Cleft and craniofacial disorders are a diverse group of deformities affecting the face and skull. These disorders are typically present at birth and can range from mild to severe. They can impact your child’s appearance and impede critical functions such as eating and breathing. In the US, approximately 600,000 children have been diagnosed with a cleft or other craniofacial disorder.

In observance of National Cleft and Craniofacial Awareness and Prevention Month, let’s discuss some of the more common disorders in greater detail.

Cleft lip and cleft palate are the most common of the cleft and craniofacial disorders. They occur when a baby’s lip or palate doesn’t form properly during pregnancy. About 1 in every 2,800 babies born in the US has a cleft lip; about 1 in every 1,700 babies is born with a cleft palate, and about 1 in every 1,600 babies is born with a cleft lip and cleft palate.

A cleft lip is a separation of the two sides of the lip. The lips form between the fourth and seventh weeks of pregnancy. A cleft occurs if the tissue forming the lip does not fuse completely during fetal development. The result is an opening in the upper lip, which can range from a small slit to a large gap that goes through the lip into the nose.

The palate, or roof of the mouth, forms between the sixth and ninth weeks of pregnancy. A cleft palate results if the tissue that makes up the palate doesn’t join together completely. In some cases, both the front of the mouth (hard palate) and the back part toward the throat (soft palate) are separated. In other cases, only one part of the palate is open.

Other cleft and craniofacial disorders include:

Hemifacial microsomia, also known as Goldenhar syndrome, is a condition in which the tissue on one side of the face is underdeveloped. This disorder typically affects the ear, mouth and jaw. In some cases, both sides of the face are affected. Hemifacial microsomia is the second most common cleft and craniofacial disorder behind cleft lip and cleft palate. It affects 1 in every 3,500 to 4,000 births.

Craniosynostosis is a disorder in which the natural sutures (soft spots) between a infant’s skull bones that enable the skull to expand as your child grows fuse before growth is complete. The result is a skull that’s abnormally shaped and pressure on a growing brain that can lead to developmental delays and learning problems. A baby’s facial bones may also be altered, creating an asymmetrical appearance.

Deformational, or positional, plagiocephaly is a change in head shape due to external pressure on the skull. It can develop if a baby sleeps in the same position most of the time or if problems with the baby’s neck muscles create a preference to turn the head in the same direction.

A vascular malformation is a birthmark or growth composed of blood vessels that can cause functional or aesthetic problems. There are several types of vascular malformations, which are named according to the blood vessel affected. Many of these malformations are apparent at birth. However, some aren’t found until the child is older, sometimes by the teenage years.

Symptoms of cleft and craniofacial disorders vary depending on the disorder and its severity. In general, these disorders are associated with head deformities and difficulties with speech, breathing, hearing and vision. Often, children with these disorders have dental problems and poor self-esteem.

Most medical professionals believe multiple factors combine to cause cleft and craniofacial disorders. Genetics is one factor. An affected child may have received a particular gene or combination of genes from one or both parents.

Environment is another factor. Women who take certain medications, have diabetes, smoke or drink alcohol in excess while pregnant are at a higher risk for having a baby with a cleft or other craniofacial disorder.

Studies have shown that women who don’t get enough folic acid during pregnancy may also be at a higher risk for having a baby with a cleft or other type of craniofacial disorder. Folic acid is a B vitamin found in leafy green vegetables, orange juice, fortified breakfast cereals and enriched grain products.

A cleft or other craniofacial disorder is usually diagnosed within the first few months of life. Many of the disorders, such as cleft lip and hemifacial microsomia, are obvious when looking at the baby. The child’s doctor may use dental or skull x-rays or a CT or MRI scan to aid in the diagnosis. Sometimes, these deformities can be diagnosed before birth using prenatal ultrasound.

Depending on the type and severity of the cleft or other craniofacial disorder, reconstructive surgery may be recommended to improve the child’s physical appearance. Surgery also helps with eating, breathing and speaking, as well as dental problems.

Children born with these disorders often require specialized health care from infancy to young adulthood.
Some research studies suggest that taking folic acid while pregnant may decrease the chances of having a baby with a cleft or other craniofacial disorder. Folic acid can be found in most multivitamins and as a stand-alone supplement.

Patti DiPanfilo

Arthritis, which is inflammation or degeneration of the joints, affects children as well as adults. Arthritis in children is called juvenile arthritis, and July is Juvenile Arthritis Awareness Month.

