevated, the likelihood of gallbladder cancer is still very small.



Week 5

Asthma is a condition in which your airways narrow and swell and produce extra mucus.
This can make breathing difficult and trigger coughing, wheezing and shortness of b reath.
For some people, asthma is a minor nuisance. For others, it can be a major problem that
interferes with daily activities and may lead to a life-threatening asthma attack.
Asthma can't be cured, but its symptoms can be controlled. Because asthma often changes
over time, it's important that you work with your doctor to track your signs and symptoms
and adjust treatment as needed.
If you have asthma, the inside walls of the airways in your lungs can become inflamed and
swollen. In addition, membranes in your airway linings may secrete excess mucus. The
result is an asthma attack. During an asthma attack, your narrowed airways make it harder
to breathe and you may cough and wheeze. Asthma symptoms range from minor to severe
and vary from person to person.
Asthma signs and symptoms include:
Shortness of breath
Chest tightness or pain
Trouble sleeping caused by shortness of breath, coughing or wheezing
A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma
in children)
Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold
or the flu
For some people, asthma symptoms flare up in certain situations:
Exercise-induced asthma, which may be worse when the air is cold and dry
Occupational asthma, triggered by workplace irritants such as chemical fumes, gases
or dust
Allergy-induced asthma, triggered by particular allergens, such as pet dander,
cockroaches or pollen
It isn't clear why some people get asthma and others don't, but it's probably due to a
combination of environmental and genetic (inherited) factors.



Asthma triggers
Exposure to various substances that trigger allergies (allergens) and irritants can trigger
signs and symptoms of asthma. Asthma triggers are different from person to person and
can include:
Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mites
Respiratory infections, such as the common cold
Physical activity (exercise-induced asthma)
Cold air
Air pollutants and irritants, such as smoke
Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin IB,
others) and naproxen (Aleve)
Strong emotions and stress
Sulfites and preservatives added to some types of foods and beverages, including
shrimp, dried fruit, processed potatoes, beer and wine
Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up
into your throat
Menstrual cycle in some women
You may also be given lung (pulmonary) function tests to determine how much air moves in
and out as you breathe. These tests may include:
Spirometry. This test estimates the narrowing of your bronchial tubes by checking
how much air you can exhale after a deep breath and how fast you can breathe out.
Peak flow. A peak flow meter is a simple device that measures how hard you can
breathe out. Lower than usual peak flow readings are a sign your lungs may not be
working as well and that your asthma may be getting worse. Your doctor will give you
instructions on how to track and deal with low peak flow readings.
Lung function tests often are done before and after taking a bronchodilator (brong-koh-DIElay-tur), such as albuterol, to open your airways. If your lung function improves with use of
a bronchodilator, it's likely you have asthma.
Other tests to diagnose asthma include:
Methacholine challenge. Methacholine is a known asthma trigger that, when inhaled,
will cause mild constriction of your airways. If you react to the methacholine, you likely
have asthma. This test may be used even if your initial lung function test is normal.



Nitric oxide test. This test, though not widely available, measures the amount of the
gas, nitric oxide, that you have in your breath. When your airways are inflamed a
sign of asthma you may have higher than normal nitric oxide levels.
Imaging tests. A chest X-ray and high-resolution computerized tomography (CT) scan
of your lungs and nose cavities (sinuses) can identify any structural abnormalities or
diseases (such as infection) that can cause or aggravate breathing problems.
Allergy testing. This can be performed by skin test or blood test. Allergy tests can
identify allergy to pets, dust, mold and pollen. If important allergy triggers are identified,
this can lead to a recommendation for allergen immunotherapy.
Provocative testing for exercise and cold-induced asthma. In these tests, your
doctor measures your airway obstruction before and after you perform vigorous
physical activity or take several breaths of cold air.
Prevention and long-term control are key in stopping asthma attacks before they start.
Treatment usually involves learning to recognize your triggers, taking steps to avoid them
and tracking your breathing to make sure your daily asthma medications are keeping
symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief
inhaler, such as albuterol.
The right medications for you depend on a number of things, including your age, your
symptoms, your asthma triggers and what seems to work best to keep your asthma under
Preventive, long-term control medications reduce the inflammation in your airways that
leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways
that are limiting breathing. In some cases, allergy medications are necessary.
Long-term asthma control medications, generally taken daily, are the cornerstone of
asthma treatment. These medications keep asthma under control on a day-to-day basis
and make it less likely you'll have an asthma attack. Types of long-term control medications
Inhaled corticosteroids. These anti-inflammatory drugs include fluticasone (Flovent
HFA), budesonide (Pulmicort Flexhaler), flunisolide (Aerobid), ciclesonide (Alvesco),
beclomethasone (Qvar) and mometasone (Asmanex).



You may need to use these medications for several days to weeks before they reach their
maximum benefit. Unlike oral corticosteroids, these corticosteroid medications have a
relatively low risk of side effects and are generally safe for long-term use.
Long-acting beta agonists. These inhaled medications, which include salmeterol
(Serevent) and formoterol (Foradil, Perforomist), open the airways. Some research
shows that they may increase the risk of a severe asthma attack, so take them only in
combination with an inhaled corticosteroid. And because these drugs c an mask
asthma deterioration, don't use them for an acute asthma attack.
Combination inhalers. These medications such as fluticasone-salmeterol (Advair
Diskus), budesonide-formoterol (Symbicort) and mometasone-formoterol (Dulera)
contain a long-acting beta agonist along with a corticosteroid. Because these
combination inhalers contain long-acting beta agonists, they may increase your risk of
having a severe asthma attack.
Quick-relief (rescue) medications are used as needed for rapid, short-term symptom
relief during an asthma attack or before exercise if your doctor recommends it. Types of
quick-relief medications include:
Short-acting beta agonists. These inhaled, quick-relief bronchodilators act within
minutes to rapidly ease symptoms during an asthma attack. They include albuterol
(ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex) and pirbuterol (Maxair).
Short-acting beta agonists can be taken using a portable, hand-held inhaler or a
nebulizer a machine that converts asthma medications to a fine mist so that they
can be inhaled through a face mask or a mouthpiece.
Ipratropium (Atrovent). Like other bronchodilators, ipratropium acts quickly to
immediately relax your airways, making it easier to breathe. Ipratropium is mostly used
for emphysema and chronic bronchitis, but it's sometimes used to treat asthma
Oral and intravenous corticosteroids. These medications which include
prednisone and methylprednisolone relieve airway inflammation caused by severe
asthma. They can cause serious side effects when used long term, so they're used
only on a short-term basis to treat severe asthma symptoms.
If you have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away.
But if your long-term control medications are working properly, you shouldn't need to use
your quick-relief inhaler very often.



