#Nocturnal Polyuria Causes

[mcatmemoranda]

GERD: gastroesophageal reflux disease. * Patients on twice-daily diuretics can take their second dose in the afternoon rather than the evening. ¶ Urinating while sitting comfortably on the toilet (men included), leaning slightly forward, and then waiting for 20 to 30 seconds to urinate again. Δ Good sleep hygiene includes sleeping in a quiet room with low lighting and appropriate temperature, avoiding nighttime use of electronic devices, and avoiding daytime naps. ◊ Patients should be referred to a physical therapist with expertise in pelvic floor rehabilitation.

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Definition and goals of management – Nocturia is a symptom, defined as any waking at night to void, most often considered clinically significant if a patient voids two or more times nightly. It is important to try to reduce the bother caused by the nocturia in addition to reducing nocturia episodes. (See 'Definition/Diagnosis' above and 'Management' above.)

●Recognition of underlying causes – Nocturia may be caused by conditions or disorders that result in low bladder volume voids, nocturnal polyuria, or sleep disturbances. Certain medical conditions may contribute to nocturia and should be treated as part of initial management. Many patients have multiple etiologies. (See 'Pathophysiology and associated conditions' above and 'Management' above.)

●Evaluation – Evaluation for nocturia should focus on patterns of fluid intake, other urinary symptoms, symptoms of possible underlying causes, and a focused physical examination. (See 'Evaluation' above.)

•A frequency-volume chart (ie, a voiding diary) will be helpful in determining the contributing causes of nocturia. Nocturnal polyuria is defined as the excretion of ≥35 percent of the 24-hour urine output during the hours of sleep (form 1). (See 'Frequency-volume chart' above.)

●Initial management – Initial measures should include adjustments in timing of fluid intake to earlier in the day, reducing salt intake if excessive, and eliminating nighttime diuretic use if present. A urinal or commode near the bed may be helpful. Fall risk at night should be considered (algorithm 1). (See 'Initial measures' above.)

●Pelvic floor muscle exercises – We suggest pelvic floor exercises for all patients (Grade 2B). Primary care providers should refer patients to physical therapists who specialize in this training. (See 'Behavioral treatment, including pelvic floor muscle exercises' above.)

●Pharmacologic treatment – Suggested initial treatment trials for nocturia include the following (algorithm 2):

•In men with nocturia related to benign prostatic hyperplasia (BPH), we suggest trials of alpha-1-adrenergic antagonists with or without 5-alpha reductase inhibitors (Grade 2B). (See 'Men with benign prostatic hyperplasia' above.)

•In patients without BPH who have low-volume voids, we suggest trials of bladder muscle relaxants (Grade 2C). (See 'Initial monotherapy: bladder relaxant therapies' above.)

•For postmenopausal women with continued nocturia despite a bladder muscle relaxant, we offer topical vaginal estrogen either alone or in combination with other therapies. (See 'Vaginal estrogen therapy (women only)' above.)

Because each of these therapies is associated with only a modest reduction in the number of nighttime voids and also has potential for side effects, many patients may choose no pharmacologic therapy.

●Refractory nocturia – For patients with refractory nocturia and who are <65 years of age, we consider treatment with desmopressin. Studies suggest that desmopressin has a small effect on nighttime voiding frequency that is of uncertain clinical significance. Baseline sodium levels must be normal, and patients must be able to recognize and report subtle fluid status changes and also be willing to undergo frequent monitoring of sodium levels in order to avoid severe hyponatremia. Desmopressin is a potentially inappropriate medication according to Beers criteria for medications for older adults. (See 'Desmopressin' above and "Drug prescribing for older adults", section on 'Beers criteria'.)

[mahehealthcare]

Understanding the Relationship between Kidney Disease and Sleep Problems        

Kidney disease, a condition that affects millions of people worldwide, can have a profound impact on various aspects of daily life, including sleep. Individuals with kidney disease often experience sleep problems, which can further worsen their overall health and quality of life. In this article, we will explore the reasons behind the correlation between kidney disease and sleep problems, shedding light on the intricate relationship between the two.

1. Disrupted Fluid Balance:

One of the primary functions of the kidneys is to regulate fluid balance in the body. However, in people with kidney disease, this balance becomes disrupted, leading to excessive fluid retention or depletion. This imbalance can result in nocturnal polyuria, where individuals produce an excessive amount of urine during the night, causing frequent awakenings and disrupted sleep patterns.

2. Electrolyte Imbalance:

Kidneys play a crucial role in maintaining the proper levels of electrolytes, such as sodium, potassium, and calcium, in the body. When kidney function is compromised, electrolyte imbalances can occur, disrupting normal bodily functions. These imbalances can lead to muscle cramps, restless leg syndrome (RLS), and periodic limb movements during sleep (PLMS), all of which can significantly disturb sleep.

3. Sleep Apnea:

Kidney disease is often associated with a higher risk of developing sleep apnea, a sleep disorder characterized by pauses in breathing during sleep. The accumulation of fluid in the body due to impaired kidney function can cause fluid retention in the neck and upper airways, leading to narrowed air passages and increased episodes of apnea. Sleep apnea not only disrupts sleep but can also contribute to other health complications.

4. Uremic Toxins:

As kidney function declines, the body's ability to eliminate waste products, including uremic toxins, diminishes. The accumulation of these toxins in the bloodstream can lead to symptoms such as nausea, itching, and restlessness, making it challenging for individuals with kidney disease to fall asleep and stay asleep throughout the night.

Conclusion:

Sleep problems are a common occurrence in individuals with kidney disease. The disruption of fluid balance, electrolyte imbalances, sleep apnea, and the accumulation of uremic toxins all contribute to the complex relationship between kidney disease and sleep problems. Recognizing and addressing these issues is crucial for improving the quality of life for those living with kidney disease.

Mahe Health Care, a leading healthcare provider, understands the challenges faced by individuals with kidney disease. With a multidisciplinary team of experts, they offer comprehensive care and support to manage kidney disease and its associated complications, including sleep problems. By addressing the underlying causes and providing tailored treatment plans, Mahe Health Care aims to improve the overall well-being of their patients, enhancing their sleep quality and overall quality of life.

[elitonebyelidah]

Nocturia: Main Causes and Remedies

When you have to wake up more than once to urinate at night, you may always think it is because of the fluids you take before bedtime. However, it could be because you are suffering from nocturia, which forces one to wake up many times to urinate. While it is not a disease, it could be signaling some other conditions, but a medical expert can help to diagnose that.

Main Causes of Nocturia

The major causes of Nocturia include decreased bladder capacity, Overactive Bladder¸ sleep disruptions, the body producing excess urine at night, or other underlying health conditions.

Excess Urine Production

During the day, especially for people who spend most of their time standing or sitting, excess fluid accumulates in the legs. As one rests at night, the fluid flows back to the kidneys and is converted to urine. Excess urine production during the night is called nocturnal polyuria and is among the most common nocturia causes, estimated to contribute up to 88% of cases.

This urine production may also be a result of consuming excess fluids before bed. It could also be because of consuming diuretics. Some of the fluids you can avoid include caffeine and alcohol.

Sleep Disruptions

Sleep problems may also provoke cases of Nocturia. Obstructive sleep apnea (OSA) is one of the culprits, as it causes pauses in breathing during the night, disrupting sleep. It does this by reducing airflow and oxygen levels, which influences hormones, which may then induce excess urine production and nocturia.

Decreased Bladder Capacity

The bladder naturally has a capacity that it can hold at any given time. The capacity may diminish due to urinary tract inflammations, heightened urge incontinence, and bladder stones. If the capacity is inadequate, it may lead to nocturia.

Tips for Managing Nocturia for Better Sleep

A medical expert may diagnose and advise you on the best remedies you can take in this case. Most of the remedies will include medications or adjustments to existing medications. Lifestyle changes may also help, including:

Reducing the amounts of fluids that you take before bedtime.

Reducing or avoiding taking diuretic fluids, including coffee, chocolate, alcohol, and carbonated and caffeinated drinks.

Keeping your legs elevated for some time before bedtime to help in reducing the reabsorption and subsequent conversion of peripheral edema to urine when you sleep.

[urologytreatment]

Why do we get the urge to frequently urinate at night?

Nighttime urination (nocturia) is a normal part of aging, but it can also be an indication of a medical problem such as diabetes, heart disease, or bladder problems. Some medical problems that result in nerve damage.

You may also wake up requiring to pee as a result of lifestyle variables (such as your diet) or medications you take. Because nocturia can cause sleep deprivation, daytime fatigue, poor concentration, depression, and loss of productivity, it's necessary to consult with a Urologist in Pune.