Juvenile arthritis can cause permanent joint damage and impact the child’s growth and physical development, so early intervention and treatment is imperative. Read on to learn more.

The most common type of childhood arthritis is juvenile idiopathic arthritis (JIA). The term “idiopathic” means the exact cause for the disorder is unknown. We do know that JIA is an autoimmune disease. In this case, the body’s germ-fighting immune system malfunctions and targets the joints’ synovial membrane (tissue lining), causing inflammation.

Researchers don’t know why this happens but believe a combination of genetic and environmental factors may be involved.

In the US, juvenile idiopathic arthritis affects about one of every 1,000 children, or about 300,000 children. There are several types of JIA. The three main types are oligoarticular, polyarticular and systemic.

About 50 percent of children with JIA have the oligoarticular type, which typically affects fewer than five joints, most often the knee, ankle and elbow. In most cases, this type is mild and symptoms may lessen or go away over time. Children with oligoarticular arthritis are at high risk for developing inflammation of the eyes (uveitis). To prevent vision loss, your child should have regular examinations by an eye doctor.

About 30 percent of children with juvenile arthritis have the polyarticular type, which affects five or more joints. It often affects the smaller joints such as those in the hands and feet. It can, however, impact larger joints, including those in the neck and jaw. Typically, polyarticular arthritis affects the same joints on both sides of the body.

Systemic arthritis, also called Still’s disease, occurs in about 10 to 20 percent of children with JIA. It affects the entire body, not just the joints. Systemic JIA typically begins with a fever and rash that come and go. In many cases, it leads to inflammation of internal organs such as the heart, liver, spleen and lymph nodes. If not treated appropriately, children with systemic JIA may develop severe arthritis in their joints that continues into adulthood.

Symptoms of JIA may come and go. Sometimes, symptoms are worse (flares) and sometimes symptoms get better (remission). Symptoms vary depending on the type of JIA and may include joint pain, swelling and tenderness; joint stiffness; limping; difficulty with fine motor activities; persistent fever; rash; weight loss; swollen lymph nodes; fatigue or irritability; growth problems; eye redness or pain; and blurred vision.

To diagnose and treat JIA, your child’s pediatrician may refer you to a pediatric rheumatologist, a specialist in arthritis and related conditions in children. The rheumatologist will perform a physical examination and review of your child’s symptoms. The specialist may order tests on your child’s blood and joint fluid, as well as x-rays or an MRI to help rule out other causes for the symptoms and classify the type of arthritis.

The goals of treatment for JIA are to control symptoms, prevent joint damage and maintain function. Treatment also aims to identify, treat and prevent complications of the disorder.

Treatment for juvenile arthritis generally involves medication and therapy. Medications used include nonsteroidal anti-inflammatory drugs (NSAIDs), which can often quickly reduce inflammation and relieve pain. If NSAIDs don’t relieve symptoms, the next step is disease-modifying anti-rheumatic drugs (DMARDs).

DMARDs suppress the immune system on a broad level, helping to prevent progression of the disease and saving the joints from permanent damage. However, these drugs may take weeks or months to relieve symptoms. Biologic response modifiers are another type of medication that block specific immune signals that cause inflammation. They help to prevent progression of JIA, achieve remission and protect against permanent joint damage.

Corticosteroids are strong inflammation-fighting medications that typically bring fast relief when injected into an affected joint. However, they have many possible side effects, including weakened bones, upset stomach and mood swings, so they are generally only used for short periods.

Physical and occupational therapy play important roles in the treatment of children with arthritis. Physical therapy can help relieve pain, improve and maintain range of motion in the affected joints and strengthen the muscles that support the joints. Occupational therapy teaches how to increase or preserve mobility so the child can more easily perform activities of daily living.

A physical or occupational therapist may recommend your child wear a splint or brace to protect the affected joints to reduce inflammation and prevent contractures, the tightening or shorting of the muscles and joints, which causes a deformity.

With prompt and appropriate treatment, most children with arthritis develop normally and can live active, full lives.

Patti DiPanfilo

Iron is a mineral your body needs to stay healthy and function properly. Iron is a major component of hemoglobin, a protein in red blood cells that carries oxygen from your lungs to the rest of your body. Iron is also used to make certain hormones such as erythropoietin (EPO), which signals the bone marrow to make more red blood cells.