Keep a record of how many puffs you use each week. If you need to use your quick-relief
inhaler more often than your doctor recommends, see your doctor. You probably need to
adjust your long-term control medication.
Allergy medications may help if your asthma is triggered or worsened by allergies. These
Allergy shots (immunotherapy). Over time, allergy shots gradually reduce your
immune system reaction to specific allergens. You generally receive shots once a
week for a few months, then once a month for a period of three to five years.
Omalizumab (Xolair). This medication, given as an injection every two to four weeks,
is specifically for people who have allergies and severe asthma. It acts by altering the
immune system.
Allergy medications. These include oral and nasal spray antihistamines and
decongestants as well as corticosteroid and cromolyn nasal sprays.



Week 6


The "urinary tract" consists of the various organs of the body that produce, store, and get
rid of urine. These include the kidneys, the ureters, the bladder, and the urethra.
Our kidneys are chemical filters for our blood. About one-quarter of the blood pumped by
the heart goes through the kidneys. The kidneys filter this blood, and the "filtrate" is
processed to separate out waste products and excess amounts of minerals, sugar, and
other chemicals. Since it sees so much of the body's blood flow, the kidneys also contain
pressure-sensitive tissue which helps the body control blood pressure, and some of the
minerals and water are saved or discarded partly to keep your blood pressure in the proper
The waste products and "extras" make up the urine, which flows through "ureters" (one per
kidney) into the bladder, where it is held until you are ready to get rid of it. When you
urinate, muscles in the bladder wall help push urine out of the bladder, through the urethra,
and out. (In men, the urethra passes through the penis; in women, the urethra opens just in
front of the vagina.) When you aren't urinating (which is most of the time) a muscle called
the "sphincter" squeezes the urethra shut to keep urine in; the sphincter relaxes when you
urinate so that urine can flow out easily.
Urinary tract infection (UTI) is a common infection that usually occurs when bacteria enter
the opening of the urethra and multiply in the urinary tract. The urinary tract includes the
kidneys, the tubes that carry urine from the kidneys to the bladder (ureters), bladder, and
the tube that carries urine from the bladder (urethra).
Urinary tract infections are also known as uncomplicated cystitis and the problem mainly
affects women. About one in five women will experience a urinary tract infection.
Infections can be caused by bacteria which get into the bladder via the urethra (small tube
leading from the bladder). Sexual intercourse may be a trigger to this happening. This is
more likely if sex has been vigorous or if lubrication is not good.
In older, post menopausal women, factors favoring urine infection relate more to changes
involving the effects of less estrogen on the tissues around the bladder and vagina.
It is believed women's genitals are more sensitive to infections because the urethra, va gina
and anus are placed close together, making it easier for bacteria to infect the urethra. The
urethra is also much shorter in women than in men.
Sometimes underlying problems such as kidney stones or kidney abnormalities may lead to
urine infections. Sometimes further tests are done to check for this, particularly if infections
are recurring often.
Pregnant women, people with diabetes and weak immune systems are also more at risk of
Pain while urinating and a frequent urge to urinate are the main symptoms of a urinary tract
infection. There may be a burning or scalding sensation when going to the toilet, passing
only a small amount of urine, or not be able to go at all. You may feel the need to go again
after having just been to the toilet. The urine may look cloudy. There may also be blood in
the urine and an ache above the pelvic bone.



The main complication of a bladder infection is that it can spread to the kidneys. A fever,
rigors (shaking and shivering), and pain on the loin area (back of the abdomen), may mean
the infection has reached the kidneys.
Children with an infection may have a change in their toileting, experience incontinence,
loose bowel movements, and have a fever. Children need a different approach to
investigating urinary infection, as underlying abnormalities need to be excluded. Men with
an infection often have a kidney stone, or an enlarged prostate gland. Men are usually
investigated after a urinary infection to make sure there is no underlying problem.
Laboratory tests of urine can confirm an infection. Inflammatory cells (white cells) are
present in the urine and a culture of the urine usually shows which bacteria are present and
which antibiotic they are sensitive to. A follow up test may be required in some cases.
In general, the farther the organ in the urinary tract from the place where the bacteria enter,
the less likely the organ is to be infected.
Urethritis. This can be due to other things besides the organisms usually involved in
UTI's; in particular, many sexually-transmitted diseases (STD's) appear initially as
urethritis. However, stool-related bacteria (the most common bacteria on the skin near
the meatus) will also often cause urethritis.
Cystitis. This is the most common form of UTI; it can be aggravated if the bladder does
not empty completely when you urinate. (Some people have valves at the bladder end
of the urethra as well as at the bladder ends of the ureters. You aren't supposed to
have urethral valves except for the sphincter; these "extra" valves usually prevent
complete bladder emptying and make cystitis more likely.)
Ureteritis. This can occur if the bacteria entered the urinary tract from above, or if the
ureter-to-bladder valves don't work properly and allow urine to "reflux" from the bladder
into the ureters.
Pyelonephritis. This can happen with infection from above, or if reflux into the ureters is
so bad that infected urine refluxes all the way to the kidney.
The condition can be prevented in some cases by following this advice:
Dab instead of wiping the genitals after urinating
Do not use feminine hygiene products
Avoid tight fitting garments like pantyhose.
Wear cotton underwear.Wash your genitals with just water or mild soap
Avoid products that may irritate the urethra (e.g., bubble bath, scented feminine
Cleanse the genital area before sexual intercourse.
Change soiled diapers in infants and toddlers promptly.
Drink plenty of water to remove bacteria from the urinary tract.
Do not routinely resist the urge to urinate.
Take showers instead of baths.
Urinate after sexual intercourse. and drink water after having sex
Women and girls should wipe from front to back after voiding to prevent contaminating
the urethra with bacteria from the anal area.





