Borderline Personality Disorder

 Raising questions, finding answers

Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women. There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. Yet, with help, many improve over time and are eventually able to lead productive lives.

Symptoms

While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.
People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.
People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

Treatment

Treatments for BPD have improved in recent years. Group and individual psychotherapy are at least partially effective for many patients. Within the past 15 years, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD, and this technique has looked promising in treatment studies. Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Antipsychotic drugs may also be used when there are distortions in thinking.

Recent Research Findings

Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits. Studies show that many, but not all individuals with BPD report a history of abuse, neglect, or separation as young children. Forty to 71 percent of BPD patients report having been sexually abused, usually by a non-caregiver. Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may result from both harmful environments as well as impulsivity and poor judgement in choosing partners and lifestyles.
NIMH-funded neuroscience research is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion. The amygdala, a small almond-shaped structure deep inside the brain, is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of drugs like alcohol, or stress. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.
Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much like people manage susceptibility to diabetes or high blood pressure.

Future Progress

Studies that translate basic findings about the neural basis of temperament, mood regulation, and cognition into clinically relevant insights which bear directly on BPD represent a growing area of NIMH-supported research. Research is also underway to test the efficacy of combining medications with behavioral treatments like DBT, and gauging the effect of childhood abuse and other stress in BPD on brain hormones. Data from the first prospective, longitudinal study of BPD, which began in the early 1990s, is expected to reveal how treatment affects the course of the illness. It will also pinpoint specific environmental factors and personality traits that predict a more favorable outcome. The Institute is also collaborating with a private foundation to help attract new researchers to develop a better understanding and better treatment for BPD.

Intermittent Explosive Disorder:

Overview

Intermittent explosive disorder is marked by sudden, unpredictable acts of violent, aggressive behavior in otherwise normal persons. The reaction is out of proportion to the event that triggers or provokes the outburst.

What is going on in the body?

The exact cause of intermittent explosive disorder is not known. Some evidence suggests there may be a link between this disorder and mild neurological problems similar to those associated with some learning disabilities.

What are the signs and symptoms of the condition?

A person who has intermittent explosive disorder:

• destroys property

• has repeated acts of sudden verbal or physical aggression

• is unable to stop or control the impulsive, aggressive actions

A person who has this disorder is not violent or aggressive most of the time. The outbreaks of severe rage and anger are usually isolated. The amount of aggression is out of proportion with the incident that triggered the outburst.

What are the causes and risks of the condition?

The cause of intermittent explosive disorder is not known. It may be caused by an abnormality in the nervous system. Things that increase a person's risk for the disorder include: a caregiver who is antisocialchild abuse and neglectconflict with a spouse or significant otherparents who abuse drugs or alcohollower socioeconomic statusparents who are not consistent in their availability or disciplinepsychiatric illness

How is the condition diagnosed?

To be diagnosed with this disorder, an individual must have had at least three episodes in his or her life where he or she lost control and committed an act of destruction, completely out of proportion to any provocation that may have occurred. Evaluation of intermittent explosive disorder begins with a medical history and physical exam. A complete psychological evaluation should be done to rule out another medical or mental disorder.

What are the long-term effects of the condition?

Someone who has intermittent explosive disorder may have social or legal problems as a result of the aggressive behavior. The behavior may also cause problems at home or school.

What are the risks to others?

Intermittent explosive disorder is not contagious.

What are the treatments for the condition?

A combination of medication and psychological treatment is generally used to treat this disorder. A wide variety of medications have been used, including antidepressants such as fluoxetine (i.e., Prozac, Sarafem), antipsychotics, anti-anxiety agents, and anticonvulsants such as phenytoin (i.e., Dilantin). Psychotherapy with a focus on awareness of appropriate limits in social settings is often helpful.

What are the side effects of the treatments?

Side effects of medicines vary. They may include allergic reactions and drowsiness.

What happens after treatment for the condition?

With effective treatment, the person can live a normal life.

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare professional. 

 

If you or anyone you know have these issues, seek help immediately. 

http://www.minddisorders.com/Flu-Inv/Intermittent-explosive-disorder.html

 

 

 

 

 

Stay safe in the sun:

Prevention

Protection from sun exposure is important all year round, not just during the summer or at the beach. Ultraviolet (UV) rays can reach you on cloudy and hazy days, as well as bright and sunny days. UV rays also reflect off of surfaces like water, cement, sand, and snow.
The hours between 10 a.m. and 4 p.m. daylight savings time (9 a.m. to 3 p.m. standard time) are the most hazardous for UV exposure in the continental United States. UV rays are the greatest during the late spring and early summer in North America.
CDC recommends easy options for sun protection

• Use sunscreen with sun protective factor (SPF) 15 or higher, and both UVA and UVB protection.
• Wear clothing to protect exposed skin.
• Wear a hat with a wide brim to shade the face, head, ears, and neck.
• Wear sunglasses that wrap around and block as close to 100% of both UVA and UVB rays as possible.
• Seek shade, especially during midday hours.