The most Common Causes of Frequent Urination at Night are-

Age-

One of the most important characteristics connected with nocturia is age. The majority of people who have the ailment are over the age of 60, while lower age can also be a factor in midnight urination. The disorder known as nocturnal polyuria is one well-known aging-related cause. (NP). As a result, the body produces large amounts of pee when sleeping. With age, the prevalence of nocturnal polyuria rises. The disorder affects approximately 77% of older women and 93% of older men. Younger people (particularly children) experience nocturia because their bladders have not yet gained their full size. The amount of urine produced at night may be greater than the organ's capacity.

Lifestyle and Diet-

The need to urinate at night might also be caused by a change in food. These variables can cause nocturia either directly (by causing the body to produce urine) or indirectly (by causing the body to produce urine). (By compressing the bladder).

Some of the most prevalent dietary components that contribute to nighttime urination include:

Caffeine and alcohol: Coffee, soda, and other caffeine-containing beverages, as well as alcoholic beverages, have diuretic qualities that enhance urine output.

Dietary salt: Excess salt (sodium) in the diet can cause nocturia in those who are obese or have low cardiac output. Sodium promotes fluid retention. When the bladder is full, the fluid may be expelled at night.

Hyper hydration: Drinking too much water before bedtime can easily result in a middle-of-the-night bathroom visit.

Low-fiber diet: Chronic constipation can occur if your diet is deficient in nutritional fibre. The accumulation of stool at night can cause the gut to stretch and put pressure on the bladder, giving you the urge to pee.

Pregnancy-

Nocturia can develop at any stage of pregnancy for a variety of reasons.

Early pregnancy: Progesterone levels rise in early pregnancy, causing bloating and water retention. This increases the likelihood of overnight urination. Nocturia can be an early indicator of pregnancy in some circumstances.

Later pregnancy: Frequent urination is usual throughout the second and third trimesters because the womb has begun to compress the bladder. Certain body positions at night can worsen the compression and cause nocturia.

After pregnancy: People may experience bladder and pelvic organ prolapse, which means the organs have slipped out of place. Both can cause urinary tract obstruction.

Medications-

Nocturia can also be caused by some drugs. This can occur in several ways:

A medication may cause the release of acetylcholine, a chemical that causes bladder contractions.

A medication may hinder the release of norepinephrine, a hormone that relaxes the bladder and other smooth muscle organs.

A diuretic effect occurs when a medicine helps the kidneys to excrete more salt and water from the body.

Acute Infection/ Conditions-

Nocturia can be a sign of acute urinary tract (urologic) diseases such as:

Kidney stones or bladder stones

Bladder infection (interstitial cystitis)

Kidney infection (pyelonephritis)

Urinary tract infection (UTI)

In acute situations, inflammation might cause a quick need to urinate due to urinary tract contractions. (Urinary urgency). Nocturia is frequently the continuation of a person's daytime urine urgency. When the cause of the inflammation is eliminated, the nocturia usually improves.

Chronic Disease/ Conditions-

Nocturia can sometimes be a sign of a more serious disease. In some cases, it might last a long period and be difficult to treat. Some of the causes are urinary-related, while others are not. The following are the common chronic causes of frequent urination at night

Benign prostatic hyperplasia (BPH)

Bladder cancer

Congestive heart failure (CHF)

Diabetes

Hypertension

Multiple sclerosis (MS)

Overactive bladder (OAB)

Parkinson's disease (PD)

Sleep apnea

Overweight/obesity

Neurogenic bladder

It can be annoying to your sleep if you have to wake up in the middle of the night to pee. While nocturia can be caused by something as simple as drinking too close to going to bed or having a small bladder, it can also be caused by certain medications and health conditions. Chronic disorders that destroy nerves, such as MS, can also cause bladder difficulties. Making adjustments to your lifestyle (such as decreasing weight or cutting back on alcohol) may assist with nocturia in certain circumstances. There are also therapies for many of the disorders that can cause it, which you can discuss with your provider. If you find that getting up to pee frequently disrupts your sleep, Consult the Best Urologist in Pune.

[nocdurna]

Nocturnal Polyuria - Medicine for Night Urination

New research shows that most cases of notarial have a common cause: nocturnal polyuria. This is a condition in which your body produces too much urine during the night, causing you to wake up and go to the bathroom. It can be caused by an overactive bladder, a common complication of an aging prostate, or it can be caused by diabetes.

[wordstitta]

Definition of nocturnal

This diary is used to keep track of things like the kind and amount of liquids you drink, trips to bathroom, etc. Your health care provider may also ask you to keep a bladder diary in order to help with a diagnosis. You'll be asked about your symptoms and health history. You and your health care provider will want to learn the cause of your nocturia. Often, several of these issues may be going on at once. Nocturnal polyuria (when your body produces too much urine at night for your bladder to hold).Edema in the lower limbs, or leg swelling.Enlarged prostate (prostatic hyperplasia (BPH).Bladder obstruction ( stones), inflammation or other problems that affect bladder capacity (like bladder surgery or fibrosis from radiation).Heart disease, vascular disease or congestive heart failure.Underlying health conditions can cause nocturia. Sleep disorders, like insomnia or sleep apnea.The timing or dose of medicines, such as: diuretic medicine (water pills), cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D.Behavioral patterns (you've trained your body to wake up during the night to use the bathroom, even if you don't necessarily have to go).Drinking too much fluid before bedtime (especially caffeine or alcohol).The following lifestyle habits are known to cause nocturia in either men or women: Or it could be from certain medication, illnesses or reduced bladder capacity. Nocturia can be from a simple habit like drinking too much fluid (especially caffeine or alcohol) before bed. The sphincter muscles then open and urine is released out of the body. This pushes urine out of the bladder and through the urethra. Once you are ready to urinate, the brain sends a signal to the bladder. It is kept closed with sphincter muscles. The urethra is a tube that carries urine from the bladder, out of the body. The muscular neck (end) of the bladder stays closed to store urine. The muscles in the lower part of the pelvis hold the bladder in place. The brain and the bladder work together to control urinary function. The bladder holds urine until you are ready to empty it. Urine travels from the kidneys to the bladder through the ureters (the tubes that join them). Normally, the kidneys make about 1½ to 2 quarts of urine each day in an adult less in children. Urine forms when the kidneys clean your blood. The "urinary tract" includes the organs in your body that make, store and remove urine.

[hiretrust]

Definition of nocturnal

Urinating more volume (if polyuria is present).Waking up more than once a night to urinate.This can cause disruptions in a normal sleep cycle. People who have nocturia wake up more than once a night to urinate. Normally, you should be able to sleep six to eight hours during the night without having to get up to go to the bathroom. Interstitial cystitis (pain in the bladder).Bladder infection or recurrent urinary tract infection.The causes of an inability of the bladder to fully fill can include: Benign prostatic hyperplasia (men), a non-cancerous overgrowth of the prostate that obstructs the flow of urine.The causes of an inability to fully empty your bladder can include: This can also occur due to difficulty sleeping - you may wake up for one reason, but then go to the bathroom while you’re awake, which will make you think that you woke up because you had to urinate. This is usually due to an inability of the bladder to fully empty (this is why it fills up faster) or the inability of the bladder to fill completely before developing the urge to urinate (low bladder volume). The total amount of urine produced is not elevated. If you have nocturnal urinary frequency, you may urinate in small amounts or urinate more frequently. Drinking too much fluid before bedtime, especially coffee, caffeinated beverages or alcohol.Certain drugs, including diuretics (water pills), cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene, and excessive vitamin D.Sleeping disorders, such as obstructive sleep apnea (breathing is interrupted or stops many times during sleep).Edema of lower extremities (swelling of the legs).The causes of nocturnal polyuria can include: It can re-enter your veins and be filtered by your kidneys, producing urine. Once you lie down to sleep, gravity no longer holds the fluid in your legs. This is usually due to fluid retention during the day that often accumulated in the feet or legs. Their urine volume during the day is normal or reduced. Those with nocturnal polyuria experience a high urine volume only at night. Diabetes insipidus, gestational diabetes (occurs during pregnancy).Untreated diabetes (Type 1 and Type 2).It can also happen if something is in the urine, pulling the extra water out, such as sugar (glucose). This is usually caused by there being too much water filtered by the kidneys. People with polyuria urinate >3,000mL in 24 hours. There are many possible causes of nocturia, depending on the type.