Week 7

A stroke occurs when the blood supply to part of your brain is interrupted or severely
reduced, depriving brain tissue of oxygen and food. Within minutes, brain cells begin to die.
It is a medical emergency. Prompt treatment is crucial. Early action can minimize brain
damage and potential complications.
The good news is that strokes can be treated and prevented, and many fewer Americans
die of stroke now than even 15 years ago.
Note when your signs and symptoms begin, because the length of time they have been
present may guide your treatment decisions:
Trouble with walking. You may stumble or experience sudden dizziness, loss of
balance or loss of coordination.
Trouble with speaking and understanding. You may experience confusion. You
may slur your words or have difficulty understanding speech.
Paralysis or numbness of the face, arm or leg. You may develop sudden
numbness, weakness or paralysis in your face, arm or leg, especially on one side of
your body. Try to raise both your arms over your head at the same time. If one arm
begins to fall, you may be having a stroke. Similarly, one side of your mouth may droop
when you try to smile.
Trouble with seeing in one or both eyes. You may suddenly have blurred or
blackened vision in one or both eyes, or you may see double.
Headache. A sudden, severe headache, which may be accompanied by vomiting,
dizziness or altered consciousness, may indicate you're having a stroke.
When to see a doctor
Seek immediate medical attention if you notice any signs or symptoms of a stroke, even
if they seem to fluctuate or disappear.
Think "FAST" and do the following:
Face. Ask the person to smile. Does one side of the face droop?
Arms. Ask the person to raise both arms. Does one arm drift downward?
Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or
The longer a stroke goes untreated, the greater the potential for brain damage and
disability. To maximize the effectiveness of evaluation and treatment, you'll need to be
treated at a hospital within three hours after your first symptoms appeared.
A stroke can sometimes cause temporary or permanent disabilities, depending on how long
the brain lacks blood flow and which part was affected. Complications may include:
Paralysis or loss of muscle movement. You may become paralyzed on one side of
your body, or lose control of certain muscles, such as those on one side of your face or
one arm. Physical therapy may help you return to activities hampered by paralysis,
such as walking, eating and dressing.
Difficulty talking or swallowing. A stroke may cause you to have less control over
the way the muscles in your mouth and throat move, making it difficult for you to talk
clearly, swallow or eat. You also may have difficulty with language (aphasia), including



speaking or understanding speech, reading, or writing. Therapy with a speech and

language pathologist may help.
Memory loss or thinking difficulties. Many people who have had strokes experience
some memory loss. Others may have difficulty thinking, making judgments, reasoning
and understanding concepts.
Emotional problems. People who have had strokes may have more difficulty
controlling their emotions, or they may develop depression.
Pain. People who have had strokes may have pain, numbness or other strange
sensations in parts of their bodies affected by stroke. For example, if a stroke causes
you to lose feeling in your left arm, you may develop an uncomfortable tingling
sensation in that arm.
People also may be sensitive to temperature changes, especially extreme cold (central
stroke pain or central pain syndrome). This complication generally develops several
weeks after a stroke, and it may improve over time. But because the pain is caused by
a problem in your brain, instead of a physical injury, there are few tr eatments.
Changes in behavior and self-care ability. People who have had strokes may
become more withdrawn and less social or more impulsive.



Week 9

Alternative names:
Acne vulgaris; cystic acne; pimples
An inflammatory skin condition characterized by superficial skin eruptions that are caused
by plugging the sking pores.
Causes, incidence and risk factors:
Acne is most common in adolescent boys, but it can occur in both sexes and at all ages.
There seems to be a familial tendency to develop acne. The condition usually begins at
puberty and may continue for many years. Three out of four teenagers have acne to some
extent, probably caused by hormonal changes that stimulate the sebaceous (oil production)
skin glands. Other hormonal changes can occur with menstrual periods, pregnancy, use of
birth pills or stress, which also aggravate acne.
Acne is caused when sebaceous glands within the hair follicles (pores) of the skin become
plugged, because secretion occurs faster than the oil and skin cells can exit the follicle. The
plug causes the follicle to bulge (causing whiteheads), and the top of the plug may darken
(causing blackheads). If the plug causes the wall of the follicle to rupture, the oil, dead skin
cells, and bacteria found normally on the surface of the skin can enter the skin and form
small infected areas called pustules (also known as pimples or zits)
If these infected areas are deep in the skin, they may enlarge to form cysts. A sebaceous
cyst forms when the sebaceous gland continues to produce oil. Instead of rupturing the
follicle wall, the follicle continues to enlarge and form a soft, pliable lump (known as a cyst)
under the skin. The cyst is usually not painful or discolored unless it becomes infected.
Acne commonly appears on the face and shoulders, but may extend to the trunk, arms and
Dirt or oil on the face can aggravate the condition. Other factors that increase the chances
of acne are hormonal changes, exposure to weather extremes, stress, oily skin, endocrine
disorders, certain tumors, and the use of certain drugs (such as cortisone, testosterone,
estrogen and others). Acne is not contagious. A tendency to have acne may persist
through ages 30s to early 40s
The tendency to develop acne is inherited. Although acne cannot be prevented, careful
cleanliness can help to lessen the effects.
Skin rash or lesion on the face, trunk (chest), neck, back, or other area
Comedones (whiteheads or blackheads)
Redness (erythema) of the skin lesions or skin around a lesion
Inflammation around the skin eruptions
Crusting of skin eruptions
Scarring of the skin
Signs and tests
Diagnosis is primarily based on the appearance of the skin. No testing is usually required.



