Lung Transplantation

A lung transplant removes a person's diseased lung and replaces it with a healthy one. The healthy lung comes from a donor who has died. Some people get one lung during a transplant. Other people get two.

Lung transplants are used for people who are likely to die from lung disease within 1 to 2 years. Their conditions are so severe that other treatments, such as medicines or breathing devices, no longer work. Lung transplants most often are used to treat people who have severe:

• COPD
• Cystic fibrosis
• Idiopathic pulmonary fibrosis
• Alpha-1 antitrypsin deficiency
• Pulmonary hypertension

Complications of lung transplantation include rejection of the transplanted lung and infection.

NIH: National Heart, Lung, and Blood Institute

Lupus

What is lupus?

Lupus is a chronic (long-lasting) type of autoimmune disease.Autoimmune diseases happen when your immune system attacks healthy cells and tissues by mistake. This attack causes inflammation. It can also damage many parts of the body, including the joints, skin, kidneys, heart, lungs, and brain.

There are several types of lupus:

• Systemic lupus erythematosus (SLE) is the most common type. It can be mild or severe and can affect many parts of the body.
• Cutaneous lupus affects the skin. It causes a rash or sores, usually after your skin is exposed to sunlight. The two major types of cutaneous lupus are discoid lupus and subacute cutaneous lupus.
• Drug-induced lupus is caused by a reaction to some medicines. The symptoms may start 3 to 6 months after starting the medicine. The symptoms usually go away when you stop taking the medicine.
• Neonatal lupus, which is rare, affects newborns. It is caused by certain antibodies that are passed from the pregnant parent to the baby.

What causes lupus?

The cause of lupus is unknown. Researchers are studying what might cause or trigger the disease, such as:

• Genetics
• Environmental factors, such as viral infections, sunlight, certain medicines, and smoking
• Problems with the immune system

Who is more likely to get lupus?

Anyone can get lupus, but women get it much more often than men.

Lupus is more common in African Americans than in White people. It is also more common in people of American Indian and Asian descent. African American and Hispanic women are more likely to have severe forms of lupus.

What are the symptoms of lupus?

Lupus can have many symptoms, and they differ from person to person. Some of the more common ones are:

• Arthritis, causing painful and swollen joints and morning stiffness
• Fever
• Fatigue or feeling tired often
• Red rashes, most often on the face (also called the "butterfly rash")
• Chest pain when taking a deep breath
• Hair loss
• Pale or purple fingers or toes, from cold and stress (Raynaud phenomenon)
• Sensitivity to the sun
• Swelling in legs or around eyes
• Mouth ulcers
• Swollen glands
• Headache and dizziness
• Confusion and memory problems

Symptoms may come and go. When you are having symptoms, it is called a flare. Flares can range from mild to severe. New symptoms may appear at any time.

What other problems can lupus cause?

Lupus causes inflammation throughout your body. This can cause problems in your organs, including:

• Kidney damage (lupus nephritis).
• Heart problems, including inflammation in the heart (myocarditis), heart valves, or lining of the heart muscle (pericarditis).
• Inflammation of blood vessels (vasculitis).
• Blood clots
• Inflammation of the tissue that surrounds the lungs (pleurisy). This can make it painful to breathe.

Some people with lupus may be more likely to develop other conditions, such as coronary artery disease (CAD) and atherosclerosis.

How is lupus diagnosed?

There is no specific test for lupus, and it's often mistaken for other diseases that cause similar symptoms. So it may take a while to get a diagnosis. To find out if you have lupus, your health care provider:

• Will ask about your symptoms, medical history, and family health history
• Will do a complete physical exam
• May order blood tests, such as ANA (antinuclear antibody), antibodies, complete blood count, and complement tests
• May order other tests, such as urine tests
• May do biopsies:
  • Skin biopsy (looking at skin samples under a microscope)
  • Kidney biopsy (looking at tissue from your kidney under a microscope)

What are the treatments for lupus?

There is no cure for lupus, but medicines and lifestyle changes can help control it.

People with lupus often need to see different providers. You will most likely have a primary care provider and a rheumatologist (a doctor who specializes in diseases of the joints and muscles). Which other specialists you will depend on how lupus affects your body. For example, if lupus is damaging your heart or blood vessels, you would see a cardiologist (a doctor who specializes in heart diseases).