Normally, your intestines absorb the right amount of iron from the food you eat. Sometimes, the body absorbs more iron than it needs, which is a condition called hemochromatosis. Your body has no natural way to rid itself of this excess iron, so it is stored in your joints and organs, such as your liver, heart and pancreas. Without treatment, hemochromatosis causes iron overload, which can seriously damage those organs.

Too much iron in the heart can cause an arrhythmia or heart failure. Excess iron in the liver can lead to cirrhosis, liver cancer or liver failure. Too much iron in the pancreas can result in the development of diabetes.

Hemochromatosis is relatively common, affecting more than 1 million Americans. There are two main types: primary and secondary.

Primary hemochromatosis, also called hereditary hemochromatosis, is usually caused by genetic factors. It typically results from mutations to the HFE gene, which controls how much iron you absorb from food. The gene mutation that most commonly causes hemochromatosis is C282Y. You are more likely to develop the disorder if you inherit two copies of the C282Y mutation, one from each parent.

Secondary hemochromatosis, which is much less common, develops due to other medical conditions, such as certain types of anemia and liver disease. It can also develop as a result of receiving numerous blood transfusions.

Symptoms typically develop after age 40 once iron has built up to a toxic level. In general, women develop symptoms about 10 years later than men, usually after menopause. The reason for the difference is that women lose blood, and therefore iron, from childbirth and menstruation. However, it begins to accumulate once they enter menopause.

Some of the more common symptoms of hemochromatosis include joint pain, fatigue, bronze or gray skin color, pain in your abdomen due to an enlarged liver, loss of sex drive, erectile dysfunction, hair loss, memory fog, abnormal heartbeat and unexplained weight loss.

Diagnosing hemochromatosis can be challenging because its symptoms are common to other conditions. Visit your doctor if you are experiencing symptoms, have one of the conditions associated with excess iron in the organs or have a family member who has hemochromatosis.

To make a diagnosis, your doctor will first ask about your symptoms as well as your personal and family medical history. He or she will perform a physical exam, which includes listening to your body with a stethoscope and tapping on your abdomen to check for an enlarged liver.

Your doctor will likely order blood tests, including a transferrin saturation test, which shows how much iron is attached to transferrin, a protein that carries iron in your blood. Another blood test is the serum ferritin, which measures the amount of ferritin, a protein that stores iron, in your blood. You doctor may order a blood test to look for the C282Y mutation as well.

If your doctor suspects liver damage, he or she may perform a liver biopsy. He or she will take a small sample of liver tissue through a needle and look at it under a microscope to see if there’s any liver damage. In some cases, you doctor can accurately evaluate the health of your liver from an MRI scan.

Hemochromatosis can be treated safely and effectively by removing blood, and therefore excess iron, from your body on a routine basis. This process is called phlebotomy, and it’s just like donating blood. The amount of blood removed and the frequency of treatment depend on your age and overall health, as well as the severity of your condition. The goal of phlebotomy is to reduce your iron level to normal.

If you have a condition that excludes you from treatment with phlebotomy, such as anemia or heart complications, another treatment may be recommended to remove the iron from your body. Chelation therapy uses medication that binds to the excess iron and allows it to be expelled from your body through your urine or stool.

If you have hemochromatosis, you should eat a healthy, well-balanced diet. Your doctor may recommend avoiding raw shellfish, iron and vitamin C supplements (vitamin C helps your body absorb iron from food) and limiting alcohol. If you have liver disease, particularly cirrhosis, you should stop drinking alcohol.

If you have a first-degree relative – parent, sibling or child – with hemochromatosis and are between 18 and 30 years old, you should be screened for the condition regularly. This way, if the condition is present, it can be discovered in its early stages, before iron overload causes organ damage. Hemochromatosis screening may include blood testing and genetic testing.

Patti DiPanfilo

Your eyes require a constant flow of tears to stay healthy and comfortable. If your eyes fail to make enough tears or if your eyes don’t make the right type of tears, you may have an irritating condition called dry eye.

July is National Dry Eye Awareness Month, so let’s take a look at the ailment in detail.

Every time you blink, a thin film of tears spreads across your eye to keep its surface smooth and clear. The tear film is made up of three layers: an oil layer for lubrication, a water layer for moisture and a mucus layer to make tears adhere to the surface of the eyes. While each layer serves an important purpose, oil and water are the most important components of the tear film.

You must have the right balance of oil and water to maintain a healthy tear film. Without oil, which is produced and released by the meibomian glands in the eyelids, the tear film becomes unstable and fails to spread evenly across the eye’s surface. As a result, the tears evaporate more quickly, resulting in dry eye. The meibomian glands can malfunction due to blockages of debris and hardened oil.