[scaleupconsulting]

Nocturnal Polyuria Causes | Medicine For Nocturia

The leading cause of nocturia is nocturnal polyuria (NP), a condition where the bladder contracts during sleep and fills with small amounts of urine. This frequent urination results in interrupted sleep, which can lead to excessive daytime sleepiness, fatigue, or loss of energy. For more information, visit: https://www.nocdurna.com/frequent-nighttime-urination/

[bluebliss]

Is Nocturia keeping you Awake in the Night?

Nocturia is a condition that keeps you awake at night as you have the urge to urinate frequently. This affects both men and women and increases with age. Most people wake up once during the night to urinate, which is considered normal. But, waking up more than once is a sign that something is wrong.

What are the different types of Nocturia and their causes?

Now let us look into the types of nocturia and their causes:

Polyuria: People suffering from Polyurea urinate >2500 liters in 24 hours. This happens when there is too much water that is being filtered by the kidneys. High fluid intake, high diabetes, and gestational diabetes could be the cause of polyurea.

Nocturnal Polyurea: Noctural polyurea is the urge to pee only at night. Whereas their urine volume is normal durig the day. The fluid gets accumulated in the legs during the day leading to swelling of the legs. But, when you rest, the fluid from the swollen foot traces back to the kidneys, increasing the urge to urinate in the night. The causes of Nocturnal Polyurea may be a diet high in sodium, congestive heart failure, drinking too much fluids before bedtime, congestive heart failure,obstructive sleep apnea.

What are the symptoms associated with Nocturia?

The symptoms associated with Nocturia are:

Waking up more than once to urinate.

Sleeplessness and tiredness even after waking up.

Urinating in high volume.

What are the treatment options for Nocturia?

If you feel you are suffering from nocturea it is advisible to see the urologist. The best Urology Hospital in Bangalore will have all the facilities and experts to treat Nocturia. Let us look into the treatment available to treat Nocturia.

Restricting fluids in the evening.

Place the leg at an elevated position while sleeping.

Wearing compression stockings that prevent fluid accumulation.

The best Urologist in Bangalore may also prescribe a few medication to cure Nocturia.

[your-dietician]

When the Symptoms of Heart Failure Are Getting Worse

New Post has been published on https://depression-md.com/when-the-symptoms-of-heart-failure-are-getting-worse/

When the Symptoms of Heart Failure Are Getting Worse

If you are living with heart failure that is no longer responding to conventional heart therapies and your symptoms are getting worse, you may have advanced heart disease. 

About 6.2 million people are living with heart failure in the United States, and that number is expected to rise. Because improvements in the treatment of heart failure have allowed people with this condition to survive substantially longer than they used to, the number of people that reach an advanced phase of the disease—also called end-stage, refractory, or terminal heart failure—is steadily growing.

Heart failure is a slowly progressive condition that can be managed but not cured without getting a heart transplant. Fortunately, medical advances have improved the quality of life to such a degree that people can engage more fully in end-of-life decisions like palliative care.

This article discusses advanced-stage heart failure in detail.

Nipitphon Na Chiangmai / EyeEm / Getty Images

Advanced Stages

In advanced heart failure, the heart no longer pumps enough blood, either because the heart cannot fill up with enough blood or can’t pump forcefully enough to meet the body’s needs. The heart still beats, but it is weak and damaged. Even more, the body is unable to compensate for the reduced blood the heart can pump. As a result, fluid often backs up into the lungs, liver, abdomen, or legs.

The most common symptoms of advanced heart failure are shortness of breath and chest pain at rest, or with minimal exertion.

The New York Heart Association classification system is the simplest and most widely used method to gauge symptom severity.

Class I

No limitations of physical activity

No heart failure symptoms

Class II

Mild limitation of physical activity

Heart failure symptoms with significant exertion; comfortable at rest or with mild activity

Class III

Marked limitation of physical activity

Heart failure symptoms with mild exertion; only comfortable at rest

Class IV

Discomfort with any activity

Heart failure symptoms occur at rest

Another classification system is the American Heart Association and American College of Cardiology’s A-to-D staging system. In this system, advanced heart failure is stage D.

Stage A: You have been diagnosed with coronary artery disease, hypertension, or diabetes mellitus, but you have yet to develop left ventricular hypertrophy, distortion of the chamber, or impaired function on echocardiogram

Stage B: You are asymptomatic but demonstrate left ventricular hypertrophy and/or impaired left ventricular function on echocardiogram.

Stage C: You have had symptoms of heart failure, but it is managed with standard treatment.

Stage D (advanced or refractory): You experience symptoms on minimal exertion or at rest in spite of optimal medical therapy and deteriorate clinically requiring repeated hospitalizations.

Heart failure is considered end-stage when life expectancy is predicted to be six months or less. Palliative or hospice care and novel research therapies are usually discussed during the final stage of heart failure.

Symptoms

Common symptoms of left-sided heart failure include:

Chest pain

Fatigue

Weakness

Shortness of breath, especially on exertion

Orthopnea, or shortness of breath when lying down

Paroxysmal nocturnal dyspnea, or awakening at night with shortness of breath

Exercise intolerance

Fast or irregular heartbeat

Peripheral edema, or swelling of the feet, angle, legs

Weight gain

Nausea

Persistent coughing or wheezing

Having to urinate more than usual (polyuria) or at night (nocturia)

When the heart is weak, fluid builds up throughout the body, causing problems. Symptoms include swelling of the feet, legs, and/or belly and having more shortness of breath. You may also feel nauseous and lose your appetite. Other common signs of progressing illness are feeling dizzy or faint and cold hands and feet due to poor blood circulation.

These common symptoms become worse as heart failure progresses and may look different at advanced stages.

Shortness of Breath

A weak heart cannot pump blood forward so it backlogs into the lungs making it difficult to breathe. During advanced heart failure, you may experience shortness of breath, or dyspnea, even with minimal exertion.

This shortness of breath is likely due to fluid overload on and around the heart and may feel like suffocating, smothering, and hungering for air.

Edema

Severe heart failure can result in blood and fluid pooling in the legs and abdomen. The body can usually accommodate large increases in volume, about five liters, but in severe heart failure, the extra fluid is enough to expand the extracellular compartments of the body.

Swelling is usually most pronounced in the feet and ankles, but the development of ascites—fluid buildup around the liver and abdomen—has an especially poor prognosis.

Of note, edema in heart failure is different from edema caused by other conditions, in that it creates a dimple when pressed. Therefore, edema caused by heart failure is also called pitting edema.

Sudden Weight Gain

During heart failure exacerbations, it is not uncommon for the body to rapidly gain weight as a result of fluid retention, sometimes as high as five pounds or more in a day.

Sleep Problems

In advanced heart failure, fluid accumulates in the lungs and more diuretic medicine is needed. Unfortunately, diuretic resistance develops in the final stages of heart failure as the body kicks fluid-retaining systems into high gear. 

When you lie down, fluid accumulation in the lungs signals the body to wake up to prevent asphyxiation. This phenomenon is called paroxysmal nocturnal dyspnea. It is not uncommon for people to wake up multiple times in the night or find it hard to find a comfortable sleeping position.

Many people with heart failure also have sleep apnea, so they may misattribute their symptoms. If you have heart failure and are frequently waking up in the middle of the night, it may be a sign of worsening heart failure, so you should contact a healthcare provider immediately. 

Coughing and Wheezing

Fluid in the lungs, or pulmonary edema, can cause coughing or wheezing. In more severe cases, these symptoms can resemble asthma, hence the going usage of the term cardiac asthma to describe these symptoms.

Symptoms of severe cough, wheezing, and spitting up pink-colored sputum should not be taken lightly, and you should contact a medical professional at the first sight of these symptoms. 

Treatment

If your symptoms do not respond to changes in medications, you may have a condition called acutely decompensated heart failure (ADHF).

Many times symptoms of advanced heart failure respond to a course of treatment in the hospital and you feel much better upon discharge, but sadly some people do not improve to the point where they can go home on oral medications alone. This is due, in part, to the ineffectiveness of diuretics, a term called diuretic resistance—or decreased natriuresis and diuresis—as a result of the body’s overactivation of the SNS system—the part of the nervous system that increases heart rate, blood pressure, breathing rate, and pupil size—and the RAAS system, which regulates blood pressure.

Sometimes medications may work to some degree but make you feel worse. Decreased cardiac output worsens kidney function and activates the SNS and RAAS systems, enhancing sodium and water retention. Once-helpful diuretics can actually worsen heart failure by worsening the glomerular filtration rate of the kidneys and hyponatremia, or low sodium levels. 