Your primary care provider should coordinate care between all of your other providers and treat other problems as they come up. You and your primary care provider will develop a treatment plan to fit your needs. You will both review the plan often to make sure that it is working. You should report new symptoms to your provider right away so that your treatment plan can be changed, if needed.

The goals of a treatment plan are to:

• Prevent flares
• Treat flares when they occur
• Reduce organ damage and other problems
• Improve your quality of life

Treatments may include drugs to:

• Reduce fever, swelling, and pain
• Reduce inflammation in your body
• Prevent or reduce flares
• Reduce or prevent damage to joints
• Suppress (lower) the activity of your immune system

Besides taking medicines for lupus, you may need to take medicines for problems that are related to lupus such as high cholesterol, high blood pressure, or infection.

Alternative and complementary therapies are therapies that are not part of standard treatments. Some people try alternative and complementary therapies to improve their lupus symptoms. But research has not clearly shown whether these treatments may help or treat lupus. Talk to your provider before trying any new treatments.

How can I cope with lupus?

It is important to take an active role in your treatment. It helps to learn more about lupus - being able to spot the warning signs of a flare can help you prevent the flare or make the symptoms less severe.

It is also important to find ways to cope with the stress of having lupus. Exercising and finding ways to relax may make it easier for you to cope. A good support system can also help.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Menopause

What is menopause?

Menopause is the time in your life when you stop having your period and can no longer get pregnant. You have reached menopause when you have not had a period for 12 months.

The time leading up to menopause is called the menopausal transition, or perimenopause. This transition usually begins in when you are in your 40s, but sometimes it can start earlier. It can last for several years. The most common age for reaching menopause is between 45 and 55 years old.

What is early menopause?

Early, or premature menopause happens when your ovaries stop making hormones and periods stop before age 40. This can happen on its own (with no known cause). It can also happen because of surgery to remove the ovaries or uterus. Medical treatments such as chemotherapy or hormone therapy to treat breast cancer may also cause early menopause.

A condition called primary ovarian insufficiency (POI) happens when your ovaries stop working normally before you are age 40. But this condition is different from early menopause. If you have POI, you may still have periods, even though they might not come regularly. And you might still be able to get pregnant.

What are the symptoms of menopause?

During the menopausal transition, your ovaries start to make less of the estrogen and progesterone hormones. The changes in these hormones cause the symptoms of menopause, which can include:

• A change in your periods; they may be:
  • Irregular, with more or less time in between periods.
  • Shorter or longer.
  • Lighter or heavier.
• Hot flashes, a sudden warm feeling in your face, neck, and chest. They may cause you to sweat. If they happen at night and cause sweating, they are called night sweats.
• Trouble sleeping, such as trouble falling asleep or getting back to sleep when you wake up. Over time, a lack of sleep can lead to fatigue and memory problems.
• Vaginal dryness, which may cause pain or discomfort during sexual intercourse.
• Mood changes, which can make you feel moody, anxious, or more irritable.
• Bladder issues, such as urinary incontinence (loss of bladder control) and urinary tract infections (UTIs).

You may also have other physical changes which could put you at risk for certain diseases. For example, the loss of estrogen can:

• Cause you to lose bone density. This can lead to osteoporosis, a condition that causes bones to become weak and break easily.
• Raise your cholesterol levels and increase your risk of heart disease and stroke.

What are the treatments for the symptoms of menopause?

You may not need treatment for the symptoms of menopause. But if you do, there are several different types of treatments:

Lifestyle changes

You may find that you can manage your symptoms with lifestyle changes. Here are some changes that might make you feel better:

• If you have hot flashes, dress in layers that can be removed at the start of a hot flash. You may want to carry a portable fan to use when you get a hot flash.
• Avoid alcohol, spicy foods, and caffeine. They can make your menopause symptoms worse.
• If you smoke, try to quit, not only for hot flashes, but for your overall health.
• Try to maintain a healthy weight. Being overweight or having obesity can make hot flashes worse.
• Have good sleep habits. Keep your bedroom dark, quiet, and cool.
• Get regular exercise. It can help you sleep better, improve your mood, and help lower your risk for many age-related diseases.
• Lower stress, for example by using relaxation techniques such as meditation, deep breathing, and muscle relaxation exercises.