Treatment is designed to prevent formation of new lesions and aid the healing of the
old lesions
Topical medications that dry up the oil and/or promote skin peeling may contai n
benzoyl peroxide, sulfur, resorcinol, salicylic acid or tretinoin, or retinoic acid (Retin-A)
Antibiotics (such as tetracycline or erythromycin) may be prescribed if the skin lesions
appear infected. Topical antibiotics (applied to a localized area of the skin) such as
clindamycin or erythromycin are also used to control infection. Note: oral tetracycline
is usually not prescribed for children until after they have all their permanent teeth,
because it can permanently discolor teeth that are still forming.
Synthetic vitamin A analogues (isotretinoin, Accutane) have been shown to be of
benefit in the treatment of severe acne. However, pregnant women and sexually
active adolescent females should not take this medication!
Other medications may include topical or injected forms of cortisone.
Surgical intervention may include professional (chemical) skin peeling, removal of
eruptions or scars (dermabrasion), or removal and/or drainage of cysts.
A small amount of sun exposure may improve acne. However, excessive exposure to
sunlight or ultraviolet rays is not recommeded because prolonged exposure increases
the risk of skin cancer.
Home treatment may lessen the effects of acne
Home treatment
Clean the skin gently but thoroughly with soap and water, removing all dirt or make-up.
Wash as often as needed to control oil, at least daily and after exercising. Use a clean
washcloth every day to prevent bacterial reinfection.
Use steam or warm, moist compresses to open clogged pores.
Shampoo hair daily when possible. Use a dandruff shampoo if necessary
Comb or pull hair back to keep hair out of the face.
Use topical astringents to remove excess oil.
Dont squeeze, scratch, pick or rub lesions. These activities can increase skin
damage. Wash your hands before and after caring for skin lesions to reduce the
chance of infection.
Dont rest your face on your hands. This irritates the skin of the face.
Identify and avoid anything that aggravates acne. This may include foods, lotions,
make-up, and so on. Avoid greasy cosmetics or creams, which can aggravate acne.
Acne often improves in the summer, so some foods that aggravate acne may be
tolerated in the summer but not in winter.
Expectations (prognosis)
Acne is usually chronic from puberty to adulthood, but eventually lessens. Acne generally
responds well to treatment after a few weeks, but may flare up from time to time. Acne is
not medically dangerous except for untreated, severe infection. Scarring may occur if
severe acne is not treated.
Skin abscess
Permanent facial scars
Skin pigment changes
Psychological damage to self-esteem, confidence, personality, social life
Side effects of Accutane (including live damage and damage to the fetus)
Side effects of other medications





Week 10

LASIK (laser assisted in situ keratomileusis) is a laser vision correction surgical procedure.
Surgeons use the Excimer laser to alter the refractive power of the cornea. During the
procedure, the surgeon creates a flap from the surface of the cornea. This flap is hinged
and folded back. The surgeon then uses the Excimer laser to remove tissue in the corneal
bed, and flatten and reshape the central cornea by a predetermined amount. Then the flap
is repositioned. The cells begin healing and clear vision is reestablished. The flap adheres
quickly to the cornea because of the physical and chemical properties of the tissue. Visual
recovery usually takes less than 24 hours and full recovery within a few days to a week.
With LASIK patients recover their visual acuity, have less postoperative corneal haze,
better healing and less corneal ulcers. After LASIK do patients need to limit activities?
Immediately following LASIK its important not to rub the eye. Patients are given shiels to
wear at bedtime and told not to rub their eyes during the day. Patients should avoid being
in a dirty or dusty environment for a few days as this may cause irritation. Swimming is not
recommended during the first month. In general there is minimal discomfort with LASIK
which is controlled with topical drop. Vision typically recovers during the first day.
The benefits of LASIK are to improve sight without the use of glasses or contact lenses.
Within one week after the procedure, 98.8 percent of The University Physicians LASIK
patients reached 20/40 or better without glasses or contact lenses. Many patients return to
their natural vision of 20/20 within a short time.
It is suggested that somebody drive the patient home as vision will be slightly hazy
following surgery. After one night the majority of patients feel their vision is clear enough to
drive themselves to their post-operative appointment the following day. Patients may return
to work within 1 to 2 days.
Yes, The LASIK Center at The University Physicians chose the VISX ATAR S2 Excimer
laser, which was approved for LASIK in 1999 by The U.S. Food and Drug Administration.
VISX follow strict clinical protocols to establish safely and effectiveness. The LASIK Center
evaluates the LASIK technique on an ongoing basis with assistance from the world renowned University of Arizona Optical Sciences Department.
Robert Snyder, M.D., professor and head, UA College of Medicine Department of
Ophthalmology, is a fellowship-trained, board-certified corneal-specialist and ophthalmic
surgeon with 14 years experience in corneal and refractive surgery. He has perfomed
more than 2,000 Excimer- laser procedures since the LASIK Center became the first FDA
approved laser center in Arizona. Other corneal specialists work under Dr. Snyder.
The ophthalmologists who conduct surgery at The LASIK Center have participated in
numerous research studies on laser vision correction over years. They have access to the
highest technology available, including the UA Optical Sciences study currently underway.
The ophthalmologist who performs your surgery will be the same person who will oversee
your follow-up care for up to a year following the procedure.
The payment includes pre-screening, a refractive surgery exam, and pre-and postoperative and follow-up care for one year. The LASIK Center accepts various methods of
payment including most major credit cards.
Patients considering LASIK must:
Be 21 years or older
Have realistic expectations of what LASIK can and cannot do
Have healthy eyes and stable vision



Be able to pay for procedure (many insurance companies consider LASIK an

elective procedure)
Be motivated for the procedure.
Patients would be good LASIK candidates if:
Their dependency on corrective lenses makes them feel handicapped
They wish to participate more freely in sports
They want more freedom to pursue activities without using corrective glasses or
contact lenses
They are unable to wear contact lenses
They would look better without glasses
Their career opportunities might be enhanced if they had better vision
They can afford the treatment without sacrificing essentials
Patients would not be good LASIK candidates if:
They are comfortable wearing glasses or contact lenses, see well and feel the
glasses look good on them
They demand perfect vision, and visual irregularities would bother them
Wearing any corrective lenses for occasional activity would make them unhappy
after they have had LASIK
What is a Neuro-Ophthalmologist?
Dr. George Sandoz is an Eye Physician and Surgeon who specializes in the care and
treatment of eye conditions. These conditions range from the routine eye exam and checkup to complex eye surgeries . In addition, Dr. Sandoz is also a Neurologist treating a wide
variety of neurological conditions. This unique combination makes Dr. Sandoz a NeuroOphthalmologist, one of only two in the state of South Carolina. This makes him uniquely
qualified to treat even the most complex eye conditions



Conditions treated
Blurry Vision
Headaches due to Blurry Vision
Eye Pain
Blurry Vision due to Migraines
Sudden Vision Loss
Crossed Eye
Seeing Flashing Lights
Droopy eye
Eye Wrinkles
Burning Eyes
Visual Field Loss
Macular Degeneration
Double vision

Vitreo-retinal Ophthalmologist
Professor of Clinical Ophthalmology
University of Arizona College of Medicine.
Dr. Ober, board-certified in ophthalmology , is a retina and vitreous specialist. After
graduating from medical school at George Washington University, Washington, DC, Dr.
Ober completed his residency at the University of Southern California Medical Center in
Los Angeles . He also has received fellowship training in diseases of the retina and
Vitreous at Moorfields Eye Hospital in England and the Johns Hopkins University School of
Medicine, Baltimore, Maryland. Before joining The University Physicians in 1993 he was a
full-time faculty member at the University of Southern California.