Diuretics may also instigate electrolyte abnormalities, further complicating treatment. 

So what are the options at this point? You’ll likely need advanced treatments such as:

Constant intravenous (IV) medications: Continuous IV medications are used for those who are getting partial relief and desire a higher quality of life. They are often used as a bridge to transplant or palliative care. Also, most insurance companies cover this service, so it is widely available to those who cannot afford other end-of-life treatment options.

Mechanical circulatory support (partial or total artificial hearts): An intra-aortic balloon pump (IABP) or ventricular assist devices (VADs) can aid the heart in pumping and effectively delivering blood to the body, but they are mostly used as a bridge to recovery or heart transplantation. IABP has emerged as the single most effective and widely used circulatory assist device, but the invasive nature of the procedure needed to place the device comes with risks of thromboembolism, bleeding, and infection.

Heart transplant: Heart transplantation is the treatment of choice for patients with heart failure refractory to medical therapy, but there are more people in need of a heart transplant than there are donors. According to the International Society for Heart and Lung Transplant, patient survival at one and three years for patients who received cardiac transplantation was approximately 85% and 79%, respectively.

Maintaining your heart failure self-care routine is vital to preserving and improving your quality of life no matter which treatment options you choose. This includes:

Limiting your salt to 2,000 mg of sodium per day

Restricting fluids like water, sodas, coffee, and soups to help avoid fluid buildup

Keeping a log of your weight and symptoms, and knowing the side effect profile of new and current medications

Receiving vaccinations for pneumonia and influenza

Continuing to treat pre-existing health conditions like high blood pressure and diabetes

Prognosis

Heart failure is associated with very high morbidity and mortality. Eighty percent of men and 70% of women over the age of 65 who are diagnosed with heart failure will die within eight years.

Stage D heart failure has a more grim prognosis. Despite improving special therapeutic interventions, the one‐year mortality rate of refractory heart failure is approximately 50%.

The most common cause of death is progressive heart failure, but sudden death may account for up to 45% of all deaths. Also, Black people are 1.5 times more likely to die of heart failure compared to White people, underscoring the health disparities that persist in the United States.

Symptoms of advanced heart failure are manifestations of severely low cardiac output. The following signs may be indicative that someone is dying of heart failure, especially if frequent hospitalizations and specialized treatment regimens are not leading to clinical improvement: 

Early satiety

Poor appetite

Abdominal pain

Nausea

Coughing up pink sputum

Renal insufficiency

Forgetfulness and memory problems

Coping

Heart failure can have a significant impact on your mental and emotional health. Feelings of anger, sadness, and fear are natural. Talking to your friends and family about how you are feeling, and seeking professional help if necessary, may help you to feel better and avoid heat-of-the-moment decisions that you may regret later.

The progression of heart failure can be unpredictable, which makes it difficult to know when to have conversations about end-of-life care. It’s important to discuss things as early as possible, giving people the time to think about treatment options and where they want to be cared for toward the end of their life. This may help them achieve some peace of mind and a sense of control.

While you have the final say on your treatment options and end-of-life care, shared decision-making that includes trusted healthcare professionals and your family means that you don’t have to make crucial decisions alone.

A Word From Verywell

If your heart function doesn’t improve or worsens in spite of the best possible self-care and medical treatments, you may have to consider other options like heart surgery, continuous infusion of intravenous drugs, and heart transplant.

Research shows people are happiest and most satisfied with their end-of-life decisions when they’ve made them with their doctors and family members, a process called shared decision-making. During this time you may want to discuss end-of-life measures like palliative care and assigning a power of attorney.

Living with advanced heart failure is not easy, and end-of-life conversations can be difficult. While you may feel scared or like you are losing control, leaning on your family and friends during these difficult times can assure that all your end-of-life needs and wishes are met.

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[nocdurna]

Nocturnal Polyuria Medicine | Medicine for Night Urination

Are you experiencing a symptom called Nocturia? Then visit NOCDURNA to learn about Nocturnal Polyuria, a major cause of nocturia, prescribing information, and Medication Guide for NOCDURNA.

[kuntalchatterjee-blog1]

Nocturia

Nocturia, also known as nocturnal polyuria, is the clinical term used for referring to continuous urination during night. As we sleep, our body produces lesser quantity of concentrated urine. This implies that we do not usually feel the need to wake up and urinate at night, and are able to sleep peacefully for at least 6 to 8 hours. It is advisable to consult a medical urologist at the earliest.

Causes Nocturnia may occur due to a wide range of causes including medical conditions, lifestyle choices, food habits, etc. Although this condition is commonly seen in older adults, it may occur at any age.

Medical conditions that cause Nocturnia

A number of medical conditions may lead to nocturia. Some of the more common ones are bladder infection and urinary tract infection (UTI). This type of infection creates a constant burning sensation and an urge to urinate throughout the day and even at night. Antibiotics are usually required for its treatment.

[chronicillnessproblems]

Chronic Fatigue in hEDS:

(also probably applies to chronic fatigue in other EDS forms and in people with HSDs, but the article technically says hEDS.)

This isn’t a full summary or anything, because if I write one I’ll probably write it when I write the others, but since I’d already typed this out in my own notes to take to my doctor, I’ll copy and paste it here too, because I put everything here even if some of it is only helpful to me. You can read the full article HERE. (also it’s an academic journal it has its own summary, bullet lists, and abstract for if you don’t have spoons for the whole article.)

Article definition of fatigue is “recent, prolonged, or chronic either less than 1, 1-6, or 6 months.” Patients with EDS should not be diagnosed with CFS/ME not because they don’t have fatigue that is very similar, sometimes indistinguishable, and can be the same in severity, but because EDS can explain the fatigue and criteria for CFS specifies that fatigue isn’t explained by another illness. 

EDS causes of fatigue:

Poor sleep quality (factors like pain, nocturnal tachycardia, sleep disordered breathing)

Chronic pain (both neuropathic and acute or chronic joint or tissue pain)

Physical deconditioning (NOT weakness) from inactivity 

Orthostatic intolerance and cardiovascular dysregulation (tachycardia, hypotension, syncope)

Bowel dysfunction (malabsorption, nutrient deficiencies.)

Noctural micturition due to bladder dysfunction or polyuria 

Anxiety and/or depression

Headaches/migraines

“Red flag” signs of other illnesses causing fatigue are:

Weight loss

Significant lymphadenopathy

clubbing 

persistent shortness of breath on exertion (consequence of cardiovascular dysfunction)

fevers

red, swollen joints

bronzing of skin

abnormalities on neurological examination

later age of onset

If “red flags,” first investigate:

Chronic infection

endocrine disorders

autoimmune inflammatory conditions

cardiorespiratory disease

sleep disordered breathing

neurological disorders (myasthenia gravis, multiple sclerosis)

There are many scales for assessing fatigue that are listed here, but the most useful one might just be to ask patient to self-record daily activity and report activities, function, and perceived disability. 

There are a lot of non-pharmaceutical treatments listed that aren’t in my notes because they aren’t working for me, but I’ll sum here that key is multidisciplinary, and some things are sleep management, rest, relaxation, use of equipment/adaptations, good sleep hygiene, careful exercise, treating pain. rest periods used with care, avoiding bed rest, graded exercise therapy, management of expectations, planning and pacing, and CBT. 

Medications may help, if chronic pain is influencing factor try antidepressants, specifically amitriptyline, at low dose. Other meds:

Melatonin,

doxepin,

cyproheptadine,

diphenhydramine,

trazodone,

propranolol,

clonazepam,

zolpidem,

a variety of others including benzodiazepines, beta blockers, muscle relaxants, and eszopiclone.

[logicpublishers]

Nighttime Urination: Causes, Treatments, And Prevention

Are you the type of person that likes urinating excessively at night? If yes, then this informative article is for you.

What Is Nocturia?

Nocturia, or nocturnal polyuria, is the medical term for excessive urination at night. During sleep time, your body produces less urine that is more concentrated. This means that most people don’t need to wake up during the night to urinate and can sleep…

[a-ayesha]

Prostate Cancer and Enlarged Prostate - Causes, Symptoms, Prevention and Treatment

We know that starting at age 40, the levels of the by-product prolactin of testosterone of men increases, stimulating the production of the enzyme 5-alpha reductase that causes the conversion of testosterone to gihydro-testosterones DHT triggering prostate enlargement and Prostate cancer. Therefore in order to prevent the symptoms of enlarged prostate and prostate cancer are to naturally impend the conversion of testosterone to DHT. Unfortunately, aging is not the only causes of enlarged prostate and prostate cancer. In this article, we will discuss other causes of prostate enlargement and prostate cancer.

