“SCD is a genetic disorder. Healthy red blood cells are round, and they move through small blood vessels to carry oxygen to all parts of the body. In someone who has SCD, the red blood cells become hard and sticky and look like a C-shaped farm tool called a “sickle”. The sickle cells die early, which causes a constant shortage of red blood cells. Also, when they travel through small blood vessels, they get stuck and clog the blood flow. This can cause pain and other serious problems such infection, acute chest syndrome and stroke.”

CDC Centers for Disease Control and Prevention

SCD is the most commonly inherited blood disorder in the United States, affecting 100,000 people, and millions more worldwide. The disease primarily affects people of African, Hispanic, Mediterranean, Middle Eastern and South Asian ancestry.

What is sickle cell disease actually?

The term sickle cell disease (SCD) describes a group of inherited red blood cell disorders. People with SCD have abnormal hemoglobin, called hemoglobin S or sickle hemoglobin, in their red blood cells.

Hemoglobin is a protein in red blood cells that carries oxygen throughout the body.

“Inherited” means that the disease is passed by genes from parents to their children. SCD is not contagious. A person cannot catch it, like a cold or infection, from someone else.

People who have SCD inherit two abnormal hemoglobin genes, one from each parent. In all forms of SCD, at least one of the two abnormal genes causes a person’s body to make hemoglobin S. When a person has two hemoglobin S genes, Hemoglobin SS, the disease is called sickle cell anemia. This is the most common and often most severe kind of SCD.

Hemoglobin SC disease and hemoglobin Sβ thalassemia (thal-uh-SEE-me-uh) are two other common forms of SCD.

Cells in tissues need a steady supply of oxygen to work well. Normally, hemoglobin in red blood cells takes up oxygen in the lungs and carries it to all the tissues of the body.

Red blood cells that contain normal hemoglobin are disc shaped (like a doughnut without a hole). This shape allows the cells to be flexible so that they can move through large and small blood vessels to deliver oxygen.

Sickle hemoglobin is not like normal hemoglobin. It can form stiff rods within the red cell, changing it into a crescent, or sickle shape.

Sickle-shaped cells are not flexible and can stick to vessel walls, causing a blockage that slows or stops the flow of blood. When this happens, oxygen can’t reach nearby tissues.

The lack of tissue oxygen can cause attacks of sudden, severe pain, called pain crisis. These pain attacks can occur without warning, and a person often needs to go to the hospital for effective treatment.

Most children with SCD are pain free between painful crises, but adolescents and adults may also suffer with chronic ongoing pain.

The red cell sickling and poor oxygen delivery can also cause organ damage. Over a lifetime, SCD can harm a person’s spleen, brain, eyes, lungs, liver, heart, kidneys, penis, joints, bones, or skin.

Sickle cells can’t change shape easily, so they tend to burst apart or hemolyze. Normal red blood cells live about 90 to 120 days, but sickle cells last only 10 to 20 days.

The body is always making new red blood cells to replace the old cells; however, in SCD the body may have trouble keeping up with how fast the cells are being destroyed. Because of this, the number of red blood cells is usually lower than normal. This condition, called anemia, can make a person have less energy.  Anemia ending line is lack of oxygen to the tissue body parts all over.

“Sickle cell disease is devastating for patients and their families,” said Jeffrey Glassberg, MD, MA, Assistant Professor of Emergency Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai. “It’s a chronic disorder causing pain in the extremities and back, infections, organ failure and other tissue damage, skin infections, loss of eyesight, severe blood clots and strokes. Patients learn to function in a constant state of pain and when that pain becomes debilitating, they often end up in the emergency room,” said Dr. Glassberg, also Associate Director of the Comprehensive Sickle Cell Program at The Mount Sinai Hospital.

“Patients with SCD are more likely to live full lives if they undergo regular checkups, prevent infections and develop healthy habits,” said Jena Simon, MS, FNP-BC, RN, also of the Comprehensive Sickle Cell Program.

Tips to Staying Healthy

• Get regular checkups. Regular health checkups can help prevent some serious problems.
• Prevent infections. Common illnesses, like influenza quickly can become dangerous for both children and adults with SCD. The best defense is to get a flu shot every fall and to stay up-to-date on other immunizations.
• People with SCD should drink 8 to 10 glasses of water every day and eat healthy food. They also should try not to get too hot, too cold, or too tired.
• Look for clinical studies. New clinical research studies are beginning all the time at Mount Sinai and elsewhere, with the goal of finding better treatments for SCD. Study participants gain early access to experimental medicines and treatments.
• Get support. People with SCD should find a patient support group or other organization in the community that can provide information, assistance, and support.