Sunscreen

The sun's UV rays can damage your skin in as little as 15 minutes. Put on sunscreen before you go outside, even on slightly cloudy or cool days. Don't forget to put a thick layer on all parts of exposed skin. Get help for hard-to-reach places like your back.
How sunscreen works. Most sun protection products work by absorbing, reflecting, or scattering sunlight. They contain chemicals that interact with the skin to protect it from UV rays. All products do not have the same ingredients; if your skin reacts badly to one product, try another one or call a doctor.
SPF. Sunscreens are assigned a sun protection factor (SPF) number that rates their effectiveness in blocking UV rays. Higher numbers indicate more protection. You should use a sunscreen with at least SPF 15.
Reapplication. Sunscreen wears off. Put it on again if you stay out in the sun for more than two hours, and after you swim or do things that make you sweat.
Expiration date. Check the sunscreen's expiration date. Sunscreen without an expiration date has a shelf life of no more than three years, but its shelf life is shorter if it has been exposed to high temperatures.
Cosmetics. Some make-up and lip balms contain some of the same chemicals used in sunscreens. If they do not have at least SPF 15, don't use them by themselves.

Clothing

Loose-fitting long-sleeved shirts and long pants made from tightly woven fabric offer the best protection from the sun's UV rays. A wet T-shirt offers much less UV protection than a dry one. Darker colors may offer more protection than lighter colors.
If wearing this type of clothing isn't practical, at least try to wear a T-shirt or a beach cover-up. Keep in mind that a typical T-shirt has an SPF rating lower than 15, so use other types of protection as well.

Hats

For the most protection, wear a hat with a brim all the way around that shades your face, ears, and the back of your neck. A tightly woven fabric, such as canvas, works best to protect your skin from UV rays. Avoid straw hats with holes that let sunlight through. A darker hat may offer more UV protection.
If you wear a baseball cap, you should also protect your ears and the back of your neck by wearing clothing that covers those areas, using sunscreen with at least SPF 15, or by staying in the shade.

Sunglasses

Sunglasses protect your eyes from UV rays and reduce the risk of cataracts. They also protect the tender skin around your eyes from sun exposure.
Sunglasses that block both UVA and UVB rays offer the best protection. Most sunglasses sold in the United States, regardless of cost, meet this standard. Wrap-around sunglasses work best because they block UV rays from sneaking in from the side.

Shade

You can reduce your risk of skin damage and skin cancer by seeking shade under an umbrella, tree, or other shelter before you need relief from the sun. Your best bet to protect your skin is to use sunscreen or wear protective clothing when you're outside—even when you're in the shade.

For more information: http://www.medicinenet.com/sun_protection_and_sunscreens/article.htm 

Crohns: What is it and how do you treat it?

Recently, while working in a nursing home, was I presented with a patient with a diagnosis of Crohns.

While there is no cure for Crohn's Disease, treatment options available vary due to the complex nature and life-altering symptoms of the disorder.
This disease covers inflammation of the gastrointestinal tract from the mouth on down, several combinations might be needed to control the varying side effects, which include diarrhea, abdominal pain, vomiting, weight loss, and possibly arthritis, skin rashes, inflammation of the eye and fatigue.
Depending on the severity and combination of the symptoms, where the disease is located in the tract, or whether Crohn's is in remission, treatment options can range from simple diet changes to surgery.
With the direction of your physician or a specialist, several treatment options might be needed to keep Crohn's under control.

 

Medication

Physicians often prescribe anti-inflammatory drugs as the first course of treatment for Crohn's, but many have a number of side effects ranging from nausea to insomnia. Included in the list of drugs are Sulfasalazine, Mesalamine and Corticosteroids, depending on the severity of the symptoms. Other medications include immune system suppressors, antibiotics, over-the-counter pain relievers, anti-diarrheal medicine. and laxatives, and vitamin and mineral supplements. Antibiotics are used to heal fistulas and abscesses to hopefully avoid surgery. As with any medication, report any and all side-effects to your doctor.

Diet

Nutrition is important with Crohn's because the disease generally decreases appetite but the body needs more caloric intake, as is normal with any chronic illness. Proper hydration and diet also play a large factor in controlling symptoms as the disease affects the digestive tract. Physicians might suggest eating smaller meals in lieu of larger ones to help with diminished appetite or prevent unnecessary inflammation. Especially during inflammations, blander foods are recommended instead of spicy foods because they are gentler on the digestive tract. Some patients might be directed to follow a low dietary fiber diet or keep a "food diary" to identify triggering foods, while others will be instructed to avoid lactose-based foods like milk or cheese. In some cases, a doctor might recommend a feeding tube or nutrition to be administered via an IV. This allows the bowel to rest, but when normal eating resumes symptoms could immediately return.