I. Causes of enlarged prostate and prostate cancer

1. Genetics Genetics may also play a role in enlarged prostate since study shows that prostate cancer and enlarged prostates can be inherited from generation to generation.

2. Hormone imbalance The outward appearance of a typical middle-aged person shows increased abdominal fat and shrinkage of muscle mass, which is the main factor causing hormone imbalance. Hormone imbalance is also caused by depression, stress, and anxiety that are the most common psychological complications of hormone imbalance.

3. Cell-growth factor For whatever reason, some people have implicated in enlarged prostate that is a growth factor.

4. Mineral deficiency Our prostate contains high amounts of zinc to function normally. Zinc deficiency causes the prostate to enlarge. This may be due to aging or uncontrolled diet with excessive alcohol drinking.

5. Obesity Study shows that uncontrolled diet that is high in saturated and trans fats are the main cause of hormone imbalance that results in prostate enlargement. Researchers suggest that excess calorie consumption could somehow directly stimulate prostate enlargement because the excess body fat that accumulates causes an imbalance of hormone levels.

6. Testosterone Testosterone deficiency may be caused by high amounts of the by-product prolactin of testosterone of men in the body that stimulates even higher productions of the enzyme 5-alpha reductase resulting in a high amount of the conversion of testosterone to gihydro-testosterones DHT thus triggering prostate enlargement. Excess estrogen seems to be the culprit in prostate enlargement that leads to the pathology and favors the development of prostate cancer.

III. Symptoms

1. Nocturia. Nocturia is defined as being awakened at night one or more times in order to pass urine. It becomes more common as the person becomes older. This common pattern seen among people with this condition is an increased number of times of waking up every night to urinate for the rest of their life.

Nocturnal Polyuria is an important cause of nocturia in which there is an overproduction of urine at night. It is defined to have nighttime urine volume that is greater than 20-30% of the total 24 hour urine volume. Nocturia occurs more commonly among older people. It also occurs in women and men differently. Women generally experience nocturia as a result from childbirth, menopause, and pelvic organ prolapse. Nocturia in men can be directly attributed to benign prostatic hyperplasia (BPH), also known as enlarged prostate.

2. Dysuria. Dysuria is a complication associated with genitourinary infections usually resulting in painful urination because the infection has made its way into the urinary tract, resulting in a urinary tract infection. Dysuria in men is usually indicative of a complication of the prostate, commonly referred to as prostatic hyperplasia caused by hormonal imbalances associated with estrogen production.

3. Asymptomatic As we know the prostate gland becomes enlarged as a man ages. Asymptomatic inflammatory prostatitis may be diagnosed when infection-fighting cells are present causing common symptoms of prostatitis such as difficulty with urination, fever, and lower back and pelvic pain.

4. Epididymitis Epididymitis is an inflammation of the epididymis that connects the testicle with the vas deferens. Epididymitis is usually caused by infection of the urethra or the bladder. Epididymitis may begin with a low grade fever and chills with a heavy sensation in the testicle which becomes increasingly sensitive to pressure or traction.

III. Prevention and treatment

A. With Foods

1. Tomato Tomatoes contain a high amount of lycopene that can help to protect the prostate and keep it healthy, but raw tomato is hard to digest. Be sure to take tomato with dark green leafy vegetables for helping the absorption of lycopene.

2. Soy bean and legume Soybeans and legumes contains isoflavones and is a unique source of phytochemicals It directly inhibits the growth of different types of cancer cells and protects the prostate from being enlarged. Study shows that isoflavones were found to markedly inhibit prostate tumors in mice implanted with prostate cancer cells. Try adding soy or rice milk to your morning cereal or oatmeal.

2. Grapefruit Grapefruits contain high amounts of vitamin C, minerals, bioflavonnoids and other plant chemicals that help to prevent enlarged prostate, prostate cancer and other forms of cancer and heart diseases.

3. Papaya Papayas are rich in antioxidants, vitamin E, vitamin C, vitamin A, carotenoids and flavonoids that have cardio protective and anti-cancer effects. Eating papayas help to promote lung health and prevents the prostate from becoming enlarged and prevents prostate cancer.

4. Bean Beans are rich in inositol pentakisphosphate. Beans are high in fiber, which helps the body rid itself of excess testosterone that reduces the conversion of testosterone to gihydro-testosterones DHT thus triggering prostate enlargement and other problems.

5. Green tea Green tea contains the antioxidant phytochemicals called polyphenols that attack growth factors and proteins, interrupting processes that increase the size of tumors, thus preventing them from spreading to other parts of the body. Green tea also help to prevent the development of benign prostate hyperplasia such as enlarged prostate and prostate cancer.

6. Broccoli Broccoli and other cruciferous vegetables, including kale and cauliflower, are rich in sulphoraphane, a cancer-fighting phytochemical that helps rid the body of excess testosterone and reduces the risk of benign protatic hyperplasia and prostate cancer.

7. Cold water fish Cold water fish contains high amounts of Omega-3 fatty acids. Study shows that omega-3 fatty acids inhibit carcinogenesis that helps significantly lower levels of omega-3 polyunsaturated fatty acids in men with benign prostate hyperplasia and prostate cancer.

B. With Supplements

1. Bee pollen Bee pollen is an antioxidant containing high amounts of flavonoids, zinc and many other elements needed by our bodies. It has an astounding record at reversing prostate cancer and other prostate problems such as enlarged prostate.

2. Prostate glandulars Animal prostates contain high amounts of zinc that nourishes the human prostate.

3. Alanine Since alanine is present in prostate fluid, it plays an important role in prostate health. This has been confirmed in some studies that Alanine helps in preventing enlarged prostate and helps in strengthening the immune system.

4. Glutamics acid The fluid produced by the prostate gland also contains high amounts of glutamic acid, and may play a role in the normal function of the prostate. High dosages of glutamic acid may cause headaches and neurological problems and people with kidney or liver disease should not consume high intakes of amino acids without first consulting with your doctor.

5. Glycine Glycine is also found in fairly large amounts in the prostate fluid and may for this reason be important in prostate health. It is required to build proteins in the body and synthesis of nucleic acids, the construction of RNA as well as DNA, bile acids and other amino acids in the body. Study shows that glycine, taken withalanine and glutamic acid help to reduced the amount of swelling in the prostate tissue.

6. Lycopene The substance found in tomatoes, fruits and vegetables can prevent and slow down prostate inflammation and prostate cancer. Study shows that lycopene helps to decrease in DNA the damage to prostate cells. Lycopene also protects against LDL cholesterol oxidation.

C. With Herbs

1. Saw palmetto Saw palmetto is the number one choice when it comes to prostate health. Recent study of American Society for Cell Biology shows that saw palmetto inhibited prostate cancer cell growth in the test tube. It has been used for a long time as an herb to treat an enlarged prostate gland in men. It may also be used to treat prostate cancer. This herbal remedy has no significant side effects and only rarely causes mild stomach upset or diarrhea.

2. American Ginseng The roots, has been used for centuries in Asian medicine as an aphrodisiac, a tonic for well being and a curative. American Ginseng is helpful in treating prostate problems due to low testosterone and androgen levels. It also inhibits cancer cells proliferation in a variety of cancer such as lung cancer, colon cancer and prostate cancer.

3. Corn silk Corn silk contains certain therapeutic properties that help to relieve the inflammation of the prostate. Corn silk are also popular as an alternative to standard Western allopathic medicine for treating bed-wetting and obesity.

4. Pumpkin seed extract Pumpkin seeds contain high amounts of zinc and fatty acids which is necessary for the prostate's health. Pumpkin seed extract helps to tone the bladder muscles, relax the sphincter mechanism and recongest the prostate.

5. Pygeum Africanum Pygeum Africanum is rich in phytosterols, the substances that inhibit the biosynthesis of prostaglandins, which is the process responsible for prostate inflammation. Phytosterols also help to reduce the size of the prostate, promote normal urination and reduce cholesterol deposits in the prostate that can occur with BPH.

6.Essiac Essiac is useful to regulate prostate gland function, stimulates gland activities, promote circulation of blood, relieves pain and inflammation and may permit increase sexual activities. Study shows that essiac possesses potent antioxidant and DNA-protective activity, properties that are common to natural anti-cancer agents.

7. Uva ursi Uva ursi is an evergreen perennial shrub. It has been used since the year 150AD by various civilizations to treat urinary tract infections, kidney problems, Prostate, and bladder dysfunction.

