The aorta is the large artery that exits in the heart and delivers blood to the body. It begins at the aortic valve that separates the left ventricle of the heart from the aorta and prevents blood from leaking back into the left ventricle after a contraction, which is actually when the heart pumps blood. The various sections of the aorta are named based upon “arch-like” initial design and the location of the aorta in the body. Thus, the beginning of the aorta is referred to as the ascending aorta (basically meaning the blood going against resistance due to the vessel being a hill for the blood to go up), followed by the arch of the aorta, then the descending aorta (which is the blood going downward via gravity with the help of the heart pumping the blood of course). The portion of the aorta that is located in the chest (called thorax) is referred to as the thoracic aorta, while the abdominal aorta (the part of the aorta below the thorax region) is located in the abdomen. The abdominal aorta extends from the diaphragm (at the bottom of the lungs like a floor to divide the lungs from the organs in the abdomen) to the mid-abdomen where it splits into the iliac arteries and when it reaches the legs the femoral arteries now start which supplies to the legs oxygenated blood. This is why commonly a cardiac catheterization to visualize the aorta and sometimes the left side of the heart is done starting in the femoral artery since in time it diverts into starting the abdominal aorta.

An aneurysm is an area of a localized widening (dilation) of a blood vessel. The word “aneurysm” is borrowed from the Greek “aneurysma” meaning “a widening”.

An aortic aneurysm involves the aorta, the major artery that leaves the heart to supply blood to the body. An aortic aneurysm is a dilation or bulging of the aorta..

Most aortic aneurysms are fusiform. They are shaped like a spindle (“fusus” means spindle in Latin) with widening all around the circumference of the aorta. (Saccular aneurysms just involve a portion of the aortic wall with a localized out pocketing).

What is inside an aortic aneurysm?

The inside walls of aneurysms are often lined with a blood clot that forms because there is stagnant blood. The wall of an aneurysm is layered, like a piece of plywood.

Who is most likely to have an abdominal aortic aneurysm?

Abdominal aortic aneurysms tend to occur in white males over the age of 60. In the United States, these aneurysms occur in up to 3.0% of the population. Aneurysms start to form at about age 50 and peak at age 80. Women are less likely to have aneurysms than men and African Americans are less likely to have aneurysms than Caucasians.

There is a genetic component that predisposes one to developing an aneurysm; the prevalence in someone who has a first-degree relative with the condition can be as high as 25%.

Collagen vascular diseases that can weaken the tissues of the aortic walls are also associated with aortic aneurysms. These diseases include Marfan syndrome and Ehlers-Danlos syndrome

Aortic aneurysms can develop anywhere along the length of the aorta but the majority are located in the abdominal aorta. Most of these abdominal aneurysms are located below the level of the renal arteries, the vessels that provide blood to the kidneys. Abdominal aortic aneurysms can extend into the iliac arteries.

What shape are most aortic aneurysms?

Most aortic aneurysms are fusiform. They are shaped like a spindle (“fusus” means spindle in Latin) with widening all around the circumference of the aorta. (Saccular aneurysms just involve a portion of the aortic wall with a localized out pocketing).

Stayed tune for Part II on Aortic Aneurysms tomorrow!

“Gaseous chemical element, symbol: O, atomic number: 8 and atomic weight 15,9994. It’s of great interest because it’s the essential element in the respiratory processes of most of the living cells and in combustion processes. It’s the most abundant element in The Earth’s crust. Nearly one fifth (in volume) of the air is oxygen. Non-combined gaseous oxygen normally exists in form of diatomic molecules, O₂, but it also exists in triatomic form, O₃, named ozone.  In normal conditions oxygen is a colourless, odourless and insipid gas; it condensates in a light blue liquid. Oxygen is part of a small group of gasses literally paramagnetic, and it’s the most paramagnetic of all. Liquid oxygen is also slightly paramagnetic.

Oxygen is essential for all forms of life since it is a constituent of DNA and almost all other biologically important compounds. Is it even more drammatically essential, in that animals must have minute by minute supply of the gas in order to survive. Oxygen in the lungs is picked up by the iron atom at the center of hemoglobin in the blood and thereby transported to where it is needed.

Every human being needs oxygen to breathe, but as in so many cases too much is not good. If one is exposed to large amounts of oxygen for a long time, lung damage can occur. Breathing 50-100% oxygen at normal pressure over a prolonged period causes lung damage. Those people who work with frequent or potentially high exposures to pure oxygen, should take lung function tests before beginning employment and after that. Oxygen is usually stored under very low temperatures and therefore one should wear special clothes to prevent the freezing of body tissues.”