Week 11

Diabetes is a disease in which the body does not make any insulin or can't use the insulin it
does make as well as it should. Insulin is a hormone made in the body. It helps glucose
(sugar) from food enter the cells where it can be used to give the body energy. Without
insulin, glucose remains in the blood stream and cannot be used for energy by the cells.
Over time, having too much glucose in the blood can cause many health problems.
Diabetes is the leading cause of new blindness, kidney disease, and amputation, and it
contributes greatly to the state's and nation's number one killer, cardiovascular disease
(heart disease and stroke). People with diabetes are more likely to die from flu or
Diabetes is not caused by eating too much sugar; in fact there is no such thing as "having a
touch of sugar," as some people believe. Only a doctor or health care provider can
diagnose diabetes either by conducting a fasting plasma glucose (FPG) test or an oral
glucose tolerance test (OGTT).
The Diabetes Epidemic
Diabetes is the most rapidly growing chronic disease of our time. It has become an
epidemic that affects one out of every 12 adult New Yorkers. Since 1994, the number of
people in the state who have diabetes has more than doubled, and it is likely that number
will double again by the year 2050.
More than one million New Yorkers have been diagnosed with diabetes. It is estimated that
another 450,000 people have diabetes and don't know it, because the symptoms may be
overlooked or misunderstood.
The Centers for Disease Control and Prevention (CDC) has recently predicted that one out
of every three children born in the United States will develop diabetes in their lifetime. For
Hispanic/Latinos, the forecast is even more alarming: one in every two.
Types of Diabetes
Type 1 Diabetes
Type 1 diabetes usually appears in children, teenagers or young adults, but it can also be
diagnosed later in life. About 5% of people with diabetes have type 1 diabetes.
People with type 1 diabetes don't make insulin. Insulin helps convert sugar, starches and
other food into energy. People with type 1 diabetes must take insulin every day to live.
Insulin is usually given by a shot or a small pump that is attached to the body.
There is no known way to prevent or cure type 1 diabetes, but it can be controlled by
keeping the level of glucose in the blood within a normal range. Keeping blood sugar at an
ideal level helps prevent complications and also helps people feel better every day. For
most people with diabetes, a healthy range is between 90 and 130 mg/dl before meals and
less than 180 mg/dl at 1 to 2 hours after a meal.
Type 2 Diabetes
Type 2 diabetes is the most common form of diabetes and it has been described as an
epidemic. The number of people with diabetes has nearly tripled since 1980, and most of
this increase is in type 2 diabetes. About 95 percent of people with diabetes have type 2



diabetes. With type 2 diabetes, the body either doesn't make enough insulin or can't use
the insulin it makes as well as it should.
While its cause is unknown, type 2 diabetes has been associated with obesity, genetic risk
factors, and inactivity. Some racial and ethnic groups are at higher risk for type 2 diabetes.
These include American Indians, African Americans, Hispanic/Latinos, Asian Americans
and Pacific Islanders.
Of great concern is the fact that cases of type 2 diabetes, found mos t often in adults, are
now being diagnosed in children and adults, especially in minority populations. Like adults,
children have a greater risk of developing type 2 diabetes if they are overweight and
inactive, and are from one of the racial and ethnic backgrounds mentioned above.
There is no known way to cure type 2 diabetes, but it can be controlled by keeping blood
sugar within a normal range. People with diabetes should talk with their doctor or health
care provider to find out what their healthy blood glucose range is. For most people with
diabetes, a healthy range is between 90 and 130 mg/dl before meals and less than 180
mg/dl at 1 to 2 hours after a meal. Some people with type 2 diabetes can control the
disease by:
Losing even small amounts of weight
Making healthier food choices
Being physically active 30 minutes a day, most days of the week
Other people may need to take one or more oral medications, and/or insulin, in addition to
the suggestions listed above.
What Causes Diabetes?
Causes of Type 1 Diabetes
In type 1 diabetes, the body no longer makes insulin because the body's own immune
system has attacked and destroyed the cells where insulin is made. The cause of this isn't
entirely clear but it may include genetic risk factors and environmental factors. One theory
is that type 1 diabetes may occur after having a specific virus.
Causes of Type 2 Diabetes
The risk of having type 2 diabetes increases as a person gets older. The cause of type 2
diabetes is largely unknown, but genetics and lifestyle clearly play roles. Type 2 diabetes
has been linked to obesity, genetic risk factors, and inactivity.
Risk factors for type 2 diabetes include:
Age (greater than age 45)
Physical inactivity
Family background that is American Indian, African American, Hispanic/Latino, Asian
American, or Pacific Islander
Parent or sibling with diabetes
High blood pressure
Abnormal cholesterol levels
Having had a baby that weighed more than 9 pounds or having had gestational
History of polycystic ovary disease (PCOS)
It is important for people at risk for type 2 diabetes to discuss with their doctor or health
care provider whether they should be tested for diabetes.