8. Soy isoflavones Study shows that an increased soy intake is related to a reduced risk of prostate cancer. Vitro tests showed that soy isoflavone inhibits growth of both androgen-sensitive and androgen-independent prostate cancer cells.

D. With Chinese Herbs

1. Saw palmetto Saw palmetto has been used for over a century in traditional Chinese medicine in treating pain in the lower back, inflammation and enlargement by inhibiting dihydrotestosterone, thereby reducing its stimulation for cancerous cell multiplication.

2. Patrinia (Bai jiang cao) Patrinia helps the body get rid of prostate inflammation and damp heat that exists in the body. In Chinese medicine damp heat in the prostate could be caused by bacteria infection, drugs and other conditions such as a habit of eating hot, spicy or greasy foods.

3. Lu lu tong (liquid amber) Lu lu tong has the ability to improve qi and blood circulation . It also helps to reduce the abdominal, back and knee pain caused by damp heat as well as difficult urination because of bladder or prostate inflammation.

4. He shou wu He shou wu contains several derivatives of tetrahydroxystilbene. These antioxidants and anti-inflammatory compounds may act as an estrogen, reducing levels of circulating male hormones such as DHT that fuel the growth of prostate cancer.

5. Niu xi (Achyranthes) Niu xi contains triterpenoid saponins and sitosterol that possesses anti-inflammatory effects in both enlarged prostate and prostate cancer inflammation. It also helps to nourish the kidney liver and reduce symptoms of damp heat and difficult urination as well as stiffness and pain of lower back.

6. Gui Zhi (tokoro) Gui Zhi is used for urinary tract disorder that pertains to ying qi levels which is the main cause of prostate inflammation. It also is used as a tonic and blood purifier.

7. Astragalus root Astragalus root is a sprawling perennial legume. The Chinese medicine uses the dried sliced or powdered root of the plant to enhance immune function by increasing the activity of certain white blood cells, which increases the production of antibodies. It also helps to increase the body's resistance to infections, to heal the allergies, and to raise and renew the vitality.

8. Che Qian zi (plantago seed) It is mainly used for stone strangury caused by lower burner damp-heat, such as the symptoms of aching pain in the lumbus and abdomen, poor urination or with hematuria, and urinary tract stones.

9. Vaccaria seed It is used to reduce pain and stiffness in the lower back, drain excessive damp heat, invigorate blood and treat difficult urination.

E. With Vitamins & Minerals

As we mentioned in previous articles, We know that starting at age 40, the levels of by-product prolactin of testosterone of men increases, stimulating the production of the enzyme 5-alpha reductase that causes the conversion of testosterone to gihydro-testosterones DHT triggering prostate enlargement and other problems. Besides aging there are many other causes of enlarged prostate and some of them might result in prostate cancer. Beside foods nutrition and herbs, vitamins and minerals also play an important role in preventing and treating prostate enlarged as well as prostate cancer.

1. Zinc Zinc is necessary for male sexual and prostate health. Zinc inhibits the uptake of testosterone into prolactin. The prostate gland contains a higher concentration of zinc than any other organ in the body, therefore zinc deficiency is the major cause of enlarged prostate as well as an early indication of prostate cancer.

2. Selenium Selenium contains an antioxidant enzyme that helps to enhance immune function, stop early cancer cells in their development and control cell damage that may lead to cancer. Foods that contain high levels of selenium are bran, broccoli, eggs, mushroom, and basil nut.

3. Vitamin C As we know Vitamin C, a water-soluble vitamin, is commonly known as an antioxidant. Some studies show that increased levels of vitamin C reduce the risk for prostate cancer as well as prostate inflammation and enlarged prostate.

4. Vitamin D Vitamin D is found in foods and is also produced by the body and activated after exposure to ultraviolet light from the sun. Studies show that activated vitamin D may be broken down in the prostate, where it may plays an important role in preventing enlarged prostate and prostate cancer. Vitamin D deficiency may increase the risk of prostate cancer.

5. Vitamin E Vitamin E plays an important role in preventing prostate cancer because it interferes with prostate specific antigen (PSA) and androgen receptor proteins that play a central role in the development of the disease.

F. With Homeopathic Remedies

1.Chimaphilia Chimpaphilia acts principally on kidneys, and genito-urinary tract; affects also lymphatic and mesenteric glands. It helps in treating urge to urinate with burn pain, strain to urinate and prostate enlargement and irritation.

2.Conium maculatum Conium maculatum is an excellent remedy for old age people. It helps to improve prostate enlargement, difficult urination, weakened urine flow and soften the prostate and enhance sexuality.

3. Hepar sulphuris calcareum Hepar sulphuris calcareum is a mixture powder of oyster shells and pure flower of sulfur. You can purchase in mixture in a health food store and follow the instructions to make your own. Hepar sulphuris calcareum has proven record in treating dribbling urine and poor flow.

4. Sabal serrulata Sabal serrulata is homeopathic to irritability of the genito-urinary organs. It is helpful in treating difficult urination caused by enlarged prostate, constant desire to urinate, as well as sexual inability.

5. Staphysagria Staphysagria is helpful in treating diseases of the genito-urinary tract such as the urge to urinate, inability to urinate fully and feeling of bladder not being empty.

6. Thuja The main action of thuja is on the genito-urinary organs. It is helpful in treating enlarged prostate, sudden desire to urinate and split urinary stream.

G. With Common Sense Approaches

1. Reduce fat and cholesterol intake, especially saturated fats. Study shows that if you eat more than 5 servings of red meat every week you could increase the risk of enlarged prostate and prostate cancer by 80%. By eating less of red meat and replacing them with cold water fish, you are ensured yourselves to get enough omega fatty acid that helps to improve your prostate health, reduce cholesterol levels, lower the risk of enlarged prostate as well as prostate cancer.

2. Eat foods containing more zinc (nuts- especially walnuts, pumpkin, seeds, safflower seeds and oysters). Zinc is an essential mineral for prostate health. It helps to reduce the size of the prostate and relieve symptoms of enlarged prostate. Foods containing zinc also contain cucurbitacines, chemicals that stop testosterone from changing to stronger forms of testosterone which encourages too many prostate cells to grow. Foods that contain cucurbitacines are nuts, walnuts, pumpkin seed, and oyster.

3. Guard your prostate with green tea Green tea contains catechins, a chemical that helps our immune system to track down tumor cells before they can do any harm to the prostate cells. Green tea may be one reason that Asian people have far fewer cases of prostate cancer than North Americans.

4. Remove all chemicals and pesticides from diet (eat organic food). Chemicals and pesticides in the processing food is toxic to our body. Intaking high doses of these poisonous chemicals will danger our immune system as well as cause inflammation of the body including the prostate.

5. Increase consumption of plants high in the sulphurophanes Study shows that you could reduce the risk of prostate cancer and prostate enlargement by 45% if you eat 24 or more servings of vegetables that contain high amounts of sulphurophanes such as broccoli, cauliflower, brussel sprouts, and cabbage.

H. Activities That Help to Maintain a Healthy Prostate

1. Moderate exercise (like walking) We know that one half to three-quarters of men older than 75 will have some cancerous changes in their prostate glands. People doing moderate exercise like walking for 2 to 3 hours per week had a 25 percent less risk of developing prostate problems than those who did not. Just 20-30 minutes walking a day would help to increase circulation of blood to the body as a side benefit for better sexual function and prostate health.

2. Sitz baths It is one of the earliest prostate treatments and the most effective remedies for prostate pain. This special bath brings a great flow of blood to a specific area of the body while the regular hot bath is pleasant and generally increases circulation throughout your body.

3. Yoga Yoga is really helpful to the prostate. It also helps tone the deep pelvic muscles there by promoting circulation. Yoga promotes flexibility, circulation, and stimulates the liver meridian. In general yoga helps a person to be more aware of his pelvic area in terms of his muscular control.

4. Kegal exercise Kegal exercise when performed while in virasana, bhekasana or frog pose also promotes good prostate health and overall benefit to the urogenital tract.

5. Spinal and pelvic massage Spinal and pelvis massage helps to a) Increase blood supply to the prostate and the pelvic area. b) Increase lymphatic flow to the prostate and the pelvic area. c) Reduces inflammatory conditions.

6. Joyful sex life Sex helps increase movement of the pelvic muscles and the blood circulation to all organs of your body. As fresh blood supply arrives your cells, organs and muscles are saturated with fresh oxygen and hormones, and as the used blood is removed, you also remove waste products and toxins from your body, thus reducing the risk of inflammation of the prostate.