Sickle Cell Disease Facts & Figures:

• SCD is an inherited blood disorder that can cause severe pain and permanent damage to the brain, heart, lungs, kidneys, liver, bones and spleen.
• SCD is most common in Africans and African-Americans. It is also found in other ethnic and racial groups, including people from South and Central America, the Caribbean, Mediterranean countries, and India.
• More than 2 million people carry the sickle cell gene that allows them potentially to pass the disease on to their children. People of African, Hispanic, Mediterranean, Middle Eastern, and Indian descent may want to be tested for the gene before having children. You can carry the gene and not have any signs or symptoms of SCD. Both parents have to have the gene to have a child with SCD.

“Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown.”

MAYO CLINIC

Scoliosis is a problem with the spine where the spine is curved instead of straight, with the upper back being rounded and the lower back having a “swayback,” or inner curved problem, reports WebMD.

According to the Scoliosis Research Society, 85 percent of all scoliosis causes are idiopathic, meaning the cause is unknown. The remaining causes of scoliosis include birth defects, such as vertebrae that form abnormally before birth, and certain disorders such as cerebral palsy, Marfan’s syndrome, muscular dystrophy and Down syndrome. Infections and spinal fractures can also cause scoliosis.curvature of the spine during surgical correction of this condition. Screws and rods are placed in order to stabilize and straighten the spine.

What You Should Know About Adult Scoliosis

Scoliosis is defined as a curve of the spine of 10 degrees. Adult scoliosis is broadly defined as a curve in your spine of 10 degrees or greater in a person 18 years of age or older. Adult scoliosis is separated into 2 common categories:

• Adult Idiopathic Scoliosis patients have had scoliosis since childhood or as a teenager and have grown into adulthood.  We do not yet know the cause of idiopathic scoliosis, but there is a lot of genetic work going on in an attempt to answer this question.

• Adult “De Novo” or Degenerative Scoliosis develops in adulthood. Degenerative scoliosis develops as a result of disc degeneration. As the disc degenerates, it loses height. If one side of the disc degenerates more rapidly than the other, the disc begins to tilt. As it tilts, more pressure is placed on one side of your spine and gravity tends to cause the spine to bend and curve. The more discs that degenerate, the more the spine begins to curve.

Scoliosis is more common in girls than in boys, and the diagnosis is usually made after a child reaches 10 years of age. A doctor performs a physical examination and may take X-rays to definitively diagnose the disease. An X-ray tells if there is any growth left in the growth plates of the femur or humerus, and scoliosis can become worse if the patient has more growing to do, states MedicineNet. Serial X-rays are performed to track the changes of the spinal curve, which helps determine the best course of treatment.

Types of idiopathic scoliosis are categorized by both age at which the curve is detected and by the type and location of the curve.

When grouped by age, scoliosis usually is categorized into three age groups:

• Infantile scoliosis: from birth to 3 years old
• Juvenile scoliosis: from 3 to 9 years old
• Adolescent scoliosis: from 10 to 18 years old

This last category of scoliosis, adolescent scoliosis, occurs in children age 10 to 18 years old, and comprises approximately 80% of all cases of idiopathic scoliosis. This age range is when rapid growth typically occurs, which is why the detection of a curve at this stage should be monitored closely for progression as the child’s skeleton develops.

Terms Used to Describe Spinal Curvature

Scoliosis curves are often described based on the direction and location of the curve. Physicians have several detailed systems to classify specific curves, but here are some common terms used to describe scoliosis:

Terms that describe the direction of the curve:

• Dextroscoliosis describes a spinal curve to the right (“dextro” = right). Usually occurring in the thoracic spine, this is the most common type of curve. It can occur on its own (forming a “C” shape) or with another curve bending the opposite way in the lower spine (forming an “S”).

Severe scoliosis can lead to heart and lung problems if not treated, as the ribs press against the chest, making breathing more difficult, states Mayo Clinic. Adults who had scoliosis as a child may experience more back pain throughout their lives as compared to people without scoliosis.