There are other potential causes for dry eye as well. Certain diseases, including rheumatoid arthritis, Sjogren’s syndrome, thyroid disease and lupus, can lead to dry eye. Being in smoky, windy or dry environments can contribute to the condition. Hormonal changes, such as those during menopause, are linked to dry eye, which may be why dry eye is nearly twice as common in women than in men.

Looking at computers and other digital devices for extended periods can cause dry eye because we tend to blink less when staring at screens. Wearing contact lenses for a long time or having had LASIK or cataract surgery can promote dry eye. Certain medications, including some antihistamines, diuretics, antidepressants and blood pressure medicines, can also dry your eyes.

Dry eye is a common condition. According to the National Eye Institute, nearly 16 million Americans have dry eye. Other sources suggest that as many as 48 percent of adult Americans regularly experience dry eye symptoms.

Symptoms include stinging and burning, fluctuating or blurred vision, a scratchy or gritty feeling like something is in your eye, redness or irritation, pain when wearing contact lenses, eye fatigue, light sensitivity, stringy mucus near your eyes, and an excess of tears.

Having lots of tears may seem odd when you have dry eye, but your eyes make more tears when they are irritated by dry eye.

Untreated, chronic dry eye can lead to serious complications, including eye infections, eye inflammation, abrasions of the corneal surface, corneal ulcers and vision loss. The cornea is the clear outer layer at the front of your eye.

To diagnose the condition, your doctor will first ask about your symptoms and general health, any medications you take and any environmental conditions you experience that may be contributing to your dry eye. The doctor will then perform a comprehensive exam to evaluate the surface of your eyes. The exam will likely include tests to measure the quantity and quality of your tears and an observation of tear flow and evaporation rate.

Treatment aims to keep the eyes well lubricated and prevent vision from being affected. The treatment approach taken depends on the severity of the condition. Mild cases can often be managed using over-the-counter artificial tears as needed to supplement natural tear production. Preservative-free preparations are recommended.

If your dry eye is more serious, your doctor may prescribe a medication such as cyclosporine (RESTASIS®, CEQUA™) or lifitegrast (XIIDRA®). These eyedrops are used twice a day to reduce inflammation and relieve the symptoms of dry eye.

To conserve the natural tears on the surface of your eyes, your doctor may recommend placing tiny silicone or gel-like plugs, called punctal plugs, to block the ducts that drain the tears. In extreme cases, surgery to permanently close the ducts may be performed.

Your doctor may recommend other treatments, such as intense-pulsed light (IPL) and the LipiFlow® Thermal Pulsation System.

Light energy from IPL warms the meibomian glands and any material clogging them. This allows the oil to flow normally from the glands into the tear film.

LipiFlow combines the controlled application of therapeutic heat with a gentle, pulsating massage. These functions work to liquify, then remove the clogging debris from the meibomian glands, enabling them to function efficiently.

A scleral lens is another way to keep the natural moisture on the eyes. This is a special contact lens that rests on the sclera, the white part of the eye. It creates a fluid-filled layer over the cornea, preventing it from drying out.

There are some steps you can take to improve dry eye. Humidify your bedroom to keep moisture in the air. Take frequent breaks when using a computer or other digital device. Wear wrap-around sunglasses when outside to protect your eyes from the wind and sun. Avoid dehydration by drinking eight to 10 glasses of water each day. Keep air from being blown directly into your eyes. Direct fans and car heaters away from your face.

And finally, use your artificial tears and/or prescription eyedrops as recommended by your doctor.

Patti DiPanfilo

This is National Migraine and Headache Awareness Month. Let’s observe it by taking a closer look at migraine, which is more than a headache. Migraine is a disabling neurological condition that has different symptoms and treatment approaches compared to other types of headaches, such as tension and cluster headaches.

Migraine causes pulsing pain that often starts on one side of your head. It typically gets worse with physical activity and makes you extremely sensitive to light, sound or smell. A migraine can last for hours or even days. Research shows it’s the sixth most disabling disorder in the world.

There are many different types of migraine. The most common are migraine with aura, or complicated migraine, and migraine without aura, or common migraine.

About 25 to 30 percent of people with migraine experience auras just before the headache pain begins. An aura is a group of sensory disturbances that may include flashes of light, zigzag lines or other vision changes. They may also include ringing in the ears, tingling on one side of the body and an inability to speak clearly. Auras serve as a warning sign that a migraine is imminent.