Diabetes often goes undiagnosed because many of its symptoms seem harmless or don't
always appear right away. Recent studies show that early detection of diabetes symptoms
and treatment can decrease the chance of developing the complications of diabetes.
Symptoms of diabetes include:
Increased thirst
Increased hunger
Having to urinate more often especially at night
Feeling very tired
Weight loss
Blurry vision
Sores that do not heal
Tingling/numbness in the hands and feet
If blood sugar is consistently high, over time it can affect the heart, eyes, kidneys, nerves,
and other parts of the body. These problems are called complications. Sometimes people
with diabetes don't realize that they have the disease until they begin to have other health
problems. For example, a doctor or health care provider may detect signs of diabetes
damage even though the patient does not know that he/she has the disease.
Complications of diabetes include:
Heart Disease People with diabetes have a higher risk for heart attack and stroke.
Eye Complications People with diabetes have a higher risk of blindness and other
vision problems.
Kidney Disease Diabetes can damage the kidneys and may lead to kidney failure.
Nerve Damage (neuropathy) Diabetes can cause damage to the nerves that run
through the body.
Foot Problems Nerve damage, infections of the feet, and problems with blood flow
to the feet can be caused by diabetes.
Skin Complications Diabetes can cause skin problems, such as infections, sores,
and itching. Skin problems are sometimes a first sign that someone has diabetes.
Dental Disease Diabetes can lead to problems with teeth and gums, called gingivitis
and periodontitis.
Diabetes is managed by keeping blood sugar under control and as close to normal as
possible. Here are some ways to manage diabetes:
Exercise. Work up to at least 30 minutes a day, most days of the week. Regular physical
activity helps to manage diabetes. People with diabetes should talk to their doctor or health
care provider before starting any exercise plan. Some good ways to get exercise are to:
Take a brisk walk (outside or inside on a treadmill).
Go dancing.
Take a low-impact aerobics class.
Swim or do water aerobic exercises.
Ice-skate or roller-skate.
Play tennis.
Ride a stationary bicycle indoors.
Here are some ideas for being more active everyday:
Choose Healthy Food. Good nutrition is a very important part of diabetes
management. People with diabetes should work with their diabetes healthcare team to
develop an eating plan that meets their personal food preferences while keeping blood
glucose in a healthy range. By choosing nutritious foods and balancing what and how
much you eat with activity level, blood sugar levels can be kept as close to normal as
possible. Here are a few tips on making healthy food choices for the entire family. Ea t



lots of vegetables and fruits. Try picking from the rainbow of colors available to add
variety to your meals. Choose more non-starchy vegetables that have lots of vitamins
and minerals such as spinach, carrots, broccoli or green beans with meals.
Choose whole grain foods instead of processed grain products like white bread, white
rice or regular pasta. Try brown rice with your stir-fry or whole wheat spaghetti with
your favorite pasta sauce.
Include fish in your meals two to three times a week and choose lean meats like
chicken and turkey without the skin. To prepare meats and fish with less fat, trim any
visible fat and use low-fat cooking methods such as broiling, grilling, roasting, poaching
or stir-frying.
Include dried beans (like kidney or pinto beans) and lentils in your meals.
Choose low fat dairy products such as milk, yogurt and cheese (1 percent fat or less).
Choose liquid oils such as canola, olive or peanut oil for cooking, instead of solid fats
such as butter, lard and shortening. Remember that all fats are high in calories. If
you're trying to lose weight, cut back on portion sizes of added fats.
Choose fruit that is in-season for dessert you'll get more flavor and pay less too! Try
to cut back on high-calorie dessert and snack foods such as chips, cookies, cakes and
ice cream that give you and your family little nutrition.
Choose water and calorie-free "diet" drinks instead of regular soda, fruit punch, sweet
tea and other sugar-sweetened drinks.
Control your portion sizes. Remember that the amount of food you eat is important in
getting to and staying at a healthy weight. Even eating too much healthy food can lead
to weight gain.



Week 12

Breast cancer is the most common type of cancer among women in the United States.
Cancer is a group of diseases. It occurs when cells become abnormal and divide without
control or order. Every organ in the body is made up of various kinds of cells. Cells
normally divide in an orderly way to produce more cells only when they are needed. This
process helps keep the body healthy.
If cells divide when new cells are not needed, they form too much tissue, called a tumor,
which can be benign or malignant.
Benign tumors are not cancer. They can usually be removed, and in most cases, they
dont come back. Most important, the cells in benign tumors do not invade other
tissues and do not spread to other parts of the body. Benign breast tumors are not a
threat to life.
Malignant tumors are cancer. They can invade and damage nearby tissues and
organs. Also, cancer cells can break away from a malignant tumor and enter the
bloodstream or lymphatic system. That is how breast cancer spreads and forms
secondary tumors in other parts of the body. The spread of the cancer is called
Each breast has 15 to 20 sections, called lobes, that are arranged like the petals of a daisy.
Each lobe has many smaller lobules, which end in dozens of tiny bulbs that can produce
milk. The lobes, lobules and bulbs are all linked with thin tubes called ducts. These ducts
lead to the nipple in the center of a dark area of skin called the areola. Fat fills the spaces
between lobules and ducts. There are no muscles in the breast but muscles lie under each
breast and cover the ribs.
Each breast also contains blood vessels and vessels that carry lymph. The lymph vessels
lead to small bean-shaped organs called lymph nodes. Clusters of lymph nodes are found
under the arm, above the collar bone, and in the chest. Lymph nodes are also found in
many other parts of the body
There are more than a hundred different types of cancer, including several types of breast
cancer. The most common type of breast cancer begins on the lining of the ducts and is
called ductal carcinoma.
When breast cancer spreads outside the breast, cancer cells are often found in the lymph
nodes under the arm. If the cancer has reached these nodes, it may mean that cancer
cells have spread to other parts of the body other lymph nodes and other organs, such as
the bones, liver or lungs.
Cancer that spreads is the same disease and has the same name as the original (primary
cancer). When breast cancer spreads is called metastatic breast cancer, even though the
secondary tumor is in another organ. Doctors may call this problem a distant disease.
When breast cancer is found and treated early a woman has more treatment choices and a
good chance of complete recovery, so it is important to detect breast cancer as early as
possible. The National Cancer Institute encourages women to take an active part in early
detection. They should talk with their doctor about this disease, the symptoms to watch for,