If lifestyle changes are not enough to improve your symptoms, you may want to contact your health care provider. They will talk to you about your symptoms, family and medical history, and preferences. They also can explain the risks and benefits of the treatments.

Non-hormone treatments

There are various non-hormone treatments for menopause symptoms, such as:

• Medicines for hot flashes, including certain antidepressants, a medicine just for hot flashes, an antiseizure medicine, and a blood pressure medicine. Some of these medicines may also help with sleep problems.
• Medicines for urinary incontinence.
• Medicines to treat or help prevent osteoporosis.
• Low-dose birth control pills for very heavy bleeding or periods that are close together.
• Water-based lubricants to treat vaginal dryness.
• Medicines for painful intercourse that is caused by vaginal changes from menopause.
• Cognitive behavioral therapy (CBT), a type of talk therapy, for trouble sleeping.

Hormone treatmentsmenopausal hormone therapy

Like all medicines, MHT has benefits and risks. Talk with your provider about whether it is safe for you. If you decide to take MHT, your provider may recommend taking the lowest dose that works for the shortest time needed.

Supplements, herbs, and "natural" hormone creams

There are various products that are marketed for menopause symptoms. They include supplements, herbs, and over-the-counter "natural" hormone creams. There has been research on many of these products. So far, none of them has clearly been shown to be helpful. Also, there is little information on the long-term safety of these products. Some supplements can have harmful side effects or interact with medicines. Check with your provider before you take use any of them.

Mitral Valve Prolapse

What is the mitral valve?

The mitral valve is one of the four valves in your heart. Heart valves have flaps that open and close. The flaps make sure that blood flows in the right direction through your heart and to the rest of your body. When your heart beats, the flaps open to let blood through. Between heartbeats, they close to stop the blood from flowing backwards.

The mitral valve opens to let blood flow from your heart's upper left chamber to the lower left chamber. When the lower left chamber contracts (squeezes) to pump blood to your body, the mitral valve closes tightly to keep any blood from flowing backwards.

What is mitral valve prolapse (MVP)?

Mitral valve prolapse (MVP) happens when the flaps of the mitral valve become floppy and don't close tightly. In some cases, blood may leak backwards through the valve to the chamber it came from. This is called backflow, or regurgitation. When there is a lot of mitral valve backflow, the heart can't push enough blood out to the body.

But most people who have MVP don't have any backflow. In fact, MVP doesn't cause any health problems for most people who have it.

Who is more likely to develop mitral valve prolapse (MVP)?

Anyone can have MVP. Most people who have it were born with it. MVP tends to run in families, but researchers don't know the exact cause.

You may be more likely to develop MVP if you:

• Are older. The risk of MVP increases as aging affects the valve.
• Had rheumatic fever, a disease that can develop after a strep throat infection and cause damage to the heart valves.
• Were born with a connective tissue disorder, such as Marfan syndrome or Ehlers-Danlos syndrome.
• Have Graves' disease, a type of thyroid condition.
• Have scoliosis (a side-to-side curve of the spine) or other problems with the bones of your body.
• Have some types of muscular dystrophy.

Mitral valve prolapse with backflow is most common in men and people who have high blood pressure.

What are the symptoms of mitral valve prolapse (MVP)?

Most people who have MVP don't have any symptoms. But if it does cause symptoms, they may include:

• Heart palpitations (feeling that your heart is fluttering, skipping beats, or beating too hard or too fast)
• Shortness of breath (feeling like you can't get enough air)
• A cough
• Fatigue, dizziness, or anxiety
• Migraines
• Chest pain

What other problems can mitral valve prolapse (MVP) cause?

In rare cases, MVP can cause other problems. They're most often caused by backflow. They can include:

• Arrhythmia, a problem with the rate or rhythm of your heartbeat
• Endocarditis, an infection in the lining of the heart and heart valves
• Heart failure

How is mitral valve prolapse (MVP) diagnosed?

Health care providers often find MVP during routine health check-ups. If you have MVP, your provider may hear a clicking sound when listening to your heart with a stethoscope. If blood flows backwards through the valve, your heart may also make a whooshing sound called a heart murmur.

You may also need certain heart tests. The most useful test is an echocardiogram, or echo. This is a type of ultrasound that uses sound waves to make a moving picture of your heart.