However, most migraine sufferers experience common migraine, without aura. Common migraines typically start slower that complicated migraines, last longer and interfere more with everyday activities. The pain is often only on one side of the head.

Migraine typically occurs in four stages: prodrome, aura, headache and postdrome. Each stage has its own symptoms.

The prodrome, or warning stage, is the calm before the storm. You may notice changes in your body and mood anywhere from a few hours to a few days before the migraine actually begins. Prodrome symptoms include difficulty concentrating, irritability and/or depression, nausea, vomiting, constipation, sensitivity to light or sound, food cravings, increased urination and muscle stiffness.

Aura symptoms were discussed above.

Symptoms of the headache stage include neck pain and stiffness; depression, giddiness and/or anxiety; sensitivity to light, sound or smell; nasal congestion; insomnia; nausea and vomiting; loss of appetite; feeling very warm or cold; diarrhea; dizziness; and blurred vision.

During this stage, you may feel a dull ache that develops into a pulsing pain that has been described as feeling like an icepick being jabbed into your head. The pain may shift from one side of your head to the other, or it can affect the front of your head, the back of your head or your entire head. The headache stage lasts anywhere from four to 72 hours.

The postdrome, also known as the migraine hangover, can last from a few hours to a day after the migraine is over. There are lingering symptoms that may include an inability to concentrate, depressed mood, fatigue, lack of comprehension and euphoric mood. About 80 percent of people with migraine experience this stage.

Researchers don’t know the cause of migraine, but they have identified certain risk factors. These include genetics. Up to 80 percent of people who have migraine have a parent, sibling or child with the disorder. Gender is another risk factor. Women are two to three times more likely to develop migraine than men. You are also at a higher risk if you live a high-stress lifestyle. Smoking also increases your risk.

Stress is a trigger for migraine. Other factors that may trigger migraine include hormonal changes; pickled, processed or canned foods; alcoholic or caffeinated beverages; certain medications; infections such as a cold or the flu; loud sounds, bright lights and strong smells such as paint fumes or heavy perfumes.

Your doctor can generally diagnose migraine based on the symptoms you report. The physician may order blood tests or an imaging exam, such as a CT or MRI, to rule out other disorders.

There is no cure for migraine. However, it can usually be managed with medication, and in some cases it can be improved. There are two main approaches that include medications: abortive and preventive.

Abortive treatment is designed to stop your migraine and ease your pain. Medications used in this approach includes over-the-counter pain relievers and prescription medications such as triptans, which reverse the changes in your brain that contribute to migraine.

Other abortive medications include ergot alkaloids, which narrow the blood vessels in the brain; and calcitonin gene-related peptide (CGRP) antagonists, which bind to CGRP and keep it from working. An influx of CGRP is believed to contribute to the development of migraine. CGRP antagonists can also be used to prevent migraine.

Preventive treatments are designed to reduce the frequency, severity and duration of migraine. They include medications such as beta blockers, calcium channel blockers, certain antidepressants and anti-seizure medications, and BOTOX injections. Wearable devices that stimulate your vagus and trigeminal nerves can also prevent migraine or give relief if the headache has started.

If you suffer from chronic migraine, don’t give up. See your doctor about abortive and preventive treatment approaches. Maybe you will find some relief from your misery.

Patti DiPanfilo

In the US, women outlive men by five years. Researchers believe certain biological and hormonal factors contribute to this phenomenon. Men tend to make matters worse, however, by neglecting their health and ignoring symptoms when they appear. According to the Centers for Disease Control and Prevention, women are 33 percent more likely to visit the doctor than men. Women are also 100 percent better at maintaining screening schedules and preventive care.

June is Men’s Health Month. In this blog post, we aim to heighten awareness of a few common health threats facing American men. We also seek to encourage early detection and treatment, as well as screening and prevention for these common disorders.

Heart disease is the leading cause of death for men in the US. Heart disease includes a number of conditions that affect the structure or function of the heart. Among them are coronary artery disease, arrhythmia, heart valve disease, cardiomyopathy, congenital heart defects and heart failure. All types of heart disease can lead to serious, sometimes fatal, complications if undetected and untreated.

Men are more likely to develop heart disease at a younger age than women, about 10 years earlier on average. Besides being male, other risk factors for heart disease include smoking, poor diet, family history, high blood pressure, high cholesterol, being overweight or obese, sedentary lifestyle, excessive stress and diabetes.