Lifestyle

Diet, proper exercise and regular sleep patterns can also help control the fatigue regularly associated with Crohn's. Cigarette smoking has been linked to Crohn's, so if you are a smoker, quitting greatly reduces the symptoms of the disease, as well as other health risks.

Surgery

As with any other disease, surgery is generally a last-choice option should other forms of therapy inadequately treat Crohn's. Again, since there is no cure for Crohn's, the ultimate goal of surgery is to provide, hopefully, a few years of remission. However, the Mayo Clinic estimates that about 75 percent of all Crohn's patients will need some type of surgery in their lives. A common procedure is bowel resection. That is when a surgeon removes damaged sections of the intestine and reconnects the ends of healthy tissue. Surgery can also be used to remove scar tissue, close fistulas or drain abscesses. Another surgery is strictureplasty where a surgeon widens a narrowed section of the bowel to allow regular flow without further shortening the intestines. Unfortunately, Crohn's generally returns to other areas of the intestine so surgery is only a temporary fix. About half of patients will need a second surgery or more, according to the Mayo Clinic.

Some helpful web resources:

Living with Crohn's disease: Practical strategies

Water Safety:

When the weather turns warm, everyone wants to be in or around the water. Hanging out at the pool or the beach on a hot day is a great way to beat the heat.

Between having fun and checking out the lifeguards, most people don't think much about water safety — but they should. For people between the ages of 5 and 24, drowning is the second leading cause of accidental death.

It doesn't have to be that way, though. Most water-related accidents can be avoided by knowing how to stay safe and following a few simple guidelines.
Swimming Smarts

"Buddy up!"
That's what swimming instructors say. Always swim with a partner, every time — whether you're swimming in a backyard pool or in a lake. Even experienced swimmers can become tired or get muscle cramps, which might make it difficult to get out of the water. When people swim together, they can help each other or go for help in case of an emergency.

Get skilled. Speaking of emergencies, it's good to be prepared. Learning some life-saving skills, such as CPR and rescue techniques, can help you save a life. If you live in DFW area we can help. Go to www.MalecHealthEducation.com for more information. A number of other organizations offer free and low fee classes for both beginning and experienced swimmers and boaters. Check with your YMCA or YWCA, local hospital, or chapter of the Red Cross.


Know your limits
  Swimming can be a lot of fun — and you might want to stay in the water as long as possible. If you're not a good swimmer or you're just learning to swim, don't go in water that's so deep you can't touch the bottom and don't try to keep up with skilled swimmers. That can be hard, especially when your friends are challenging you — but it's a pretty sure bet they'd rather have you safe and alive.

If you are a good swimmer and have had lessons, keep an eye on friends who aren't as comfortable or as skilled as you are. If it seems like they (or you) are getting tired or a little uneasy, suggest that you take a break from swimming for a while.

Swim in safe areas only. It's a good idea to swim only in places that are supervised by a lifeguard. No one can anticipate changing ocean currents, riptides, sudden storms, or other hidden dangers. In the event that something does go wrong, lifeguards are trained in rescue techniques.

Swimming in an open body of water (like a river, lake, or ocean) is different from swimming in a pool. You need more energy to handle the currents and other conditions in the open water.

If you do find yourself caught in a current, don't panic and don't fight the current. Swim with the current, gradually trying to make your way back to shore as you do so. Even a very good swimmer who tries to swim against a strong current will get worn out. If you're going to be swimming in an open body of water, it's a great idea to take swimming lessons that provide you with tips on handling unexpected hazards.

Some areas with extremely strong currents are off limits when it comes to swimming. Do your research so you know where not to swim.Be careful about diving. Diving injuries can cause permanent spinal cord damage, paralysis, and sometimes even death. Protect yourself by only diving in areas that are known to be safe, such as the deep end of a supervised pool. If an area is posted with "No Diving" or "No Swimming" signs, pay attention to them. A "No Diving" sign means the water isn't safe for a head-first entry. Even if you plan to jump in feet first, check the water's depth before you leap to make sure there are no hidden rocks or other hazards. Lakes or rivers can be cloudy and hazards may be hard to see.

Watch the sun
Sun reflecting off the water or off sand can intensify the burning rays. You might not feel sunburned when the water feels cool and refreshing, but the pain will catch up with you later — so remember to reapply sunscreen frequently and cover up much of the time.

Drink plenty of fluids
It's easy to get dehydrated in the sun, particularly if you're active and sweating. Keep up with fluids — particularly water — to prevent dehydration. Dizziness, feeling lightheaded, or nausea can be signs of dehydration and overheating.