What are the treatments for mitral valve prolapse (MVP)?

Most people don't need any treatment for MVP. If you have symptoms with little or no backflow, you may only need medicine to relieve your discomfort.

If the amount of backflow is significant, you may need treatment to prevent other heart problems from developing. Treatments may include:

• Medicines to help your heart work better.
• Heart surgery to repair or replace a very abnormal mitral valve with backflow. The goal of surgery is to improve your symptoms and reduce your risk of developing heart failure.

When possible, valve repair is generally preferred over replacement. That's because repairs are less likely to weaken the heart muscle, and they're less likely to cause heart infection.

Can mitral valve prolapse be prevented?

You can't prevent mitral valve prolapse. But if you have mitral valve prolapse, you can help prevent the rare but serious problems it can cause by:

• Brushing and flossing your teeth regularly. That helps keep bacteria out of your bloodstream, which further reduces the rare risk of a heart infection.
• Asking your provider if you need to take antibiotics before dental work or surgery to lower your risk of heart infection. This mostly applies to people who have had valve repair or replacement surgery.
• Getting regular check-ups and taking any medicines that your provider may have prescribed.
• Making heart-healthy habits part of your life to prevent heart disease.

NIH: National Heart, Lung, and Blood Institute

Nutrition for Older Adults

What is nutrition and why is it important for older adults?

Nutrition is about eating a healthy and balanced diet so your body gets the nutrients that it needs. Nutrients are substances in foods that our bodies need so they can function and grow. They include carbohydrates, fats, proteins, vitamins, minerals, and water.

Good nutrition is important, no matter what your age. It gives you energy and can help you control your weight. It may also help prevent some diseases, such as osteoporosis, high blood pressure, heart disease, type 2 diabetes, and certain cancers.

But as you age, your body and life change, and so does what you need to stay healthy. For example, you may need fewer calories, but you still need to get enough nutrients. Some older adults need more protein.

What can make it harder for me to eat healthy as I age?

Some changes that can happen as you age can make it harder for you to eat healthy. These include changes in your:

• Home life, such as suddenly living alone or having trouble getting around
• Health, which can make it harder for you to cook or feed yourself
• Medicines, which can change how food tastes, make your mouth dry, or take away your appetite
• Income, which means that you may not have as much money for food
• Sense of smell and taste
• Problems chewing or swallowing your food

How can I eat healthy as I age?

To stay healthy as you age, you should:

• Eat foods that give you lots of nutrients without a lot of extra calories, such as
  • Fruits and vegetables (choose different types with bright colors)
  • Whole grains, like oatmeal, whole-wheat bread, and brown rice
  • Fat-free or low-fat milk and cheese, or soy or rice milk that has added vitamin D and calcium
  • Seafood, lean meats, poultry, and eggs
  • Beans, nuts, and seeds
• Avoid empty calories. These are foods with lots of calories but few nutrients, such as chips, candy, baked goods, soda, and alcohol.
• Pick foods that are low in cholesterol and fat. You especially want to try to avoid saturated and trans fats. Saturated fats are usually fats that come from animals. Trans fats are processed fats in stick margarine and vegetable shortening. You may find them in some store-bought baked goods and fried foods at some fast-food restaurants.
• Drink enough liquids, so you don't get dehydrated. Some people lose their sense of thirst as they age. And certain medicines might make it even more important to have plenty of fluids.
• Be physically active. If you have started losing your appetite, exercising may help you to feel hungrier.

What can I do if I am having trouble eating healthy?

Sometimes health issues or other problems can make it hard to eat healthy. Here are some tips that might help:

• If you are tired of eating alone, try organizing some potluck meals or cooking with a friend. You can also look into having some meals at a nearby senior center, community center, or religious facility.
• If you are having trouble chewing, see your dentist to check for problems
• If you are having trouble swallowing, try drinking plenty of liquids with your meal. If that does not help, check with your health care provider. A health condition or medicine could be causing the problem.
• If you're having trouble smelling and tasting your food, try adding color and texture to make your food more interesting
• If you aren't eating enough, add some healthy snacks throughout the day to help you get more nutrients and calories
• If an illness is making it harder for you to cook or feed yourself, check with your health care provider. He or she may recommend an occupational therapist, who can help you find ways to make it easier.

NIH: National Institute on Aging