You can reduce your risk by controlling your blood pressure, cholesterol and diabetes; stopping smoking, eating a heart-healthy diet; getting regular exercise; moderating your alcohol intake; maintaining a healthy weight; managing stress; and visiting your doctor for routine checkups.

Cancer is the second leading cause of death for men in the US. Prostate cancer is the most common cancer in men, followed by lung cancer and colorectal cancer. However, lung cancer is responsible for more deaths than prostate and colorectal cancers combined. Fortunately, better treatments and early detection are improving the survival rates for all of these cancers.

Early detection is the key. If you are between ages 50 and 80, have a long history of smoking, currently smoke or quit in the last 15 years, annual screening for lung cancer using CT scanning may be recommended for you. Screening this way has been found to lower the risk of death from lung cancer by 20 percent.

The US Preventive Services Task Force recommends colon cancer screening with colonoscopy beginning at age 45 for people at average risk for the cancer. If you have a family history or another colon-related medical condition, your health care provider may recommend beginning the screening process at a younger age.

Discuss the options for prostate cancer screening, such as the prostate-specific antigen (PSA) test, with your health care provider. Together, you can determine if the PSA test is right for you based on your risk factors and symptoms.

It’s important to be aware of your cancer risk factors and the screening recommendations because some cancers don’t produce symptoms until they are advanced. At that point, the cancers are often more difficult to treat, and you are less likely to have a positive outcome.

Men are more likely to develop type 2 diabetes, or adult-onset diabetes, at a lower weight than women in part because they store more fat in the bellies, which is a major risk factor. Type 2 is the most common type of diabetes, affecting 90 to 95 percent of the 13 million men with diabetes. With type 2 diabetes, your body has a problem with the way it breaks down and uses glucose (sugar) for fuel. As a result, there is too much glucose circulating in the bloodstream.

High glucose levels damage the body’s blood vessels, including the tiny blood vessels in the eyes, causing a condition called diabetic retinopathy. It also increases the risk for kidney and heart disease. Damaged blood vessels lead to poor circulation, which can cause erectile dysfunction (ED), the inability to produce and maintain an erection suitable for sex.

To avoid these complications of diabetes, including ED, exercise regularly, eat healthy food, manage your blood pressure and cholesterol levels, check your blood sugar throughout the day and visit your health care provider for routine blood tests. Your provider may prescribe medication and/or insulin injections to help control your blood glucose and reduce the risk for complications of diabetes.

Remember, routine checkups and screening tests can spot disease in its early stages, when its most treatable. These exams may save your life. Take control of your health; make an appointment with your health care provider for a checkup today.

– Patti DiPanfilo

A healthy spine has three natural curves: an inward curve at the neck (cervical curve), an outward curve at the middle of the back (thoracic curve) and an inward curve at the lower back (lumbar curve). An abnormal sideways curve of the spine is a condition called scoliosis.

June is National Scoliosis Awareness Month. Let’s use this time to learn more about this common spinal disorder.

Scoliosis affects approximately 2 to 3 percent of Americans, or an estimated 6 to 9 million people. Nearly 3 million new cases of scoliosis are diagnosed in the US each year. Anyone can get scoliosis, but the most common type, adolescent idiopathic scoliosis (AIS), affects children between the ages of 10 and 18. AIS is found in as many as four in 100 adolescents. However, scoliosis can affect adults as well.

Idiopathic means there is no identifiable cause. However, there appears to be hereditary factors involved because the disorder sometimes runs in families. Less common types of scoliosis may be caused by certain neuromuscular conditions, such as cerebral palsy or muscular dystrophy; birth defects; injuries or infections of the spine; and spinal abnormalities.

Most cases of scoliosis begin when children are between 10 and 15 years old, during the adolescent growth spurt. At this point, the condition occurs equally between males and females. However, the curves in females are eight times more likely to progress to a degree large enough to require treatment.

There are several signs that may suggest a person has scoliosis:

• Shoulders are uneven. One shoulder blade may appear more prominent than the other.
• The head is not centered directly above the pelvis.
• The waist is uneven.
• One hip is higher than the other.
• One side of the ribcage juts forward.
• A prominence is present on one side of the back when bending forward.
• The entire body leans to one side.