Getting too cool
Speaking of temperature, it's possible to get too cool. How? Staying in very cool water for long periods can lower your body temperature. A temperature of 70° Fahrenheit (20° Celsius) is positively balmy on land, but did you know that water below 70° Fahrenheit will feel cold to most swimmers? Your body temperature drops far more quickly in water than it does on land. And if you're swimming, you're using energy and losing body heat even faster than if you were keeping still. Monitor yourself when swimming in cold water and stay close to shore. If feel your body start to shiver or your muscles cramp up, get out of the water quickly; it doesn't take long for hypothermia to set in.

Alcohol and water never mix
Alcohol is involved in numerous water-related injuries and up to half of all water-related deaths. The statistics for teenage guys are particularly scary: One half of all adolescent male drownings are tied to alcohol use.At the Water Park

OK, so you do more splashing than swimming, but it's just as important to know your skill level at the water park as it is at the pool. Take a moment to read warnings and other signs. And make sure you do slide runs feet first or you'll put yourself at risk for a ride that's a lot less fun — one to your doctor or dentist.
Boating Safety

More people die in boating accidents every year than in airplane crashes or train wrecks, but a little common sense can make boating both enjoyable and safe. If you are going to go boating, make sure the captain or person handling the boat is experienced and competent.

Alcohol and water still don't mix
One third of boating deaths are alcohol related. Alcohol distorts a person's judgment no matter where they are — but that distortion is even greater on the water. The U.S. Coast Guard warns people about a condition called boater's fatigue, which means that the wind, noise, heat, and vibration of the boat all combine to wear you down when you're on the water.

Because there are no road signs or lane markers on the water and the weather can be unpredictable, it's important to be able to think quickly and react well under pressure. If you're drinking, this can be almost impossible.

Personal flotation devices
It's always a good idea for everyone on the boat to wear a Coast Guard-approved life jacket, whether the boat is a large speedboat or a canoe — and whether you're a good swimmer or not. Wearing a life jacket (also known as a personal flotation device, or PFD) is the law in some states for certain age groups, and you could face a stiff penalty for breaking it. Your state may also require that you wear an approved life jacket for water skiing and other on-water activities. Wearing a PFD is like wearing a helmet while biking. It may take a few minutes to get used to it, but it definitely can be a lifesaver. Don't leave land without it.

Stay in touch
Before going out on a boat, let somebody on land know where you are going and about how long you'll be out. That way, if you do get into trouble, someone will have an idea of where to look for you. If you're going to be on the water for a long time, it's a good idea to have a radio with you so you can check the weather reports. Water conducts electricity, so if you hear a storm warning, get off the water as quickly as you can.

Jet skis
If you're using jet skis or personal watercraft, follow the same rules as you do for boating. You should also check out the laws in your area governing the use of personal watercraft. Some states won't allow people under a certain age to operate these devices; others require you to take a course or pass a test before you can ride one.

Now Have Fun! Be Safe!!

The pool and the beach are great places to learn new skills, socialize, and check out everyone's new bathing suit. So don't let paying attention to safety turn you off. Being prepared will make you feel more comfortable and in charge.

For more information go to National Drowning Prevention Alliance.

What You Can Do To Keep Yourself and Others Safe from Unintentional Poisoning:

* Follow directions on labels when you give or take medicines. Some medicines cannot be taken safely with other medications or with alcohol.
* To avoid drug interactions, check with your doctor if you are taking more than one prescription medication at a time.
* Keep medicines in their original bottles or containers.
* Never share or sell your prescription drugs to others, including family members.
* Keep all pain medications, such as methadone, hydrocodone, and oxycodone, in a safe place only reachable by people for whom use is prescribed.
* Monitor the use of medicines for children and teenagers, such as medicines for attention deficit disorder, or ADD, and cold and cough medications.
* Follow federal guidelines for disposal of unused, unneeded, or expired prescription drugs.

To protect children from poisoning:

* Keep medicines and toxic products, such as cleaning solutions, in locked or childproof cabinets.
* Put the nationwide poison control center phone number, 1-800-222-1222, on or near every telephone in your home. You should also program it into your cellular phone. Call poison control if you think a child has been poisoned and if they are awake and alert. Call 911 if you have a poison emergency and your child has collapsed or is not breathing.
* Follow label directions and read all warnings when giving medicines to children.
* Always secure the child safety cap and put medicine away immediately after you use it.

June is National Safety Month:

What You Should Know

* In 2006, a total of 27,531 people in the United States died from unintentional poisoning.
* In 2008, more than 2,000 people a day— a total of 732,316— were seen in emergency departments after a poisoning incident.
* Unintentional poisoning deaths are on the rise. Poisoning death rates in the United States increased by 63% from 1999 to 2004.
* 96% of unintentional poisoning deaths are a result of drug poisoning—and more than half of them are due to prescription drugs.
* An estimated 71,000 children (18 years old and younger) are seen in emergency departments each year because of medication poisonings (excluding recreational drug use). Over 80% were because an unsupervised child found and consumed

Glucosamine: What is it?