and an appropriate schedule of checkups. The doctors advice will be based on the
womans age, medical history and other factors.
Women should ask the doctor about:
Mammograms (x-ray of the breast)
Breast exams by a doctor or nurse and
Breast self examination (BSE)
A mammogram is a special kind of X- ray that is different from a chest X-ray or X rays of
other part of the body.
Mammography involves two X-rays of each breast one taken from side and one from the
top. The breast must be squeezed between two plates for the picture to be clear. While
this squeezing may be a bit uncomfortable, it lasts only a few seconds. In many cases, it
can show breast tumors before they cause symptoms or can be felt. A mammogram can
also show small deposits of calcium in the breast. A cluster of very tiny specks of calcium
(called microcalcifications) may be an early sign of cancer.
Mammography should be done only by specially trained people using machines designed
just for taking X-rays of the breast. The pictures should be checked by a qualified
radiologist. Women should talk to their doctor or call the cancer information service for help
in finding out where to get a mammogram.
Mammography is an excellent tool, but we know that it can not find every abnormal area in
the breast. So another important step in early detection is for women to have the breast
examined regularly by a doctor or nurse. Between visits to the doctor women should
examine their breasts every month. It is important to remember that every womans
breasts are different. And each womans breasts change because of age, the menstrual
cycle, pregnancy, menopause or taking birth control pills or other hormones. It is normal for
the breasts to feel lumpy and uneven. Also, its common for a womans breasts to be
swollen and tender right before or during her menstrual period.
Early breast cancer usually does not cause pain. In fact, when it first develops, breast
cancer may cause no symptoms at all. But as the cancer grows, it can cause changes that
women should watch for:
A lump or thickening in or near the breast or in the underarm area;
A change in the size or shape of the breast;
A discharge from the nipple; or
A change in the color or feel of the skin of the breast, areola, or nipple (dimpled,
puckered or scaly)
A woman should see her doctor if she notices any of these changes. Most often, they are
not cancer, but only a doctor can tell for sure.
An abnormal area on a mammogram, a lump, or other changes in the breast can be
caused by cancer or by other less serious problems. To find out the cause of any of these
signs or symptoms, a womans doctor does a careful physical exam and asks about her
personal and family medical history. In addition to checking general signs of health, the
doctor may do one or more of the breast exams described below to help make a diagnosis.



Palpation: The doctor can tell a lot about a lump its size, its texture, and whether it
moves easily by palpation, carefully feeling the lump and the tissue around it. Benign
lumps often feel different from cancerous ones.
Mammography: X-rays of the breast can give the doctor important information about a
breast lump. If an area on the mammogram looks suspicious or is not clear, additional
views may be needed.
Ultrasonography: Sometimes the doctor orders ultrasonography which can often show
whether a lump is solid or filled with fluid. This exam uses high frequency sound waves,
which cannot be heard by humans. The sound waves enter the breast and bounce
back. The pattern of their echoes produces a picture called a sonogram, which is
displayed on a screen. This exam is often used along with mammography.
Often, the doctor must remove fluid or tissue from the breast to make a diagnosis
Aspiration or needle biopsy. The doctor uses a needle to remove fluid or a small
amount of tissue from a breast lump. This procedure may show whether the lump is a
fluid filled cyst (not cancer) or a solid mass (which may or may not be cancer). The
material removed in a needle biopsy goes to a lab to be checked for a cancer cells.
Surgical biopsy. The doctor cuts out part or all of a lump or suspicious area. A
pathologist examines the tissue under a microscope to check for cancer cells.
Many treatment methods are used for breast cancer. Treatment depends on the size and
location of the tumor in the breast, the results of lab tests (including hormone receptor
tests) done on the cancer cells, and the stage (or extent) of the disease. Methods of
treatment for breast cancer are local or systemic. Local treatments are used to remove,
destroy or control cancer cells in a specific area. Surgery and radiation therapy are local
treatments. Systemic treatments are used to destroy or control cancer cells all over the
body. Chemotherapy and hormone therapy are systemic treatments. A patient may have
just one form of treatment or a combination, depending on her needs.
Surgery is the most common treatment for breast cancer. An operation to remove the
breast is a mastectomy; an operation to remove the cancer but not the breast is called
breast-sparing surgery which is usually followed by radiation therapy to destroy any cancer
cells that may remain in the area. In radiation therapy (also called radiotherapy), highenergy rays are used to damage cancer cells and stop them from growing. Radiation may
come from a machine outside the body (external radiation). It can also come from
radioactive materials placed directly in the breast in thin plastic tubes (implant radiation).
Chemotherapy is the use of drugs to kill cancer cells. In most cases, breast cancer is
treated with a combination of drugs. The drugs may be given by mouth or by injection into
the vein or muscle.





Week 13

If you have sex, you may also have an STD, with subtle or noticeable STD symptoms.
Straight or gay, married or single, you're vulnerable to STDs and STD symptoms, whether
you engage in oral, anal or vaginal sex. Although condoms are highly effective for reducing
transmission of STDs, keep in mind that no method is foolproof.
STD symptoms aren't always obvious. If you think you have STD symptoms or have been
exposed to an STD, see a doctor. Some STDs can be treated easily and eliminated, but
others require more involved, long-term treatment.
Either way, it's essential to be evaluated, and if diagnosed with an STD, also known as a
sexually transmitted infection (STI) get treated. It's also essential to inform any partners
so that they can be evaluated and treated. If untreated, STDs can increase your risk of
acquiring another STD such as HIV. This happens because an STD can stimulate an
immune response in the genital area or cause sores, either of which might ma ke HIV
transmission more likely. Some untreated STDs can also lead to infertility.
STIs are often asymptomatic
You could have an STI and be asymptomatic without any signs or symptoms. In fact,
this happens with a lot of STIs. Even though you have no symptoms, you're still at risk of
passing the infection along to your sex partners. That's why it's important to use protection,
such as a condom, during sex. And visit your doctor on a regular basis for STI screening,
so you can identify a potential infection and get treated for it before passing it along to
someone else.
Some of the following diseases, such as hepatitis, can be transmitted without sexual
contact. Others, such as gonorrhea, can only be transmitted through sexual contact.
Chlamydia symptoms
Chlamydia is a bacterial infection of your genital tract. Chlamydia may be difficult for you to
detect because early-stage infections often cause few or no signs and symptoms. When
they do occur, they usually start one to three weeks after you've been exposed to
chlamydia. Even when signs and symptoms do occur, they're often mild and passing,
making them easy to overlook. Signs and symptoms may include:
Painful urination
Lower abdominal pain
Vaginal discharge in women
Discharge from the penis in men