If your child exhibits any of these signs, visit your pediatrician for an evaluation. The doctor will carefully review your child’s medical history and will ask about his or her growth. As part of the physical exam, the doctor may perform an Adam’s forward bend test. The doctor will have your child stand with his or her feet together and bend 90 degrees at the waist. In this position, a protruding ribcage and any abnormal spinal curves are easily detected.

The doctor will use imaging scans such as x-ray, CT and MRI to assess the shape, direction, location and angle of the spinal curve.

A diagnosis of scoliosis is made when the Cobb angle, a measurement of the sideways curvature of the spine, is at least 10 degrees. A curve is considered significant if it is greater than 25 to 30 degrees.

Most cases of AIS are mild, and treatment involves monitoring your child regularly for progression of the curve. Bracing may be recommended if your child’s spinal curve measures 25 to 40 degrees. If the curve is greater than this, the doctor may recommend surgery.

Braces are most effective when worn before your child’s bones stop growing. Large studies have shown that braces, when used properly, successfully halt curve progression in about 80 percent of children with scoliosis. For best results, braces must be worn 16 to 23 hours every day until bone growth stops. Today’s modern braces fit neatly around the body and are not visible under clothing.

The standard surgery for severe scoliosis is spinal fusion. During this procedure, the surgeon fuses two or more bones in the spine (vertebrae) together so they no longer move independently. The doctor places pieces of bone or a bone-like material between the vertebrae to help them fuse. The surgeon inserts metal rods and screws to hold the spine straight while fusion takes place. The rods can be adjusted in children as they grow.

The outlook for people with scoliosis depends on the severity of the curvature. In cases where the curve is mild to moderate, the condition is unlikely to interfere with functioning and everyday activities. People with severe curves, however, may experience some physical limitations.

If you or your child have difficulty living with scoliosis, consider joining a support group. The National Scoliosis Foundation (scoliosis.org), is a good place to look for helpful resources.

Patti DiPanfilo

Prevent Blindness America, the nation’s leading volunteer eye health and safety organization, has declared June as Cataract Awareness Month. Cataracts, which are the clouding of the lens, are the leading cause of vision loss in the US and the leading cause of blindness in the world. Want to know more about these sight-stealers? Read on.

The lens is positioned behind the iris, the colored portion of your eye. It focuses light entering the eye onto the retina, the light-sensitive layer of nerve tissue lining the back of the eye. The retina turns light into electrical signals, which then travel from the retina to the brain through the optic nerve. The brain interprets the electrical signals as the images you see.

The lens is made up of mostly proteins and water. As the proteins break down over time, they clump together and make the lens cloudy, so it’s difficult for light to pass through to the retina. As a result, vision is distorted. This is a natural part of the aging process.

Because most cataracts develop slowly over years, you may not notice any signs or symptoms until the cataracts become large and begin to block the light entering your eye. Common signs and symptoms of cataracts include:

• Clouded, blurred, hazy or foggy vision.
• Sensitivity to light and glare, particularly that from oncoming headlights while driving at night.
• Difficulty seeing at night or needing additional light to read and perform close-up tasks.
• Seeing halos around lights.
• Faded or yellowing of colors.
• Double vision out of the affected eye.
• Requiring frequent upgrades to glasses or contact lens prescriptions.

Most cataracts are age-related. More than half of all Americans have had a cataract or cataract surgery by age 80. But there are other factors that can increase your risk for developing cataracts at a younger age. These include: a family history of cataracts, diabetes, excessive exposure to sunlight, smoking, obesity, high blood pressure, previous eye injury or eye surgery, prolonged use of steroid medications and drinking excessive amounts of alcohol.

To diagnose cataracts, your eye doctor will ask you about your symptoms. The doctor will also look closely at your eye and may use certain tests. These tests may include a visual acuity test, which is the “eye chart exam”; a slit-lamp test, which uses a special microscope with a bright light that permits the doctor to view different parts of your eye; and a retinal exam, in which the doctor dilates your pupils and determine how much light is reaching your retina.

The only way to treat cataracts is surgery. However, you may not need surgery right away. If your cataracts are caught early and your symptoms are mild, you may be successfully treated with a new prescription for your glasses or contact lenses. But when your symptoms get in the way of your daily tasks, particularly if they make driving dangerous, it’s time to consider cataract surgery.

Cataract surgery is typically performed on one eye at a time, with a break of a week or two in between. Each procedure takes just minutes and starts with the breakup and removal of the clouded lens. Then, a clear replacement lens is implanted, permanently correcting the vision.