I have suffered from knee pain for years. This could be attributed to congenital or developmental defects (never developed the full amount of cartilage in my knees) or the years of serving in the infantry or even football and martial arts. Whatever the reason for the pain, I wanted relief. I found that glucosamine alleviates these pains. But why??

Glucosamine is a natural compound that is found in healthy cartilage. Glucosamine sulfate is a normal constituent of glycoaminoglycans in cartilage matrix and synovial fluid.
Available evidence from randomized controlled trials supports the use of glucosamine sulfate in the treatment of osteoarthritis, particularly of the knee. It is believed that the sulfate moiety provides clinical benefit in the synovial fluid by strengthening cartilage and aiding glycosaminoglycan synthesis. If this hypothesis is confirmed, it would mean that only the glucosamine sulfate form is effective and non-sulfated glucosamine forms are not effective.
Glucosamine is commonly taken in combination with chondroitin, a glycosaminoglycan derived from articular cartilage. Use of complementary therapies, including glucosamine, is common in patients with osteoarthritis, and may allow for reduced doses of non-steroidal anti-inflammatory agents.

Synonyms

2-acetamido-2-deoxyglucose, acetylglucosamine, Arth-X Plus®, chitosamine, ChitoSeal, Clo-Sur PAD, D-glucosamine, disease modifying drugs for osteoarthritis (DMOAD), enhanced glucosamine sulfate, Flexi-Factors®, glucosamine chlorohydrate, Glucosamine Complex®, glucosamine hydrochloride, glucosamine hydroiodide, Glucosamine Mega®, glucosamine N-Acetyl, glucosamine sulfate, glucosamine sulphate, Joint Factors®, N-acetyl D-glucosamine (NAG, N-A-G), Nutri-Joint®, poly-N-acetyl glucosamine (pGlcNAc), Poly-NAG, Syvek Patch, Ultra Maximum Strength Glucosamine Sulfate®.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Knee osteoarthritis (mild-to-moderate)

Based on human research, there is good evidence to support the use of glucosamine sulfate in the treatment of mild-to-moderate knee osteoarthritis. Most studies have used glucosamine sulfate supplied by one European manufacturer (Rotta Research Laboratorium), and it is not known if glucosamine preparations made by other manufacturers are equally effective. Although some studies of glucosamine have not found benefits, these have either included patients with severe osteoarthritis or used products other than glucosamine sulfate . The evidence for the effect of glycosaminoglycan polysulphate is conflicting and merits further investigation. More well-designed clinical trials are needed to confirm safety and effectiveness, and to test different formulations of glucosamine.

Osteoarthritis (general)

Several human studies and animal experiments report benefits of glucosamine in treating osteoarthritis of various joints of the body, although the evidence is less plentiful than that for knee osteoarthritis. Some of these benefits include pain relief, possibly due to an anti-inflammatory effect of glucosamine, and improved joint function. Overall, these studies have not been well designed. Although there is some promising research, more study is needed in this area before a firm conclusion can be made.

Chronic venous insufficiency

"Chronic venous insufficiency" is a syndrome that includes leg swelling, varicose veins, pain, itching, skin changes, and skin ulcers. The term is more commonly used in Europe than in the United States. Currently, there is not enough reliable scientific evidence to recommend glucosamine in the treatment of this condition.

Diabetes (and related conditions)

Early research suggests that glucosamine does not improve blood sugar control, lipid levels, or apolipoprotein levels in diabetics. Additional research is needed in this area.

Diabetes (and related conditions)

Early research suggests that glucosamine does not improve blood sugar control, lipid levels, or apolipoprotein levels in diabetics. Additional research is needed in this area.

Inflammatory bowel disease (Crohn's disease, ulcerative colitis)

Preliminary research reports improvements with N-acetyl glucosamine as an added therapy in inflammatory bowel disease. Further scientific evidence is necessary before a strong recommendation can be made.

Inflammatory bowel disease (Crohn's disease, ulcerative colitis)

Preliminary research reports improvements with N-acetyl glucosamine as an added therapy in inflammatory bowel disease. Further scientific evidence is necessary before a strong recommendation can be made.

Inflammatory bowel disease (Crohn's disease, ulcerative colitis)

Preliminary research reports improvements with N-acetyl glucosamine as an added therapy in inflammatory bowel disease. Further scientific evidence is necessary before a strong recommendation can be made.

Pain (leg pain)

Preliminary human research reports benefits of injected glucosamine plus chondroitin in the treatment of leg pain arising from advanced lumbar degenerative disc disease. Further scientific evidence is necessary before a firm recommendation can be made.

 Rehabilitation (after knee injury)

Glucosamine has been given to athletes with acute knee injuries. Although glucosamine did not improve pain, it did help improve flexibility. Additional research is needed to confirm these early findings.