Symptoms of scoliosis include an uneven waist, uneven shoulders, disjointed hip and a protruding shoulder blade, according to Mayo Clinic. The spine also curves or twists in acute cases, and the disease can cause one side of the ribs to protrude more than the other. Severe cases also induce labored breathing and back pain.

Diagnosis

Scoliosis can be recognized and diagnosed with a clinical exam, but xrays are necessary to fully evaluate the magnitude and type of scoliosis present. For a proper scoliosis evaluation, full length, whole spine xrays need to be performed. An MRI may also be recommended if there are symptoms of leg pain that may be associated with stenosis or if there is concern about possible spinal cord compression or abnormalities.

Treatment

The treatment of adult scoliosis is very individualized and based on the specific symptoms and age of the patient. Many patients have scoliosis and have very minor symptoms and live with it without treatment. Patients with predominant symptoms of back pain would typically be treated with physical therapy. Patients with back pain and leg pain may receive some benefit from injection treatment to help relieve the leg pain.  If lumbar stenosis (narrowing of the spinal canal) is present and is unresponsive to non-surgical treatment, then a decompression( removal of bone and ligaments pressing on the nerves) may be recommended. If the scoliosis is greater than 30 degrees, a fusion procedure will most likely be recommended along with the decompression. The fusion is recommended to prevent the curve from progressing when the spine is destabilized by the bone removal that is necessary to  decompress the nerves. Fusions are usually accompanied with metal rod and screw placement into the spine to help correct and stabilize the scoliosis and help the bone heal or fuse together. The length of the fusion, or the number of spine levels included, depends on the type of scoliosis and the area of the spine involved. The goal of adult scoliosis surgery is to first remove pressure on the nerves, and second to keep the scoliosis from progressing further.

“Safe blood saves lives and improves health. Blood transfusion is needed for:

• women with complications of pregnancy, such as ectopic pregnancies and haemorrhage before, during or after childbirth;
• children with severe anemia often resulting from malaria or malnutrition;
• people with severe trauma following man-made and natural disasters; and
• many complex medical and surgical procedures and cancer patients.”

World Health Organization (WHO)

Why do we need blood donor’s?

We need to make sure that we have enough supplies of all blood groups and blood types to treat all types of conditions.

By giving blood, every donor helps us meet the challenge of providing life-saving products whenever and wherever they are needed.

The American Red Cross states the following facts:

• Every two seconds someone in the U.S. needs blood.
• Approximately 36,000 units of red blood cells are needed every day in the U.S.
• Nearly 7,000 units of platelets and 10,000 units of plasma are needed daily in the U.S.
• Nearly 21 million blood components are transfused each year in the U.S.
• The average red blood cell transfusion is approximately 3 pints.
• The blood type most often requested by hospitals is type O.
• The blood used in an emergency is already on the shelves before the event occurs.
• It is estimated that sickle cell disease affects 90,000 to 100,000 people in the U.S. About 1,000 babies are born with the disease each year. Sickle cell patients can require frequent blood transfusions throughout their lives.

• The number of whole blood and red blood cell units collected in the U.S. in a year: 13.6 million
• The number of blood donors in the U.S. in a year: 6.8 million
• Although an estimated 38 percent of the U.S. population is eligible to donate blood at any given time, less than 10 percent of that eligible population actually do each year.
• Blood cannot be manufactured – it can only come from generous donors.
• Type O negative blood (red cells) can be transfused to patients of all blood types. It is always in great demand and often in short supply. Type O is the “Universal Blood Donor”
• Type AB positive plasma can be transfused, it’s the “Universal Blood Recepient”.

This allows pt’s diagnosed with this illness to experience:

• Bleeding due to lack of platelets
• shortness of breath due to lack of RBC’s carrying oxygen (02) to the tissues of the body.
• Dizziness again due to lack of 02 carried to the brain with anemic, & bleeding causing your B/P to be low (orthostatic b/p-changing your position anemic and blood dropping from the brain to cause dizziness) also.
• cognitive impairment due to lack of 02 to the brain since RBC count is low in the body.
• Bruising due to low platelets.
• petachiae (small red/purple spots on the skin)
• susceptibility to infections

Conditions for needing blood donors:

Aplastic anemia occurs when bone marrow stops making enough blood forming stem cells. In all three blood lines; red blood cells, white blood cells and platelets, patients with aplastic anemia have a low blood count. The bone marrow is found to be aplastic which means there is a low growth of blood forming stem cells.