You can see there are many different methods that help to maintain a healthy prostate. I hope this information will help. if you need more information. please visit my home page at:benign prostatic hypertrophy treatment

[your-dietician]

Left-Sided Heart Failure: Overview and More

New Post has been published on https://depression-md.com/left-sided-heart-failure-overview-and-more/

Left-Sided Heart Failure: Overview and More

The signs and symptoms of left-sided heart failure can be confused with another medical condition or even go unnoticed. Edema, fatigue, and shortness of breath—even in the absence of chest pain—can be signs of a failing heart.

The left ventricle (LV) is the chamber that is responsible for pumping blood from the heart to the rest of the body. Dysfunction of the left ventricle leads to two types of heart failure: systolic and diastolic.

Heart failure (HF) is common in the United States with over six million people. Additionally, nearly one million new cases are diagnosed each year. Fortunately, medical advances have made it possible to manage heart failure.

patrickheagney / Getty Images

Types of Left-Sided Heart Failure

The heart has two main pumping chambers: the right ventricle and the left ventricle. The right ventricle receives deoxygenated blood from the body and sends it to the lungs, where it picks up oxygen. The larger and more powerful left ventricle pumps oxygenated blood to the body through the aorta.

Conditions such as hypertension, obesity, and coronary heart disease make the heart have to work harder to pump the same amount of blood. Over time, the heart’s main pumping power source is gradually weakened and can no longer handle the blood that it is receiving from the lungs. When this happens, heart failure occurs.

There are two types of left-sided heart failure:

Heart failure with preserved ejection fraction (HFpEF), also called diastolic heart failure: In this type, the heart muscle contracts normally, but the ventricles do not relax as they should during ventricular filling (or when the ventricles relax).

Heart failure with reduced ejection fraction (HFrEF), also called systolic heart failure: In this type, the heart muscle does not contract effectively, and less oxygen-rich blood is pumped out to the body.

Left-Sided Heart Failure Symptoms

You may not notice the signs of left-sided heart failure right away. Or you might attribute any mild symptoms you have to something else, such as allergies, congestion, indigestion, or a cold.

As the heart weakens, fluid backs up into the lungs and around the heart. When this happens, your symptoms may get worse and prompt you to seek medical care.

Older adults and people who are obese may have atypical signs and symptoms of heart failure Any sign of chest discomfort or a rapid decline in health should be treated as a medical emergency.

The symptoms of left-sided heart failure include:

Chest pain

Fatigue

Weakness

Shortness of breath (especially on exertion)

Orthopnea (shortness of breath when lying down)

Paroxysmal nocturnal dyspnea (awakening at night with shortness of breath)

Exercise intolerance

Fast or irregular heartbeat

Peripheral edema (swelling of the feet, ankles, and legs)

Unexplained weight gain

Nausea

Persistent coughing or wheezing

Having to urinate more than usual (polyuria) or at night (nocturia)

As time goes on, your heart may try to compensate by pumping harder to meet your body’s blood and oxygen demands. This causes more damage, which can lead to:

Enlarged heart

Rapid heart rate

High blood pressure

Less blood flow to the arms and legs

Early diagnosis and treatment can help slow the progression of left-sided heart failure and help you learn to adequately manage your symptoms. If undiagnosed and untreated, left-sided heart failure can cause complications like kidney or liver disease and heart attack.

Causes

The most common cause of heart failure is reduced left ventricular myocardial function. There are two types of dysfunction: systolic and diastolic.

Systolic dysfunction (HFrEF) is often due to:

Diastolic dysfunction (HFpEF) is most often due to:

Below is a list of the most common causes of left-sided heart failure and explanations on how these conditions contribute to heart failure.

High blood pressure: Chronic hypertension is one of the most common causes of diastolic heart failure. High blood pressure over a long time means that the heart has to work harder to pump blood through the body. As a result, the heart gets more muscular and stiffer, which affects its ability to relax during the resting stages of the cardiac cycle when it fills with blood. 

Diabetes: High blood sugar levels are toxic to blood vessels and may cause them to stiffen. Like high blood pressure, the heart muscle can thicken when it has to work harder against increased pressure.

Coronary artery disease: Blockages in the heart’s blood vessels allow less blood to flow through your heart than usual. Very low blood flow to the heart can lead to the death of heart muscle cells (ischemia), preventing the heart from relaxing and filling as it normally would. 

Pericardial disease: Fluid around the heart (pericardial tamponade) or a thickened outer covering on the heart (pericardial constriction) can limit the heart’s ability to fill with blood.

Other heart conditions: Several other heart conditions can cause the left ventricle to thicken, compromising its ability to relax and fill with blood. Aortic stenosis (narrowing of the aortic valve) and hypertrophic cardiomyopathy (an inherited heart muscle disorder that leads to a very thickened left ventricular wall) are two examples.

Obesity: Increased fat padding around the heart causes the heart to have to work harder to pump.

Sedentary lifestyle: A lack of physical activity can put you at higher risk of high blood pressure, diabetes, coronary artery disease, and obesity—all of which contribute to diastolic heart failure. 

Obstructive sleep apnea (OSA): OSA is characterized by partial or complete cessation of breathing during sleep. This leads to a complex set of changes in the body, including increases in blood pressure, diminished oxygen delivery to the heart, and increased sympathetic nervous system activity. As a result of these changes, there is a mismatch between oxygen supply and demand, which may predispose you to cardiac ischemia and arrhythmia, left ventricular hypertrophy, left ventricular enlargement, and both systolic and diastolic heart failure.

Hypertension, diabetes, obesity, and a sedentary lifestyle are preventable risk factors that you should be aware of whether you have heart failure or not.

The New York Heart Association classification system is the simplest and most widely used method to gauge symptom severity among people with heart failure.

Class I

No limitations of physical activity

No heart failure symptoms

Class II

Mild limitation of physical activity

Heart failure symptoms with significant exertion; comfortable at rest or with mild activity

Class III

Marked limitation of physical activity

Heart failure symptoms with mild exertion; only comfortable at rest

Class IV

Discomfort with any activity

Heart failure symptoms occur at rest

Diagnosis

Heart Failure With Preserved Ejection Fraction

A diagnosis of HFpEF is made based on your clinical history, physical examination, laboratory data, echocardiography, and when necessary, by cardiac catheterization.

To make a diagnosis of heart failure, a doctor needs to assess a patient for:

The clinical signs and symptoms of heart failure, and

Evidence of normal, or near-normal, left ventricular systolic heart function with an LV ejection fraction over 50%, and

An assessment of the heart’s diastolic characteristics with an echocardiogram.

An echocardiogram (or cardiac echo) is an ultrasound of the heart that can provide information on how the heart relaxes and fills with blood, also known as diastolic function, cardiac output, and the ejection fraction.

A diagnosis of diastolic heart dysfunction can also be measured invasively, using a catheter to measure the mean pulmonary capillary wedge pressure, or non-invasively, using doppler imaging techniques.

While HFpEF is a heterogeneous syndrome with multiple different conditions that contribute to the syndrome, high blood pressure, diabetes, and coronary artery disease are the biggest culprits.

Heart Failure With Reduced Ejection Fraction

The diagnostic workup for HFrEF includes an assessment of your clinical history, a physical examination, lab work, and an echocardiography assessment of LV structure and function.

If echocardiography is inconclusive, additional imaging tests might be considered, including:

Radionuclide scan

Cardiac catheterization

Magnetic resonance imaging (MRI)

Computed tomography (CT) scan and endomyocardial biopsy

Cardiopulmonary exercise testing

HFrEF is a clinical syndrome that is diagnosed based on your symptoms of edema, fatigue, and shortness of breath, plus evidence of reduced left ventricular pumping power and blood delivery, usually documented by a left ventricular ejection fraction (LVEF) equal to or less than 40% on echocardiography.

The signs of HFrEF on physical exam include elevated jugular venous pressure, pulmonary crepitation, and displaced apex beat—but they don’t have to be present to make a diagnosis.

Instead, as noted above, the diagnostic hallmark of HFrEF is LVEF equal to or less than 40%, according to both the European Society of Cardiology HF guidelines and the American College of Cardiology Foundation/American Heart Association Task Force on the management of HF.

Treatment

Left-sided heart failure is a progressive condition with no cure, but it can be managed. In most people, heart failure is a chronic condition that requires lifelong treatment. Most treatments are geared toward slowing the progression of heart failure and managing symptoms. 

Treatment of left-sided heart failure depends on the type of heart failure. There is no one-size-fits-all approach to managing the condition. The treatment should take the whole person into account, not just the heart.