 Rheumatoid arthritis

Early human research reports benefits of glucosamine in the treatment of joint pain and swelling in rheumatoid arthritis. In other research, glucosamine did not exert anti-rheumatic effects, but it did improve symptoms of the disease. However, this is early information, and additional research is needed before a conclusion can be drawn. The treatment of rheumatoid arthritis can be complicated, and a qualified healthcare provider should follow patients with this disease.

Temporomandibular joint (TMJ) disorders

There is a lack of sufficient evidence to recommend for or against the use of glucosamine (or the combination of glucosamine and chondroitin) in the treatment of temporomandibular joint disorders.

High cholesterol

Glucosamine does not appear to alter LDL or HDL levels in patients with chronic joint pain or diabetes.

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

AIDS, athletic injuries, back pain, bleeding esophageal varices (blood vessels in the esophagus), cancer, congestive heart failure, depression, fibromyalgia, kidney stones, migraine headache, immunosuppression, osteoporosis, pain, psoriasis, skin rejuvenation, spondylosis deformans (growth of bony spurs on the spine), topical hypopigmenting agent (combination product containing multiple ingredients), wound healing.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)
In most available studies, 500 milligrams of glucosamine sulfate has been taken by mouth as tablets or capsules three times daily for 30 to 90 days. Once daily dosing as 1.5 grams (1,500 milligrams) has also been used. Limited research has used 1,500 milligrams daily as a crystalline powder for oral solution or 500 milligrams of glucosamine hydrochloride three times daily. Dosing of 20 milligrams per kilogram of body weight daily has also been recommended in some publications. One study used a dose of 2,000 milligrams per day for 12 weeks.
Another kind of glucosamine that has been used is a topical form in combination with chondroitin for a four-week period. Safety and effectiveness of these formulations are not clearly proven.
Glucosamine hydrochloride provides more glucosamine than glucosamine sulfate, although this difference likely does not matter when products are prepared to provide a total of 500 milligrams of glucosamine per tablet.
Children (younger than 18 years)
There is not enough scientific evidence to recommend the use of glucosamine in children.
Research in children has shown that there could be a relationship between the ingestion of MSM (methylsulfonylmethane) and autism; whether it is beneficial or harmful is unclear. MSM is often marketed with glucosamine as a dietary supplement and at this time should be avoided in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies
Since glucosamine can be made from the shells of shrimp, crab, and other shellfish, people with shellfish allergy or iodine hypersensitivity may have an allergic reaction to glucosamine products. However, some research suggests that there is not enough shrimp allergen in glucosamine supplements to trigger reactions in patients who are allergic to shrimp. Nevertheless, caution is warranted. A serious hypersensitivity reaction including throat swelling has been reported with glucosamine sulfate. There are reported cases suggesting a link between glucosamine/chondroitin products and asthma exacerbations.
Side Effects and Warnings
In most human studies, glucosamine sulfate has been well tolerated for 30 to 90 days.
Side effects may include upset stomach, drowsiness, insomnia, headache, skin reactions, sun sensitivity, and nail toughening. There are rare reports of abdominal pain, loss of appetite, vomiting, nausea, flatulence (gas), constipation, heartburn, and diarrhea. Based on several human cases, temporary increases in blood pressure and heart rate, as well as palpitations, may occur with glucosamine/chondroitin products. Based on animal research, glucosamine theoretically may increase the risk for eye cataract formation.
It remains unclear if glucosamine alters blood sugar levels. Several human studies suggest that glucosamine taken by mouth has no effects on blood sugar, while other research reports mixed effects on insulin. When glucosamine is injected, it appears to cause insulin resistance and endothelial dysfunction. Preliminary studies show no effect on mean hemoglobin A1c concentrations in patients with type 2 diabetes mellitus. Caution is advised in patients with diabetes or hypoglycemia and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider and medication adjustments may be necessary.
In theory glucosamine may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.
In several human cases, abnormally high amounts of protein were found in the urine of patients receiving glucosamine/chondroitin products. The clinical meaning of this is unclear. Glucosamine is removed from the body mainly in the urine, and elimination of glucosamine from the body is delayed in people with reduced kidney function. Acute interstitial nephritis, a condition that causes the kidneys to become swollen and possibly dysfunctional, has been reported in a patient taking glucosamine. Increased blood levels of creatine phosphokinase may occur with glucosamine/chondroitin, which may be due to impurities in some products. This may alter certain laboratory tests measured by healthcare providers.
Early data suggest that glucosamine may modulate the immune system, although the clinical relevance of this is not clear.
One patient developed liver inflammation (acute cholestatic hepatitis) after taking glucosamine forte.
Pregnancy and Breastfeeding
Glucosamine is not recommended during pregnancy or breastfeeding due to lack of scientific evidence.