Pain during sexual intercourse in women

Testicular pain in men
Gonorrhea symptoms
Gonorrhea is a bacterial infection of your genital tract. The first gonorrhea symptoms
generally appear within two to 10 days after exposure. However, some people may be
infected for months before signs or symptoms occur. Signs and symptoms of gonorrhea
may include:
Thick, cloudy or bloody discharge from the penis or vagina
Pain or burning sensation when urinating
Abnormal menstrual bleeding
Painful, swollen testicles
Painful bowel movements
Anal itching
Trichomoniasis symptoms
Trichomoniasis is a common STI caused by a microscopic, one-celled parasite called
Trichomonas vaginalis. This organism spreads during sexual intercourse with someone
who already has the infection. The organism usually infects the urinary tract in men, but
often causes no symptoms in men. Trichomoniasis typically infects the vagina in women.
When trichomoniasis causes symptoms, they may range from mild irritation to severe
inflammation. Signs and symptoms may include:
Clear, white, greenish or yellowish vaginal discharge
Discharge from the penis
Strong vaginal odor
Vaginal itching or irritation
Itching or irritation inside the penis
Pain during sexual intercourse
Painful urination
HIV symptoms
HIV is an infection with the human immunodeficiency virus. HIV interferes with your body's
ability to effectively fight off viruses, bacteria and fungi that cause disease, and it can lead
to AIDS, a chronic, life-threatening disease.
When first infected with HIV, you may have no symptoms at all. Some people develop a flulike illness, usually two to six weeks after being infected.
Early signs and symptoms
Early HIV signs and symptoms may include:



Sore throat
Swollen lymph glands
These early signs and symptoms usually disappear within a week to a month and are often
mistaken for those of another viral infection. During this period, you are very infectious.
More-persistent or -severe symptoms of HIV infection may not appear for 10 years or more
after the initial infection.
As the virus continues to multiply and destroy immune cells, you may develop mild
infections or chronic signs and symptoms such as:
Swollen lymph nodes often one of the first signs of HIV infection
Weight loss
Cough and shortness of breath
Later stage HIV infection
Signs and symptoms of later stage HIV infection include:
Persistent, unexplained fatigue
Soaking night sweats
Shaking chills or fever higher than 100.4 F (38 C) for several weeks
Swelling of lymph nodes for more than three months
Chronic diarrhea
Persistent headaches
Unusual, opportunistic infections



Week 14


Ebola virus and Marburg virus are related viruses that cause hemorrhagic fevers
illnesses marked by severe bleeding (hemorrhage), organ failure and, in many cases,
death. Both viruses are native to Africa, where sporadic outbreaks have occurred for
Ebola virus and Marburg virus live in animal hosts, and humans can contract the viruses
from infected animals. After the initial transmission, the viruses can spread from person to
person through contact with body fluids or contaminated needles.
No drug has been approved to treat either virus. People diagnosed with Ebola or Marburg
virus receive supportive care and treatment for complications. Scientists are coming closer
to developing vaccines for these deadly diseases.
The Centers for Disease Control and Prevention monitors the United States for conditions
such as Ebola infection, and its labs can test for the Ebola virus. Mayo Clinic does not test
for the Ebola and Marburg viruses.
Signs and symptoms typically begin abruptly within five to 10 days of infection with Ebola or
Marburg virus. Early signs and symptoms include:


Severe headache
Joint and muscle aches


Over time, symptoms become increasingly severe and may include:

Nausea and vomiting
Stomach pain
Diarrhea (may be bloody)
Severe weight loss
Red eyes
Internal bleeding
Raised rash
Chest pain and cough
Bleeding, usually from the eyes, and bruising (people near death may bleed from
other orifices, such as ears, nose and rectum)
Ebola virus has been found in African monkeys, chimps and other nonhuman primates. A
milder strain of Ebola has been discovered in monkeys and pigs in the Philippines. Marburg
virus has been found in monkeys, chimps and fruit bats in Africa.
Transmission from animals to humans
Experts suspect that both viruses are transmitted to humans through an infected animal's
bodily fluids. Examples include:
Blood. Butchering or eating infected animals can spread the viruses. Scientists who
have operated on infected animals as part of their research have also contracted
the virus.



Waste products. Tourists in certain African caves and some underground mine
workers have been infected with the Marburg virus, possibly through contact with
the feces or urine of infected bats.
Transmission from person to person
Infected people typically don't become contagious until they develop symptoms. Family
members are often infected as they care for sick relatives or prepare the dead for burial.
Medical personnel can be infected if they don't use protective gear, such as surgical masks
and gloves. Medical centers in Africa are often so poor that they must reuse needles and
syringes. Some of the worst Ebola epidemics have occurred because contaminated
injection equipment wasn't sterilized between uses.
There's no evidence that Ebola virus or Marburg virus can be spread via insect bites.
Risk factors
For most people, the risk of getting Ebola or Marburg viruses (hemorrhagic fevers) is low.
The risk increases if you:
Travel to Africa. You're at increased risk if you visit or work in areas where Ebola
virus or Marburg virus outbreaks have occurred.
Conduct animal research. People are more likely to contract the Ebola or Marburg
virus if they conduct animal research with monkeys imported from Africa or the
Provide medical or personal care. Family members are often infected as they
care for sick relatives. Medical personnel also can be infected if they don't use
protective gear, such as surgical masks and gloves.
Prepare people for burial. The bodies of people who have died of Ebola or
Marburg hemorrhagic fever are still contagious. Helping prepare these bodies for
burial can increase your risk of developing the disease.
Both Ebola and Marburg hemorrhagic fevers lead to death for a high percentage of people
who are affected. As the illness progresses, it can cause:
Multiple organ failure
Severe bleeding


One reason the viruses are so deadly is that they interfere with the immune system's ability
to mount a defense. But scientists don't understand why some people recover from Ebola
and Marburg and others don't.
For people who survive, recovery is slow. It may take months to regain weight and strength,
and the viruses remain in the body for weeks. People may experience:
Hair loss
Sensory changes
Liver inflammation (hepatitis)


Eye inflammation
Testicular inflammation


Week 15







24/8 AL 29/8
31/08 AL 05/09
07/09 AL 12/09
14/09 AL19/09
28/08 AL 03/10
05/10 AL 10/10
12/10 AL 17/10
19/10 AL24/10
26/10 AL31/10