“Nothing compares to the joy of coming home to a loyal companion. The unconditional love of a pet can do more than keep you company. Pets may also decrease stress, improve heart health, and even help children with their emotional and social skills.  An estimated 68% of U.S. households have a pet.  Interacting with animals has been shown to decrease levels of cortisol (a stress-related hormone) and lower blood pressure. Other studies have found that animals can reduce loneliness, increase feelings of social support, and boost your mood.”

National Institute of Health NIH News in Health (https://newsinhealth.nih.gov/2018/02/power-pets)

Animals play an important role in many people’s lives.  In addition to seeing-eye dogs and dogs that can be trained to detect seizures, animals can also be used in occupational therapy, speech therapy, or physical rehabilitation to help patients recover.  Aside from these designated therapeutic roles, animals are also valued as companions, which can certainly affect the quality of our lives.  Is that companionship beneficial to our health? The better we understand the human-animal bond, the more we can use it to improve people’s lives.

Over 71 million American households (62%) have a pet, and most people think of their pets as members of the family. Some research studies have found that people who have a pet have healthier hearts, stay home sick less often, make fewer visits to the doctor, get more exercise, and are less depressed.  Pets may also have a significant impact on allergies, asthma, social support, and social interactions with other people.

Impact on Physical Health

Companion animals may improve heart health by lowering blood pressure and regulating the heart rate during stressful situations.  In a 2002 study, researchers measured changes in heart rate and blood pressure among people who had a dog or cat, compared to those who did not, when participants were under stress (performing a timed math task).  People with a dog or cat had lower resting heart rates and blood pressure measures at the beginning of the experiment than non-pet owners.  People with a dog or cat were also less likely to have spikes in heart rates and blood pressure while performing the math task, and their heart rates and blood pressure returned to normal more quickly. They also made fewer errors in their math when their pet was present in the room.⁴  All these findings indicated that having a dog or cat lowered the risk of heart disease, as well as lowering stress so that performance improved.

A similar study found that having your dog in the room lowered blood pressure better than taking a popular type of blood pressure medication (ACE inhibitor) when you are under stress.⁵

Children’s exposure to companion animals may also ease anxiety.  For example, one study measured blood pressure, heart rate, and behavioral distress in healthy children aged 3 to 6 at two different doctor visits for routine physicals.  At one visit a dog (unrelated to the child) was present in the room and at the other visit the dog was absent.  When the dog was present, children had lower blood pressure measures, lower heart rates, and less behavioral distress.⁶  Research on the health benefits of child and animal interaction is limited.  Further research is needed on how pets influence child development and specific health outcomes.

These findings suggest that the social support a pet provides can make a person feel more relaxed and decrease stress.⁷  Social support from friends and family can have similar benefits, but interpersonal relationships often cause stress as well, whereas pets may be less likely to cause stress.  The social support provided by a pet might also encourage more social interactions with people, reducing feelings of isolation or loneliness.  For example, walking with a dog has been found to increase social interaction, especially with strangers, compared to walking without a dog.⁸

Among elderly people, pet ownership might also be an important source of social support that enhances well-being.  In one study, elderly individuals that had a dog or cat were better able to perform certain physical activities deemed “activities of daily living,” such as the ability to climb stairs; bend, kneel, or stoop; take medication; prepare meals; and bathe and dress oneself.  There were not significant differences between dog and cat owners in their abilities to perform these activities.  Neither the length of time of having a dog or cat nor the level of attachment to the animal influenced performance abilities.    Companion animals did not seem to have an impact on psychological health but researchers suggested that a care-taking role may give older individuals a sense of responsibility and purpose that contributes to their overall well-being.

“In the United States, the most common type of heart disease is coronary artery disease (CAD), which leads many to heart attacks. You can greatly reduce your risk for CAD through lifestyle changes and, in some cases, medication. CAD consists of cholesterol and placque build up, even tar if a smoker, that can be deadly in time with blocking the arteries called atherosclerosis. This in time left untreated can lead to a heart attack or even silent heart attack. CAD also is the brittling of the arteries causing narrowing of the arteries called arteriosclerosis. Here it is the ending result is the blood supply is affected in not getting enough oxygen to the tissue, in particular the heart for CAD.

It is still the number one killer even greater than cancer in both men and women today.”

AHA American Heart Association

“Yersiniosis refers to the illnesses caused by Y. enterocolitica and less often by Y. pseudotuberculosis infections. Infection occurs most often in young children. Common symptoms in children are fever, abdominal pain, and diarrhea, which is often bloody.