Selected references

1. Albert SG, Oiknine RF, Parseghian S, et al. The effect of glucosamine on Serum HDL cholesterol and apolipoprotein AI levels in people with diabetes. Diabetes Care 2007 Nov;30(11):2800-3.
2. Audimoolam VK, Bhandari S. Acute interstitial nephritis induced by glucosamine. Nephrol Dial Transplant 2006 Jul;21(7):2031.
3. Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis. N Engl J Med 2006 Feb 23;354(8):795-808.
4. Dudek A, Raczkiewicz-Papierska A, T?ustochowicz W. [Efficacy of glucosamine sulfate treatment in patients with osteoarthritis] Pol Merkur Lekarski 2007 Mar;22(129):204-7.
5. Herrero-Beaumont G, Ivorra JA, Del Carmen Trabado M, et al. Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: a randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator. Arthritis Rheum 2007 Feb;56(2):555-67.
6. Mehta K, Gala J, Bhasale S, et al. Comparison of glucosamine sulfate and a polyherbal supplement for the relief of osteoarthritis of the knee: a randomized controlled trial [ISRCTN25438351]. BMC Complement Altern Med 2007 Oct 31;7:34.
7. Miller MR, Mathews RS, Reeves KD. Treatment of painful advanced internal lumbar disc derangement with intradiscal injection of hypertonic dextrose. Pain Physician 2006 Apr;9(2):115-21.
8. Muniyappa R, Karne RJ, Hall G, et al. Oral glucosamine for 6 weeks at standard doses does not cause or worsen insulin resistance or endothelial dysfunction in lean or obese subjects. Diabetes 2006 Nov;55(11):3142-50.
9. Nakamura H, Masuko K, Yudoh K, et al. Effects of glucosamine administration on patients with rheumatoid arthritis. Rheumatol Int 2007 Jan;27(3):213-8.
10. Ossendza RA, Grandval P, Chinoune F, et al. [Acute cholestatic hepatitis due to glucosamine forte]. Gastroenterol Clin Biol 2007 Apr;31(4):449-50
11. Østergaard K, Hviid T, Hyllested-Winge JL. [The effect of glucosamine sulphate on the blood levels of cholesterol or triglycerides--a clinical study]. Ugeskr Laeger 2007 Jan 29;169(5):407-10.
12. Ostojic SM, Arsic M, Prodanovic S, et al. Glucosamine administration in athletes: effects on recovery of acute knee injury.Res Sports Med 2007 Apr-Jun;15(2):113-24.
13. Theodosakis J. A randomized, double blind, placebo controlled trial of a topical cream containing glucosamine sulfate, chondroitin sulfate, and camphor for osteoarthritis of the knee. J Rheumatol 2004;31(4):826-827.
14. Thie NM, Prasad NG, Major PW. Evaluation of glucosamine sulfate compared to ibuprofen for the treatment of temporomandibular joint osteoarthritis: a randomized double blind controlled 3 month clinical trial. J Rheumatol 2001;28(6):1347-1355.
15. Villacis J, Rice TR, Bucci LR, et al. Do shrimp-allergic individuals tolerate shrimp-derived glucosamine? Clin Exp Allergy 2006 Nov;36(11):1457-61.

Knee Pain:

A Baker's cyst is a fluid-filled cyst that causes a bulge and a feeling of tightness behind your knee. The pain can get worse when you fully flex or extend your knee or when you're active. A Baker's cyst, also called a popliteal cyst, is usually the result of a problem with your knee joint, such as arthritis or a cartilage tear. Both conditions can cause your knee to produce too much fluid, which can lead to a Baker's cyst.

Symptoms

Although a Baker's cyst may cause swelling and make you uncomfortable, treating the probable underlying problem usually provides relief.

In some cases, a Baker's cyst causes no pain, and you may not even notice it. If you do experience signs and symptoms, you may notice:

§                                 Swelling behind your knee, and sometimes in your leg

§                                 Knee pain

§                                 Stiffness

§                                 Texture similar to a balloon filled with water

When to see a doctor
If you're experiencing pain and swelling behind your knee, see your doctor to determine the cause. Though unlikely, a bulge behind your knee may be a sign of a more serious condition, such as a tumor or a popliteal artery aneurysm, rather than a fluid-filled cyst.

Causes

CLICK TO ENLARGE

The cartilage and tendons in your knee rely on a lubricating fluid called synovial (si-NO-vee-ul) fluid. This fluid helps your leg swing smoothly and reduces friction between the moving parts of your knee.

Synovial fluid circulates throughout your knee and passes in and out of various tissue pouches (bursae) throughout your knee. A valve-like system exists between your knee joint and the bursa on the back of your knee (popliteal bursa). This regulates the amount of synovial fluid going in and out of the bursa.

But sometimes the knee produces too much synovial fluid, resulting in buildup of fluid in the bursa and what is called a Baker's cyst. This can be caused by:

§                                 Inflammation of the knee joint, such as occurs with various types of arthritis

§                                 Knee injury, such as a cartilage tear

Complications

Rarely, a Baker's cyst bursts and synovial fluid leaks into the calf region causing:

§                                 Sharp pain in your knee

§                                 Swelling

§                                 Sometimes, redness of your calf or a feeling of water running down your calf

These signs and symptoms closely resemble those of a blood clot in a vein in your leg. If you have swelling and redness of your calf, you'll need prompt medical evaluation.