Cancer of all types –  Where with or without the treatments of chemo or radiation in the end cancer itself kills all good cells that are created by our bone marrow.  Chemo or radiation kill the bad cells = cancer cells and good cells = RBCs, WBCs, Platelets.  So blood transfusion commonly needed in cancer patients.

Anemia– Lack of RBCs in the body.

Conditions causing bleeding in the body like GI bleed, hemmoragic stroke, endometriosis, hemophilia, and simple patients in the OR that bleed and need blood transfusions in the OR and ICU and even possibly on the Med/Surg or Telemetry unit.  I could go on with types of conditions the deciding factor that makes the doctor order the blood transfusion is obviously heavy bleeding occurring right in front of the surgeon’s or ER MDs eyes or checking the Complete Blood Count called a CBC looking at the hemoglobin (Hmg)-think of it at the fluids in the bloodstream and looking at the Hematocrit (Hct)-think of it as the solids in the bloodstream and if the Hg is critical 6-7 than one or two blood transfusions are ordered.

Treatments:

• Treatments vary on a case by case basis. Age is often the determining factor for which treatment to use. Stem cell transplantation may be used for individuals younger than 30 years and who have a matched sibling donor=Blood Donor Needed.
• Stem cell transplantation is a procedure which replaces defective bone marrow with healthy cells. Around 80% of patients make a complete recovery using stem cell transplantation.
• For older patients with aplastic anemia, immune suppressing therapy with anti-thymocyte globulin(ATG) and cyclosporin is typically used. Around 70-80% of aplastic anemia patients respond to this treatment.

“Bursitis is most often caused by repetitive motions (i.e., overuse); or direct, minor impact on the area (such as from such activities as repeated bumping or prolonged pressure from kneeling). Less often, bursitis is caused from a sudden, more serious injury.”

Cleveland Clinic

Bursitis (bur-SY-tis) is a painful condition that affects the small, fluid-filled sacs — called bursae (bur-SEE) — that cushion the bones, tendons and muscles near your joints. Bursitis occurs when bursae become inflamed.

The most common locations for bursitis are in the shoulder, elbow and hip. But you can also have bursitis by your knee, heel and the base of your big toe. Bursitis often occurs near joints that perform frequent repetitive motion.

Treatment typically involves resting the affected joint and protecting it from further trauma. In most cases, bursitis pain goes away within a few weeks with proper treatment, but recurrent flare-ups of bursitis are common.

If you have bursitis, the affected joint may experience the following symptoms:

• Feel achy or stiff
• Hurt more when you move it or press on it
• Look swollen and red

When to see a doctor

Consult your doctor if you have:

• Disabling joint pain
• Pain for more than one to two weeks
• Excessive swelling, redness, bruising or a rash in the affected area
• Sharp or shooting pain, especially when you exercise or exert yourself
• A fever going to a systemic infection from localized where the bursitis is probably.

The most common causes of bursitis are repetitive motions or positions that irritate the bursae around a joint. Examples include:

• Throwing a baseball or lifting something over your head repeatedly
• Leaning on your elbows for long periods
• Extensive kneeling for tasks such as laying carpet or scrubbing floors
• Prolonged sitting, particularly on hard surfaces

Other causes include injury or trauma to the affected area, inflammatory arthritis such as rheumatoid arthritis, gout, and infection.

Anyone can develop bursitis, but certain factors may increase your risk:

Age. The occurrence of bursitis becomes more common with aging.

Occupations or hobbies. If your work or hobby requires repetitive motion or pressure on particular bursae, your risk of developing bursitis increases. Examples include carpet laying, tile setting, gardening, painting and playing a musical instrument.

Other medical conditions. Certain systemic diseases and conditions — such as rheumatoid arthritis, gout and diabetes — increase your risk of developing bursitis.

Doctors can often diagnose bursitis based on a medical history and physical exam but if further testing needed the M.D. will do the following:

Imaging tests. X-ray images can’t positively establish the diagnosis of bursitis, but they can help to exclude other causes of your discomfort. Ultrasound or MRI may be used if your bursitis can’t easily be diagnosed by a physical exam alone.