Most people become infected by eating contaminated food, especially raw or undercooked pork, or through contact with a person who has prepared a pork product, such as chitlins. For example, babies and infants can be infected if their caretakers handle contaminated food and then do not wash their hands properly before handling the child or the child’s toys, bottles, or pacifiers.  People occasionally become infected after drinking contaminated milk or untreated water, or after contact with infected animals or their feces.  On rare occasions, people become infected through person-to-person contact. For example, caretakers can become infected if they do not wash their hands properly after changing the diaper of a child with yersiniosis.”

CDC – Centers for Disease Control and Prevention  (https://www.cdc.gov/yersinia/faq.html)

“Agoraphobia is fear of and anxiety about being in situations or places without a way to escape easily or in which help might not be available if intense anxiety develops.  The situations are avoided, or they may be endured but with substantial anxiety. About 30 to 50% of people with agoraphobia also have panic disorder.  Agoraphobia without panic disorder affects about 2% of women and 1% of men during any 12-month period. Peak age at onset is the early 20s; first appearance after age 40 is unusual.”

Merck Manual Professional Version (https://www.merckmanuals.com/professional/psychiatric-disorders/anxiety-and-stressor-related-disorders/agoraphobia)

What is Agoraphobia:

Agoraphobia (ag-uh-ruh-FOE-be-uh) is a type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed. You fear an actual or anticipated situation, such as using public transportation, being in open or enclosed spaces, standing in line, or being in a crowd.

The anxiety is caused by fear that there’s no easy way to escape or get help if the anxiety intensifies. Most people who have agoraphobia develop it after having one or more panic attacks, causing them to worry about having another attack and avoid the places where it may happen again.

People with agoraphobia often have a hard time feeling safe in any public place, especially where crowds gather. You may feel that you need a companion, such as a relative or friend, to go with you to public places. The fear can be so overwhelming that you may feel unable to leave your home.

Agoraphobia treatment can be challenging because it usually means confronting your fears. But with psychotherapy and medications, you can escape the trap of agoraphobia and live a more enjoyable life.

How Agoraphobia is Diagnosed:

• Signs and symptoms
• In-depth interview with your doctor or a mental health professional
• Physical exam to rule out other conditions that could be causing your symptoms
• Criteria for agoraphobia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Treatments for  Agoraphobia :

Agoraphobia treatment usually includes both psychotherapy and medication. It may take some time, but treatment can help you get better.

1.) Psychotherapy

Psychotherapy involves working with a therapist to set goals and learn practical skills to reduce your anxiety symptoms. Cognitive behavioral therapy is one of the most effective forms of psychotherapy for anxiety disorders, including agoraphobia.

Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to better tolerate anxiety, directly challenge your worries and gradually return to the activities you’ve avoided because of anxiety. Through this process, your symptoms improve as you build on your initial success.

You can learn:

• What factors may trigger a panic attack or panic-like symptoms and what makes them worse
• How to cope with and tolerate symptoms of anxiety
• Ways to directly challenge your worries, such as the likelihood of bad things happening in social situations
• That your anxiety gradually decreases if you remain in situations and that you can manage these symptoms until they do
• How to change unwanted or unhealthy behaviors through desensitization, also called exposure therapy, to safely face the places and situations that cause fear and anxiety

If you have trouble leaving your home, you may wonder how you could possibly go to a therapist’s office. Therapists who treat agoraphobia are well aware of this problem.

If you feel homebound due to agoraphobia, look for a therapist who can help you find alternatives to office appointments, at least in the early part of treatment. He or she may offer to see you first in your home or meet you in what you consider a safe place (safe zone). Some therapists may also offer some sessions over the phone, through email, or using computer programs or other media.

If the agoraphobia is so severe that you cannot access care, you might benefit from a more intensive hospital program that specializes in the treatment of anxiety.

You may want to take a trusted relative or friend to your appointment who can offer comfort, help and coaching, if needed.

2.) Medications

Certain types of antidepressants are often used to treat agoraphobia, and sometimes anti-anxiety drugs are used on a limited basis. Antidepressants are more effective than anti-anxiety medications in the treatment of agoraphobia.

• Antidepressants. Certain antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are used for the treatment of panic disorder with agoraphobia. Other types of antidepressants may also effectively treat agoraphobia.
• Anti-anxiety medication. Anti-anxiety drugs called benzodiazepines are sedatives that, in limited circumstances, your doctor may prescribe to temporarily relieve anxiety symptoms. Benzodiazepines are generally used only for relieving acute anxiety on a short-term basis. Because they can be habit-forming, these drugs aren’t a good choice if you’ve had long-term problems with anxiety or problems with alcohol or drug abuse.

It may take weeks for medication to relieve symptoms. And you may have to try several different medications before you find one that works best for you.