The new lens, called an intraocular lens (IOL), is positioned in the same place as your natural lens and remains a permanent part of your eye. IOLs are typically made of a flexible plastic such as acrylic or silicone. IOLs come in different focusing powers to correct a variety of vision issues. They are clear, shaped to fit your eyes and personalized to your vision needs.

No studies have shown how to prevent cataracts or slow their progression. But there are a few things you can do to help safeguard your eye health. These include:

• Get regular eye exams.
• Quit smoking.
• Manage your diabetes, high blood pressure and other chronic health conditions.
• Eat a healthy diet that includes plenty of fruits and vegetables.
• Wear sunglasses when outdoors.
• Drink alcohol in moderation.

— Patti DiPanfilo

May is Hepatitis Awareness Month. Although awareness may already be high due to a current mysterious pediatric outbreak that has affected more than 500 children in 20 countries and more than 180 kids in the US over the past six months.

Hepatitis is an inflammatory condition of the liver, and when your liver is inflamed, its ability to function can be compromised. Hepatitis is most commonly caused by a viral infection, although there are other causes as well. We’re concentrating on viral hepatitis in this blog.

There are five known types of viral hepatitis classified as hepatitis A, B, C, D and E. In the US, the most frequently diagnosed, affecting an estimated 4.4 million Americans, are hepatitis A, B and C.

Each of these conditions is caused by a different virus: the hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Hepatitis A. B and C have similar symptoms but are spread in different ways and can affect the liver differently.

Regarding the current outbreak: The Centers for Disease Control and Prevention is investigating cases with unknown causes in 36 states and territories. Though most children have recovered, at least five have died and 16 needed a liver transplant. As of May 20, the illness of one Florida child under 10 was under investigation, but state officials said there are no confirmed cases.

The most common symptoms of hepatitis include: dark urine, yellowing of the skin or whites of the eyes (jaundice), clay-colored stool, low-grade fever, loss of appetite, fatigue and aching joints. You may also feel sick to your stomach or have stomach pain. If you experience any or a combination of these symptoms, contact your doctor right away.

To diagnose hepatitis, your doctor will perform a physical exam and review of your symptoms. The doctor will use blood tests to check for the presence of the virus and may also use liver function tests to see how your liver is working, an abdominal ultrasound to look for liver damage or enlargement, or a liver biopsy to sample any abnormal areas of your liver and study them under a microscope.

Hepatitis A is usually a short-term illness that doesn’t lead to a chronic, or long-lasting, infection. The hepatitis A virus is found in the stool and blood of people who are infected. Hepatitis A, which is highly contagious, is commonly spread by eating contaminated food or drink. It can also be spread through close personal contact with someone who is infected, such as during oral or anal sex.

There is no cure for hepatitis A. Treatment typically consists of rest, adequate nutrition and fluids. In rare cases, people with hepatitis A require hospitalization. This type of hepatitis normally resolves within two months without having any long-term effects, and you will have lifelong immunity afterward.

Hepatitis B is spread through contact with body fluids such as blood, vaginal secretions and semen containing the hepatitis B virus (HBV). Your risk for getting hepatitis B increases if you inject drugs or if you have sex or share razors with someone who has it.

Some people with hepatitis B, particularly those who get infected as adults, are able to clear the virus from their bodies without treatment. For others, short-term hepatitis B progresses into a chronic, lifelong infection that over time can result in serious health problems such as liver damage, cirrhosis, liver cancer and even death.

When treatment for hepatitis B is needed, there are several medications available and others in development. However, people who start hepatitis B treatment may need to take medication indefinitely because these medications do not lead to a cure.

Hepatitis C is one of the most common causes of liver disease in the US and used to be the primary reason for liver transplants. The infection is chronic in 75 to 85 percent of people who have it, and 1 to 5 percent experience life-threatening complications, such as liver failure.

Hepatitis C is spread by coming into contact with the blood of a person who is infected with the hepatitis C virus (HCV). This can happen if you share drug injection equipment; have sex with someone who is infected; or share personal items such as razors, nail clippers or toothbrushes with an infected person. In addition, about 6 percent of infants born to infected mothers will get hepatitis C.

Treatment is recommended for all people including children 3 and older and pregnant women with hepatitis C. Treatment involves taking medication for a course of eight to 12 weeks. The cure rate with this therapy is more than 90 percent with few side effects.

To help prevent hepatitis, there are vaccines against hepatitis A and B, but there is no vaccine available for hepatitis C.

By Patti DiPanfilo