Lab tests. Your doctor may perform blood tests or an analysis of fluid from the inflamed bursa to pinpoint the cause of your joint inflammation and pain.

Types of treatment:

Bursitis treatment usually involves conservative measures, such as rest, ice and taking a pain reliever. If conservative measures don’t work, treatment may include:

• Medication. If the inflammation in your bursa is caused by an infection, your doctor might prescribe an antibiotic.
• Therapy. Your doctor may recommend physical therapy or exercises to strengthen the muscles in the affected area to ease pain and prevent recurrence.
• Injections. Your doctor may inject a corticosteroid drug into the bursa to relieve inflammation in your shoulder or hip. This treatment generally brings rapid pain relief and, in many cases, one injection is all you need.
• Assistive device. Temporary use of a walking cane or other device will help relieve pressure on the affected area.
• Surgery. Sometimes an inflamed bursa must be surgically drained, but only rarely is surgical removal of the affected bursa necessary.

Measures you can take to relieve the pain of bursitis include:

• Rest and immobilize the affected area
• Apply ice to reduce swelling
• Take an over-the-counter medication, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), to relieve pain and reduce inflammation
• Cushion your knees if you sleep on your side by placing a small pillow between your legs
• Avoid elbow pressure by not leaning or placing your weight on your elbows to rise from a lying position or if taking long drives and leaning on the Right elbow or Left elbow on the door or console.

Ways you can prevent Bursitis:

While not all types of bursitis can be prevented, you can reduce your risk and the severity of flare-ups by changing cushioning your areas of where bursitis can take place:

• Using kneeling pads. Use some type of padding to reduce the pressure on your knees if your job or hobby requires a lot of kneeling.
• Lifting properly. Bend your knees when you lift. Failing to do so puts extra stress on the bursae in your hips.
• Wheeling heavy loads. Carrying heavy loads puts stress on the bursae in your shoulders. Use a dolly or a wheeled cart instead.
• Taking frequent breaks. Alternate repetitive tasks with rest or other activities.
• Walking around. Try not to sit in one position too long, especially on hard surfaces, because that puts pressure on the bursae in your hips and buttocks.
• Maintaining a healthy weight. Being overweight places more stress on your joints.
• Exercising. Strengthening your muscles can help protect your affected joint.
• Warming up and stretching before strenuous activities to protect your joints from injury.

“After a cancer diagnosis, staging provides important information about the extent of cancer in the body and anticipated response to treatment.”

American Cancer Society

Many treatments can fight stomach cancer. The one you and your doctor choose will depend on how long you’ve had the disease or how much it has spread in your body, called the stage of your cancer.

Surgery. Your doctor might remove part of your stomach or other tissues nearby that have cancer cells. Surgery gets rid of the tumor and stops cancer from spreading to other parts of your body. If your disease is in a more advanced stage, your doctor might need to remove all of your stomach=Gastrectomy or in some other cases the Surgeon may only have to remove part of the stomach=Partial Gastrectomy.

Some tumors can keep food from moving in and out of your stomach. In that case, you might have surgery to put in a stent, a device that keeps the pathways open.

Chemotherapy. Drugs kill your cancer cells or keep them from growing. You can take them as pills or through an IV at a clinic. Chemo usually takes several weeks. The drugs can cause side effects, but your doctor can help you find ways to feel better during treatment.

Radiation. High-energy waves or particles can kill cancer cells and shrink tumors. Your doctor may use an X-ray or other machine to beam radiation at the spot where your tumor is.

Chemoradiation. Your doctor might use this mix of chemotherapy and radiation to shrink your tumor before surgery.

Targeted drugs. These newer drugs are different because they fight only cancer cells. Other treatments, like chemo and radiation, can kill healthy cells along with diseased ones. As a result, targeted therapies have fewer side effects than these other treatments.

How Can I Prevent Stomach Cancer?

Treat stomach infections. If you have ulcers from an H. pylori infection, get treatment. Antibiotics can kill the bacteria, and other drugs will heal the sores in the lining of your stomach to cut your risk of cancer.

Eat healthy. Get more fresh fruits and vegetables on your plate every day. They’re high in fiber and in some vitamins that can lower your cancer risk. Avoid very salty, pickled, cured, or smoked foods like hot dogs, processed lunch meats, or smoked cheeses. Keep your weight at a healthy level, too. Being overweight or obese can also raise your risk of the disease.