Both starting and ending a course of antidepressants can cause side effects that create uncomfortable physical sensations or even panic attack symptoms. For this reason, your doctor likely will gradually increase your dose during treatment, and slowly decrease your dose when he or she feels you’re ready to stop taking medication.

3,) Alternative medicine

Certain dietary and herbal supplements claim to have calming and anti-anxiety benefits. Before you take any of these for agoraphobia, talk with your doctor. Although these supplements are available without a prescription, they still pose possible health risks.

For example, the herbal supplement kava, also called kava kava, appeared to be a promising treatment for anxiety, but there have been reports of serious liver damage, even with short-term use. The Food and Drug Administration has issued warnings but not banned sales in the United States. Avoid using any product that contains kava until more-rigorous safety studies are done, especially if you have liver problems or take medications that affect your liver.

“Nonalcoholic fatty liver disease (NAFLD) is the build up of extra fat in liver cells that is not caused by alcohol. It is normal for the liver to contain some fat. However, if more than 5% – 10% percent of the liver’s weight is fat, then it is called a fatty liver (steatosis). The more severe form of NAFLD is called nonalcoholic steatohepatitis (NASH). NASH causes the liver to swell and become damaged.”.

American Liver Foundation  (https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-fatty-liver-disease-nafld/)

The liver is a large, meaty organ that sits on the right side of the belly. Weighing about 3 pounds, the liver is reddish-brown in color and feels rubbery to the touch. Normally you can’t feel the liver, because it’s protected by the rib cage.

The liver has two large sections, called the right and the left lobes. The gallbladder sits under the liver, along with parts of the pancreas and intestines. The liver and these organs work together to digest, absorb, and process food.

The liver’s main job is to filter the blood coming from the digestive tract, before passing it to the rest of the body. The liver also detoxifies chemicals and metabolizes drugs. As it does so, the liver secretes bile that ends up back in the intestines. The liver also makes proteins important for blood clotting and other functions.

The liver is a vital organ of vertebrates and in some other animals. In the human it is located in the upper right quadrant of the abdomen, below the diaphragm. The liver has a wide range of functions, including detoxification of various metabolites, protein synthesis, and the production of biochemicals necessary for digestion.

The liver is a gland and plays a major role in metabolism with numerous functions in the human body, including regulation of glycogen storage, decomposition of red blood cells, plasma protein synthesis, hormone production, and detoxification.  It is an accessory digestive gland and produces bile, an alkaline compound which aids in digestion via the emulsification of lipids. The gallbladder, a small pouch that sits just under the liver, stores bile produced by the liver^. The liver’s highly specialized tissue consisting of mostly hepatocytes regulates a wide variety of high-volume biochemical reactions, including the synthesis and breakdown of small and complex molecules, many of which are necessary for normal vital functions Estimates regarding the organ’s total number of functions vary, but textbooks generally cite it being around 500.

Nonalcoholic fatty liver disease is a term used to describe the accumulation of fat in the liver of people who drink little or no alcohol.

Nonalcoholic fatty liver disease is common and, for most people, causes no signs and symptoms and no complications.

But in some people with nonalcoholic fatty liver disease, the fat that accumulates can cause inflammation and scarring in the liver. This more serious form of nonalcoholic fatty liver disease is sometimes called nonalcoholic steatohepatitis.

At its most severe, nonalcoholic fatty liver disease can progress to liver failure.

Much of the American Liver Foundation’s emphasis during October continues to point to the cause and treatment for liver diseases like hepatitis A, B and C; cirrhosis, biliary atresia and liver cancer.

Much of the Foundation’s emphasis during October continues to point to the cause and treatment for liver diseases like hepatitis A, B and C; cirrhosis, biliary atresia and liver cancer.

But the Foundation is also tapping into the heightened awareness during Liver Awareness Month to draw attention to the alarming increase in the incidence of Non-Alcoholic Fatty Liver Disease (NAFLD), which, staggeringly, affects up to 25 percent of people in the United States.

As its name suggests, NAFLD is the buildup of extra fat in the liver that isn’t caused by alcohol. It’s normal for the liver to contain some fat. But if more than 5 to 10 percent of the liver’s weight is fat, then it is called a “fatty liver.”

Most often, NAFLD tends to develop in people who are overweight or obese or have diabetes, high cholesterol or high triglycerides. Sedentary behavior is another major contributing factor to the onset of NAFLD.

For these reasons, concern continues to grow as one in 10 children—that’s seven million children in the United States—is estimated to have fatty livers.

NALFD can become even more serious. It can progress to Non-Alcoholic Steatohepatitis (NASH), which means that along with the fat, there is inflammation and damage to the liver. A swollen liver may cause scarring (cirrhosis) over time and may even lead to liver cancer or liver failure.