A sound treatment plan usually starts with controlling a patient’s blood pressure and relieving fluid overload, which can cause swelling or shortness of breath, as well as addressing the anticipated mental, emotional, and physical changes that a patient will experience.

Numerous randomized trials have shown the efficacy of using a diuretic, an ACE inhibitor or an angiotensin receptor blocker, and a beta-blocker. Most patients with HFrEF will benefit from being on these medications.

Treating the root cause of a patient’s heart failure is the key to slowing heart disease. Here are a few examples:

If the cause of your heart failure is a narrowed or leaky heart valve or an abnormal connection between heart chambers, surgery can often correct the problem.

If it is blockage of a coronary artery, drug treatment, surgery, or angioplasty with a coronary stent may be the answer.

Antihypertensive drugs can reduce and control high blood pressure.

Antibiotics can eliminate some infections.

Heart Failure With Preserved Ejection Fraction Treatment

Diuretics are a mainstay of HFpEF treatment, but the medication is only as effective as the changes that a person makes to their diet and overall lifestyle.

If you have HFpEF, your doctor will likely suggest that you follow a treatment regimen that includes a combination of diet and lifestyle changes, medicines, and sometimes a device to protect your heart from abnormal rhythms.

Diet and Lifestyle Changes

If you have heart failure, the following lifestyle changes may help you manage your symptoms:

Reducing your salt intake is especially important. Too much salt in your diet can cause fluid retention, which counteracts the drugs (diuretics) that increase water excretion and relieve fluid accumulation.

The efficacy of medication in the treatment of diastolic heart failure is inconclusive. Therefore, the best way to manage HFpEF is to treat its underlying cause, such as hypertension, diabetes, or coronary artery disease.

Diuretics and beta-blockers are commonly used to manage HF symptoms. They work by removing excess fluid from the body and slowing the heart and giving it more time to fill. The use of diuretics like ACE inhibitors, thiazides, and spironolactone have even been found to increase life expectancy.

Management by Stage

The American College of Cardiology and the American Heart Association (ACC/AHA) recommend that cardiologists manage heart failure by its stage.

Stage A includes managing heart failure risk factors like high blood pressure and high cholesterol. This may include putting you on a thiazide diuretic or ACE inhibitor and a statin.

Stage B is diastolic dysfunction without symptoms. In this case, your cardiologist will likely prescribe a thiazide diuretic, ACE inhibitor, or nondihydropyridine calcium channel blockers to help ease the load on your heart.

Stage C is symptomatic heart failure with or without hypertension. At this stage, your doctor will focus on treating the volume overload on your heart by using diuretics. 

The ACC/AHA also recommends starting or continuing a combined endurance and resistance training program for patients with HFpEF to improve exercise capacity, physical functioning, and diastolic function. Exercise has been proven to help the heart work more efficiently.

Heart Failure With Reduced Ejection Fraction Treatment

Treatment for anyone with heart failure should start with lifestyle modification such as:

Diet modification, including low sodium and fluid intake

Smoking cessation

Decreased alcohol intake

Increased exercise

Maintaining a healthy weight

Pharmacotherapy is the cornerstone of the treatment of HFrEF. The main validated heart failure medications are:

Angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs): Proven to reduce mortality rates and improve kidney function

Beta-blockers: Proven to reduce mortality rates by decreasing strain on the heart

Diuretics: Includes drugs like thiazides, which not only reduce mortality, but also reduce congestive symptoms by removing fluid around the heart and lungs. Loop diuretics produce a more intense and shorter diuresis effect than thiazides.

Mineralocorticoid receptor antagonists (MRAs), such as spironolactone and eplerenone: Used when beta-blockers and ACE inhibitors fail. They should be used cautiously in those with kidney disease, as the medication can exacerbate renal dysfunction.

Digoxin: Has a high side effect profile and is used as a last-ditch effort to reduce hospitalization

Ivabradine: Works like a beta-blocker to slow the heart; often prescribed to those who cannot tolerate beta-blockers and used together with ACE inhibitors/ARBs or MRAs/ARBs

Medications are usually added based on how effective they are at managing your symptoms. Your cardiologist will likely start with a combination of an ACE inhibitor, beta-blocker, or diuretics for symptom relief. If you are still symptomatic and your LVEF is equal to or less than 35%, an MRA might be added.

If you are still symptomatic and your LVEF is equal to or less than 35%, your doctor may suggest replacing your ACE inhibitor with an angiotensin receptor-neprilysin inhibitor. Ivabradine or cardiac resynchronization therapy might also be considered.

Finally, if you are still asymptomatic, digoxin, an LV assist device, or heart transplantation should be considered.

Prognosis

There is no cure for left-sided heart failure, but timely management greatly increases your chances of living well with the condition.

Left-sided heart failure, whether HFpEF or HFrEF, is a progressive condition associated with increased mortality, even if you do not have symptoms.

The prognosis of left-sided heart failure depends on many factors, including:

Age

The extent of left-sided heart failure: There are four stages of heart failure, with each indicating how serious your condition is.

Prior medical conditions, like diabetes

Prior hospitalizations

How your body responds to medical treatments

Exercise intolerance

HFpEF Prognosis

The outlook for HFpEF is especially poor if you have been hospitalized, with one-year mortality rates as high as 25% among older patients, and five-year mortality rates of 24% for those over the age of 60 and 54% for those over 80.

Factors associated with a worse prognosis include higher levels of NT-proBNP, older age, diabetes, past history of heart attack or chronic obstructive pulmonary disease (COPD), reduced glomerular filtration rate and diastolic function, and right ventricular remodeling on cardiac echo.

HFrEF Prognosis

Diastolic heart failure tends to have a better short-term prognosis compared to systolic heart failure.

Normal ejection fraction rates range between 50% and 70%. Research shows that the severity of left ventricular dysfunction, measured by the ejection fraction, is proportional to increases in mortality rates.

In other words, the worse the left-sided heart failure, the worse the prognosis. In one trial, 50% of participants with an ejection fraction below 15% did not live for one year.

Survival rates in patients with heart failure are 75.9% at one year, 45.5% at five years, and 24.5% at 10 years, compared to 97%, 85%, and 75% in the general population, respectively.

Despite advances in medical technology, treatment, and widespread heart health campaigns, high mortality rates of 15% to 20% during the first year of diagnosis (and rising to 40% to 50% within five years of diagnosis) have remained relatively consistent in recent decades.

If you are over 65 years old, you are at a particularly high risk of heart disease. This underscores the need to start a heart-healthy life sooner rather than later. Research has shown that older patients hospitalized with congestive heart failure face a grave prognosis, particularly if their heart failure symptoms are caused by LV systolic dysfunction.

Coping

If you have heart failure, feelings of fear, anger, emotional distress, and depression may arise after the initial diagnosis. The physical limitations can be tough to accept, and you may not be ready to make all the changes that are asked of you. All these reactions are natural. Talking to friends and family can help you navigate these challenges.

From adapting to taking daily medication to making adjustments to your social life, living with heart failure is not easy. The key is to make lifestyle changes that lessen the chances of having heart failure exacerbations.

Stay in tune with your symptoms and contact a healthcare professional immediately if you sense that your condition is worsening.

Limiting your stress, quitting smoking, and exercising can benefit both your physical and mental health. Addressing your emotional well-being is key, because depression and anxiety may lead you to turn to ways of coping—like smoking, drinking alcohol, using substances, or making dietary choices that are not the best for your heart health—that could worsen your physical health.

If you are experiencing the following symptoms for two or more weeks, you might be suffering from depression:

Feeling sad

Not enjoying normal activities

Trouble concentrating

Fatigue

Withdrawal from friends and family

Feeling hopeless and worthless

Excessive sleepiness

Loss of appetite

Suicidal thoughts

Recognizing that you might be depressed is the first step to taking action. Talk to your doctor about what options you have for treatment. This might include seeing a mental health provider and working through your stress with methods like cognitive behavioral therapy or medication. Or you might find that staying active and communicating with your loved ones about how you are feeling is enough to manage your mental health.

A Word From Verywell

Learning that you have heart failure is scary, but the better you understand the signs and symptoms of the condition, the better prepared you will be to take steps that can prevent exacerbations.

The once grim prognosis for heart failure can now be well managed with a combination of lifestyle modifications and medical monitoring. For example, you might start following a low-sodium diet, taking medications, and having frequent check-ins with your cardiologist.

While having to make many lifestyle changes in a short time can seem daunting, leaning on your friends and family, reaching out to a mental healthcare professional, and taking part in support groups can help.

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