Preparing for your appointment

You're likely to first see your family doctor or a general practitioner. However, you may then be referred to a doctor who specializes in disorders affecting the bones, joints and muscles (an orthopedist or orthopedic surgeon, rheumatologist, or physical medicine and rehabilitation specialist).

Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to arrive well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

§                                 Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

§                                 Write down key personal information, including recent life changes.

§                                 Make a list of all medications, vitamins and supplements that you're taking.

§                                 Write down questions to ask your doctor.

Your time with your doctor may be limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For a Baker's cyst, some basic questions to ask your doctor include:

§                                 What caused this cyst to develop?

§                                 What kinds of tests do I need? Do these tests require any special preparation?

§                                 Is a Baker's cyst temporary or long lasting?

§                                 What treatments are available, and which do you recommend?

§                                 What types of side effects can I expect from treatment?

§                                 What steps can I take on my own that might help?

§                                 Do I need to limit my activity? If so, how much? And, for how long?

§                                 I have another health condition. How can I best manage these conditions together?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment anytime you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:

§                                 When did you first begin experiencing symptoms?

§                                 Do you feel pain or stiffness all the time, or does the pain come and go with activity?

§                                 Does your knee swell, feel unstable or lock?

§                                 How severe are your symptoms?

§                                 Does anything seem to improve your symptoms?

§                                 What, if anything, appears to worsen your symptoms?

What you can do in the meantime
If the cyst isn't causing you pain, you may not need to do anything prior to seeing your doctor. However, if the cyst is causing symptoms, such as pain and stiffness, taking the following steps may help:

§                                 Use a cold pack or ice wrapped in a protective covering to ice the affected area when it's bothering you.

§                                 Rest your affected knee and keep the leg elevated whenever possible.

§                                 Take an over-the-counter pain-relieving medication to ease your symptoms. Nonsteroidal anti-inflammatory medications (NSAIDs) — such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others) — can reduce pain and inflammation, while acetaminophen (Tylenol, others) can ease pain.

§                                 Use a knee sleeve or brace for compression.

Tests and diagnosis

A Baker's cyst can often be diagnosed with a physical exam. However, because some of the signs and symptoms of a Baker's cyst mimic those of more serious conditions, such as a blood clot or tumor, your doctor may order noninvasive imagine tests, including:

§                                 Ultrasound

§                                 Magnetic resonance imaging (MRI)

Treatments and drugs

Many times, no treatment is required and a Baker's cyst will disappear on its own.

If the cyst is very large and causes a lot of pain, your doctor may use the following treatments:

§                                 Physical therapy. Icing, a compression wrap and crutches may help reduce pain and swelling. Gentle range-of-motion and strengthening exercises for the muscles around your knee also may help to reduce your symptoms and preserve knee function.

§                                 Fluid drainage. Your doctor may drain the fluid from the knee joint using a needle. This is called needle aspiration and is often performed under ultrasound guidance.

§                                 Medication. Your doctor may inject a corticosteroid medication, such as cortisone, into your knee to reduce inflammation. This may relieve pain, but it doesn't always prevent recurrence of the cyst.

Typically though, doctors treat the underlying cause rather than the Baker's cyst itself.

If your doctor determines that a cartilage tear is causing the overproduction of synovial fluid, he or she may recommend surgery to remove or repair the torn cartilage.

In some instances, particularly if you have osteoarthritis, the cyst may not go away even after your doctor treats the underlying cause. If the cyst doesn't get better, causes pain and interferes with your ability to bend your knee, or if — in spite of aspirations — fluid in the cyst recurs and hinders knee function, you may need to be evaluated for surgery to remove the cyst.

Lifestyle and home remedies

If your doctor determines that arthritis is causing the cyst, he or she may advise you to take some or all of the following steps to reduce the inflammation and lessen the production of synovial fluid:

§                                 Follow the P.R.I.C.E. principles. These letters stand for protection, rest, ice, compression and elevation. Protect your leg by using crutches to take the weight off the knee joint and to allow pain-free walking. Rest your leg. Ice the inflamed area. Compress your knee with a wrap, sleeve or brace. And elevate your leg when possible, especially at night.

§                                 Try nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. NSAIDs, such as aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve, others) and similar drugs, can help relieve pain, as can acetaminophen (Tylenol, others). Prescription NSAIDs can provide higher doses and greater potency than over-the-counter NSAIDs.

§                                 Scale back your physical activity. Doing so will reduce irritation of your knee joint. Your doctor can offer you guidance on how long you need to reduce your activity levels, and may be able to suggest alternative forms of exercise you can do in the meantime.